Health and Prostate

The classic categorization of prostatitis into four main groups evolved in the 1960s and 1970s and has remained the standard. Patients don't always fit neatly into one category or another, however, and guidelines for treating such patients do not exist. What should be done, for instance, with the patient whose prostatic fluid culture is positive for an atypical organism or with the asymptomatic patient with leukocytes in their prostatic fluid? What treatment type would most likely benefit the patient with perineal pain but no voiding symptoms? The National Institutes of Health Consensus Conference on Prostatitis has devised a new prostatitis classification system to help solve these types of problems. Category I and II refer to acute and chronic bacterial prostatitis. Category III refers to chronic pelvic pain syndrome in the presence of negative prostatic fluid cultures. Category IIIA identifies patients with significant inflammation in the prostatic fluid, that is nonbacterial prostatitis, and category IIIB identifies patients without significant prostatic fluid inflammation, that is, prostatodynia. Read more [...]

Diagnosis and treatment of prostatitis requires diligence and persistence on the part of both the physician and the patient. Although diagnosis of acute bacterial prostatitis is easily made and its treatment straightforward, chronic bacterial prostatitis and other inflammatory prostatic syndromes are more difficult to define and differentiate. Diagnosis and documentation of specific infection is often elusive, despite careful evaluation. Clinical evaluation and diagnosis of prostatitis is variable. Family practice physicians and urologists do not routinely utilize a standard diagnosis protocol to evaluate patients with symptoms of prostatitis. Moon reviewed a questionnaire completed by primary care physicians and urologists diagnosing and treating prostatitis in Wisconsin. His study demonstrated that fewer than 50% of urologists and only 11 % of primary care providers evaluated expressed prostatic secretions to differentiate prostatic diseases. Similarly, few urologists or primary care physicians suggested nonantibacterial therapy to patients with prostatitis. While the nomenclature for prostatitis Read more [...]

The diagnosis of acute bacterial prostatitis is usually straightforward and readily apparent on physical examination. Patients are frequently febrile and toxic with severe rigors, back pain, perineal pain, dysuria, urgency, and frequency with associated mild to moderate obstructive urinary symptoms. As many as one-third of patients with acute bacterial prostatitis will present in acute urinary retention as a result of prostatic edema and enlargement secondary to acute inflammation of an already enlarged and partially obstructed urethra. Once a diagnosis is presumed by history, physical examination usually supports the diagnosis, with a rectal examination demonstrating a severely swollen, extremely tender prostate. Expression of prostatic secretions in acute bacterial prostatitis should not be performed because of the potential for systemic spread of prostatic infection. If prostatic fluid is available for microscopic examination, multiple polymorphonuclear leukocytes, both singularly and in clumps, are demonstrated. Urine culture as well as prostatic fluid culture will reveal the infectious pathogen, Read more [...]

Most patients with nonacute inflammatory and infectious diseases of the prostate present with similar symptoms, including bladder inflammation with irritative voiding symptoms such as urinary frequency, urgency, and dysuria. Referred pain can occur to the low back, genitalia, supra-pubic area, and lower extremities; frequently perineal pain, scrotalgia, and postejaculatory discomfort occur alone or in combination in these patients. Obstructive symptoms are uncommon without coexistent prostatic hyperplasia. Obstructive symptoms may, however, occur in patients with associated bladder neck spasm and inflammatory prostatic conditions such as prostatodynia. Krieger and colleagues investigated the standardized evaluation of symptoms associated with chronic prostatitis. They compared a symptom index in 50 patients with prostatitis and 75 control patients. It was useful, reproducible, and helped in identifying symptoms. In their series, patients with prostatitis were more likely than control patients to complain of perineal, lower abdominal, testicular, penile, and postejaculatory pain as well as sexual Read more [...]