Prostatitis Syndromes. Part 1
The related syndromes of prostatitis remain a frustrating clinical entity both for clinicians, especially primary care physicians, and for their patients. The primary problem facing physicians is differentiating between bacterial and non-bacterial prostatitis. Although non-bacterial prostatitis appears to be far more common, the bacterial disease is deemed more important because it is the leading cause of relapse in urinary tract infections in men.
Much of the confusion about the etiology and significance of prostatitis relates to improper diagnostic plans that lead clinicians to lump together as prostatitis diseases of variable type and sequelae. But proper therapy varies considerably for different syndromes with different underlying causes. While many prostatitis syndromes have a very similar clinical presentation, several distinct types are recognized. Inflammation of the prostate can be acute or chronic and can be bacterial or non-bacterial in origin. Patients with prostatodynia have no demonstrable prostatic inflammation, and symptoms might not be related to the prostate at all (Table 1).
| Table 1. The Prostatitis Syndromes | ||||||
|
Syndrome |
Definition |
Prostate Exami-nation |
Urine Culture |
Eps Pus Cells |
Eps Culture |
Anti-biotic Treat-ment |
| Acute bacterial prostatitis | Acute bacterial inflammation of prostate gland |
Boggy, tender |
+ |
+a |
+a |
4 wk |
| Chronic bacterial prostatitis | Chronic bacterial inflammation of prostate gland |
Usually tender |
+/- |
+ |
+ |
6 wk (mini-mum) |
| Chronic non-bacterial prostatitis | Inflammation of prostate gland not associated with common bacterial pathogens |
Maybe uncom-fortable |
- |
+
|
- |
2-4 wk (trial) |
| Prostato-dynia | No evidence of prostatic inflammation |
Normal |
- |
- |
- |
None |
| EPS – expressed prostatic secretion
a Not usually required |
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