Prostatitis and Chronic Pelvic Pain Syndrome: An Update

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Escherichia coli is the most common cause of bacterial prostatitis.
Escherichia coli is the most common cause of bacterial prostatitis.

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Introduction

The modern description of the clinical presentation of prostatitis was established by the turn of the twentieth century by Young, Gereghty, and Stevens.1 For most of the last century, prostatic massage constituted the mainstay of therapy,2 although with the introduction of sulfonamides and prostate localization techniques by Meares and Stamey,3 antibiotics have taken a more dominant role. Unfortunately, antibiotics did not represent a panacea for this difficult clinical entity, especially for patients without an identified bacterial cause for their symptoms.

Prostatitis is the most common urologic diagnosis in men younger than 50 years and the third most common urologic diagnosis in men older than 50 years after benign prostatic hyperplasia (BPH) and prostate cancer. There were almost two million U.S. physician visits annually from 1990 to 1994 with prostatitis listed as the diagnosis.4 Symptoms of prostatitis wax and wane, with approximately one third to one half of patients experiencing relief of symptoms over a one-year period.5

Classification

Prostatitis is a grab bag term encompassing various clinical entities with differing presentations and etiologies. An initial classification system developed by Drach et al in 1978 was largely based on the localization tests described by the Meares-Stamey 4 glass technique.3,6 A number of factors limited the utility of this traditional classification technique, including: the abandonment by most physicians of the rigorous 4 glass technique, the perception that patients could respond to antibiotics regardless of category, and finally, the realization that some patients would not be easily fit within any specific category.7

The limitations of the traditional classification system led to the development of the National Institutes of Health (NIH) classification system (see Table 1 below).8 The NIH system, which was developed for clinical research purposes, incorporates clinical findings with laboratory results of culture as well as microscopic findings from expressed prostatic secretions, pre-prostatic and post-prostatic massage urine sediment, or semen analysis. 


 

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