Prostatitis: From Diagnosis to Treatment

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Urinary tract infections (UTIs) are a significant source of morbidity and mortality, despite the widespread use of antibiotics. Prostatitis is a prevalent and debilitating disease, representing the most common urological diagnosis in men under the age of 50 years. Despite its prevalence and its drain on health care resources, our understanding of the etiology, diagnosis and treatment of prostatitis has not advanced to a widely accepted level. Recently, a consensus has been reached on the definition and classification of prostatitis. Traditionally, prostatitis has been classified into the four clinical entities: i) Acute bacterial prostatitis (ABP), ii) Chronic bacterial prostatitis (CBP) iii) Non or abacterial prostatitis (NBP), iv) Prostatodynia. To improve the definition and understanding of prostatitis a new classification system has been proposed by the National Institute of Health (NIH). It includes: i) ABP, ii) CBP, represents the traditional forms of acute and chronic bacterial prostatitis, defined by the presence of both prostatic inflammation and uro-pathogenic bacteria in prostatic culture, iii) Chronic pelvic pain syndrome (CPPS) with the inflammatory and non-inflammatory type, which is characterized by prostatitis like symptoms in the absence of bacterial localization to the prostate iv) asymptomatic inflammatory prostatitis, which is characterized by pathogenic evidence of prostatic inflammation in patients without symptoms (includes patients who have prostatic inflammation diagnosed after prostatic biopsy) (Magri et al., 2010). Risk factors that allow bacterial colonization and/or infection of the prostate with potentially pathogenic bacteria include intraprostatic ductal reflux; phimosis; specific blood groups; unprotected anal intercourse; UTI; acute epididymitis; indwelling urethral or condom catheters; and transurethral operations (especially in men who have infected urine) (Westesson & Shoskes, 2010). In a study, nearly 9.7% of male respondents (aged 20 to 74 years) reported pain or discomfort in the perineum or with ejaculation or both, plus a total pain score (possible 0 to 21) of 4 or greater (Vaidyanathan & Mishra, 2008). This location and level of pain would be sufficient to lead most physicians to make a diagnosis of chronic prostatitis (CP). In this age group, 6.6% of men reported similar symptoms over the previous week with a pain score of 8 or greater, which would place them in the moderate or severe category (Vaidyanathan & Mishra, 2008). The modern era of prostatitis management began in the 1960s with Meares and Stamey's description of the four-glass lower urinary tract segmented localization study. With this