The Treatment of Chronic Bacterial Prostatitis: Principles and Management

Abstract

Chronic bacterial prostatitis (CBP) is a subtle disease, often insidious in its onset, that challenges the acumen as well as the patience and determination of every urologist, when it comes to cure this disease. However, CBP is a clinical entity accurately defined by two basic features: recurrent urinary tract infections (UTIs) and persistence of gram-negative enterobacteria, mainly Escherichia coli, in the prostatic secretion. CBP is probably the most common cause of recurrent UTIs in the male patient because the bacterial pathogen often persists unaltered in the prostatic secretion during antibacterial therapy, frequently insufficient and inadequate, and eventually reinfects the urine after treatment is withdrawn. CBP is mainly a bacteriologic diagnosis and, therefore, sequential bacteriologic localization cultures of the initially voided urine, the midstream urine, and the expressed prostatic secretion (EPS) are essential in reaching the right diagnosis and cannot be replaced by any other method. Demonstration of gram-negative bacteria in the EPS in the presence of sterile initial and midstream urine cultures are highly diagnostic for CBP. Alternatively, a significantly higher bacterial level (of a log or more) in the EPS compared to the initial urethral specimen is also considered diagnostic of CBP.