Prostatitis

Acute bacterial prostatitis is an uncommon, aggressive disease. Patients are ill-appearing, often febrile, and complaining of pain in their perineum or low back. A urinary tract infection is also usually present. If acute urinary retention or any immunocompromised state complicates the management, or the patient appears toxic, admission and intravenous antibiotics are warranted. The profound inflammation associated with acute prostatitis permits a wide variety of antibiotic choices. Fluoroquinolones are the drug of choice. Chronic prostatitis is a more difficult disease process to define and treat. The hazy line between chronic bacterial prostatitis and CPPS rests squarely on the shoulders of culture data. Many specific bacteria have been implicated. Some are clearly pathogens, and others are ubiquitous organisms, and their role in pathogenesis is unclear. There may also be a role for environmental stressors and genetic variations. CPPS remains something of a mystery. No studies to date have enlightened us as to the exact etiology despite an abundance of theories. Certain cases may be infectious, some respond to psychotherapy and antidepressants, but most have a chronic recurrent course that is frustrating to both the patient and physician. The implementation of a new classification system and advanced research techniques may soon enlighten us and provide some relief to millions of patients.