Prostatitis syndromes: pathophysiology, differential diagnosis, and treatment

Area of Science:

• Urology
• Microbiology
• Pathology

Background:

• Prostatitis syndromes involve complex genitourinary tract anatomy and physiology.
• Host defenses can be overcome, leading to prostate infections.
• Histologic findings for prostatitis do not always align with clinical or microbiologic data.

Purpose of the Study:

• To classify prostatitis patients based on lower urinary tract localization studies.
• To differentiate between bacterial and nonbacterial prostatitis syndromes.
• To review current understanding and treatment approaches for prostatitis.

Main Methods:

• Classification of patients into four diagnostic groups: acute bacterial prostatitis, chronic bacterial prostatitis, nonbacterial prostatitis, and prostatodynia.
• Utilizing lower urinary tract localization studies to distinguish patients with and without bacteriuria.
• Reviewing existing literature on prostatitis pathophysiology and treatment.

Main Results:

• Progress has been made in understanding and treating acute and chronic bacterial prostatitis.
• Limited reliable data exist on the causes of nonbacterial prostatitis and prostatodynia.
• Granulomatous prostatitis, a distinct histologic reaction, requires accurate etiologic diagnosis for treatment.

Conclusions:

• Accurate diagnosis, particularly distinguishing bacteriuria, is critical for managing prostatitis.
• Current therapeutic strategies for nonbacterial prostatitis and prostatodynia are largely unsatisfactory.
• Effective treatment for granulomatous prostatitis hinges on identifying the underlying cause.