Prostatitis--an increasing clinical problem for diagnosis and management

Prostatitis remains a challenging condition. The clinical features are often nonspecific while the aetiology and pathogenesis can be diverse and includes inflammatory, obstructive, and/or chemical causes and may also be related to calculi. Four categories are recognized: acute bacterial prostatitis, chronic bacterial prostatitis, non-bacterial prostatitis and prostatodynia. The diagnosis of prostatitis was advanced substantially by the introduction of sequential sampling of urine aliquots following prostatic massage. Bacterial prostatitis is largely associated with the Enterobacteriaceae although Pseudomonas spp., enterococci and Staphylococcus aureus may also be isolated. In chronic bacterial prostatitis a variety of streptococci and anaerobic bacteria may be isolated. Treatment is difficult largely owing to the limited range of agents able to achieve therapeutic concentrations within prostatic fluid, which has a pH lower than that of plasma. Trimethroprim, co-trimoxazole and the tetracyclines have been widely used. The quinolones have recently been shown to diffuse readily into the prostate; ofloxacin and temafloxacin have produced the highest concentrations in prostatic fluid. Antibiotic treatment requires prolonged high dosage and careful monitoring to ensure that bacterial eradication has occurred. Other forms of management have included the judicious use of anti-inflammatory agents and analgesics. In some patients zinc sulphate has proved to be of symptomatic benefit.