Preface Chronic aseptic prostatitis is a condition that urologists often need to diagnose and treat and is clinically very difficult. Approximately 50% of men will experience symptoms that resemble prostatitis in some way during their lifetime, and only 5-10% of these are caused by bacteria. Most patients with prostatitis (90%) have chronic aseptic prostatitis (CP) or chronic pelvic pain symptoms (CPSS), which present as urinary frequency, urgency, pelvic pain, painful intercourse, and painful ejaculation, and are more than 3 months old. Traditional approaches to the treatment of CP/CPPS include empirical antimicrobial therapy and other pharmacologic or nonpharmacologic treatments. Although reported to be effective in the short term, these treatments are difficult to be effective in the long term. Recently, it has been suggested that chronic pelvic pain and other CP/CPPS-related symptoms may be related to chronic pelvic pain of bladder origin, or interstitial cystitis (IC).CP/CPPS and IC share similar clinical symptoms and pathology, and recent data also suggest that treatment for IC is equally effective in patients with CP/CPPS, so as a physician you should consider the possibility of IC when diagnosing chronic pelvic Therefore, as physicians should consider the possibility of IC when diagnosing chronic pelvic pain in men.
General remarks and definitions Lu Jianwei, Department of Urology, Shanghai Renji Hospital The National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), a division of the National Institutes of Health (NIH), classifies prostatitis into four types (Table 1). Types I and II represent acute or chronic bacterial prostatitis and are uncommon, accounting for about 5-10% of patients. Type III prostatitis (CP) is the most common type, accounting for about 90% of cases. Type IV is asymptomatic infectious prostatitis (AIP) and is seen only in patients without a history of genitourinary infection, often found incidentally during evaluation of their prostate cancer or fertility, or on semen examination containing high concentrations of leukocytes. Acute bacterial prostatitis (ABP), or type I, although the least common, may have the most serious consequences. ABP is diagnosed in approximately 2 out of 10,000 outpatients and presents with acute urinary tract infection (UTI), urinary frequency, urgency, nocturia, and acute perineal, subpubic, and genital (especially testicular) pain. Patients usually have high fever, chills, nausea, vomiting, burning sensation or pain in the urethra. The urine has a foul odor and the urine line becomes thin; there is blood in the urine or semen. If left untreated, ABP can lead to confusion, decreased blood pressure, sepsis, and even life-threatening conditions. patients with ABP require aggressive treatment, including hospitalization, parenteral antibiotics, analgesia, and intravenous rehydration. Chronic bacterial prostatitis (CBP), type II, is diagnosed if a patient presents with multiple urinary tract infections, each caused by the same pathogen in the prostate. CBP has similar symptoms to ABP, but to a lesser degree: pain in the testicles or lumbosacral region, perineal or pelvic floor pain, and the presence of urinary symptoms such as frequency, urgency, painful urination or burning sensation. During the interval of bacteriuria, patients are usually asymptomatic, but some still experience recurrent hypothermia, hesitant urination and thinning of the urinary line. In contrast to ABP, CBP is tricky to diagnose and treat. patients with CBP have no fever, the vast majority of urine cultures are negative, and the history is usually of recurrent urinary tract infections, epididymitis, and urethritis (caused by the same pathogens). The diagnosis of CBP requires that bacteria be found in prostate-specific areas (including semen or urine after prostate massage and post-prostate extrusion secretions [EPS]). A 10-fold increase in the bacterial count in a prostate sample compared to a urethral sample confirms the diagnosis of CBP.
Treatment of acute and chronic bacterial prostatitis with broad-spectrum antibacterial agents that can effectively penetrate the prostate tissue is recommended in the same way as for ABP, with CBP treated empirically with antibiotics and may be accompanied by adjunctive therapy. The drugs that can effectively penetrate the prostate tissue and kill both gram-negative and positive bacteria include fluoroquinolones (ciprofloxacin, levofloxacin, ofloxacin, norfloxacin), methotrexate (TMP) and sulfamethoxazole.