Prostatitis: Diagnosis and Treatment

Summary

Chronic prostatitis is a common affliction of men. It is characteristically associated with irritative voiding symptoms and perineal or low back discomfort, although a variety of other symptoms are also sometimes encountered. Two major varieties of chronic prostatitis are prevalent today: bacterial prostatitis, caused primarily by Gram-negative organisms, mainly of the coliform group, and non-bacterial prostatitis of unknown aetiology, which, unfortunately, is the most common type. Although the symptoms of these 2 types of chronic prostatitis are often similar, the clinical significance and recommended management of the two are quite different; therefore, proper diagnosis is important. The most accurate way for the clinician to confirm the diagnosis of bacterial prostatitis is the performance of essentially simultaneous quantitative bacterial cultures of the urethra, bladder urine and expressed prostatic secretions.

Although chronic bacterial prostatitis is now recognised as the most common cause of relapsing urinary tract infection in men, eradication of the pathogenic organism from prostatic secretions is difficult because most of the currently available antibacterial agents fail to diffuse into prostatic fluid. Since trimethoprim diffuses freely into prostatic fluid, trimethoprim-sulphamethoxazole (co-trimoxazole) is the most effective antibacterial agent for use in cases of chronic bacterial prostatitis when the pathogen is sensitive to this drug combination. Since the aetiology of non-bacterial prostatitis remains unknown, cure is generally not possible and therapy is directed primarily towards achieving symptomatic control.