"Chronic Prostatitis"

- Classification -

1996, Ivo Tarfusser, MD

CURRENT CLASSIFICATION (Drach et al, 1978):

  • Acute form:
    • Acute prostatitis
  • Chronic forms:
    • Chronic bacterial prostatitis
    • Nonbacterial prostatitis
    • Prostatodynia

I. ACUTE PROSTATITIS

This form of prostatitis is very unfrequent. It is a quite severe disease characterized by high fever, chills, severe pain in the lower abdominal region and in the perineum, burning at voiding or difficulties to void. This disease is unfrequent, easily recognizable and has to be treated like other severe bacterial urinary infections.

II. "CHRONIC PROSTATITIS"

This is a very diffuse term, commonly used to describe a collection of symptoms characterized by the presence of pain or discomfort in the perigenital area (perineum, groin, testicular region) often radiating to the lower back or the inside of the thigh. The location of discomfort may vary from individual to individual, and in the same individual at different occations. A variety of micturitional symptoms from the lower urinary tract (frequent necessity to void, urgency, burning sensation at voiding, feeling of uncomplete emptying of the bladder, difficulties to keep completely tight, etc) may accompany the pain or dominate the picture. Many times, ejaculation is painful, or a crampy discomfort follows ejaculation. Regrettably, in every day's urological slang, the term "chronic prostatitis" is used very loosely by the professionals: from a patho-anatomical point of view, chronic prostatitis is a real inflammatory condition of the prostate which can be verified by histological examination of prostatic tissue; in every day's urological slang, however, the term is often used to describe the collection of symptoms listed above, even if there is to evidence of inflammation in the prostate. In fact, chronic prostatitis (= inflammation of the prostate) can produce a "chronic prostatitis syndrome" (i e the symptoms), but there are other conditions, not associated with inflammation, which can lead to identical symptom. In order to avoid such confusion, I will consistently use citation marks ("chronic prostatitis syndrome" or "chronic prostatitis") when I am referring to the more or less characteristic complaints mentioned above.

The subdivision according to Drach and colleagues is based on the analysis of the prostatic fluid (presence of white blood cells and/or micro-organisms):

  1. Chronic Bacterial Prostatitis (CBP): presence of white blood cells and micro-organisms
  2. Nonbacterial Prostatitis (NBP): presence of white blood cells, but no bacteria
  3. Prostatodynia (PDy) ="painful prostate": normal count of white blood cells and absence of bacteria

Whereas acute bacterial prostatitis is rare, "chronic prostatitis" is very common, some reports estimate about half of the masculine population to be affected at least once in their life-time, others report even higher figures. Chronic bacterial prostatitis (CBP) is the least frequent condition whith only around 5% of all patients affected by "chronic prostatitis". The occurrence of nonbacterial prostatitis (NBP) and prostatodynia (PDy) varies in different reports, but both share more or less half of the remainder. In office practice and in younger men, prostatodynia is probably dominating.