Prostatitis

Abstract

Prostatitis is a common and frustrating problem for the patient, the general practitioner, and the urologist. It is a difficult subject to review because much of the literature is so imprecise as to definition of the disease and acceptable diagnostic techniques that most of the available data are impossible to interpret. In truth, the term prostatitis has been a “wastebasket” diagnosis for any patient with unexplained pelvic, genitourinary, or ejaculatory symptoms whose prostate appears tender on examination. There is no generally accepted definition, no clearly established criteria for making the diagnosis, and no definite pathophysiology. The incidence of prostatitis is unclear. One of the greatest problems confronted in reviewing the literature is the multiplicity of patient types which are considered as having prostatitis by various authors without any objective criteria for making the diagnosis. Moreover, the findings used to diagnose prostatitis, even in the most thoughtful studies, are so nonspecific that refutation of these studies is easy because it can be shown that selected patients are in most ways no different from some healthy adult men among the general population. Because very few authors have defined prostatitis, and almost no two works used the same criteria for inclusion of patients within a study, few direct comparisons can be made of the findings of one author with those of another. Indeed, except for true bacterial prostatitis due to Enterobacteriaceae, pseudomonas, and enterococci, which is invariably associated with recurrent bacteriuria and which most of this review will concentrate upon, it is fair to comment that little more is known about prostatitis than was presented by Hugh H. Young in 1906 (Young et al. 1906).