VICTORIA J. SHARP, MD, and ELIZABETH B. TAKACS, MD, college of Iowa health Care, Iowa City, Iowa

CHARLES R. POWELL, MD, Indiana University college of Medicine, Indianapolis, Indiana

Am Fam Physician. 2010 Aug 15;82(4):397-406.

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*
patient information: See associated handout top top prostatitis.


Prostatitis varieties from a straightforward clinical entity in that is acute form to a complex, debilitating problem when chronic. It is frequently a resource of frustration because that the dealing with physician and patient. There are four classifications the prostatitis: acute bacterial, chronic bacterial, chronic prostatitis/chronic pelvic ache syndrome, and also asymptomatic. Diagnosis that acute and chronic bacterial prostatitis is primarily based on history, physical examination, pee culture, and urine specimen trial and error pre- and also post-prostatic massage. The differential diagnosis of prostatitis includes acute cystitis, light prostatic hyperplasia, urinary tract stones, bladder cancer, prostatic abscess, enterovesical fistula, and foreign body within the urinary tract. The mainstay of treatment is an antimicrobial regimen. Chronic pelvic pains syndrome is a more an overwhelming entity, in part because that pathology is poorly understood. Diagnosis is often based upon exclusion of various other urologic problems (e.g., voiding dysfunction, bladder cancer) in association v its presentation. Frequently used medications encompass antimicrobials, alpha blockers, and also anti-inflammatory agents, however the efficiency of this agents has actually not been sustained in clinical trials. Small studies provide minimal support because that the use of nonpharmacologic modalities. Asymptomatic prostatitis is one incidental detect in a patient gift evaluated for other urologic problems.


The pervasiveness of prostatitis is about 8.2 percent (range: 2.2 to 9.7 percent).1 the accounts for 8 percent of access time to urologists, and up come 1 percent of visits to primary treatment physicians.2 In 2000, the estimated cost to diagnose and also treat prostatitis to be $84 million, not including pharmaceutical spending.3 men with chronic prostatitis experience disability in mental and also physical domains of health-related quality of life together measured with validated questionnaires.4 In 2002, roughly 14 percent of guys with a medical claim for prostatitis to let go work.3 this statistics clearly underscore the wide and far-ranging effect of prostatitis on patient top quality of life and the economic impact of the condition.


SORT: key RECOMMENDATIONS because that PRACTICEClinical recommendationEvidence ratingReferences

The 2-glass pre- and post-prostatic massage check is a reasonable alternate to the desired Meares-Stamey 4-glass test for diagnosing prostatitis.

C

7

Optimal expression of antibiotic therapy for acute bacter prostatitis is six weeks.

B

16, 17

In acute bacterial prostatitis, patients must be evaluated with imaging for abscess if fevers persist more than 36 hrs after ideal antibiotic coverage.

C

9, 17

To stop symptom flare-up, suppressive low-dose antibiotics have to be considered in males with chronic bacter prostatitis whose societies remain positive.

C

15, 16


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, skilled opinion, or case series. Because that information around the SORT evidence rating system, go to https://www.keolistravelservices.com/afpsort.xml.


SORT: vital RECOMMENDATIONS because that PRACTICEClinical recommendationEvidence ratingReferences

The 2-glass pre- and also post-prostatic massage test is a reasonable different to the wanted Meares-Stamey 4-glass test for diagnosing prostatitis.

C

7

Optimal term of antibiotic therapy for acute bacter prostatitis is 6 weeks.

B

16, 17

In acute bacterial prostatitis, patients need to be evaluated with imaging for abscess if fevers persist much more than 36 hrs after suitable antibiotic coverage.

C

9, 17

To avoid symptom flare-up, suppressive low-dose antibiotics have to be taken into consideration in guys with chronic bacterial prostatitis whose cultures remain positive.

C

15, 16


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, skilled opinion, or instance series. For information around the SORT proof rating system, walk to https://www.keolistravelservices.com/afpsort.xml.

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Prostatitis is a broad diagnosis that incorporates four clinical entities, including acute disease requiring instant attention (acute bacter prostatitis), two chronic conditions (chronic bacterial prostatitis, chronic pelvic pains syndrome), and also an incidental finding (asymptomatic prostatitis) noted during the evaluation and treatment of other urologic conditions. This short article will familiarize primary care physicians v the categories of prostatitis as defined by the nationwide Institutes of wellness (NIH; Table 15) and also elucidate the epidemiology, clinical presentation, diagnosis, and also treatment of each.6


Table 1.National academy of health and wellness Consensus category of ProstatitisType of syndromeDescriptionBacteria culturesVB1*VB2†EPSVB3‡

WBC counting per HPF (400x)

I. Acute bacter prostatitis

Acute infection of the prostate gland

> 10

+

+

§

+

II. Chronic bacterial prostatitis

Chronic epidemic of the prostate gland

> 10

+

+

III. Chronic pelvic ache syndrome

Chronic pelvic ache in the lack of bacteria localized come the prostate

> 10

A. Inflammatory

Significant WBC counting in the EPS, VB3, or semen

B. Noninflammatory

Insignificant WBC counting in the EPS, VB3, or semen

10


EPS = to express prostatic secretions; HPF = high-power field; VB = voided bladder; WBC = white blood cell; + = optimistic culture.