Page 1 - Prostatitis

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cua guideline
Original research

Prostatitis

J. Curtis Nickel, MD, FRCSC

Department of Urology, Queen’s University, Kingston, ON

Cite as: Can Urol Assoc J 2011;5(5):306-15; DOI:10.5489/cuaj.11211
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World Health Organization (WHO) consensus meeting,
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European Guideline Committee recommendations, a
Background recent comprehensive literature search performed by one of
the authors and expert Canadian panel discussion. Medline
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and EMBASE databases were used to identify relevant stud-
Almost 9% of Canadian men experience some prostatitis ies published in English from 1949 (for Medline) or 1974
symptoms over the course of a year, in about 6%, the symp- (for EMBASE) until January 31, 2011. We used search terms
toms are a bother, with approximately a third experiencing and strategies for each database. The levels of evidence
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a remission of symptoms over a year during follow-up. Men and grades of recommendations were based on the ICUD/
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with clinically significant prostatitis symptoms account for WHO modified Oxford Center for Evidence-Based Medicine
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about 3% of Canadian male outpatient visits and causes sig- Grading System. These recommendations are summarized at
nificant morbidity and cost. Less than 10% of the patients the end of this guideline document. Within the document,
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suffer from acute or chronic bacterial prostatitis, conditions the level of evidence and recommendation grade are includ-
which are well-defined by clinical and microbiologic param- ed where appropriate and denoted as 3:A which means
eters and usually amenable to antimicrobial therapy. Acute Level 3 evidence and Grade A recommendation.
prostatitis is characterized by a severe urinary tract infec-
tion (UTI), irritative and obstructive voiding symptoms with Definition
generalized urosepsis. Acute prostatitis responds promptly to
antimicrobial therapy, and is usually self-limiting. Chronic Prostatitis describes a combination of infectious diseases
bacterial prostatitis is usually associated with mild to moder- (acute and chronic bacterial prostatitis), CPPS or asymp-
ate pelvic pain symptoms and intermittent episodes of acute tomatic prostatitis. The NIH classification of prostatitis syn-
UTIs. Long-term antimicrobial therapy is curative in about dromes includes:
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60% to 80% of patients. Category I: Acute bacterial prostatitis (ABP) which is asso-
Most men with “chronic prostatitis” have chronic prosta- ciated with severe prostatitis symptoms, systemic infection
titis/chronic pelvic pain syndrome (CP/CPPS), characterized and acute bacterial UTI.
by pelvic pain (i.e., perineal, suprapubic, testicular, penile) Category II: Chronic bacterial prostatitis (CBP) which is
variable urinary symptoms and sexual dysfunction (primarily caused by chronic bacterial infection of the prostate with
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pain associated with ejaculation). The National Institutes of or without prostatitis symptoms and usually with recurrent
Health-Chronic Prostatitis Symptom Index (NIH-CPSI) is a UTIs caused by the same bacterial strain.
reliable means of capturing the symptoms and impact of CP/ Category III: Chronic prostatitis/chronic pelvic pain syn-
CPPS. The etiology of this syndrome is not fully known, the drome which is characterized by chronic pelvic pain symp-
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evaluation has been controversial and treatment is, unfortu- toms and possibly voiding symptoms in the absence of UTI.
nately, frequently unsuccessful. Focused multimodal therapy Category IV: Asymptomatic inflammatory prostatitis
appears to be more successful than empiric monotherapy. (AIP) which is characterized by prostate inflammation in
The recommendations presented in these guidelines were the absence of genitourinary tract symptoms.
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developed from North American NIH consensus meetings,
International Consultation on Urologic Disease (ICUD)/

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