by Ivo Tarfusser, MD (© 1996)
CURRENT CLASSIFICATION (Drach et al, 1978):
This form of prostatitis is very unfrequent. It is a quitesevere disease characterized by high fever, chills, severe pain in the lowerabdominal region and in the perineum, burning at voiding or difficulties tovoid. This disease is unfrequent, easily recognizable and has to be treated likeother severe bacterial urinary infections.
This is a very diffuse term, commonly used to describe acollection of symptoms characterized by the presence of pain or discomfort inthe perigenital area (perineum, groin, testicular region) often radiating to thelower back or the inside of the thigh. The location of discomfort may vary fromindividual to individual, and in the same individual at different occations. Avariety of micturitional symptoms from the lower urinary tract (frequentnecessity to void, urgency, burning sensation at voiding, feeling of uncompleteemptying of the bladder, difficulties to keep completely tight, etc) mayaccompany the pain or dominate the picture. Many times, ejaculation is painful,or a crampy discomfort follows ejaculation. Regrettably, in every day'surological slang, the term "chronic prostatitis" is used very looselyby the professionals: from a patho-anatomical point of view, chronic prostatitisis a real inflammatory condition of the prostate which can be verified byhistological examination of prostatic tissue; in every day's urological slang,however, the term is often used to describe the collection of symptoms listedabove, even if there is to evidence of inflammation in the prostate. In fact,chronic prostatitis (= inflammation of the prostate) can produce a "chronicprostatitis syndrome" (i e the symptoms), but there are other conditions,not associated with inflammation, which can lead to identical symptom. In orderto avoid such confusion, I will consistently use citation marks ("chronicprostatitis syndrome" or "chronic prostatitis") when I amreferring to the more or less characteristic complaints mentioned above.
The subdivision according to Drach and colleagues is based on the analysisof the prostatic fluid (presence of white blood cells and/or micro-organisms):
- Chronic Bacterial Prostatitis (CBP): presence of whiteblood cells and micro-organisms
- Nonbacterial Prostatitis (NBP): presence of white bloodcells, but no bacteria
- Prostatodynia (PDy) ="painful prostate": normalcount 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 tobe affected at least once in their life-time, others report even higher figures.Chronic bacterial prostatitis (CBP) is the least frequent condition whith onlyaround 5% of all patients affected by "chronic prostatitis". Theoccurrence of nonbacterial prostatitis (NBP) and prostatodynia (PDy) varies indifferent reports, but both share more or less half of the remainder. In officepractice and in younger men, prostatodynia is probably dominating.