Korean J Urol.  2012 Feb;53(2):69-77.

Chronic Prostatitis: Approaches for Best Management

• Lee KS
• Choi JD

Abstract

Prostatitis is a prevalent condition that encompasses a large array of clinical symptoms with significant impacts on men's life. The diagnosis and treatment of this disorder presents numerous challenges for urologists, most notably, a lack of specific and effective diagnostic methods. Chronic bacterial prostatitis is successfully treated with appropriate antibiotics that penetrate the prostate and kill the causative organisms. Prostatitis category III (chronic pelvic pain syndrome) is common, very bothersome, and enigmatic. Symptoms are usually prolonged and, generally speaking, treatment results are unsatisfactory. During the last decade, research has focused on the distress caused by the condition, but although our knowledge has certainly increased, there have been no real breakthroughs; controversies and many unanswered questions remain. Furthermore, the optimal management of category III prostatitis is not known. Conventional prolonged courses of antibiotic therapy have not proven to be efficacious. Novel therapies providing some evidence for efficacy include alpha-blocker, anti-inflammatory phytotherapy, physiotherapy, neuroleptics, and others, each offering therapeutic mechanisms. A stepwise approach involving multimodal therapy is often successful for treating patients. The UPOINT technique has been used to clinically phenotype these patients and drive the appropriate selection of multimodal therapy.

Keyword

Chronic pelvic pain syndrome; Chronic prostatitis; Prostate

MeSH Terms

Anti-Bacterial Agents
Antipsychotic Agents
Humans
Pelvic Pain
Phenotype
Phytotherapy
Prostate
Prostatitis
Anti-Bacterial Agents
Antipsychotic Agents

Figure

• 

  FIG. 1 A suggested diagnostic algorithm for the evaluation of patients presenting with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). UTIs, urinary tract infections; TRUS, transrectal ultrasonography; CT, computed tomography; MRI, magnetic resonance imaging; DRE, digital rectal examination; PSA, prostate-specific antigen.

• 

  FIG. 2 A suggested therapeutic algorithm for the treatment of patients presenting with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). TUMT, transurethral microwave thermotherapy. *Amitriptyline, gabapentin, biofeedback, massage therapy, acupuncture, neurostimulation.

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