Classification of Prostatitis Syndrome
The diagnosis of symptomatic prostatitis refers to a variety of entities which may be related to infection and inflammation of the prostate gland (bacterial prostatitis), inflammatory and non-inflammatory chronic pelvic pain syndrome, and pelvic pain not related to prostatitis.
Clinical Diagnostics
In acute bacterial prostatitis, clinical symptoms are typical. Infection is defined by midstream urine analysis. In CBP, the key point of diagnosis is the use of a 2-glass test, with or without additional ejaculate analysis. The same test is used to define or exclude inflammation and / or infection in CPPS. In CPPS, symptomatic evaluation is based on a validated NIH-CPSI questionnaire. Additional phenotyping may be helpful in characterizing the predominant symptoms.
Therapy
Antibiotics surely play a fundamental role in bacterial prostatitis therapy. They should be introduced empirically in acute prostatitis with a high intravenous dose and always guided by resistance determination in chronic cases. Thanks to their pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones remain the most highly recommended antibiotics. The most appropriate treatment for chronic pelvic pain syndrome is a multimodal approach based on phenotyping including alpha-blockers, antibiotics, anti-inflammatory medication, hormonal therapy, phytotherapy, antispasmotics and non-drug-related strategies, such as psychotherapy and attempts to improve relaxation of the pelvic floor. The response can be evaluated by a drop in symptoms, using the scoring of the NIH-CPSI.
Diagnosis of prostatitis refers to a variety of inflammatory and non-inflammatory, symptomatic and non-symptomatic entities often not affecting the prostate gland. Prostatitis syndrome has been classified in a consensus process as infectious disease (acute and chronic), chronic pelvic pain syndrome (CPPS) and asymptomatic prostatitis [1]
Table 1
NIH classification system for prostatitis syndromes [1]
Category | Nomenclature |
---|---|
I | Acute bacterial prostatitis |
II | Chronic bacterial prostatitis |
III | Chronic pelvic pain syndrome (CPPS) |
III A | Inflammatory |
III B | Non-inflammatory |
IV | Asymptomatic prostatitis |
In clinical practice, 90 percent of outpatients suffer from CPPS, inflammatory or non-inflammatory disease [5]
This review covers accepted aspects of diagnostic procedures and therapeutic attempts in men suffering from symptomatic prostatitis and CPPS (Categories I to III).
Careful medical history (e.g. physical examination) investigating presence of fever and voiding dysfunction is fundamental. It should include scrotal evaluation and a gentle digital rectal examination without prostate massage, which
is not recommended due to the risk of bacterial dissemination. The prostate is usually described as tender and swollen [6]
Diagnosis is based on microscopic analysis of a midstream urine specimen with evidence of leucocytes and confirmed by a microbiological culture, which is mandatory and the only laboratory examination required [7]
Table 2
Common pathogens in bacterial prostatitis (NIH I, II) [6]
Etiologically recognized pathogens | Microorganisms of debatable significance | Fastidious microorganisms |
---|---|---|
E. coli | Staphylococci | M. tuberculosis |
Klebsiella sp. | Streptococci | Candida sp. |
Proteus mirabilis | Corynebacterium sp. |
|
Enterococcus faecalis | C. trachomatis |
|
P. aeruginosa | U. urealyticum |
|
|
M. hominis |
|
Ultrasound evaluation of the residual urine is indicated to exclude urinary retention. TRUS may reveal intraprostatic abscesses, which usually appears as a hypoechogenic walled-off collection of fluid [7]
A history of recurrent urinary tract infections with the same pathogenic agent is typical [7]
Bacteriological localization cultures are fundamental for the diagnosis of chronic bacterial prostatitis [7]
Semen culture of the ejaculate alone is not sufficient for diagnosis of CBP due to a sensibility of only 50% in identifying bacteriospermia [7]
TRUS is an option in patients with suspicion for prostatic abscess. The relevance of prostatic calcification is unknown [7]
Lower urinary tract symptoms and pelvic pain due to pathologies of the prostate have always affected quality of life in men of all ages. For years, understanding of the condition was based merely on a prostate relationship via an organ
pathology involving somatic or visual tissue lesions [5]
Table 3
Phenotype classification modified according to Shoskes and Nickel [23]
U | P | O | I | N | T | S |
---|---|---|---|---|---|---|
Urinary | Psychological | Organ specific | Infection | Neurologic/Systemic | Tenderness | Sexual dysfunction |
Disturbed voiding | Depression | Inflammatory prostatic secretions | Infection | Instable bowel syndrome, fibromyalgia, chronic fatigue syndrome | Pelvic floor spasm | Erectile, ejaculatory, orgasmic dysfunction |
The simple “2-glass test” for analyzing the number of leukocytes in VB3 [14]
TRUS is normally not indicated [7]
An association between male sexual dysfunction and prostatitis syndrome, especially CPPS, has been the subject of controversy for years [25]
Since prostatitis is common in males of reproductive age, a negative impact on semen composition, and thus on fertility, may be suspected. Unfortunately, only a few studies are available investigating different types of prostatitis. In patients with NIH type II prostatitis, a recent meta-analysis evaluated seven studies including 249 patients and 163 controls [32]
Acute bacterial prostatitis is a serious infection. The main symptoms are high fever, pelvic pain and general discomfort. It can also result in septicemia and urosepsis, with elevated risk for the patient's life and mandatory hospitalization [36]. Initial antibiotic treatment is empirical and experience-based [37]. A broad-spectrum penicillin derivative with a beta-lactamase inhibitor, third-generation cephalosporin or fluoroquinolone, possibly in association with aminoglycoside, is suggested [10]
Due to their proven pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones (especially levofloxacin and ciprofloxacin) are the most recommended antibiotics agents for treating chronic bacterial prostatitis [11]
Due to the complexity of the pathogenetic mechanisms and the heterogeneity of symptoms, understanding CPPS, especially the appropriate therapeutic approach, is still a challenge and a matter of debate [5]
Due to this unsatisfactory situation, a multimodal therapy seems to be the best approach [43]
It is nowadays generally agreed that this condition does not require additional diagnosis or therapy. Antimicrobial therapy can be suggested to patients with raised PSA [24]
Dr. Benelli is assigned to Giessen University for “Uro-Andrology” for one year
Supported by Excellence Initiative of Hessen: LOEWE: Urogenital infection/inflammation and male infertility (MIBIE)
Diagnosis of prostatitis refers to a variety of inflammatory and non-inflammatory, symptomatic and non-symptomatic entities often not affecting the prostate gland. Prostatitis syndrome has been classified in a consensus process as infectious disease (acute and chronic), chronic pelvic pain syndrome (CPPS) and asymptomatic prostatitis [1]
Table 1
NIH classification system for prostatitis syndromes [1]
Category | Nomenclature |
---|---|
I | Acute bacterial prostatitis |
II | Chronic bacterial prostatitis |
III | Chronic pelvic pain syndrome (CPPS) |
III A | Inflammatory |
III B | Non-inflammatory |
IV | Asymptomatic prostatitis |
In clinical practice, 90 percent of outpatients suffer from CPPS, inflammatory or non-inflammatory disease [5]
This review covers accepted aspects of diagnostic procedures and therapeutic attempts in men suffering from symptomatic prostatitis and CPPS (Categories I to III).
Careful medical history (e.g. physical examination) investigating presence of fever and voiding dysfunction is fundamental. It should include scrotal evaluation and a gentle digital rectal examination without prostate massage, which
is not recommended due to the risk of bacterial dissemination. The prostate is usually described as tender and swollen [6]
Diagnosis is based on microscopic analysis of a midstream urine specimen with evidence of leucocytes and confirmed by a microbiological culture, which is mandatory and the only laboratory examination required [7]
Table 2
Common pathogens in bacterial prostatitis (NIH I, II) [6]
Etiologically recognized pathogens | Microorganisms of debatable significance | Fastidious microorganisms |
---|---|---|
E. coli | Staphylococci | M. tuberculosis |
Klebsiella sp. | Streptococci | Candida sp. |
Proteus mirabilis | Corynebacterium sp. |
|
Enterococcus faecalis | C. trachomatis |
|
P. aeruginosa | U. urealyticum |
|
|
M. hominis |
|
Ultrasound evaluation of the residual urine is indicated to exclude urinary retention. TRUS may reveal intraprostatic abscesses, which usually appears as a hypoechogenic walled-off collection of fluid [7]
A history of recurrent urinary tract infections with the same pathogenic agent is typical [7]
Bacteriological localization cultures are fundamental for the diagnosis of chronic bacterial prostatitis [7]
Semen culture of the ejaculate alone is not sufficient for diagnosis of CBP due to a sensibility of only 50% in identifying bacteriospermia [7]
TRUS is an option in patients with suspicion for prostatic abscess. The relevance of prostatic calcification is unknown [7]
Lower urinary tract symptoms and pelvic pain due to pathologies of the prostate have always affected quality of life in men of all ages. For years, understanding of the condition was based merely on a prostate relationship via an organ
pathology involving somatic or visual tissue lesions [5]
Table 3
Phenotype classification modified according to Shoskes and Nickel [23]
U | P | O | I | N | T | S |
---|---|---|---|---|---|---|
Urinary | Psychological | Organ specific | Infection | Neurologic/Systemic | Tenderness | Sexual dysfunction |
Disturbed voiding | Depression | Inflammatory prostatic secretions | Infection | Instable bowel syndrome, fibromyalgia, chronic fatigue syndrome | Pelvic floor spasm | Erectile, ejaculatory, orgasmic dysfunction |
The simple “2-glass test” for analyzing the number of leukocytes in VB3 [14]
TRUS is normally not indicated [7]
An association between male sexual dysfunction and prostatitis syndrome, especially CPPS, has been the subject of controversy for years [25]
Since prostatitis is common in males of reproductive age, a negative impact on semen composition, and thus on fertility, may be suspected. Unfortunately, only a few studies are available investigating different types of prostatitis. In patients with NIH type II prostatitis, a recent meta-analysis evaluated seven studies including 249 patients and 163 controls [32]
Acute bacterial prostatitis is a serious infection. The main symptoms are high fever, pelvic pain and general discomfort. It can also result in septicemia and urosepsis, with elevated risk for the patient's life and mandatory hospitalization [36]. Initial antibiotic treatment is empirical and experience-based [37]. A broad-spectrum penicillin derivative with a beta-lactamase inhibitor, third-generation cephalosporin or fluoroquinolone, possibly in association with aminoglycoside, is suggested [10]
Due to their proven pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones (especially levofloxacin and ciprofloxacin) are the most recommended antibiotics agents for treating chronic bacterial prostatitis [11]
Due to the complexity of the pathogenetic mechanisms and the heterogeneity of symptoms, understanding CPPS, especially the appropriate therapeutic approach, is still a challenge and a matter of debate [5]
Due to this unsatisfactory situation, a multimodal therapy seems to be the best approach [43]
It is nowadays generally agreed that this condition does not require additional diagnosis or therapy. Antimicrobial therapy can be suggested to patients with raised PSA [24]
Dr. Benelli is assigned to Giessen University for “Uro-Andrology” for one year
Supported by Excellence Initiative of Hessen: LOEWE: Urogenital infection/inflammation and male infertility (MIBIE)
Diagnosis of prostatitis refers to a variety of inflammatory and non-inflammatory, symptomatic and non-symptomatic entities often not affecting the prostate gland. Prostatitis syndrome has been classified in a consensus process as infectious disease (acute and chronic), chronic pelvic pain syndrome (CPPS) and asymptomatic prostatitis [1]
Table 1
NIH classification system for prostatitis syndromes [1]
Category | Nomenclature |
---|---|
I | Acute bacterial prostatitis |
II | Chronic bacterial prostatitis |
III | Chronic pelvic pain syndrome (CPPS) |
III A | Inflammatory |
III B | Non-inflammatory |
IV | Asymptomatic prostatitis |
In clinical practice, 90 percent of outpatients suffer from CPPS, inflammatory or non-inflammatory disease [5]
This review covers accepted aspects of diagnostic procedures and therapeutic attempts in men suffering from symptomatic prostatitis and CPPS (Categories I to III).
Careful medical history (e.g. physical examination) investigating presence of fever and voiding dysfunction is fundamental. It should include scrotal evaluation and a gentle digital rectal examination without prostate massage, which
is not recommended due to the risk of bacterial dissemination. The prostate is usually described as tender and swollen [6]
Diagnosis is based on microscopic analysis of a midstream urine specimen with evidence of leucocytes and confirmed by a microbiological culture, which is mandatory and the only laboratory examination required [7]
Table 2
Common pathogens in bacterial prostatitis (NIH I, II) [6]
Etiologically recognized pathogens | Microorganisms of debatable significance | Fastidious microorganisms |
---|---|---|
E. coli | Staphylococci | M. tuberculosis |
Klebsiella sp. | Streptococci | Candida sp. |
Proteus mirabilis | Corynebacterium sp. |
|
Enterococcus faecalis | C. trachomatis |
|
P. aeruginosa | U. urealyticum |
|
|
M. hominis |
|
Ultrasound evaluation of the residual urine is indicated to exclude urinary retention. TRUS may reveal intraprostatic abscesses, which usually appears as a hypoechogenic walled-off collection of fluid [7]
A history of recurrent urinary tract infections with the same pathogenic agent is typical [7]
Bacteriological localization cultures are fundamental for the diagnosis of chronic bacterial prostatitis [7]
Semen culture of the ejaculate alone is not sufficient for diagnosis of CBP due to a sensibility of only 50% in identifying bacteriospermia [7]
TRUS is an option in patients with suspicion for prostatic abscess. The relevance of prostatic calcification is unknown [7]
Lower urinary tract symptoms and pelvic pain due to pathologies of the prostate have always affected quality of life in men of all ages. For years, understanding of the condition was based merely on a prostate relationship via an organ
pathology involving somatic or visual tissue lesions [5]
Table 3
Phenotype classification modified according to Shoskes and Nickel [23]
U | P | O | I | N | T | S |
---|---|---|---|---|---|---|
Urinary | Psychological | Organ specific | Infection | Neurologic/Systemic | Tenderness | Sexual dysfunction |
Disturbed voiding | Depression | Inflammatory prostatic secretions | Infection | Instable bowel syndrome, fibromyalgia, chronic fatigue syndrome | Pelvic floor spasm | Erectile, ejaculatory, orgasmic dysfunction |
The simple “2-glass test” for analyzing the number of leukocytes in VB3 [14]
TRUS is normally not indicated [7]
An association between male sexual dysfunction and prostatitis syndrome, especially CPPS, has been the subject of controversy for years [25]
Since prostatitis is common in males of reproductive age, a negative impact on semen composition, and thus on fertility, may be suspected. Unfortunately, only a few studies are available investigating different types of prostatitis. In patients with NIH type II prostatitis, a recent meta-analysis evaluated seven studies including 249 patients and 163 controls [32]
Acute bacterial prostatitis is a serious infection. The main symptoms are high fever, pelvic pain and general discomfort. It can also result in septicemia and urosepsis, with elevated risk for the patient's life and mandatory hospitalization [36]. Initial antibiotic treatment is empirical and experience-based [37]. A broad-spectrum penicillin derivative with a beta-lactamase inhibitor, third-generation cephalosporin or fluoroquinolone, possibly in association with aminoglycoside, is suggested [10]
Due to their proven pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones (especially levofloxacin and ciprofloxacin) are the most recommended antibiotics agents for treating chronic bacterial prostatitis [11]
Due to the complexity of the pathogenetic mechanisms and the heterogeneity of symptoms, understanding CPPS, especially the appropriate therapeutic approach, is still a challenge and a matter of debate [5]
Due to this unsatisfactory situation, a multimodal therapy seems to be the best approach [43]
It is nowadays generally agreed that this condition does not require additional diagnosis or therapy. Antimicrobial therapy can be suggested to patients with raised PSA [24]
Dr. Benelli is assigned to Giessen University for “Uro-Andrology” for one year
Supported by Excellence Initiative of Hessen: LOEWE: Urogenital infection/inflammation and male infertility (MIBIE)
Diagnosis of prostatitis refers to a variety of inflammatory and non-inflammatory, symptomatic and non-symptomatic entities often not affecting the prostate gland. Prostatitis syndrome has been classified in a consensus process as infectious disease (acute and chronic), chronic pelvic pain syndrome (CPPS) and asymptomatic prostatitis [1]
Table 1
NIH classification system for prostatitis syndromes [1]
Category | Nomenclature |
---|---|
I | Acute bacterial prostatitis |
II | Chronic bacterial prostatitis |
III | Chronic pelvic pain syndrome (CPPS) |
III A | Inflammatory |
III B | Non-inflammatory |
IV | Asymptomatic prostatitis |
In clinical practice, 90 percent of outpatients suffer from CPPS, inflammatory or non-inflammatory disease [5]
This review covers accepted aspects of diagnostic procedures and therapeutic attempts in men suffering from symptomatic prostatitis and CPPS (Categories I to III).
Careful medical history (e.g. physical examination) investigating presence of fever and voiding dysfunction is fundamental. It should include scrotal evaluation and a gentle digital rectal examination without prostate massage, which
is not recommended due to the risk of bacterial dissemination. The prostate is usually described as tender and swollen [6]
Diagnosis is based on microscopic analysis of a midstream urine specimen with evidence of leucocytes and confirmed by a microbiological culture, which is mandatory and the only laboratory examination required [7]
Table 2
Common pathogens in bacterial prostatitis (NIH I, II) [6]
Etiologically recognized pathogens | Microorganisms of debatable significance | Fastidious microorganisms |
---|---|---|
E. coli | Staphylococci | M. tuberculosis |
Klebsiella sp. | Streptococci | Candida sp. |
Proteus mirabilis | Corynebacterium sp. |
|
Enterococcus faecalis | C. trachomatis |
|
P. aeruginosa | U. urealyticum |
|
|
M. hominis |
|
Ultrasound evaluation of the residual urine is indicated to exclude urinary retention. TRUS may reveal intraprostatic abscesses, which usually appears as a hypoechogenic walled-off collection of fluid [7]
A history of recurrent urinary tract infections with the same pathogenic agent is typical [7]
Bacteriological localization cultures are fundamental for the diagnosis of chronic bacterial prostatitis [7]
Semen culture of the ejaculate alone is not sufficient for diagnosis of CBP due to a sensibility of only 50% in identifying bacteriospermia [7]
TRUS is an option in patients with suspicion for prostatic abscess. The relevance of prostatic calcification is unknown [7]
Lower urinary tract symptoms and pelvic pain due to pathologies of the prostate have always affected quality of life in men of all ages. For years, understanding of the condition was based merely on a prostate relationship via an organ
pathology involving somatic or visual tissue lesions [5]
Table 3
Phenotype classification modified according to Shoskes and Nickel [23]
U | P | O | I | N | T | S |
---|---|---|---|---|---|---|
Urinary | Psychological | Organ specific | Infection | Neurologic/Systemic | Tenderness | Sexual dysfunction |
Disturbed voiding | Depression | Inflammatory prostatic secretions | Infection | Instable bowel syndrome, fibromyalgia, chronic fatigue syndrome | Pelvic floor spasm | Erectile, ejaculatory, orgasmic dysfunction |
The simple “2-glass test” for analyzing the number of leukocytes in VB3 [14]
TRUS is normally not indicated [7]
An association between male sexual dysfunction and prostatitis syndrome, especially CPPS, has been the subject of controversy for years [25]
Since prostatitis is common in males of reproductive age, a negative impact on semen composition, and thus on fertility, may be suspected. Unfortunately, only a few studies are available investigating different types of prostatitis. In patients with NIH type II prostatitis, a recent meta-analysis evaluated seven studies including 249 patients and 163 controls [32]
Acute bacterial prostatitis is a serious infection. The main symptoms are high fever, pelvic pain and general discomfort. It can also result in septicemia and urosepsis, with elevated risk for the patient's life and mandatory hospitalization [36]. Initial antibiotic treatment is empirical and experience-based [37]. A broad-spectrum penicillin derivative with a beta-lactamase inhibitor, third-generation cephalosporin or fluoroquinolone, possibly in association with aminoglycoside, is suggested [10]
Due to their proven pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones (especially levofloxacin and ciprofloxacin) are the most recommended antibiotics agents for treating chronic bacterial prostatitis [11]
Due to the complexity of the pathogenetic mechanisms and the heterogeneity of symptoms, understanding CPPS, especially the appropriate therapeutic approach, is still a challenge and a matter of debate [5]
Due to this unsatisfactory situation, a multimodal therapy seems to be the best approach [43]
It is nowadays generally agreed that this condition does not require additional diagnosis or therapy. Antimicrobial therapy can be suggested to patients with raised PSA [24]
Dr. Benelli is assigned to Giessen University for “Uro-Andrology” for one year
Supported by Excellence Initiative of Hessen: LOEWE: Urogenital infection/inflammation and male infertility (MIBIE)
Diagnosis of prostatitis refers to a variety of inflammatory and non-inflammatory, symptomatic and non-symptomatic entities often not affecting the prostate gland. Prostatitis syndrome has been classified in a consensus process as infectious disease (acute and chronic), chronic pelvic pain syndrome (CPPS) and asymptomatic prostatitis [1]
Table 1
NIH classification system for prostatitis syndromes [1]
Category | Nomenclature |
---|---|
I | Acute bacterial prostatitis |
II | Chronic bacterial prostatitis |
III | Chronic pelvic pain syndrome (CPPS) |
III A | Inflammatory |
III B | Non-inflammatory |
IV | Asymptomatic prostatitis |
In clinical practice, 90 percent of outpatients suffer from CPPS, inflammatory or non-inflammatory disease [5]
This review covers accepted aspects of diagnostic procedures and therapeutic attempts in men suffering from symptomatic prostatitis and CPPS (Categories I to III).
Careful medical history (e.g. physical examination) investigating presence of fever and voiding dysfunction is fundamental. It should include scrotal evaluation and a gentle digital rectal examination without prostate massage, which
is not recommended due to the risk of bacterial dissemination. The prostate is usually described as tender and swollen [6]
Diagnosis is based on microscopic analysis of a midstream urine specimen with evidence of leucocytes and confirmed by a microbiological culture, which is mandatory and the only laboratory examination required [7]
Table 2
Common pathogens in bacterial prostatitis (NIH I, II) [6]
Etiologically recognized pathogens | Microorganisms of debatable significance | Fastidious microorganisms |
---|---|---|
E. coli | Staphylococci | M. tuberculosis |
Klebsiella sp. | Streptococci | Candida sp. |
Proteus mirabilis | Corynebacterium sp. |
|
Enterococcus faecalis | C. trachomatis |
|
P. aeruginosa | U. urealyticum |
|
|
M. hominis |
|
Ultrasound evaluation of the residual urine is indicated to exclude urinary retention. TRUS may reveal intraprostatic abscesses, which usually appears as a hypoechogenic walled-off collection of fluid [7]
A history of recurrent urinary tract infections with the same pathogenic agent is typical [7]
Bacteriological localization cultures are fundamental for the diagnosis of chronic bacterial prostatitis [7]
Semen culture of the ejaculate alone is not sufficient for diagnosis of CBP due to a sensibility of only 50% in identifying bacteriospermia [7]
TRUS is an option in patients with suspicion for prostatic abscess. The relevance of prostatic calcification is unknown [7]
Lower urinary tract symptoms and pelvic pain due to pathologies of the prostate have always affected quality of life in men of all ages. For years, understanding of the condition was based merely on a prostate relationship via an organ
pathology involving somatic or visual tissue lesions [5]
Table 3
Phenotype classification modified according to Shoskes and Nickel [23]
U | P | O | I | N | T | S |
---|---|---|---|---|---|---|
Urinary | Psychological | Organ specific | Infection | Neurologic/Systemic | Tenderness | Sexual dysfunction |
Disturbed voiding | Depression | Inflammatory prostatic secretions | Infection | Instable bowel syndrome, fibromyalgia, chronic fatigue syndrome | Pelvic floor spasm | Erectile, ejaculatory, orgasmic dysfunction |
The simple “2-glass test” for analyzing the number of leukocytes in VB3 [14]
TRUS is normally not indicated [7]
An association between male sexual dysfunction and prostatitis syndrome, especially CPPS, has been the subject of controversy for years [25]
Since prostatitis is common in males of reproductive age, a negative impact on semen composition, and thus on fertility, may be suspected. Unfortunately, only a few studies are available investigating different types of prostatitis. In patients with NIH type II prostatitis, a recent meta-analysis evaluated seven studies including 249 patients and 163 controls [32]
Acute bacterial prostatitis is a serious infection. The main symptoms are high fever, pelvic pain and general discomfort. It can also result in septicemia and urosepsis, with elevated risk for the patient's life and mandatory hospitalization [36]. Initial antibiotic treatment is empirical and experience-based [37]. A broad-spectrum penicillin derivative with a beta-lactamase inhibitor, third-generation cephalosporin or fluoroquinolone, possibly in association with aminoglycoside, is suggested [10]
Due to their proven pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones (especially levofloxacin and ciprofloxacin) are the most recommended antibiotics agents for treating chronic bacterial prostatitis [11]
Due to the complexity of the pathogenetic mechanisms and the heterogeneity of symptoms, understanding CPPS, especially the appropriate therapeutic approach, is still a challenge and a matter of debate [5]
Due to this unsatisfactory situation, a multimodal therapy seems to be the best approach [43]
It is nowadays generally agreed that this condition does not require additional diagnosis or therapy. Antimicrobial therapy can be suggested to patients with raised PSA [24]
Dr. Benelli is assigned to Giessen University for “Uro-Andrology” for one year
Supported by Excellence Initiative of Hessen: LOEWE: Urogenital infection/inflammation and male infertility (MIBIE)
Diagnosis of prostatitis refers to a variety of inflammatory and non-inflammatory, symptomatic and non-symptomatic entities often not affecting the prostate gland. Prostatitis syndrome has been classified in a consensus process as infectious disease (acute and chronic), chronic pelvic pain syndrome (CPPS) and asymptomatic prostatitis [1]
Table 1
NIH classification system for prostatitis syndromes [1]
Category | Nomenclature |
---|---|
I | Acute bacterial prostatitis |
II | Chronic bacterial prostatitis |
III | Chronic pelvic pain syndrome (CPPS) |
III A | Inflammatory |
III B | Non-inflammatory |
IV | Asymptomatic prostatitis |
In clinical practice, 90 percent of outpatients suffer from CPPS, inflammatory or non-inflammatory disease [5]
This review covers accepted aspects of diagnostic procedures and therapeutic attempts in men suffering from symptomatic prostatitis and CPPS (Categories I to III).
Careful medical history (e.g. physical examination) investigating presence of fever and voiding dysfunction is fundamental. It should include scrotal evaluation and a gentle digital rectal examination without prostate massage, which
is not recommended due to the risk of bacterial dissemination. The prostate is usually described as tender and swollen [6]
Diagnosis is based on microscopic analysis of a midstream urine specimen with evidence of leucocytes and confirmed by a microbiological culture, which is mandatory and the only laboratory examination required [7]
Table 2
Common pathogens in bacterial prostatitis (NIH I, II) [6]
Etiologically recognized pathogens | Microorganisms of debatable significance | Fastidious microorganisms |
---|---|---|
E. coli | Staphylococci | M. tuberculosis |
Klebsiella sp. | Streptococci | Candida sp. |
Proteus mirabilis | Corynebacterium sp. |
|
Enterococcus faecalis | C. trachomatis |
|
P. aeruginosa | U. urealyticum |
|
|
M. hominis |
|
Ultrasound evaluation of the residual urine is indicated to exclude urinary retention. TRUS may reveal intraprostatic abscesses, which usually appears as a hypoechogenic walled-off collection of fluid [7]
A history of recurrent urinary tract infections with the same pathogenic agent is typical [7]
Bacteriological localization cultures are fundamental for the diagnosis of chronic bacterial prostatitis [7]
Semen culture of the ejaculate alone is not sufficient for diagnosis of CBP due to a sensibility of only 50% in identifying bacteriospermia [7]
TRUS is an option in patients with suspicion for prostatic abscess. The relevance of prostatic calcification is unknown [7]
Lower urinary tract symptoms and pelvic pain due to pathologies of the prostate have always affected quality of life in men of all ages. For years, understanding of the condition was based merely on a prostate relationship via an organ
pathology involving somatic or visual tissue lesions [5]
Table 3
Phenotype classification modified according to Shoskes and Nickel [23]
U | P | O | I | N | T | S |
---|---|---|---|---|---|---|
Urinary | Psychological | Organ specific | Infection | Neurologic/Systemic | Tenderness | Sexual dysfunction |
Disturbed voiding | Depression | Inflammatory prostatic secretions | Infection | Instable bowel syndrome, fibromyalgia, chronic fatigue syndrome | Pelvic floor spasm | Erectile, ejaculatory, orgasmic dysfunction |
The simple “2-glass test” for analyzing the number of leukocytes in VB3 [14]
TRUS is normally not indicated [7]
An association between male sexual dysfunction and prostatitis syndrome, especially CPPS, has been the subject of controversy for years [25]
Since prostatitis is common in males of reproductive age, a negative impact on semen composition, and thus on fertility, may be suspected. Unfortunately, only a few studies are available investigating different types of prostatitis. In patients with NIH type II prostatitis, a recent meta-analysis evaluated seven studies including 249 patients and 163 controls [32]
Acute bacterial prostatitis is a serious infection. The main symptoms are high fever, pelvic pain and general discomfort. It can also result in septicemia and urosepsis, with elevated risk for the patient's life and mandatory hospitalization [36]. Initial antibiotic treatment is empirical and experience-based [37]. A broad-spectrum penicillin derivative with a beta-lactamase inhibitor, third-generation cephalosporin or fluoroquinolone, possibly in association with aminoglycoside, is suggested [10]
Due to their proven pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones (especially levofloxacin and ciprofloxacin) are the most recommended antibiotics agents for treating chronic bacterial prostatitis [11]
Due to the complexity of the pathogenetic mechanisms and the heterogeneity of symptoms, understanding CPPS, especially the appropriate therapeutic approach, is still a challenge and a matter of debate [5]
Due to this unsatisfactory situation, a multimodal therapy seems to be the best approach [43]
It is nowadays generally agreed that this condition does not require additional diagnosis or therapy. Antimicrobial therapy can be suggested to patients with raised PSA [24]
Dr. Benelli is assigned to Giessen University for “Uro-Andrology” for one year
Supported by Excellence Initiative of Hessen: LOEWE: Urogenital infection/inflammation and male infertility (MIBIE)
Diagnosis of prostatitis refers to a variety of inflammatory and non-inflammatory, symptomatic and non-symptomatic entities often not affecting the prostate gland. Prostatitis syndrome has been classified in a consensus process as infectious disease (acute and chronic), chronic pelvic pain syndrome (CPPS) and asymptomatic prostatitis [1]
Table 1
NIH classification system for prostatitis syndromes [1]
Category | Nomenclature |
---|---|
I | Acute bacterial prostatitis |
II | Chronic bacterial prostatitis |
III | Chronic pelvic pain syndrome (CPPS) |
III A | Inflammatory |
III B | Non-inflammatory |
IV | Asymptomatic prostatitis |
In clinical practice, 90 percent of outpatients suffer from CPPS, inflammatory or non-inflammatory disease [5]
This review covers accepted aspects of diagnostic procedures and therapeutic attempts in men suffering from symptomatic prostatitis and CPPS (Categories I to III).
Careful medical history (e.g. physical examination) investigating presence of fever and voiding dysfunction is fundamental. It should include scrotal evaluation and a gentle digital rectal examination without prostate massage, which
is not recommended due to the risk of bacterial dissemination. The prostate is usually described as tender and swollen [6]
Diagnosis is based on microscopic analysis of a midstream urine specimen with evidence of leucocytes and confirmed by a microbiological culture, which is mandatory and the only laboratory examination required [7]
Table 2
Common pathogens in bacterial prostatitis (NIH I, II) [6]
Etiologically recognized pathogens | Microorganisms of debatable significance | Fastidious microorganisms |
---|---|---|
E. coli | Staphylococci | M. tuberculosis |
Klebsiella sp. | Streptococci | Candida sp. |
Proteus mirabilis | Corynebacterium sp. |
|
Enterococcus faecalis | C. trachomatis |
|
P. aeruginosa | U. urealyticum |
|
|
M. hominis |
|
Ultrasound evaluation of the residual urine is indicated to exclude urinary retention. TRUS may reveal intraprostatic abscesses, which usually appears as a hypoechogenic walled-off collection of fluid [7]
A history of recurrent urinary tract infections with the same pathogenic agent is typical [7]
Bacteriological localization cultures are fundamental for the diagnosis of chronic bacterial prostatitis [7]
Semen culture of the ejaculate alone is not sufficient for diagnosis of CBP due to a sensibility of only 50% in identifying bacteriospermia [7]
TRUS is an option in patients with suspicion for prostatic abscess. The relevance of prostatic calcification is unknown [7]
Lower urinary tract symptoms and pelvic pain due to pathologies of the prostate have always affected quality of life in men of all ages. For years, understanding of the condition was based merely on a prostate relationship via an organ
pathology involving somatic or visual tissue lesions [5]
Table 3
Phenotype classification modified according to Shoskes and Nickel [23]
U | P | O | I | N | T | S |
---|---|---|---|---|---|---|
Urinary | Psychological | Organ specific | Infection | Neurologic/Systemic | Tenderness | Sexual dysfunction |
Disturbed voiding | Depression | Inflammatory prostatic secretions | Infection | Instable bowel syndrome, fibromyalgia, chronic fatigue syndrome | Pelvic floor spasm | Erectile, ejaculatory, orgasmic dysfunction |
The simple “2-glass test” for analyzing the number of leukocytes in VB3 [14]
TRUS is normally not indicated [7]
An association between male sexual dysfunction and prostatitis syndrome, especially CPPS, has been the subject of controversy for years [25]
Since prostatitis is common in males of reproductive age, a negative impact on semen composition, and thus on fertility, may be suspected. Unfortunately, only a few studies are available investigating different types of prostatitis. In patients with NIH type II prostatitis, a recent meta-analysis evaluated seven studies including 249 patients and 163 controls [32]
Acute bacterial prostatitis is a serious infection. The main symptoms are high fever, pelvic pain and general discomfort. It can also result in septicemia and urosepsis, with elevated risk for the patient's life and mandatory hospitalization [36]. Initial antibiotic treatment is empirical and experience-based [37]. A broad-spectrum penicillin derivative with a beta-lactamase inhibitor, third-generation cephalosporin or fluoroquinolone, possibly in association with aminoglycoside, is suggested [10]
Due to their proven pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones (especially levofloxacin and ciprofloxacin) are the most recommended antibiotics agents for treating chronic bacterial prostatitis [11]
Due to the complexity of the pathogenetic mechanisms and the heterogeneity of symptoms, understanding CPPS, especially the appropriate therapeutic approach, is still a challenge and a matter of debate [5]
Due to this unsatisfactory situation, a multimodal therapy seems to be the best approach [43]
It is nowadays generally agreed that this condition does not require additional diagnosis or therapy. Antimicrobial therapy can be suggested to patients with raised PSA [24]
Dr. Benelli is assigned to Giessen University for “Uro-Andrology” for one year
Supported by Excellence Initiative of Hessen: LOEWE: Urogenital infection/inflammation and male infertility (MIBIE)
Diagnosis of prostatitis refers to a variety of inflammatory and non-inflammatory, symptomatic and non-symptomatic entities often not affecting the prostate gland. Prostatitis syndrome has been classified in a consensus process as infectious disease (acute and chronic), chronic pelvic pain syndrome (CPPS) and asymptomatic prostatitis [1]
Table 1
NIH classification system for prostatitis syndromes [1]
Category | Nomenclature |
---|---|
I | Acute bacterial prostatitis |
II | Chronic bacterial prostatitis |
III | Chronic pelvic pain syndrome (CPPS) |
III A | Inflammatory |
III B | Non-inflammatory |
IV | Asymptomatic prostatitis |
In clinical practice, 90 percent of outpatients suffer from CPPS, inflammatory or non-inflammatory disease [5]
This review covers accepted aspects of diagnostic procedures and therapeutic attempts in men suffering from symptomatic prostatitis and CPPS (Categories I to III).
Careful medical history (e.g. physical examination) investigating presence of fever and voiding dysfunction is fundamental. It should include scrotal evaluation and a gentle digital rectal examination without prostate massage, which
is not recommended due to the risk of bacterial dissemination. The prostate is usually described as tender and swollen [6]
Diagnosis is based on microscopic analysis of a midstream urine specimen with evidence of leucocytes and confirmed by a microbiological culture, which is mandatory and the only laboratory examination required [7]
Table 2
Common pathogens in bacterial prostatitis (NIH I, II) [6]
Etiologically recognized pathogens | Microorganisms of debatable significance | Fastidious microorganisms |
---|---|---|
E. coli | Staphylococci | M. tuberculosis |
Klebsiella sp. | Streptococci | Candida sp. |
Proteus mirabilis | Corynebacterium sp. |
|
Enterococcus faecalis | C. trachomatis |
|
P. aeruginosa | U. urealyticum |
|
|
M. hominis |
|
Ultrasound evaluation of the residual urine is indicated to exclude urinary retention. TRUS may reveal intraprostatic abscesses, which usually appears as a hypoechogenic walled-off collection of fluid [7]
A history of recurrent urinary tract infections with the same pathogenic agent is typical [7]
Bacteriological localization cultures are fundamental for the diagnosis of chronic bacterial prostatitis [7]
Semen culture of the ejaculate alone is not sufficient for diagnosis of CBP due to a sensibility of only 50% in identifying bacteriospermia [7]
TRUS is an option in patients with suspicion for prostatic abscess. The relevance of prostatic calcification is unknown [7]
Lower urinary tract symptoms and pelvic pain due to pathologies of the prostate have always affected quality of life in men of all ages. For years, understanding of the condition was based merely on a prostate relationship via an organ
pathology involving somatic or visual tissue lesions [5]
Table 3
Phenotype classification modified according to Shoskes and Nickel [23]
U | P | O | I | N | T | S |
---|---|---|---|---|---|---|
Urinary | Psychological | Organ specific | Infection | Neurologic/Systemic | Tenderness | Sexual dysfunction |
Disturbed voiding | Depression | Inflammatory prostatic secretions | Infection | Instable bowel syndrome, fibromyalgia, chronic fatigue syndrome | Pelvic floor spasm | Erectile, ejaculatory, orgasmic dysfunction |
The simple “2-glass test” for analyzing the number of leukocytes in VB3 [14]
TRUS is normally not indicated [7]
An association between male sexual dysfunction and prostatitis syndrome, especially CPPS, has been the subject of controversy for years [25]
Since prostatitis is common in males of reproductive age, a negative impact on semen composition, and thus on fertility, may be suspected. Unfortunately, only a few studies are available investigating different types of prostatitis. In patients with NIH type II prostatitis, a recent meta-analysis evaluated seven studies including 249 patients and 163 controls [32]
Acute bacterial prostatitis is a serious infection. The main symptoms are high fever, pelvic pain and general discomfort. It can also result in septicemia and urosepsis, with elevated risk for the patient's life and mandatory hospitalization [36]. Initial antibiotic treatment is empirical and experience-based [37]. A broad-spectrum penicillin derivative with a beta-lactamase inhibitor, third-generation cephalosporin or fluoroquinolone, possibly in association with aminoglycoside, is suggested [10]
Due to their proven pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones (especially levofloxacin and ciprofloxacin) are the most recommended antibiotics agents for treating chronic bacterial prostatitis [11]
Due to the complexity of the pathogenetic mechanisms and the heterogeneity of symptoms, understanding CPPS, especially the appropriate therapeutic approach, is still a challenge and a matter of debate [5]
Due to this unsatisfactory situation, a multimodal therapy seems to be the best approach [43]
It is nowadays generally agreed that this condition does not require additional diagnosis or therapy. Antimicrobial therapy can be suggested to patients with raised PSA [24]
Dr. Benelli is assigned to Giessen University for “Uro-Andrology” for one year
Supported by Excellence Initiative of Hessen: LOEWE: Urogenital infection/inflammation and male infertility (MIBIE)
Diagnosis of prostatitis refers to a variety of inflammatory and non-inflammatory, symptomatic and non-symptomatic entities often not affecting the prostate gland. Prostatitis syndrome has been classified in a consensus process as infectious disease (acute and chronic), chronic pelvic pain syndrome (CPPS) and asymptomatic prostatitis [1]
Table 1
NIH classification system for prostatitis syndromes [1]
Category | Nomenclature |
---|---|
I | Acute bacterial prostatitis |
II | Chronic bacterial prostatitis |
III | Chronic pelvic pain syndrome (CPPS) |
III A | Inflammatory |
III B | Non-inflammatory |
IV | Asymptomatic prostatitis |
In clinical practice, 90 percent of outpatients suffer from CPPS, inflammatory or non-inflammatory disease [5]
This review covers accepted aspects of diagnostic procedures and therapeutic attempts in men suffering from symptomatic prostatitis and CPPS (Categories I to III).
Careful medical history (e.g. physical examination) investigating presence of fever and voiding dysfunction is fundamental. It should include scrotal evaluation and a gentle digital rectal examination without prostate massage, which
is not recommended due to the risk of bacterial dissemination. The prostate is usually described as tender and swollen [6]
Diagnosis is based on microscopic analysis of a midstream urine specimen with evidence of leucocytes and confirmed by a microbiological culture, which is mandatory and the only laboratory examination required [7]
Table 2
Common pathogens in bacterial prostatitis (NIH I, II) [6]
Etiologically recognized pathogens | Microorganisms of debatable significance | Fastidious microorganisms |
---|---|---|
E. coli | Staphylococci | M. tuberculosis |
Klebsiella sp. | Streptococci | Candida sp. |
Proteus mirabilis | Corynebacterium sp. |
|
Enterococcus faecalis | C. trachomatis |
|
P. aeruginosa | U. urealyticum |
|
|
M. hominis |
|
Ultrasound evaluation of the residual urine is indicated to exclude urinary retention. TRUS may reveal intraprostatic abscesses, which usually appears as a hypoechogenic walled-off collection of fluid [7]
A history of recurrent urinary tract infections with the same pathogenic agent is typical [7]
Bacteriological localization cultures are fundamental for the diagnosis of chronic bacterial prostatitis [7]
Semen culture of the ejaculate alone is not sufficient for diagnosis of CBP due to a sensibility of only 50% in identifying bacteriospermia [7]
TRUS is an option in patients with suspicion for prostatic abscess. The relevance of prostatic calcification is unknown [7]
Lower urinary tract symptoms and pelvic pain due to pathologies of the prostate have always affected quality of life in men of all ages. For years, understanding of the condition was based merely on a prostate relationship via an organ
pathology involving somatic or visual tissue lesions [5]
Table 3
Phenotype classification modified according to Shoskes and Nickel [23]
U | P | O | I | N | T | S |
---|---|---|---|---|---|---|
Urinary | Psychological | Organ specific | Infection | Neurologic/Systemic | Tenderness | Sexual dysfunction |
Disturbed voiding | Depression | Inflammatory prostatic secretions | Infection | Instable bowel syndrome, fibromyalgia, chronic fatigue syndrome | Pelvic floor spasm | Erectile, ejaculatory, orgasmic dysfunction |
The simple “2-glass test” for analyzing the number of leukocytes in VB3 [14]
TRUS is normally not indicated [7]
An association between male sexual dysfunction and prostatitis syndrome, especially CPPS, has been the subject of controversy for years [25]
Since prostatitis is common in males of reproductive age, a negative impact on semen composition, and thus on fertility, may be suspected. Unfortunately, only a few studies are available investigating different types of prostatitis. In patients with NIH type II prostatitis, a recent meta-analysis evaluated seven studies including 249 patients and 163 controls [32]
Acute bacterial prostatitis is a serious infection. The main symptoms are high fever, pelvic pain and general discomfort. It can also result in septicemia and urosepsis, with elevated risk for the patient's life and mandatory hospitalization [36]. Initial antibiotic treatment is empirical and experience-based [37]. A broad-spectrum penicillin derivative with a beta-lactamase inhibitor, third-generation cephalosporin or fluoroquinolone, possibly in association with aminoglycoside, is suggested [10]
Due to their proven pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones (especially levofloxacin and ciprofloxacin) are the most recommended antibiotics agents for treating chronic bacterial prostatitis [11]
Due to the complexity of the pathogenetic mechanisms and the heterogeneity of symptoms, understanding CPPS, especially the appropriate therapeutic approach, is still a challenge and a matter of debate [5]
Due to this unsatisfactory situation, a multimodal therapy seems to be the best approach [43]
It is nowadays generally agreed that this condition does not require additional diagnosis or therapy. Antimicrobial therapy can be suggested to patients with raised PSA [24]
Dr. Benelli is assigned to Giessen University for “Uro-Andrology” for one year
Supported by Excellence Initiative of Hessen: LOEWE: Urogenital infection/inflammation and male infertility (MIBIE)
Diagnosis of prostatitis refers to a variety of inflammatory and non-inflammatory, symptomatic and non-symptomatic entities often not affecting the prostate gland. Prostatitis syndrome has been classified in a consensus process as infectious disease (acute and chronic), chronic pelvic pain syndrome (CPPS) and asymptomatic prostatitis [1]
Table 1
NIH classification system for prostatitis syndromes [1]
Category | Nomenclature |
---|---|
I | Acute bacterial prostatitis |
II | Chronic bacterial prostatitis |
III | Chronic pelvic pain syndrome (CPPS) |
III A | Inflammatory |
III B | Non-inflammatory |
IV | Asymptomatic prostatitis |
In clinical practice, 90 percent of outpatients suffer from CPPS, inflammatory or non-inflammatory disease [5]
This review covers accepted aspects of diagnostic procedures and therapeutic attempts in men suffering from symptomatic prostatitis and CPPS (Categories I to III).
Careful medical history (e.g. physical examination) investigating presence of fever and voiding dysfunction is fundamental. It should include scrotal evaluation and a gentle digital rectal examination without prostate massage, which
is not recommended due to the risk of bacterial dissemination. The prostate is usually described as tender and swollen [6]
Diagnosis is based on microscopic analysis of a midstream urine specimen with evidence of leucocytes and confirmed by a microbiological culture, which is mandatory and the only laboratory examination required [7]
Table 2
Common pathogens in bacterial prostatitis (NIH I, II) [6]
Etiologically recognized pathogens | Microorganisms of debatable significance | Fastidious microorganisms |
---|---|---|
E. coli | Staphylococci | M. tuberculosis |
Klebsiella sp. | Streptococci | Candida sp. |
Proteus mirabilis | Corynebacterium sp. |
|
Enterococcus faecalis | C. trachomatis |
|
P. aeruginosa | U. urealyticum |
|
|
M. hominis |
|
Ultrasound evaluation of the residual urine is indicated to exclude urinary retention. TRUS may reveal intraprostatic abscesses, which usually appears as a hypoechogenic walled-off collection of fluid [7]
A history of recurrent urinary tract infections with the same pathogenic agent is typical [7]
Bacteriological localization cultures are fundamental for the diagnosis of chronic bacterial prostatitis [7]
Semen culture of the ejaculate alone is not sufficient for diagnosis of CBP due to a sensibility of only 50% in identifying bacteriospermia [7]
TRUS is an option in patients with suspicion for prostatic abscess. The relevance of prostatic calcification is unknown [7]
Lower urinary tract symptoms and pelvic pain due to pathologies of the prostate have always affected quality of life in men of all ages. For years, understanding of the condition was based merely on a prostate relationship via an organ
pathology involving somatic or visual tissue lesions [5]
Table 3
Phenotype classification modified according to Shoskes and Nickel [23]
U | P | O | I | N | T | S |
---|---|---|---|---|---|---|
Urinary | Psychological | Organ specific | Infection | Neurologic/Systemic | Tenderness | Sexual dysfunction |
Disturbed voiding | Depression | Inflammatory prostatic secretions | Infection | Instable bowel syndrome, fibromyalgia, chronic fatigue syndrome | Pelvic floor spasm | Erectile, ejaculatory, orgasmic dysfunction |
The simple “2-glass test” for analyzing the number of leukocytes in VB3 [14]
TRUS is normally not indicated [7]
An association between male sexual dysfunction and prostatitis syndrome, especially CPPS, has been the subject of controversy for years [25]
Since prostatitis is common in males of reproductive age, a negative impact on semen composition, and thus on fertility, may be suspected. Unfortunately, only a few studies are available investigating different types of prostatitis. In patients with NIH type II prostatitis, a recent meta-analysis evaluated seven studies including 249 patients and 163 controls [32]
Acute bacterial prostatitis is a serious infection. The main symptoms are high fever, pelvic pain and general discomfort. It can also result in septicemia and urosepsis, with elevated risk for the patient's life and mandatory hospitalization [36]. Initial antibiotic treatment is empirical and experience-based [37]. A broad-spectrum penicillin derivative with a beta-lactamase inhibitor, third-generation cephalosporin or fluoroquinolone, possibly in association with aminoglycoside, is suggested [10]
Due to their proven pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones (especially levofloxacin and ciprofloxacin) are the most recommended antibiotics agents for treating chronic bacterial prostatitis [11]
Due to the complexity of the pathogenetic mechanisms and the heterogeneity of symptoms, understanding CPPS, especially the appropriate therapeutic approach, is still a challenge and a matter of debate [5]
Due to this unsatisfactory situation, a multimodal therapy seems to be the best approach [43]
It is nowadays generally agreed that this condition does not require additional diagnosis or therapy. Antimicrobial therapy can be suggested to patients with raised PSA [24]
Dr. Benelli is assigned to Giessen University for “Uro-Andrology” for one year
Supported by Excellence Initiative of Hessen: LOEWE: Urogenital infection/inflammation and male infertility (MIBIE)
Diagnosis of prostatitis refers to a variety of inflammatory and non-inflammatory, symptomatic and non-symptomatic entities often not affecting the prostate gland. Prostatitis syndrome has been classified in a consensus process as infectious disease (acute and chronic), chronic pelvic pain syndrome (CPPS) and asymptomatic prostatitis [1]
Table 1
NIH classification system for prostatitis syndromes [1]
Category | Nomenclature |
---|---|
I | Acute bacterial prostatitis |
II | Chronic bacterial prostatitis |
III | Chronic pelvic pain syndrome (CPPS) |
III A | Inflammatory |
III B | Non-inflammatory |
IV | Asymptomatic prostatitis |
In clinical practice, 90 percent of outpatients suffer from CPPS, inflammatory or non-inflammatory disease [5]
This review covers accepted aspects of diagnostic procedures and therapeutic attempts in men suffering from symptomatic prostatitis and CPPS (Categories I to III).
Careful medical history (e.g. physical examination) investigating presence of fever and voiding dysfunction is fundamental. It should include scrotal evaluation and a gentle digital rectal examination without prostate massage, which
is not recommended due to the risk of bacterial dissemination. The prostate is usually described as tender and swollen [6]
Diagnosis is based on microscopic analysis of a midstream urine specimen with evidence of leucocytes and confirmed by a microbiological culture, which is mandatory and the only laboratory examination required [7]
Table 2
Common pathogens in bacterial prostatitis (NIH I, II) [6]
Etiologically recognized pathogens | Microorganisms of debatable significance | Fastidious microorganisms |
---|---|---|
E. coli | Staphylococci | M. tuberculosis |
Klebsiella sp. | Streptococci | Candida sp. |
Proteus mirabilis | Corynebacterium sp. |
|
Enterococcus faecalis | C. trachomatis |
|
P. aeruginosa | U. urealyticum |
|
|
M. hominis |
|
Ultrasound evaluation of the residual urine is indicated to exclude urinary retention. TRUS may reveal intraprostatic abscesses, which usually appears as a hypoechogenic walled-off collection of fluid [7]
A history of recurrent urinary tract infections with the same pathogenic agent is typical [7]
Bacteriological localization cultures are fundamental for the diagnosis of chronic bacterial prostatitis [7]
Semen culture of the ejaculate alone is not sufficient for diagnosis of CBP due to a sensibility of only 50% in identifying bacteriospermia [7]
TRUS is an option in patients with suspicion for prostatic abscess. The relevance of prostatic calcification is unknown [7]
Lower urinary tract symptoms and pelvic pain due to pathologies of the prostate have always affected quality of life in men of all ages. For years, understanding of the condition was based merely on a prostate relationship via an organ
pathology involving somatic or visual tissue lesions [5]
Table 3
Phenotype classification modified according to Shoskes and Nickel [23]
U | P | O | I | N | T | S |
---|---|---|---|---|---|---|
Urinary | Psychological | Organ specific | Infection | Neurologic/Systemic | Tenderness | Sexual dysfunction |
Disturbed voiding | Depression | Inflammatory prostatic secretions | Infection | Instable bowel syndrome, fibromyalgia, chronic fatigue syndrome | Pelvic floor spasm | Erectile, ejaculatory, orgasmic dysfunction |
The simple “2-glass test” for analyzing the number of leukocytes in VB3 [14]
TRUS is normally not indicated [7]
An association between male sexual dysfunction and prostatitis syndrome, especially CPPS, has been the subject of controversy for years [25]
Since prostatitis is common in males of reproductive age, a negative impact on semen composition, and thus on fertility, may be suspected. Unfortunately, only a few studies are available investigating different types of prostatitis. In patients with NIH type II prostatitis, a recent meta-analysis evaluated seven studies including 249 patients and 163 controls [32]
Acute bacterial prostatitis is a serious infection. The main symptoms are high fever, pelvic pain and general discomfort. It can also result in septicemia and urosepsis, with elevated risk for the patient's life and mandatory hospitalization [36]. Initial antibiotic treatment is empirical and experience-based [37]. A broad-spectrum penicillin derivative with a beta-lactamase inhibitor, third-generation cephalosporin or fluoroquinolone, possibly in association with aminoglycoside, is suggested [10]
Due to their proven pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones (especially levofloxacin and ciprofloxacin) are the most recommended antibiotics agents for treating chronic bacterial prostatitis [11]
Due to the complexity of the pathogenetic mechanisms and the heterogeneity of symptoms, understanding CPPS, especially the appropriate therapeutic approach, is still a challenge and a matter of debate [5]
Due to this unsatisfactory situation, a multimodal therapy seems to be the best approach [43]
It is nowadays generally agreed that this condition does not require additional diagnosis or therapy. Antimicrobial therapy can be suggested to patients with raised PSA [24]
Dr. Benelli is assigned to Giessen University for “Uro-Andrology” for one year
Supported by Excellence Initiative of Hessen: LOEWE: Urogenital infection/inflammation and male infertility (MIBIE)
Diagnosis of prostatitis refers to a variety of inflammatory and non-inflammatory, symptomatic and non-symptomatic entities often not affecting the prostate gland. Prostatitis syndrome has been classified in a consensus process as infectious disease (acute and chronic), chronic pelvic pain syndrome (CPPS) and asymptomatic prostatitis [1]
Table 1
NIH classification system for prostatitis syndromes [1]
Category | Nomenclature |
---|---|
I | Acute bacterial prostatitis |
II | Chronic bacterial prostatitis |
III | Chronic pelvic pain syndrome (CPPS) |
III A | Inflammatory |
III B | Non-inflammatory |
IV | Asymptomatic prostatitis |
In clinical practice, 90 percent of outpatients suffer from CPPS, inflammatory or non-inflammatory disease [5]
This review covers accepted aspects of diagnostic procedures and therapeutic attempts in men suffering from symptomatic prostatitis and CPPS (Categories I to III).
Careful medical history (e.g. physical examination) investigating presence of fever and voiding dysfunction is fundamental. It should include scrotal evaluation and a gentle digital rectal examination without prostate massage, which
is not recommended due to the risk of bacterial dissemination. The prostate is usually described as tender and swollen [6]
Diagnosis is based on microscopic analysis of a midstream urine specimen with evidence of leucocytes and confirmed by a microbiological culture, which is mandatory and the only laboratory examination required [7]
Table 2
Common pathogens in bacterial prostatitis (NIH I, II) [6]
Etiologically recognized pathogens | Microorganisms of debatable significance | Fastidious microorganisms |
---|---|---|
E. coli | Staphylococci | M. tuberculosis |
Klebsiella sp. | Streptococci | Candida sp. |
Proteus mirabilis | Corynebacterium sp. |
|
Enterococcus faecalis | C. trachomatis |
|
P. aeruginosa | U. urealyticum |
|
|
M. hominis |
|
Ultrasound evaluation of the residual urine is indicated to exclude urinary retention. TRUS may reveal intraprostatic abscesses, which usually appears as a hypoechogenic walled-off collection of fluid [7]
A history of recurrent urinary tract infections with the same pathogenic agent is typical [7]
Bacteriological localization cultures are fundamental for the diagnosis of chronic bacterial prostatitis [7]
Semen culture of the ejaculate alone is not sufficient for diagnosis of CBP due to a sensibility of only 50% in identifying bacteriospermia [7]
TRUS is an option in patients with suspicion for prostatic abscess. The relevance of prostatic calcification is unknown [7]
Lower urinary tract symptoms and pelvic pain due to pathologies of the prostate have always affected quality of life in men of all ages. For years, understanding of the condition was based merely on a prostate relationship via an organ
pathology involving somatic or visual tissue lesions [5]
Table 3
Phenotype classification modified according to Shoskes and Nickel [23]
U | P | O | I | N | T | S |
---|---|---|---|---|---|---|
Urinary | Psychological | Organ specific | Infection | Neurologic/Systemic | Tenderness | Sexual dysfunction |
Disturbed voiding | Depression | Inflammatory prostatic secretions | Infection | Instable bowel syndrome, fibromyalgia, chronic fatigue syndrome | Pelvic floor spasm | Erectile, ejaculatory, orgasmic dysfunction |
The simple “2-glass test” for analyzing the number of leukocytes in VB3 [14]
TRUS is normally not indicated [7]
An association between male sexual dysfunction and prostatitis syndrome, especially CPPS, has been the subject of controversy for years [25]
Since prostatitis is common in males of reproductive age, a negative impact on semen composition, and thus on fertility, may be suspected. Unfortunately, only a few studies are available investigating different types of prostatitis. In patients with NIH type II prostatitis, a recent meta-analysis evaluated seven studies including 249 patients and 163 controls [32]
Acute bacterial prostatitis is a serious infection. The main symptoms are high fever, pelvic pain and general discomfort. It can also result in septicemia and urosepsis, with elevated risk for the patient's life and mandatory hospitalization [36]. Initial antibiotic treatment is empirical and experience-based [37]. A broad-spectrum penicillin derivative with a beta-lactamase inhibitor, third-generation cephalosporin or fluoroquinolone, possibly in association with aminoglycoside, is suggested [10]
Due to their proven pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones (especially levofloxacin and ciprofloxacin) are the most recommended antibiotics agents for treating chronic bacterial prostatitis [11]
Due to the complexity of the pathogenetic mechanisms and the heterogeneity of symptoms, understanding CPPS, especially the appropriate therapeutic approach, is still a challenge and a matter of debate [5]
Due to this unsatisfactory situation, a multimodal therapy seems to be the best approach [43]
It is nowadays generally agreed that this condition does not require additional diagnosis or therapy. Antimicrobial therapy can be suggested to patients with raised PSA [24]
Dr. Benelli is assigned to Giessen University for “Uro-Andrology” for one year
Supported by Excellence Initiative of Hessen: LOEWE: Urogenital infection/inflammation and male infertility (MIBIE)
Diagnosis of prostatitis refers to a variety of inflammatory and non-inflammatory, symptomatic and non-symptomatic entities often not affecting the prostate gland. Prostatitis syndrome has been classified in a consensus process as infectious disease (acute and chronic), chronic pelvic pain syndrome (CPPS) and asymptomatic prostatitis [1]
Table 1
NIH classification system for prostatitis syndromes [1]
Category | Nomenclature |
---|---|
I | Acute bacterial prostatitis |
II | Chronic bacterial prostatitis |
III | Chronic pelvic pain syndrome (CPPS) |
III A | Inflammatory |
III B | Non-inflammatory |
IV | Asymptomatic prostatitis |
In clinical practice, 90 percent of outpatients suffer from CPPS, inflammatory or non-inflammatory disease [5]
This review covers accepted aspects of diagnostic procedures and therapeutic attempts in men suffering from symptomatic prostatitis and CPPS (Categories I to III).
Careful medical history (e.g. physical examination) investigating presence of fever and voiding dysfunction is fundamental. It should include scrotal evaluation and a gentle digital rectal examination without prostate massage, which
is not recommended due to the risk of bacterial dissemination. The prostate is usually described as tender and swollen [6]
Diagnosis is based on microscopic analysis of a midstream urine specimen with evidence of leucocytes and confirmed by a microbiological culture, which is mandatory and the only laboratory examination required [7]
Table 2
Common pathogens in bacterial prostatitis (NIH I, II) [6]
Etiologically recognized pathogens | Microorganisms of debatable significance | Fastidious microorganisms |
---|---|---|
E. coli | Staphylococci | M. tuberculosis |
Klebsiella sp. | Streptococci | Candida sp. |
Proteus mirabilis | Corynebacterium sp. |
|
Enterococcus faecalis | C. trachomatis |
|
P. aeruginosa | U. urealyticum |
|
|
M. hominis |
|
Ultrasound evaluation of the residual urine is indicated to exclude urinary retention. TRUS may reveal intraprostatic abscesses, which usually appears as a hypoechogenic walled-off collection of fluid [7]
A history of recurrent urinary tract infections with the same pathogenic agent is typical [7]
Bacteriological localization cultures are fundamental for the diagnosis of chronic bacterial prostatitis [7]
Semen culture of the ejaculate alone is not sufficient for diagnosis of CBP due to a sensibility of only 50% in identifying bacteriospermia [7]
TRUS is an option in patients with suspicion for prostatic abscess. The relevance of prostatic calcification is unknown [7]
Lower urinary tract symptoms and pelvic pain due to pathologies of the prostate have always affected quality of life in men of all ages. For years, understanding of the condition was based merely on a prostate relationship via an organ
pathology involving somatic or visual tissue lesions [5]
Table 3
Phenotype classification modified according to Shoskes and Nickel [23]
U | P | O | I | N | T | S |
---|---|---|---|---|---|---|
Urinary | Psychological | Organ specific | Infection | Neurologic/Systemic | Tenderness | Sexual dysfunction |
Disturbed voiding | Depression | Inflammatory prostatic secretions | Infection | Instable bowel syndrome, fibromyalgia, chronic fatigue syndrome | Pelvic floor spasm | Erectile, ejaculatory, orgasmic dysfunction |
The simple “2-glass test” for analyzing the number of leukocytes in VB3 [14]
TRUS is normally not indicated [7]
An association between male sexual dysfunction and prostatitis syndrome, especially CPPS, has been the subject of controversy for years [25]
Since prostatitis is common in males of reproductive age, a negative impact on semen composition, and thus on fertility, may be suspected. Unfortunately, only a few studies are available investigating different types of prostatitis. In patients with NIH type II prostatitis, a recent meta-analysis evaluated seven studies including 249 patients and 163 controls [32]
Acute bacterial prostatitis is a serious infection. The main symptoms are high fever, pelvic pain and general discomfort. It can also result in septicemia and urosepsis, with elevated risk for the patient's life and mandatory hospitalization [36]. Initial antibiotic treatment is empirical and experience-based [37]. A broad-spectrum penicillin derivative with a beta-lactamase inhibitor, third-generation cephalosporin or fluoroquinolone, possibly in association with aminoglycoside, is suggested [10]
Due to their proven pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones (especially levofloxacin and ciprofloxacin) are the most recommended antibiotics agents for treating chronic bacterial prostatitis [11]
Due to the complexity of the pathogenetic mechanisms and the heterogeneity of symptoms, understanding CPPS, especially the appropriate therapeutic approach, is still a challenge and a matter of debate [5]
Due to this unsatisfactory situation, a multimodal therapy seems to be the best approach [43]
It is nowadays generally agreed that this condition does not require additional diagnosis or therapy. Antimicrobial therapy can be suggested to patients with raised PSA [24]
Dr. Benelli is assigned to Giessen University for “Uro-Andrology” for one year
Supported by Excellence Initiative of Hessen: LOEWE: Urogenital infection/inflammation and male infertility (MIBIE)
Diagnosis of prostatitis refers to a variety of inflammatory and non-inflammatory, symptomatic and non-symptomatic entities often not affecting the prostate gland. Prostatitis syndrome has been classified in a consensus process as infectious disease (acute and chronic), chronic pelvic pain syndrome (CPPS) and asymptomatic prostatitis [1]
Table 1
NIH classification system for prostatitis syndromes [1]
Category | Nomenclature |
---|---|
I | Acute bacterial prostatitis |
II | Chronic bacterial prostatitis |
III | Chronic pelvic pain syndrome (CPPS) |
III A | Inflammatory |
III B | Non-inflammatory |
IV | Asymptomatic prostatitis |
In clinical practice, 90 percent of outpatients suffer from CPPS, inflammatory or non-inflammatory disease [5]
This review covers accepted aspects of diagnostic procedures and therapeutic attempts in men suffering from symptomatic prostatitis and CPPS (Categories I to III).
Careful medical history (e.g. physical examination) investigating presence of fever and voiding dysfunction is fundamental. It should include scrotal evaluation and a gentle digital rectal examination without prostate massage, which
is not recommended due to the risk of bacterial dissemination. The prostate is usually described as tender and swollen [6]
Diagnosis is based on microscopic analysis of a midstream urine specimen with evidence of leucocytes and confirmed by a microbiological culture, which is mandatory and the only laboratory examination required [7]
Table 2
Common pathogens in bacterial prostatitis (NIH I, II) [6]
Etiologically recognized pathogens | Microorganisms of debatable significance | Fastidious microorganisms |
---|---|---|
E. coli | Staphylococci | M. tuberculosis |
Klebsiella sp. | Streptococci | Candida sp. |
Proteus mirabilis | Corynebacterium sp. |
|
Enterococcus faecalis | C. trachomatis |
|
P. aeruginosa | U. urealyticum |
|
|
M. hominis |
|
Ultrasound evaluation of the residual urine is indicated to exclude urinary retention. TRUS may reveal intraprostatic abscesses, which usually appears as a hypoechogenic walled-off collection of fluid [7]
A history of recurrent urinary tract infections with the same pathogenic agent is typical [7]
Bacteriological localization cultures are fundamental for the diagnosis of chronic bacterial prostatitis [7]
Semen culture of the ejaculate alone is not sufficient for diagnosis of CBP due to a sensibility of only 50% in identifying bacteriospermia [7]
TRUS is an option in patients with suspicion for prostatic abscess. The relevance of prostatic calcification is unknown [7]
Lower urinary tract symptoms and pelvic pain due to pathologies of the prostate have always affected quality of life in men of all ages. For years, understanding of the condition was based merely on a prostate relationship via an organ
pathology involving somatic or visual tissue lesions [5]
Table 3
Phenotype classification modified according to Shoskes and Nickel [23]
U | P | O | I | N | T | S |
---|---|---|---|---|---|---|
Urinary | Psychological | Organ specific | Infection | Neurologic/Systemic | Tenderness | Sexual dysfunction |
Disturbed voiding | Depression | Inflammatory prostatic secretions | Infection | Instable bowel syndrome, fibromyalgia, chronic fatigue syndrome | Pelvic floor spasm | Erectile, ejaculatory, orgasmic dysfunction |
The simple “2-glass test” for analyzing the number of leukocytes in VB3 [14]
TRUS is normally not indicated [7]
An association between male sexual dysfunction and prostatitis syndrome, especially CPPS, has been the subject of controversy for years [25]
Since prostatitis is common in males of reproductive age, a negative impact on semen composition, and thus on fertility, may be suspected. Unfortunately, only a few studies are available investigating different types of prostatitis. In patients with NIH type II prostatitis, a recent meta-analysis evaluated seven studies including 249 patients and 163 controls [32]
Acute bacterial prostatitis is a serious infection. The main symptoms are high fever, pelvic pain and general discomfort. It can also result in septicemia and urosepsis, with elevated risk for the patient's life and mandatory hospitalization [36]. Initial antibiotic treatment is empirical and experience-based [37]. A broad-spectrum penicillin derivative with a beta-lactamase inhibitor, third-generation cephalosporin or fluoroquinolone, possibly in association with aminoglycoside, is suggested [10]
Due to their proven pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones (especially levofloxacin and ciprofloxacin) are the most recommended antibiotics agents for treating chronic bacterial prostatitis [11]
Due to the complexity of the pathogenetic mechanisms and the heterogeneity of symptoms, understanding CPPS, especially the appropriate therapeutic approach, is still a challenge and a matter of debate [5]
Due to this unsatisfactory situation, a multimodal therapy seems to be the best approach [43]
It is nowadays generally agreed that this condition does not require additional diagnosis or therapy. Antimicrobial therapy can be suggested to patients with raised PSA [24]
Dr. Benelli is assigned to Giessen University for “Uro-Andrology” for one year
Supported by Excellence Initiative of Hessen: LOEWE: Urogenital infection/inflammation and male infertility (MIBIE)
Diagnosis of prostatitis refers to a variety of inflammatory and non-inflammatory, symptomatic and non-symptomatic entities often not affecting the prostate gland. Prostatitis syndrome has been classified in a consensus process as infectious disease (acute and chronic), chronic pelvic pain syndrome (CPPS) and asymptomatic prostatitis [1]
Table 1
NIH classification system for prostatitis syndromes [1]
Category | Nomenclature |
---|---|
I | Acute bacterial prostatitis |
II | Chronic bacterial prostatitis |
III | Chronic pelvic pain syndrome (CPPS) |
III A | Inflammatory |
III B | Non-inflammatory |
IV | Asymptomatic prostatitis |
In clinical practice, 90 percent of outpatients suffer from CPPS, inflammatory or non-inflammatory disease [5]
This review covers accepted aspects of diagnostic procedures and therapeutic attempts in men suffering from symptomatic prostatitis and CPPS (Categories I to III).
Careful medical history (e.g. physical examination) investigating presence of fever and voiding dysfunction is fundamental. It should include scrotal evaluation and a gentle digital rectal examination without prostate massage, which
is not recommended due to the risk of bacterial dissemination. The prostate is usually described as tender and swollen [6]
Diagnosis is based on microscopic analysis of a midstream urine specimen with evidence of leucocytes and confirmed by a microbiological culture, which is mandatory and the only laboratory examination required [7]
Table 2
Common pathogens in bacterial prostatitis (NIH I, II) [6]
Etiologically recognized pathogens | Microorganisms of debatable significance | Fastidious microorganisms |
---|---|---|
E. coli | Staphylococci | M. tuberculosis |
Klebsiella sp. | Streptococci | Candida sp. |
Proteus mirabilis | Corynebacterium sp. |
|
Enterococcus faecalis | C. trachomatis |
|
P. aeruginosa | U. urealyticum |
|
|
M. hominis |
|
Ultrasound evaluation of the residual urine is indicated to exclude urinary retention. TRUS may reveal intraprostatic abscesses, which usually appears as a hypoechogenic walled-off collection of fluid [7]
A history of recurrent urinary tract infections with the same pathogenic agent is typical [7]
Bacteriological localization cultures are fundamental for the diagnosis of chronic bacterial prostatitis [7]
Semen culture of the ejaculate alone is not sufficient for diagnosis of CBP due to a sensibility of only 50% in identifying bacteriospermia [7]
TRUS is an option in patients with suspicion for prostatic abscess. The relevance of prostatic calcification is unknown [7]
Lower urinary tract symptoms and pelvic pain due to pathologies of the prostate have always affected quality of life in men of all ages. For years, understanding of the condition was based merely on a prostate relationship via an organ
pathology involving somatic or visual tissue lesions [5]
Table 3
Phenotype classification modified according to Shoskes and Nickel [23]
U | P | O | I | N | T | S |
---|---|---|---|---|---|---|
Urinary | Psychological | Organ specific | Infection | Neurologic/Systemic | Tenderness | Sexual dysfunction |
Disturbed voiding | Depression | Inflammatory prostatic secretions | Infection | Instable bowel syndrome, fibromyalgia, chronic fatigue syndrome | Pelvic floor spasm | Erectile, ejaculatory, orgasmic dysfunction |
The simple “2-glass test” for analyzing the number of leukocytes in VB3 [14]
TRUS is normally not indicated [7]
An association between male sexual dysfunction and prostatitis syndrome, especially CPPS, has been the subject of controversy for years [25]
Since prostatitis is common in males of reproductive age, a negative impact on semen composition, and thus on fertility, may be suspected. Unfortunately, only a few studies are available investigating different types of prostatitis. In patients with NIH type II prostatitis, a recent meta-analysis evaluated seven studies including 249 patients and 163 controls [32]
Acute bacterial prostatitis is a serious infection. The main symptoms are high fever, pelvic pain and general discomfort. It can also result in septicemia and urosepsis, with elevated risk for the patient's life and mandatory hospitalization [36]. Initial antibiotic treatment is empirical and experience-based [37]. A broad-spectrum penicillin derivative with a beta-lactamase inhibitor, third-generation cephalosporin or fluoroquinolone, possibly in association with aminoglycoside, is suggested [10]
Due to their proven pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones (especially levofloxacin and ciprofloxacin) are the most recommended antibiotics agents for treating chronic bacterial prostatitis [11]
Due to the complexity of the pathogenetic mechanisms and the heterogeneity of symptoms, understanding CPPS, especially the appropriate therapeutic approach, is still a challenge and a matter of debate [5]
Due to this unsatisfactory situation, a multimodal therapy seems to be the best approach [43]
It is nowadays generally agreed that this condition does not require additional diagnosis or therapy. Antimicrobial therapy can be suggested to patients with raised PSA [24]
Dr. Benelli is assigned to Giessen University for “Uro-Andrology” for one year
Supported by Excellence Initiative of Hessen: LOEWE: Urogenital infection/inflammation and male infertility (MIBIE)