[Classification, diagnosis and treatment of prostatitis syndrome]

Abstract

The term prostatitis syndrome refers to a number of conditions affecting the prostate. Prostatitis syndrome is clinically manifested through symptoms of the lower urogenital tract and perineum. Basic factors in the classification of prostatitis syndrome are clinical symptoms and signs, and the presence of leukocytes and bacteria in selectivelly collected urine samples and in expressed prostatic secretion obtained by the Meares and Stamey localization technique. Antimicrobial therapy is indicated in patients with acute bacterial prostatitis, chronic bacterial prostatitis and chronic inflammatory nonbacterial prostatitis, which also includes bacterial prostatitis unproved by classical methods. Empirical antimicrobial treatment should be initiated immediately in patients with acute bacterial prostatitis and in patients with acute exacerbation of chronic bacterial prostatitis. Targeted antimicrobial therapy is administered in patients with chronic bacterial prostatitis after obtained microbiological results, and empirical antimicrobial therapy lasting for 2-6 weeks in patients with chronic inflammatory nonbacterial prostatitis. Because of their broad spectrum of activity and pharmacodynamic and pharmacokinetic characteristics, fluoroquinolones, ciprofloxacin and ofloxacin are first choice antimicrobial drugs for the treatment of prostatic inflammatory diseases. The efficacy of administered antimicrobial treatment should be followed up 4-6 weeks (early follow-up) and 6 months (late follow up) after the end of antimicrobial therapy. The treatment of a noninflammatory chronic pelvic pain syndrome without proved infection includes phytotherapy, hygienic-dietetic measures, microwave thermotherapy, alpha-adrenergic blocking agents, muscle relaxants, analgesics, non-steroidal antiflogistics, 5-alpha-reductase inhibitors, modified living habits, psychotherapy and antispasmodic analgesics. All patients with chronic types of prostatitis syndrome should avoid drinking alcohol, carbonated beverages, spices, cycling, colds, especially sitting on cold surfaces.