How is chronic prostatitis differentiated from similar clinical entities such as prostatodynia or nonbacterial prostatitis?

Updated: Jan 02, 2020
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Patients with chronic prostatitis, by definition, have had symptoms for at least 3 months. Although this condition is not life threatening, the patient's quality of life has been compared with someone with unstable angina or active Crohn disease. Interestingly, many men with chronic bacterial prostatitis are asymptomatic.

Chronic bacterial prostatitis and nonbacterial prostatitis have similar presentations, including dysuria, frequency, urgency, perineal discomfort, and a low-grade temperature. The only way to differentiate between these 2 entities is through culture of prostatic secretions.

Prostatodynia, a noninflammatory disorder, also has a symptom complex similar to that of chronic prostatitis, except that the patient does not give a history of recurrent UTIs.

In chronic bacterial prostatitis, the physical findings are variable. A low-grade fever may be present, and the rectal examination may be unremarkable or may reveal severe anal sphincter spasm. The prostate may be mildly or extremely tender.

Examination of urine voided after prostate massage is more helpful diagnostically than quantitating the amount of pain experienced during the digital examination. The Meares-Stamey 4-glass test with prostatic massage is a classic diagnostic test for chronic prostatitis. Prostatic massage should not be conducted in the setting of UTI or urethritis.

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