Managing chronic prostatitis: A modern approach

into the outpatient office of a urologist leave with a coded diagnosis of prostatitis. Urologists have described the traditional approach to the diagnosis and management of the chronic prostatitis syndromes as one of the most frustrating areas of urologic practice. Urologists have no problem with the 5% to 10% of patients with a clear diagnosis of acute bacterial prostatitis (acute bacterial infection of the lower urinary tract and prostate) and chronic bacterial prostatitis (recurrent urinary tract infections, usually with the same organism whose nidus resides in the prostate gland). By contrast, urologists have great difficulty managing the vast majority of patients who present with genitourinary pain and voiding symptoms that are not associated with a clearly defined infection of the lower urinary tract or prostate. There is light at the end of the tunnel for the practicing urologist. In fact, developments in the field are evolving so quickly, particularly over the last 3 years, that it is difficult for clinicians to keep up. North American and international consensus meetings have established definitions, classification systems, symptom indices, and diagnostic algorithms aimed at improving our diagnosis of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Numerous randomized, placebo-controlled trials are beginning to provide a solid evidence-based approach to the treatment of the condition once it has been diagnosed, classified, and evaluated in a specific patient. This article provides a stepwise approach to the evaluation and treatment of this condition, based on current evidence.