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Am Fam Physician. 2000;62(3):637

Chronic bacterial prostatitis typically demonstrates a culture of expressed prostatic secretions that is positive for pathogens. Symptoms include recurrent urinary tract infection, back pain or perineal pain, or patients may be asymptomatic. Organisms that commonly cause bacterial prostatitis include Escherichia coli, other gram-negative Enterobacteriaceae, occasionally Pseudomonas species and, rarely, gram-positive enterococci. Patients with chronic abacterial prostatitis may have pelvic or perineal pain that is associated with urinary urgency, nocturia, weak urinary stream, frequency, dysuria, hesitancy and inflammation (white blood cells). Most cases of chronic prostatitis are abacterial. Stern and Schaeffer reviewed the treatments available for patients with chronic prostatitis by conducting a MEDLINE search and a review of all relevant randomized controlled trials.

Treatments for patients with chronic bacterial prostatitis include antimicrobials, with limited evidence suggesting that quinolones are more effective than trimethoprim-sulfamethoxazole. Duration of treatment with these agents varies. Limited evidence was found to support other antibiotic regimens. Side effects of quinolones were rare, and no adverse effects were associated with trimethoprim-sulfamethoxazole treatment. Late relapse (six to 12 months following treatment) was common. Minimal evidence was found to support local injection of antimicrobials or the addition of alpha blockers to an antimicrobial treatment regimen to improve outcome and limit recurrence. Transurethral resection of the prostate was supported only in patients with refractory infection. Radical prostatectomy is a treatment of last resort that is not supported by data from randomized controlled studies and may cause impotence or urinary incontinence.

Treating patients who have chronic abacterial prostatitis with alpha blockers may relieve symptoms without any side effects. Minimal evidence is found to support transurethral microwave thermotherapy or allopurinol administration. No formal evaluation of the use of prostatic massage, sitz baths and biofeedback in men with abacterial prostatitis was found. The accompanying table outlines the management of chronic prostatitis.

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