Prostatitis is a label applied to symptom complexes involving perineal discomfort and voiding symptoms. Stamey [1] defined this spectrum of prostatic disease as a “wastebasket of clinical ignorance.” The non-urological symptoms of prostatitis include pain in the area of the anus, bladder, abdomen, and groin and pain during ejaculation. Clinical and laboratory investigations during the last three decades have changed our understanding of these pathologies.

Prostatitis is the most common urologic diagnosis in men younger than age 50 years; chronic prostatitis most commonly affects men older than 50 years [2]. Estimations show that 50% of men will experience symptoms of prostatitis at some time in their lives [1].

Prostatitis is an infection or inflammation of the prostate which may be acute or chronic. Prostatitis is associated with substantial cost and significant resource consumption.

Traditional classifications present significant limitation, and the NIH classification has now been recognized as the best system for clinical practice and research (Table 11.2).

Etiology may be infective (gram-negative, gram-positive, anaerobic, chlamydial infection), chemical-induced inflammation (noxious substances in the urine), immunologic alteration, psychological factors, pelvic floor muscle abnormalities, and painful bladder syndrome.

The infective agents in acute and chronic bacterial prostatitis are the same in type and incidence as those that cause urinary tract infection. Common uropathogenic strains of Escherichia coli are the most frequent causes of prostatitis, whereas other coliform bacteria (Proteus, Klebsiella, Enterobacter, Morganella, Serratia, Citrobacter) and pseudomonas are the less frequent causes [1]. The role of chlamydial etiology of prostate infection is both confusing and conflicting.

Gram-negative Enterobacteriaceae and enterococci are responsible for most cases of bacterial prostatitis.

Krieger and Riley [4] showed that only 8% of patients with CPPS tested positive for microorganism. However chronic abacterial prostatitis may, in certain cases, actually be due to an occult, chronic bacterial infection [5].

The pathogenesis of bacterial prostatitis is unclear. It is known, however, that the infective agent must first reach the prostate, colonized the gland, and then invade the secretory system. The ascending urethral route of infection is the most common route with reflux into the prostatic ducts, but lymphogenous or hematogenous routes are also possible. Intraprostatic urinary reflux occurs commonly and is an important cause of prostatic calculi [6].

Risk factors of prostatic infection include alterated prostatic host defense, dysfunctional voiding, intraprostatic ductal reflex, immunologic alterations, chemical-induced inflammation, pelvic floor muscle abnormalities, neuroendocrine mechanisms, psychological factors, and painful bladder syndrome.

Acute bacterial prostatitis presentation is usually dramatic with fever; low back, groin, and perineal pain; voiding dysfunction; and constitutional symptoms (malaise, arthralgia, and myalgia). The prostate is tender, tense, swollen, and painful. The degree of pain during prostatic palpation is variable. Urinalysis reveals pyuria and bacteriuria, and cultures will be positive.