Chronic bacterial and non-bacterial prostatitis.

Chronic prostatitis is ill-understood, difficult to diagnose and often unresponsive to treatment. To clarify some of the diagnostic difficulties 135 patients and 28 control subjects were prospectively studied. Patients with chronic bacterial prostatitis, chronic non-bacterial prostatitis and recurrent non-specific urethritis (NSU) without prostatitis resembled each other in demographic characteristics. Patients with prostatodynia were more often married and born abroad. Symptoms were more common in prostatodynia but diagnosis of prostatitis and prostatodynia depended on examination of the expressed prostatic secretion (EPS) for leucocytes and microorganisms. An inflammatory response in the EPS was found in both forms of prostatitis but not in the other conditions. Leucocyte counts of the EPS appeared to be more sensitive than simple microscopic estimation. The EPS leucocyte figures support a previous finding that the upper limit of normal for the EPS count is around 500 cells per mm3 by the method used. The pathogenic micro-organisms cultured from the EPS of the patients with chronic bacterial prostatitis were the usual urinary pathogens reported by others. For reasons which are not clear, saprophytic organisms were more common in chronic non-bacterial prostatitis than in the other groups. While the demographic differences and increased symptoms in patients with prostatodynia will not help in diagnosis, there may be a relationship with emotional stress and this should be considered in the management of these patients.