Practical approach to the management of prostatitis.

The management of prostatitis remains a frustrating problem for the clinical urologist. The various disease processes are poorly understood, the clinical presentation is extremely variable, the definitive diagnosis is difficult, and treatment is dismal. A sound clinical approach to the diagnosis and treatment of the various prostatitis syndromes by clarifying the etiology, rationalizing the classification, and describing a practical plan for diagnosis and a common sense approach to treatment is presented in this article. A combination of dysfunctional voiding and intraprostatic reflux of urine (sterile or infected) is the underlying pathogenic mechanism. Prostatodynia should be dropped from the classification of the prostatitis syndromes and should be relegated to the role of the most important differential diagnosis. Physicians who have abandoned the standard three-glass test of Meares and Stamey should consider the Pre- and Post-Massage Test (PPMT) for the diagnosis of prostatitis. An understanding of the pathogenic and etiologic mechanisms along with an appreciation of the importance of correct diagnosis at first presentation combined with a knowledge of the latest treatment studies will lead to improved management and treatment of patients with prostatitis.