Prostatitis describes a combination of infectious diseases acute and chronic bacterial prostatitischronic pelvic pain syndrome, and asymptomatic inflammation.
We employed evidence-based methods to review the epidemiology of prostatitis syndromes. The prevalence of prostatitis symptoms could be compared in five studies surveying 10 men. Overall, participants met various criteria for prostatitis, representing an overall rate of 8. A history of sexually transmitted diseases was associated with an increased risk for prostatitis symptoms.
Men reporting a history of prostatitis symptoms had a substantially increased rate of benign prostatic hyperplasia, lower urinary tract symptoms and prostate cancer. In one study, the incidence of physician-diagnosed prostatitis was 4. Two studies suggest that about one-third of men reporting prostatitis symptoms had resolution after 1 year.
Patients with previous episodes and more severe symptoms are at higher risk for chronic pelvic pain. The prevalence of prostatitis symptoms is high, comparable to rates of ischamic heart disease and diabetes. We need to define natural history and consequences of prostatitis, develop better algorithms for diagnosis and treatment, and develop strategies for prevention.
A resurgence of interest in prostatitis has occurred during the last decade. This has been accompanied by a new level of understanding Abstracts von Prostatitis the epidemiology, morbidity and economic impact of these conditions. Much progress dates from Abstracts von Prostatitis recognition that infection and inflammation are important in certain prostatitis syndromes. Despite limited information on the causes of other prostatitis syndromes, these conditions can be defined and important treatment studies have been initiated.
This article employs evidence-based methods to review the epidemiology of prostatitis syndromes, examines the clinical implications of these data, and outlines areas for future research. Prostatitis describes a combination of infectious diseases acute and chronic bacterial prostatitisa chronic pelvic pain syndrome and asymptomatic inflammation. The National Institutes of Health classification has been accepted internationally and includes four syndromes Table 1 [ 1 ].
Category I, acute bacterial prostatitis, is characterised by an acute bacterial urinary tract infection. Category II, chronic bacterial prostatitis, is a persistent bacterial infection of the prostate leading to recurrent urinary tract Abstracts von Prostatitis caused by the same bacterial strain. There are two subtypes. Category IV, asymptomatic inflammatory prostatitis, occurs in patients who have no symptoms but who have documented inflammation in prostatic tissue or in their Abstracts von Prostatitis fluid.
Papers published in peer-reviewed journals were included in this review. Papers in non-peer-reviewed supplements were excluded. An exhaustive list was obtained through the major databases e. Search terms included: prostatitis, pelvic pain, inflammation, epidemiology and survey.
We also reviewed tables of contents of the major urology journals and other relevant journals, for the previous 3 months, to take into account possible delay in indexing papers in the databases. These approaches identified more than references. After reviewing the titles and abstracts, 86 articles were identified for detailed review. For inclusion in this analysis, studies were required to Abstracts von Prostatitis criteria that have been outlined for epidemiological studies of prostatitis Table 2 [ 2 ].
Abstracts von Prostatitis criteria were required: 1. Included studies were population-based rather than case series or referral patients from tertiary care institutions.
A clear case and standardised definition was required, ideally a reasonable relationship to patients seen in routine clinical practice. Publication in the peer-reviewed literature was required. In addition to the required criteria, at least one other Abstracts von Prostatitis criterion was necessary for inclusion. However, a population-based study found low agreement between physician-diagnosed prostatitis and the NIH-CPSI pain measures, suggesting that the index, by itself, may have limited Abstracts von Prostatitis to determine the presence or absence of prostatitis [ 13 ].
Abstracts von Prostatitis standardised strategy for surveying the population should be used to assure that participants are likely to represent the overall population. The optimal strategy should incorporate a mechanism to verify that cases identified in the survey Abstracts von Prostatitis met the case definition, such as a detailed chart review or, ideally, a standardised clinical examination.
The population should be large enough to provide reasonable statistical power for the desired comparisons. Although the studies described below met the inclusion criteria, most had important limitations. Few studies included adequate microbiological evaluation.
Most did not include chart reviews or physical examination to assure that subjects did not have the exclusion criteria for chronic prostatitis listed in Table 1footnote 2. Most studies relied exclusively on symptom questionnaires, or portions of validated symptom assessment instruments. Such surveys are easy to administer, but they were not designed Abstracts von Prostatitis diagnosis. Other urological conditions may present with symptoms that overlap the symptoms of prostatitis.
We identified ten studies that met the inclusion criteria. Of these ten studies: seven Abstracts von Prostatitis from North America [ 14 — 19 ], two were from Asia [ 2021 ], and one was from Europe [ 22 ]. The prevalence of prostatitis symptoms could be compared in five studies that surveyed varied ambulatory populations [ Abstracts von Prostatitis15172021 ]. These populations included a total of 10 men. Overall, participants met various criteria for symptoms of prostatitis, representing an overall rate of 8.
In these studies the prevalence of prostatitis symptoms ranged from 2. Roberts and associates determined the occurrence of a physician-assigned diagnosis of prostatitis using a self-administered, validated questionnaire as part of the Olmsted County Study of Urinary Symptoms and Health Status Among Men study [ 14 ].
Their population included randomly selected 40—year-old men from Minnesota. Medical records were then reviewed for a physician-assigned diagnosis of prostatitis. These findings suggest that the prevalence of a physician-assigned diagnosis of prostatitis is high, comparable to rates of ischemic heart disease and diabetes.
Participants suffering an initial episode of prostatitis were more likely to suffer from further episodes than other participants. In a subsequent study, this group determined the prevalence of prostatitis-like symptoms Abstracts von Prostatitis a community-based cohort of older men [ 17 ].
Subjects were participants in a longitudinal study of lower urinary tract symptoms. Participants reporting prostatitis-like symptoms Abstracts von Prostatitis higher pain scores mean 6. Pain frequency odds ratio OR Nickel Abstracts von Prostatitis associates employed questions similar Abstracts von Prostatitis the NIH-CPSI pain domain to determine the prevalence of prostatitis-like symptoms in 20—year-old men from Eastern Canada [ 15 ].
Of participants, 84 9. Prostatitis-like symptoms occurred in Overall, 57 men 6. Tan and associates conducted a cross-sectional study to determine the prevalence of prostatitis symptoms, lower urinary tract symptoms, and erectile dysfunction in Singapore [ 20 ]. Of 21—year-old participants, 2. The average age of men with prostatitis-like symptoms Abstracts von Prostatitis 43 years old. Cheah and associates surveyed an ethnically and racially diverse population in Northern Malaysia [ 21 ].
Of participants, 8. Five additional studies met the inclusion criteria but were not directly comparable to those summarised above because of the different denominators or outcome measures employed by the investigators [ Abstracts von Prostatitis22 — 24 ]. Randomly selected physicians completed forms summarising reasons for patient visits and physician diagnoses. The rate of a prostatitis diagnosis was fold greater for visits to urologists than for visits to primary care physicians.
In this cohort, prostatitis was diagnosed more commonly among 36—year-old men than among 18—year-old men. In a subsequent study, this group evaluated the prevalence and correlates of prostatitis symptoms among United States health professionals without prostate cancer [ 23 ].
Subjects provided demographic, clinical and lifestyle information; urological diagnoses; and described lower urinary tract symptoms. Participants reporting a history of benign prostatic hyperplasia BPH had a 7. Other factors associated with a history Abstracts von Prostatitis prostatitis included a history of Abstracts von Prostatitis transmitted disease OR 1. The men with prostatitis alone were younger and had less severe urinary symptoms than the men with BPH alone.
Mehik and associates determined the prevalence of prostatitis symptoms among randomly selected men in the most Northern provinces of Finland Oulu and Lapland aged 20—59 [ 22 ]. The lifetime prevalence of prostatitis symptoms was Compared to men 20—39 years old, the risk of prostatitis was 1.
The incidence of prostatitis was Divorced and single men had a lower risk of prostatitis than married men. Clemens and associates used computer searches of the Kaiser Permanente Northwest Portland, Oregon database during a 2-year interval to identify men with Abstracts von Prostatitis physician diagnoses of prostatitis [ 25 ]. Chart reviews were performed on Abstracts von Prostatitis random subset to categorise cases using the NIH definitions.
The incidence of physician-diagnosed prostatitis was 4. We identified only two studies that considered the natural history of prostatitis symptoms that met the inclusion criteria [ 2627 ]. Both studies considered the outcome after the usual clinical treatment in North American populations. Nickel and associates conducted a 1-year follow-up study of their cohort from Eastern Canada [ 26 ]. A questionnaire incorporating the NIH-CPSI pain and voiding domains was compared for 40 men who had reported prostatitis-like symptoms in their initial survey and age-matched controls without Abstracts von Prostatitis symptoms in Abstracts von Prostatitis same survey.
Thus, about one-third had resolution of prostatitis-like symptoms after 1 year usually those with a shorter duration and less severe symptoms. The severity of symptoms Abstracts von Prostatitis men with persistent, chronic prostatitis remained relatively unchanged over the year. Turner and associates studied men with physician-diagnosed prostatitis Abstracts von Prostatitis a large health-maintenance organisation [ 27 ].
Telephone interviews were conducted at baseline, 3, 6 and month follow-up. Abstracts von Prostatitis average, symptoms improved substantially during months 1—3, modestly from Abstracts von Prostatitis 3—6, then remained unchanged.
Better outcomes were noted for men whose initial visit Abstracts von Prostatitis for a first lifetime episode compared with a recurrent episode. However, chronic, persistent or recurrent symptoms are common. The limited number of studies that met our evidence-based criteria were sufficient to support Abstracts von Prostatitis conclusion that prostatitis is an important worldwide problem that merits additional investigation.
Possible reasons for this almost five-fold variation in prevalence include differences: in study design, selection of populations for investigation, cultural factors, variations in practice patterns, genetic differences or exposure to undefined risk factors.