The Painful Prostate

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Abstract
Summary: A clinical diagnosis of chronic prostatitis was made on 105 adult males who were subsequently admitted and investigated by Stamey localisation techniques, psychological questionnaires, urine flow studies, cystourethroscopy and prostatic biopsy or transurethral prostatectomy.From the Stamey localisation studies and cultures of the tissue obtained at transurethral prostatectomy a diagnosis of bacterial prostatitis was made in 50%, of which half were Staphylococcus albus and half were well recognised urinary pathogens.Other significant pathology was found in 25% and, particularly of note, were 2 patients who presented with chronic cystitis (biopsy negative) and subsequently developed carcinoma of the bladder. Also in this group were 5 unsuspected strictures and 5 patients with poor flow rates but normal endoscopy.Investigations in the remaining 25 % were all negative except for a significantly higher incidence of neuroticism when compared with the other groups and controls.Follow‐up over 18 months to 3 years shows that treatment results in improvement in 75%. Half of the patients with pathogenic bacterial prostatitis were asymptomatic compared with only a quarter of the group with negative findings. Transurethral prostatectomy is of particular value in patients with chronic bacterial prostatitis and evidence of outflow obstruction. Preoperative psychological screening is helpful in selecting patients suitable for surgery.