Definition and epidemiology of chronic prostatitis

According to several epidemiological studies the frequency of chronic prostatitis in the general population is 15-68% (Nickel JC, 1999). In the United States on patients with prostatitis accounts for about 8% of all outpatient visits to urologists (Collins MM et al. 1998). This is the most frequent urologic disease profile in men and 50 years and third in frequency in individuals older than 50 years (after BPH and prostate cancer). Investigations Moon et al. (1997) showed that about 65% of the male population in Wisconsin (USA) aged 20 to 50 years have a history of prostatitis. In Holland, during a similar study of chronic prostatitis was detected in 24% of men. Prevalence of diagnosis of prostatitis, among urological outpatients in Italy is 12.8% and is the cause of up to 19% of all visits to the doctor.
Conflicting and scarcity of epidemiological data on chronic prostatitis result from imprecise definition of the disease. The modern interpretation of the term "chronic prostatitis" and the classification of the disease have been mixed. Under his mask can hide a wide range of states of the prostate and lower urinary tract, ranging from infectious prostatitis, chronic pelvic pain syndrome, or so-called prostatodinii with abakterialnom prostatitis and ending with neurogenic dysfunction, allergy and metabolic disorders. Many experts consider chronic prostatitis as an inflammatory disease primarily of infectious origin with the possible accession of autoimmune disorders characterized by lesions of the parenchyma and interstitial tissue of the prostate.
At the same time it should be noted that chronic prostatitis abakterialny 8 times more common than the bacterial form of the disease, up to 10% of all cases (Roberts RO et al., 1997). According to Brunner H. et al. (1983) surveyed 600 patients at a specialized clinic, chronic bacterial prostatitis was detected only 5% of cases, abakterialny prostatitis - at 64% and prostatodiniya - 31% of patients. However, these data do not deny the role of other non-"classical" bacterial infection in the pathogenesis of chronic prostatitis abakterialnogo, as well as the fact that bacterial prostatitis may be in a certain period prior to abakterialnomu.
According to Johansen T.E.B. (2001) prostatitis - a syndrome characterized by symptoms of dysfunction of the lower urinary tract (LUTS) in the presence of inflammation in the prostate. At the same time are all types of chronic prostatitis, "is not acute. Specialists of the National Institutes of Health follows interpret the clinical concept of chronic prostatitis:
• the presence of pain in the pelvic / perineum, urogenital system for at-least 3 months;
• presence (or absence) of obstructive or irritative symptoms of urination;
• positive (or negative) results of bacteriological study.

Alexander R.B. et al. (2002) identified the following main characteristics of the disease:
- The term "prostatitis" - means inflammation of the prostate gland;
- Presence of inflammation is not the same infection
- The most important symptom for diagnosis is pain or discomfort in the pelvic area in men;
- Is considered a chronic prostatitis, symptoms of which there are more than 3 months;
- Symptoms of lower urinary tract function and sexual dysfunction is often accompanied by chronic prostatitis.

In the analytical work devoted to the syndrome of chronic pelvic pain in men, emphasizes that abakterialny chronic prostatitis is characterized by the following basic properties (Egan KJ and Krieger JL 1997):
- The main complaint is pain;
- Repeated and unsuccessful treatment history.

The variety of interpretations, including, can be attributed to the lack of quality of epidemiological studies of chronic prostatitis, which form the starting point should be clear and unambiguous definition of the disease. In addition, crucial for the organization of such research is reliable, universally accepted system for the standardized assessment of symptoms and diagnosis of prostatitis, which only formed.
Summarizing the above views, we can agree that the diagnosis of chronic prostatitis must meet the following conditions:

- Presence of inflammation in the prostate gland with positive or negative results of bacteriological tests;
- Presence of pain, discomfort in the pelvis and / or symptoms of lower urinary tract function;
- Duration of the disease for more than 3 months.

In epidemiological program "The Lennox and Addington County" is used for prostate-specific scale NIH-CPSI in men 20-74 years old (Downey et al. 2000). The presence of pain or discomfort in the perineum at rest and / or PE was reported 49,7% of respondents. The total score on the scale of pain was at least 4, with 36,6% of men have experienced pain during the previous week, the severity score of 8 or more. The specified location and severity of pain, usually enough doctors to diagnose "abakterialny prostatitis" (Nickel JC et al. 2001).

In the remaining 90% of cases, when using laboratory methods can not detect the bacteria, which are the cause of chronic prostatitis, the condition is classified as "chronic prostatitis nebakterialny" or "prostatodiniya. Observed for prostate symptoms are nonspecific. Awareness of the fact that the presence of symptoms does not necessarily indicate an isolated disease of the prostate gland, led to the emergence of a new term "chronic prostatitis / chronic pelvic pain syndrome." This term is used for patients with symptomatic prostatitis nebakterialnogo origin.
Thus, prostatitis is not fully known, the disease, since studies prevents ambiguous interpretation of the characteristic of his clinical and diagnostic features, as well as limited physical access to the prostate.
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