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Prostatites: mise au point

Prostatitis: a review

Resume

Les prostatites sont des pathologies fréquentes. Elles apparaissent comme un groupe très hétérogène. Le diagnostic de prostatite aiguë a toujours été bien individualisé, alors que celui de prostatite chronique a toujours été beaucoup plus difficile.

La classification traditionnelle distingue les prostatites aiguës associant un syndrome infectieux général, accompagné d’une altération de l’état général, de troubles mictionnels et surtout, d’une prostate douloureuse au toucher rectal, et les prostatites chroniques regroupant toutes les autres pathologies associant des troubles mictionnels, des douleurs pelviennes ou périnéales ainsi qu’un éventuel écoulement urétra. Plus récemment, une classification plus objective, basée sur des critères histologiques et bactériologiques, reposant sur l’analyse des urines et du liquide prostatique a été proposée par le NIH (National Institutes of Health). Cette classification permet d’individualiser 4 cadres: prostatites bactériennes aiguës (catégorie 1), prostatites bactériennes chroniques (catégorie 2), prostatites non bactériennes (catégorie 3A), prostatodynies (catégorie 3B).

La nécessité d’un traitement bien conduit semble très importante pour éviter les récidives et le passage à la chronicité. La recherche d’une sténose de l’urètre est indispensable. La prise en charge des tableaux chroniques est plus difficile et impose une analyse bactériologique. Enfin il faut vérifier le statut androgénique du patient car tout déficit peut favoriser l’infection.

Abstract

Prostatitis is frequent and appears to corresponds to a very heterogeneous group of diseases. The diagnosis of acute prostatitis has always been well defined, while that of chronic prostatitis has always been much more difficult.

The conventional classification distinguishes acute prostatitis comprising a systemic infectious syndrome, accompanied by alteration of the general state, voiding disorders and especially a painful prostate on digital rectal examination, and chronic prostatitis corresponding to all other diseases associating voiding disorders, perineal or pelvic pain and possible urethral discharge. More recently, a more objective classification, based on bacteriological and histological criteria derived from analysis of urine and prostatic liquid was proposed by the NIH (National Institutes of Health). This classification defines 4 categories: acute bacterial prostatitis (category 1), chronic bacterial prostatitis (category 2), non-bacterial prostatitis (category 3A), prostatodynia (category 3B).

Well conducted treatment appears to be very important to prevent recurrence and the development of chronic prostatitis. The presence of an urethral stricture must be excluded. The management of chronic prostatitis is more difficult and requires bacteriological examination. Finally the patient’s androgen status must be verified, as androgen deficiency can promote infection.

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Correspondence to Jean-Louis Pariente.

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Edouard Amar, Pierre Bondil, Daniel Chevallier, Patrick Coloby, Pierre Costa, Florence Gour, Béatrice Cuzin, Dominique Delavierre, Manuel Demailly, Jean Philippe Dumas, Antoine Faix, François Giuliano, Jean Hermabessiere, Vincent Izard, Alain Jardin, Frédérique Kirsc-Noir, Michel Le Guillou, Philippe Mahe, Olivier Montaigne, Pierre Plante, Jean Marc Rigot, Dominique Rossi, Michel Schouman, Louis Sibert, Nicolas Thiounn, Laurent Wagner, Hervé Wallerand.

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Pariente, J., Soyeur, L. Prostatites: mise au point. Androl. 13, 445–451 (2003). https://doi.org/10.1007/BF03035211

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Mots-clefs

  • prostatite aiguë
  • prostatite chronique
  • Chlamydia trachomatis
  • androgènes
  • infertilité masculine

Key Words

  • acute prostatitis
  • chronic prostatitis
  • Chlamydia trachomatis
  • androgens
  • male infertility