The term prostatodynia, or chronic pelvic pain syndrome (CPPS), is used to designate unexplained chronic pelvic pain in men. This pain is associated with irritative voiding symptoms and/or pain located in the groin, genitalia, or perineum in the absence of pyuria and bacteriuria (no pus cells or bacteria seen on microscopic analysis of the urine). However, excess white blood cells (WBCs) or bacteria seen on Gram stain and culture of expressed prostatic secretions (EPS) may be found. (See Workup.)

The use of the term prostatodynia is not encouraged in current practice. This term carries the negative historical connotation of being a "wastebasket" designation for a melange of psychosomatic symptoms and suggests that the source of the patient's symptoms invariably lies within the prostate gland itself. Current research has provided evidence of numerous extraprostatic considerations, including neuropathic and other systemic pathologies. (See Etiology.)

Categories of prostatitis

The National Institutes of Health (NIH) describes four categories ofprostatitis, as follows:

• Type I - Acute bacterial prostatitis
• Type II - Chronic bacterial prostatitis
• Type III - Chronic abacterial prostatitis, ie, CPPS, categorized as either type IIIa (inflammatory CPPS) or type IIIb (noninflammatory CPPS)
• Type IV - Asymptomatic inflammatory prostatitis

An academic distinction is currently made between (1) patients with excess WBCs in their prostatic secretions (chronic nonbacterial prostatitis, class IIIa) and (2) those with normal prostatic secretions (prostatodynia, class IIIb). However, the clinical value of this distinction is now being challenged. The sole parameter is the number of WBCs seen within a smear of prostatic secretions, yet this number may vary widely within the same specimen and even more so from sample to sample taken from the same patient.

Furthermore, asymptomatic control patients devoid of any evidence of pelvic pathology have also been found to have a significant number of WBCs in their prostatic secretions. At present, the distinction seems to provide no meaningful differential with respect to either etiology or treatment options.