A plain-English glossary

• A
• B
• C
• D
• E
• F
• G
• H
• I
• L
• M
• N
• O
• P
• R
• S
• T
• U
• V
• Numbers

A

Acute

Arriving quickly and lasting a short time. In prostatitis it describes an illness that develops over hours or days, as opposed to one that has settled in over months.

Alpha-blocker

A class of medicine that relaxes smooth muscle around the bladder neck and prostate, used to ease urinary symptoms. Results in chronic pelvic pain syndrome are mixed.

Analgesic

Any medicine whose job is to reduce pain, as distinct from one that treats the cause of the pain.

Antibiotic resistance

The ability of bacteria to survive a drug that used to kill them. It is one of the concrete reasons guidance discourages repeated antibiotic courses where no organism has been found.

Asymptomatic inflammatory prostatitis

Category IV. Inflammation visible in prostate tissue or secretions in someone who has no symptoms at all, usually discovered while something else was being investigated.

B

Bacterial prostatitis

Prostatitis in which an organism can actually be grown from a sample. Covers Category I, which arrives suddenly, and Category II, which recurs.

Benign prostatic hyperplasia (BPH)

Age-related enlargement of the prostate. A separate condition from prostatitis, though the urinary symptoms overlap and the two can coexist.

Bladder neck

The ring of muscle where the bladder empties into the urethra. Tension here is one explanation for a weak or hesitant stream.

Bladder pain syndrome

Persistent bladder-centred pain with urinary frequency and no infection, also called interstitial cystitis. It shares a great deal of ground with Category III prostatitis.

C

Catastrophising

A measurable pattern of thought in which pain is expected to be permanent, uncontrollable and ruinous. It is not a character flaw; it is a predictor of worse outcomes, and it responds to treatment.

Categories I to IV

The four-part NIH consensus classification of prostatitis syndromes, which sorts cases by whether an organism can be demonstrated and how long symptoms have lasted. Explained in chapter one.

Chronic

Long-running. In this field the conventional threshold is symptoms present for at least three months out of the previous six.

Chronic pelvic pain syndrome (CP/CPPS)

Category III, and around nine in ten diagnoses: pelvic pain lasting three months or more with no organism found on any test. Split into IIIA, where inflammatory cells are present, and IIIB, where they are not.

Cochrane review

A systematic review produced to a defined methodological standard by the Cochrane collaboration. Treated as high-quality evidence because the method is published alongside the conclusion.

Culture

A laboratory attempt to grow bacteria from a sample. “No growth” on a culture report means nothing grew in that specimen under those conditions — the finding that defines Category III.

Cystoscopy

Looking inside the bladder and urethra with a thin camera. Used where there is blood in the urine or another reason to exclude bladder disease, not as a routine prostatitis test.

D

Differential diagnosis

The list of conditions that could plausibly explain a set of symptoms, which an assessment works through and narrows down. For pelvic pain it is a long list.

Digital rectal examination (DRE)

Examination of the prostate, and often the pelvic floor muscles, with a gloved finger through the rectum. It takes seconds and is the only way to feel the gland directly.

Dysuria

Pain, burning or stinging on passing urine.

E

Ejaculatory pain

Pain during or, more commonly, in the hours after ejaculation. A frequent feature of Category III and a useful one to report, because it helps locate the problem.

Empirical treatment

Treatment started on the balance of probabilities, before test results confirm anything. Reasonable once; questionable as a repeated strategy.

Epididymitis

Inflammation of the coiled tube behind the testicle. One of the conditions that can imitate prostatitis, and one that needs different treatment.

Escherichia coli

A gut bacterium, usually shortened to E. coli, responsible for the majority of bacterial prostatitis cases.

F

Flare

A temporary worsening of chronic symptoms, often traceable to a trigger, which then settles back. Part of the normal course rather than evidence of deterioration.

Four-glass test

See Meares–Stamey test.

G

Gram-negative and Gram-positive

Two broad groups of bacteria, separated by how they take up a laboratory stain. The distinction matters because it narrows the choice of effective antibiotic.

Guideline

A document in which a professional body sets out what the evidence currently supports. The European Association of Urology and the American Urological Association both publish ones relevant here, and both are freely readable.

H

Haematuria

Blood in the urine, whether visible or detected only on testing. New visible blood always needs assessment.

Hesitancy

Difficulty getting the stream started, or a delay before it begins.

I

Interstitial cystitis

Another name for bladder pain syndrome. Worth knowing because some people with a Category III label fit this picture better.

Intravenous

Given directly into a vein. Severe acute bacterial prostatitis sometimes starts this way in hospital before switching to tablets.

L

Lower urinary tract symptoms (LUTS)

The collective term for frequency, urgency, hesitancy, weak flow, incomplete emptying and getting up at night. A description, not a diagnosis.

M

Meares–Stamey test

The classical four-sample sequence — first urine, mid-stream urine, prostatic fluid and post-massage urine — used to work out whether an infection comes from the urethra, the bladder or the prostate. Thorough, time-consuming, and now mostly confined to specialist practice.

Multimodal treatment

Combining several treatments aimed at different mechanisms at the same time. The standard approach to Category III, precisely because single treatments usually disappoint.

Myofascial trigger point

A tight, exquisitely tender spot in a muscle that can refer pain some distance away. Trigger points in the pelvic floor can reproduce almost the whole prostatitis symptom set.

N

Neuromodulation

Altering how nerves signal, either with medicines or with a device, rather than treating the tissue the pain appears to come from. Used in specialist pain services for selected patients.

NIH-CPSI

The NIH Chronic Prostatitis Symptom Index: a short validated questionnaire scoring pain, urinary symptoms and quality of life. Its real value lies in repeating it, so two scores can be compared.

Nocturia

Waking in the night to pass urine. How many times is a question clinicians ask because the number is informative.

O

Orchitis

Inflammation of a testicle. Another condition on the differential list for pelvic and genital pain.

P

Pelvic floor

The sheet of muscle slung across the base of the pelvis, supporting the bladder and bowel and surrounding the prostate. When it will not relax, it becomes a pain generator in its own right.

Perineum

The area between the scrotum and the anus. The most commonly reported site of pain in chronic pelvic pain syndrome.

Phenotyping

Sorting people with the same diagnosis into subgroups by their actual symptom pattern, so treatment can be aimed rather than guessed. See UPOINT.

Post-massage urine test

Comparing urine passed before and after prostatic massage, to see whether bacteria or inflammatory cells appear afterwards. A shorter, more practical descendant of the four-glass test.

Prostate

A walnut-sized gland below the bladder, wrapped around the top of the urethra, which produces part of the fluid that carries sperm.

Prostatic abscess

A walled-off pocket of infection in the gland, an uncommon complication of acute bacterial prostatitis. It may need draining as well as antibiotics.

Prostatic massage

Pressure applied to the gland during a rectal examination, either to obtain a sample or, historically, as a treatment. Avoided where acute bacterial infection is suspected.

PSA (prostate-specific antigen)

A protein measurable in blood. It is not a test for prostatitis, and inflammation of any kind can push it up — which is why a reading taken during an active episode is difficult to interpret and usually repeated later.

Pudendal nerve

The main nerve supplying the perineum and genitals. Irritation or compression of it can produce pain that is easily mistaken for a prostate problem.

R

Randomised controlled trial

A study in which participants are allocated to treatments by chance, so the groups are comparable. The reason this matters here: in a condition that naturally fluctuates, anything less can make almost any treatment look effective.

Referred pain

Pain felt somewhere other than its source, because the nerves involved share pathways. It explains why a prostate problem can be felt in the testicle, the back or the thigh.

Retention

Being unable to empty the bladder. Complete retention is painful, is an emergency, and needs same-day care.

S

Sensitisation

A state in which the nervous system amplifies pain signals, so that ordinary sensations register as painful and pain outlasts whatever started it. A documented physiological change, central to understanding Category III.

Sepsis

A dangerous whole-body response to infection. Acute bacterial prostatitis is one of the routes to it, which is why fever with shivering and pelvic pain is treated as urgent.

Sitz bath

Sitting in warm water deep enough to cover the hips and perineum. No trial evidence, widely reported as comforting, negligible risk.

Suprapubic

Just above the pubic bone, in the low central abdomen. A common site of prostatitis pain, often worse as the bladder fills.

Systematic review

A study of studies: all the research on a question gathered by a declared method and assessed together. Generally stronger evidence than any single trial within it.

Systemic

Affecting the whole body rather than one area. Fever, chills and feeling profoundly unwell are systemic features, and they change how urgently a case is treated.

T

Transrectal ultrasound

An ultrasound scan of the prostate taken through the rectum. Used for specific questions such as a suspected abscess, not as a general prostatitis test.

U

UPOINT

A six-domain framework — Urinary, Psychosocial, Organ-specific, Infection, Neurological, Tenderness — used to profile someone with chronic pelvic pain and direct treatment only at the domains that are positive. Set out in chapter three.

Urethra

The tube carrying urine out of the bladder. Its first stretch passes straight through the prostate, which is why gland problems disturb urination.

Urethritis

Inflammation of the urethra, often from a sexually transmitted infection, causing pain on urinating and sometimes discharge.

Urgency

A sudden, hard-to-defer need to pass urine. Distinct from frequency, which is about how often.

Urinalysis

Basic chemical and microscopic testing of a urine sample, usually the first test done. Quick, cheap and informative.

Urodynamics

Tests measuring how the bladder fills, holds and empties, including flow rate. Used where obstruction or a bladder-function problem is suspected.

Urologist

A surgeon specialising in the urinary tract and male reproductive organs. The usual specialist for prostatitis, though persistent Category III cases are often best served by a pain service as well.

V

Voiding

The clinical word for passing urine. “Voiding symptoms” means trouble getting urine out, as opposed to storage symptoms, which means trouble holding it in.

Numbers you may be shown

Three months

The duration of symptoms, within the previous six months, that marks the boundary between an acute episode and a chronic syndrome.

38 °C / 100.4 °F

The temperature conventionally treated as a fever. Combined with pelvic pain and shivering, it is a reason for same-day assessment.

NIH-CPSI total score

Runs from 0 to 43, combining pain, urinary symptoms and quality of life. The absolute figure matters less than the change between two measurements taken weeks apart.

Eight to twelve weeks

The interval commonly used to judge whether a treatment for chronic symptoms is working, which is why it is worth agreeing a review date when you start one.

Around 90 per cent

The share of prostatitis diagnoses that fall into Category III, where no organism is ever found.

Sources

• European Association of Urology, Guidelines on Chronic Pelvic Pain and Guidelines on Urological Infections.
• NIDDK, Prostatitis: Inflammation of the Prostate.
• MedlinePlus, medical encyclopaedia — used to check that our plain wording matches accepted definitions.
• National Health Service (United Kingdom), Prostatitis.

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