Questions posted in the The Urology Forum have been answered by urologists from Henry Ford Health System and by Dr. Kevin Pho.

Subject: Re: More Prostatitis
Forum: The Urology Forum
Topic Area:
Posted by HFHS M.D.-MS on February 04, 1998 at 18:10:34:
In Reply to: More Prostatitis posted by Bo M on February 04, 1998 at 13:04:08:



Hello,

I've read the comments previously posted, and over the last 5 months,
i have done more research on the disorder than I have for my Master's
Thesis years ago.

I have been diagnosed with non-bacterial prostatitis. Post message
prostate secretion shows a high number (20-25) of white blood cells,
indicating inflammation. However culture of post message urine shows
no growth of bacteria. Cultures of urine for chlamydia and other
pathogens proved negative. Kidney, Liver, sedementation rates were
all normal. Epididimytis was ruled out using scrotal ultrasound.

Symptoms:
Pain in the groin, testicles, rectal pains and perineal pains.
Pain comes and goes during the day, but has been present in various
forms everyday of the past 5 months.

Note: The whole thing started with a tingling feeling in the
urethra, which developed into testicle pain 5 days later. The rest
of the symptoms developed with time.

Treatment:
2 weeks of a tetracycline produced no results.

Naproxen (Naprosyn) and Voltarene were used as antiinflammatories
for 4 weeks: no improvement.

4 weeks of Cipro + Flagyl (for anaerobic cover): No improvement.

My uro is out of options now.

The pain is bad and I do not think I can live with this.

What do you suggest next: different antibiotics, something else?
I really hope that you have a constructive answer.

Best Regards,
Bo


Dear Bo;
Thanks for your question.
Have you been worked up for Interstitial Cystitis (IC)?
The seventh edition of Campbells Textbook of Urology states, ...diagnosis of IC should be considered in patients with a clinical diagnosis of prostodynia or nonbacterial prostatitis (NBP) that is refractory to treatment. IC has a 10:1 female to male predominance and makes it very easy to overlook in the male patient. There are many different treatments available for IC.

Have you had video urodynamics (VFUDs) ? As you probably read in the Urology Forum answer to Davidoff, regarding Prostatitis, dated 01-09-98, some men with presumed NBP/ Prostadynia also have obstructive and irratative voiding symptoms and are misdiagnosed when they in fact have a primary (congenital) bladder neck contracture (PBNC). If abnormalities are found suggesting obstruction, a trial of alpha blockers or surgery may help. If alpha blockers do help, they have to be continued indefinitely else return of symptoms. Campbells states that some investigators theorize that men with NBP/ prostadynia may cause reflux of urine into their prostatic ducts which result in a chemically induced inflammation of the prostate. Alpha blockers should help with this.
Even if you dont have a PBNC, a VFUDs would be another test to help support the correct diagnosis of Prostadynia/ NBP. The typical VFUDs findings for NBP / prostodynia are also listed in seventh edition Campbells , page 625.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).
Good Luck
Sincerely:

HFHS M.D.-MS
*Keyword: Nonbacterial Prostatitis, Prostadynia, Primary Bladder Neck Contracture
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