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Chronic Noninfectious ProstatitisAka: Prostatodynia, Nonbacterial Prostatitis, Chronic Pelvic Pain in Men, Chronic Prostatitis Related Pain

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  1. See Also
    1. Prostatitis
    2. Acute Prostatitis
    3. Chronic Bacterial Prostatitis
  2. Epidemiology
    1. Young or middle aged patients (under age 50 years)
  3. Pathophysiology
    1. Prostate inflammation without pathogenic organism
    2. Etiology not yet fully elucidated
      1. Pelvic Floor inflammation
      2. Perineal neuromuscular dysfunction
      3. Bladder neck spasm may increase urethral pressure
        1. Intraprostatic urine reflux
        2. Chemical Prostatitis
  4. Symptoms (sudden onset)
    1. Chronic Pain and discomfort in pelvis
    2. Irritative urinary symptoms (Mild to Moderate)
      1. Urine hesitancy
      2. Urine interruption (voiding in pulses)
      3. Decreased urine stream and caliber
      4. Postvoid dribbling
  5. Signs: Digital Rectal Exam
    1. Prostate minimally tender of normal on exam
  6. Labs: Expressed Prostatic Secretion
    1. Leukocytosis
      1. White Blood Cells with excessive fat droplets
      2. Macrophages with excessive fat droplets
    2. Urine Culture negative
      1. Segmented Urine Cultures normal in 75% of cases
  7. Differential Diagnosis
    1. See Prostatitis
    2. Chronic Bacterial Prostatitis
  8. Management
    1. Step 1: Consider causes above
    2. Step 2: Consider infectious cause
      1. Exclude Chronic Bacterial Prostatitis
      2. Consider empiric antibiotics for atypical bacteria
        1. Doxycycline 100 mg PO bid for 14 days or
        2. Erythromycin 500 mg PO qid for 14 days
    3. Step 3: Symptomatic Management
      1. See Prostatitis Management for general measures
      2. Alpha Adrenergic Antagonists for Obstructive Uropathy
        1. Prazosin
        2. Doxazosin
        3. Tamsulosin
        4. Terazosin (Hytrin)
          1. Reduces pain in Chronic Prostatitis
          2. Cheah (2003) J Urol 169:592
      3. Anticholinergic Medications for irritation symptoms
        1. Oxybutynin (Ditropan) 5 mg PO tid
        2. Hyoscyamine 0.375 mg PO bid

Prostatic pain (C0240812)

ConceptsSign or Symptom (T184)
EnglishPAIN PROSTATIC, Prostatalgia, Prostate pain, Prostatic pain, Prostatodynia
Spanishdolor prostatico, prostatalgia, prostatodinia
Parent ConceptsAbdominal Pain (C0000737), Pain in male genitalia (C0458104), Finding of sensation of prostate (C0577257), Duplicate concept (C1274013)
SourcesCST, DXP, MTH, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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