Creator: Dr. Raman Tanwar
Published: 2016-09-10T12:20:42-04:00

Patient's Query

Hi doctor,

I am a 27 year old sexually active male. I have been with the same girl for the past 10 years and we are loyal in the relationship. I am having a ton of issues and pain in my lower region. The symptoms are lower back pain, pain in my pubic region, pain and tingling in my testicles, burning with and without urination and pain within the penis. I have been to three different walk-in clinics and had three different antibiotics, including Levaquin, Bactrim and Cipro. I went to a urologist and was told to have pelvic pain syndrome. I have had similar issues in the past. I dealt with a prostate infection a few years ago and that was treated with antibiotics. But, this time nothing is working. Most urine cultures show no bacteria. My thoughts are possibly pudendal neuralgia or interstitial cystitis, as my mom has IC. Do you advise sonogram or endoscopy or medications?

Answer

Dr. Raman Tanwar

Andrology General Surgery Urology

Hi,

Welcome to icliniq.com.

Your symptoms do point towards chronic prostatitis. With negative culture and positive pus cells, it is likely that you are suffering from CPPS IIIA, which is non-bacterial inflammatory chronic prostatitis. Now, this is a difficult condition to manage and requires long-term therapy. I would suggest that you follow up with a urologist on a long term basis. Therapy takes some time and different medications work for different patients.

IC (interstitial cystitis- painful bladder) is also a possible condition, but CPPS is more common in males than IC. You do not meet all criteria for IC as per the classic definitions. So, I would keep CPPS as the first differential. I am mentioning some tests that you may want to get done to clarify the situation in a better way.

The Probable causes:

Recurrent infections.

Investigations to be done:

Urine anti-proliferative factor, EPS Culture (expressed prostatic secretions) after prostatic massage, uroflowmetry with post-void residual urine assessment and cystoscopy.

Differential diagnosis:

1. CPPS IIIA.
2. BPS (bladder pain syndrome) / IC.

Treatment plan:

I suggest combination of Amitriptyline, alpha blockers, NSAIDS (nonsteroidal anti-inflammatory drugs) and Gabapentin. Dietary modifications will be necessary. Consult your specialist doctor, discuss with him or her and take the medicine with consent.

Preventive measures:

Stay away from spices, coffee and anything that you feel trigger the symptoms or aggravate them.

Regarding follow up:

Revert back with the reports to a urologist online.---> https://www.icliniq.com/ask-a-doctor-online/urologist

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Patient's Query

Thank you doctor,

I really appreciate your answer and the extra information. I am going to follow up with a urologist. Is kidney stone or bladder stone a possible cause of this? Do you think getting a sonogram of my bladder, kidneys and scrotum would be beneficial in trying to rule out?

Answer

Dr. Raman Tanwar

Andrology General Surgery Urology

Hi,

Welcome back to icliniq.com.

Bladder stones are a possibility, but less likely. Kidney stones are very unlikely to cause such symptoms.

You may do well by getting an ultrasound done and I do recommend it.

The post-void residual assessment that I mentioned is done by sonography only and it may be a good chance to assess bladder stone. It is likely that your sonography may show the changes of cystitis.

I will appreciate if you can send over the reports to me so that I can help you further. The therapy would obviously be best under the guidance of urologist.

Revert back with the reports to a urologist online --> https://www.icliniq.com/ask-a-doctor-online/urologist

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