Dr. Raman Tanwar
MCH., MS., FELLOWSHIP IN ANDROLOGY ., FELLOWSHIP IN MEN'S HEALTH (UNIVERSITY OF NAPLES)., MBBS., (DIFF
Andrology, General Surgery, Urology
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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.Treatment plan:
2. BPS (bladder pain syndrome) / IC.
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