Urology Book


Chronic Noninfectious Prostatitis

Aka: Chronic Noninfectious Prostatitis, Prostatodynia, Nonbacterial Prostatitis, Chronic Pelvic Pain in Men, Chronic Prostatitis Related Pain
  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
      1. Low pack pain
      2. Perineal pain
      3. Lower Abdominal Pain
      4. Scrotal Pain
      5. Pain in penis
      6. Pain in inner thighs
    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
    3. Associated symptoms
      1. Sexual Dysfunction
      2. Mood Disorder (e.g. emotional stress, Anxiety Disorder, Major Depression)
  5. Signs
    1. General physical exam
    2. Digital Rectal Exam
      1. Prostate minimally tender of normal on exam
  6. Labs
    1. Urinalysis and Urine Culture
    2. Urine Cytology
    3. Post-void residual
    4. 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. Diagnostics: Advanced testing to consider
    1. Prostate Specific Antigen
    2. Semen Analysis and culture
    3. Transrectal Ultrasonography-guided biopsy
    4. CT Abdomen and Pelvis
    5. Urine flow (urodynamics)
  8. Differential Diagnosis
    1. See Prostatitis
    2. Chronic Bacterial Prostatitis
    3. Benign Prostatic Hyperplasia
    4. Voiding dysfunction
    5. Bladder Cancer
    6. Prostate Cancer
    7. Mullerian duct remnants
    8. Neuropathy
    9. Ejaculatory duct obstruction
    10. Cystitis
      1. Interstitial Cystitis
      2. Radiation cystitis
      3. Eosinophilic cystitis
      4. Chronic proliferative cystitis
  9. Management
    1. See Chronic Prostatitis for urology Consultation
    2. Step 1: Consider causes above
    3. Step 2: Consider infectious cause
      1. Treat as Chronic Bacterial Prostatitis
    4. Step 3: Symptomatic Management
      1. See Prostatitis Management for general measures
      2. Obstructive Uropathy symptoms
        1. Alpha Adrenergic Antagonists (Prazosin, Doxazosin, Tamsulosin, Terazosin
          1. Reduces pain in Chronic Prostatitis
          2. Cheah (2003) J Urol 169:592-6 [PubMed]
      3. Pain symptoms predominate: Antiinflammatory agents
        1. Pentosan (Elmiron) 900 mg daily for 16 weeks
          1. Risk of Retinal damage (Pigmentary Maculopathy) with prolonged use (typically with years of use)
        2. Finasteride (Proscar) 5 mg daily for 6 weeks
        3. Quercetin (bioflavinoid supplement) 500 mg twice daily for 30 days
      4. Irritation symptoms: Anticholinergic Agents
        1. Oxybutynin (Ditropan)
      5. Neuropathic pain agents
        1. Gabapentin (Neurontin)
        2. Pregabalin (Lyrica)
        3. Tricyclic Antidepressants (e.g. Amitriptyline, Nortriptyline)
    5. Step 4: Non-pharmacologic management
      1. Biofeedback
      2. Physical therapy
      3. Sacral neuromodulation
  10. References
    1. Habermacher (2006) Annu Rev Med 57:195-206 [PubMed]
    2. Holt (2016) Am Fam Physician 93(4):290-6 [PubMed]
    3. Pontari (2008) Urol Clin North Am 35(1): 81-9 [PubMed]
    4. Pontari (2007) J Urol 177(6): 2050-7 [PubMed]
    5. Sharp (2010) Am Fam Physician 82(4): 397-406 [PubMed]
    6. Schaeffer (2006) N Engl J Med 355(16): 1690-8 [PubMed]

Prostatic pain (C0240812)

Definition (NCI) Pain in the prostate gland.
Definition (NCI_CTCAE) A disorder characterized by a sensation of marked discomfort in the prostate gland.
Concepts Sign or Symptom (T184)
SnomedCT 247383007, 236674002, 207198002, 36729000
Italian Dolore prostatico, Prostatodinia
English Prostadynia, [D]Prostadynia, Prostatic pain, Pain prostatic, Prostatic Pain, prostadynia, prostatodynia, Pain;prostate, prostate pain, pain prostate, Prostatodynia (finding), Prostate painful, Prostatalgia, Prostatodynia, Prostate pain, Prostatic pain (finding)
Dutch prostatodynie, pijn aan prostaat, prostaatpijn
French Prostatodynie, Douleur prostatique
German Prostatodynie, Prostataschmerz
Portuguese Prostatodinia, Dor prostática
Spanish Prostatodinia, dolor prostático (hallazgo), dolor prostático, prostatalgia, prostatodinia, Dolor prostático
Japanese 前立腺痛, ゼンリツセンツウ
Czech Bolest prostaty, Prostatická bolest, Prostatodynie
Hungarian Prostatodynia, Prostata fájdalom, Prostatafájdalom
Derived from the NIH UMLS (Unified Medical Language System)

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