Antimicrobials are indicated in selected cases only.
Definition and aetiology
Painful condition in the male genital area, perineum or pelvic area that has lasted for more than 3 months without findings of a bacterial urinary tract infection
Usually (in more than 90% of the cases) the patient has sterile prostatodynia. The condition tends to recur several times a year.
The disease may be caused by bacteria residing in the prostatic ducts.
Definite aetiology still remains unclear (multi-aetiological).
Symptoms
The symptoms are similar to those of acute prostatitis but milder and recurring.
Voiding difficulties and burning on urination, increased urinary frequency, feeling of incomplete emptying of the bladder
Aching pain in the lower abdomen, scrotum, perineum, glans, or inner thighs
Feeling of pressure in the perineum, anus or anterior to the anus
Massage of the prostate and ejaculations sometimes alleviate the symptoms.
There is no standardized prostate massage, but one method is to massage both lobes from the lateral side towards the midline for a couple of minutes.
Continuity of the doctor-patient relationship; reassurance of the benign nature of the condition; diagnosis and treatment of possible depression
Antimicrobial drugs are not indicated for prostatodynia.
A fractionated urine sample is taken in frequently recurring cases.
First, a urine sample is collected at the beginning of the stream. Then the prostate is massaged and a new urine sample is taken immediately to be microscoped and cultured.
If bacteria are detected, treat with a 1-2-month course of sulpha-trimethoprim or fluoroquinolones (starting with e.g. norfloxacin 400 mg twice daily, lowering the dose later on). Potential adverse effects associated with fluoroquinolones should be carefully considered before using them.
In case of inflammatory chronic prostatodynia the post-massage sample usually contains leucocytes.