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Acute and chronic prostatitis discussion. Arnon Krongrad, MD, moderator.

Hello everyone,
I'm extremely confused and frustrated by what I've been told about what may be going on with me, and I'm hoping that perhaps someone can clear things up for me.
Background: I'm a 28 y/o male and have had the following symptoms for at least 5 years: frequency/urgency/hesitation, random shooting pains on both sides of pelvic region, testicles, or rectum,occasional mild burning sensation when urinating. I have noticed that the pains will sometimes occur when I feel an urge to urinate, but not exclusively.
After seeing a urologist, I've learned that my bladder capacity is normal, as demonstrated by morning voids. Urinalyses show no evidence of infection, and digital exam found no enlargement of prostate. A cystoscopy found a polyp at the bladder neck near the prostate. I was told that this may or may not be causing symptoms, and that it could be removed by cystoscopy w/ fulgration. I had that procedure done, and the biopsy came back showing cystitis cystica. At the follow-up the doctor diagnosed me with chronic prostatitis, prescribed me Cipro, and instructed me tomonitor my diet. After doing some research, I'm left with several questions:
1) I've learned that cystitis cystica is caused by inflammation of the bladder, as a result of infection or medical procedures, and that it can produce the symptoms that I experience. I can't find any relationship between it and non-bacterial prostatitis. Since the biopsy was taken from the bladder only, why would the doctor presume a prostate condition?
2) When the doctor said that "cystitis" was found, I asked if it was interstitial cystitis. She said that it was not because IC is a diagnosis of exclusion and in my case, an actual inflammation was found. I'm confused because from what I've read about IC, it can exist with or without inflammation of the bladder?
3) On the same point, I've learned that non-bacterial prostatitis (CPPS) falls into two categories, one with inflammation and one without, and that some doctors believe that the latter form may be the same condition as IC. Since there was no testing of my prostate, other than the digital exam, I would assume it's not known whether or not my prostate is inflamed. In that case, how could my doctor rule out IC?
4) The recent studies that I've read have indicated that treating non-bacterial prostatitis with antibiotics may not be worth the risk of side-effects and resistance. I was given 7 days of Cipro and told to call back if my symptoms persisted. I'm assuming that they will and, if so, do you all think I should continue antibiotic treatment just in case?
Thank you so much in advance for your responses. I really just want to get to the bottom of what's going on with me and what I should do about it.

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Hi and welcome,

Did you not seek medical care for 5 years? That's a long time with this, in many cases treatable condition.

 

I am not a doctor but a patient who is a living example of the conseqences of taking too short cipro courses - and 7 days is too short. If you respond to this treatment, try to get it extended to a total of 6 weeks BEFORE the 7 days are over.

 

If you respond somewhat, but not enough, it could also be a chlamydia infection (regardless of negative testing) as ciprofloxacin only have moderate activicy against this bacteria. After reading on plenty of prostatitis cases - the burning sensation when urinating seems to be present in chlamydial prostatitis but absent in many other cases. Other than this being a common symptom even with urethral-only chlamydia, I have no scientific data for this assumption and it is my personal observation only.

 

If you fail to respond to any antibiotics, you might have a non-bacterial condition that requires further investigation.

Thanks very much for your welcome and reply.  I also thought that 7 days seemed short, considering most things I've read talk about a 4 - 6 week course of treatment.  Yesterday, I left a message with my doctor's nurse asking about this.  She called back and told me that the doctor said that if I don't feel better after the 7 days to call her to renew, the theory being that if it has cleared up by the end of the week, then there would be no reason to renew.  Has your experience proved otherwise?  I was starting to wonder whether I should bother renewing in either case, as I've seen so much about antibiotics being prescribed as kind of a don't-know-what-else-to-do approach, but maybe it's worth a shot?

As to your question about waiting 5 years, I have put it off for some time, but it was actually after going through tests when it was first occuring.  I had seen a urologist at that time and had basically the same results- no bacteria found, they did a cystoscopy b/c my stream is weak but found no strictures, and perhaps the cyst that they recently fulgrated hadn't formed yet at that time.  The only difference was that that doctor had said that probably did not have chronic prostatits because I was not regularly waking up in the night to urinate, which I still don't really. Somewhere along the line I dropped the ball and just started living with the symptoms, but I decided recently to pick it back up.

Oh, and just to clarify, I hesitated to mention the mild burning sensation b/c it really is mild and infrequent, and the sensation kind of feels the same sometimes at the tip of the penis when not urinating. The only time I've felt severe burning was after the cystoscopy's.  My biggest complaints are the frequency/urgency and the hesitation/weak stream.  The random pains are annoying and uncomfortable, but the urinary symptoms are really frustrating.

 

Thanks again.

A symptomatic clearup is not the same as complete eradication of the infection. I had my symtoms gone after 2 days on cipro and quit after 8 days, only to see the infection come back, being much harder to clear that time. Yet today, a year later, I'm suffering with some multiresistent, stubborn infection that spreaded into nearby organs. Quitting that initial course was perhapst the biggest mistake I've done in my life, and I can only advise you on not doing the same mistake.

Prostatitis is really difficult to get rid of and you really have to do research about it. Ask your doctor why it was ruled out and whether it needs to be reconsidered. Another random tip that might help is taking natural supplements. I know that most people think they are scams but Super Beta Prostate is different from the average supplement. It contains beta-sitosterol and has been quite effective for many many men.

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