Treatment of chronic prostatitis requires a team of experts
Iama 60-year-old man and suffer from chronic prostatitis/chronic pelvic pain syndrome. I have had bouts of prostatitis since childhood, but the last few years, it has been almost constant. My symptoms are burning, and I always get the feeling that I have to urinate. I have seen numerous urologists, but none who are familiar with treating this condition. I have been tested for infection. My prostate is not enlarged, and my PSA level is normal.
I have attempted biofeedback, acupuncture and Chinese herbs, all with no relief. I am at my wit’s end. Do you know of any treatments or specialists who deal with this issue? Also, do you have any other suggestions? Is there another type of doctor I should reach out to, such as a neurologist or pain specialist? — S.S.
Dear S.S.: Your symptoms, although they are often attributed to the prostate, may not be caused by the prostate at all. Chronic pelvic pain in men is very common. It affects at least 2% of men, and some studies say as much as 10%.
For non-specialists like me, initial treatment is usually a combination of an alpha blocker like tamsulosin (Flomax) and an anti-inflammatory like ibuprofen, once infection is ruled out. A careful exam is usually enough to look for other common problems, but blood testing and even imaging studies may sometimes be done.
I have occasionally found men that are so worried about painful urination that they stop drinking, consciously or unconsciously, to minimize pain. However, concentrated urine often makes symptoms worse, and increasing hydration can make a world of difference.
It sounds like you have gone way past the kind of treatment a generalist can give, and although all adult urologists are certainly familiar with chronic pelvic pain in men, it doesn’t sound like you have found an expert in that condition. Many institutions have teams to treat male pelvic pain ( just as there are teams for female chronic pelvic pain), usually consisting of a urologist, pain management specialist and pelvic floor physical therapist. I had no trouble finding several institutions in my city with well-run expert centers, but those who live in smaller cities or rural areas may have a harder time. Since many conditions can lead to similar symptoms, the team approach is best.
Dear Dr. Roach: I was rejected for whole blood donation because I failed the hemoglobin fingerstick test. This had never happened to me before. Is it possible the blood drop was too small in the cuvette? How does that machine work? Does it depend on the volume of blood in the cuvette? — J.J.
The point-ofcare devices commonly used at blood banks are pretty accurate. Ninety-five percent of the time, they are correct to within 2 g/dL compared with the hospital laboratory machine. So, 5% of the time, they are off by more than 2 points, which is certainly enough to take a person from the normal range to the range at which the blood bank will not accept the blood.
The mechanisms of measuring hemoglobin are out of the scope of this column, but air bubbles in the capillary tube and other procedural issues can cause error. If my patient came in to me with this concern, I’d recheck the hemoglobin through the hospital lab.