Prostatodynia
or Noninflammatory chronic pelvic pain syndrome is difficult to treat
because it is not clear what causes this form of prostatitis. The
primary goal of treatment is to relieve symptoms. Nonnarcotic pain
medications, muscle relaxers, and alpha-blockers are used.
Medical Care
Surgical Care
Diet
Activity
MEDICAL CARE:
Prostatic massage (therapeutic)
- The role of prostate massage in providing symptomatic relief is controversial.
- With
little evidence-based medicine to commend it, regularly repeated
prostatic massages have been recommended in the past, particularly for
patients with a large, congested gland.
- Some patients find that massage provides temporary relief worth the awkwardness and discomfort of the maneuver itself.
Therapeutic ejaculation
- The role of frequent ejaculation in either producing or reducing CPPS symptoms remains controversial.
- Patients
with enlarged, symptomatically congested glands are often advised that
regular sexual intercourse may alleviate their symptoms.
- While
little objective evidence substantiates this claim, most patients find
this recommendation more attractive than serial prostate massages by
their local urologist.
- Whether frequent sexual
intercourse relieves or actually exacerbates the condition seems to
vary idiosyncratically from patient to patient.
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SURGICAL CARE:
For
instances of severely disabling CPPS, transurethral resection of the
prostate (TURP) and even radical prostatectomy have been undertaken.
Transurethral resection of the prostate (TURP)
- A
widely held opinion among urologists is that TURP should be reserved
for those patients who have experienced extreme, persistent symptoms
over a protracted period, with no relief from nonoperative
interventions.
- Reserve TURP as a rarely employed approach
of last resort, offered only by experienced resectionists, and, even
then, with the clear understanding that symptomatic relief is not
guaranteed.
- Indeed, a risk exists that symptoms might
even become worse and includes the added burdens of impotence and
urinary incontinence.
- When TURP is undertaken, completing
a thorough resection of all tissues, down to the capsule, is essential.
The concern is that residual tissue, partially coagulated, with
obstruction of the ductal drainage from prostatic acini might
exacerbate the patient's symptoms (Smart, 1975).
Radical prostatectomy
- This is an extreme measure.
- Consider this treatment only in the most desperate of cases, if at all (Davis, 1990).
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DIET:
- The influence of diet on this condition is variable.
- Traditionally,
these patients have been warned to avoid excessive intake of prostate
irritants, such as coffee, tea, soda (cola drinks and diet drinks may
be especially irritating), spicy foods, and alcohol.
- Alkalinization
of the urine seems to help some patients. A teaspoonful of baking soda
(sodium bicarbonate) in a tall glass of warm water taken at bedtime may
help reduce nighttime symptoms. However, caution patients regarding the
risk of an excessive sodium load with higher oral intakes, especially
in those under treatment for hypertension, fluid retention, or
congestive heart failure. A potassium-based alkalinizer, such as
potassium citrate (Urocit K), may prove more efficacious under these
circumstances. Stephen Leslie, MD, reports anecdotally that he has
found some patients to have very alkaline urine, which can also be
irritating and result in discomfort and dysuria.
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ACTIVITY:
- Sitz baths may provide partial relief from acute exacerbations.
- Rather
than a shallow, perineal dip, a deep tub bath in water as hot as can be
comfortably tolerated seems to provide better overall temporary relief
and relaxation.
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