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Urology/CPPS, Non Bacterial


QUESTION: Hello Stephen, ill keep this simple.

I've had a discomfort in my penis for 4 months to this day. I had also been experiencing testicle pain for 2 months, which has since subsided. I'm constantly feeling "pressure" in the penis, almost like I need to urinate at all times, even though I do not. Other symptoms that have come and gone, recur, or still trouble me include : feeling of incomplete emptying, pain with ejaculation, and trouble getting erect due to the discomfort.

Here are the negative tests I have undergone, showing no abnormalities.

Scrotal and kidney ultrasounds
Prostate exam
Urine and blood samples

My doctor has put me on 15 days of flomax to see if I might have nonbacterial prostatitis.

Here are my two brief questions.

What treatments, and I mean any, can I try to moving forward. I'm already practicing hot baths, fluids, and flomax to no avail yet. Any suggestions that have worked to relieve symptoms in some patients, are appreciated.

And secondly. I have read respectable literature from university medical centers and the NIH, stating that many males with prostatitis like symptoms present with some degree of pelvic floor issues. I know you are a urologist but I wanted to ask you if that is a plausible thing for me to get evaluated, since all my medical tests are absent of any findings. Is it possible for make PFD to cause urinary symptoms and pelvic area pain? If theres ANY chance PT can help in my case, I'd love to give it a try.

Thanks much Stephen, any insight would be fantastic.

Prostatitis Patient, looking for relieve.

ANSWER: First, flomax is not going to confirm to deny that you have prostatitis.  Since other causes have pretty much been excluded, prostatitis is likely.

The confirmatory test for prostatitis is the 2-glass or 4 glass urine test.  You can find it on the Internet as it's too involved to get into there except to say that it's an examination of the urine and prostatic fluid before and after a prostate massage.  

Other treatments that can be used that were not mentioned include the following:

antibiotics (sulfa/trimethoprim, cipro, doxycycline, etc.), NSAIDs like ibuprofen, hot sitz baths, quercetin, use of a donut for sitting, avoidance of caffeine and hot spices, overactive bladder medication like ditropan or vesicare for the urgency symptoms, etc.  You can also try viagra for the difficulty with erections if that is severe enough.  Talk to your local urologist about any or all of these therapies.

---------- FOLLOW-UP ----------

QUESTION: Thank you for such a clear response, which actually trumps those given to me by my urologist.

I was able to contact him about the "Stamey" test, as he referred to it. He said he doesn't believe it is indicated so he will not perform it and offered me a referral to the Mayo Clinic for expert evaluation. However, this is difficult as the clinic is 3 hours away from my home.

Anyways, not to babble on.

I feel as if my doctors truly do not want to deal with my case since a culprit has not been found. For this reason I have went ahead and scheduled treatment with a Pelvic Floor Specialist who stated she believes she can help me.

I wanted to ask you about a few other things, If you would be kind enough to spare some time.

What other tests can I get in an attempt to locate a cause?
Is research and treatment advancing in this area? It would burden me to live with this pain.

and lastly, there is a "Pelvic Pain Center" in Minneapolis MN, they treat patients who present with know known etiology for their pain. They do tests and regional nerve blocks looking into Pudendal Nerve conditions. As a urologist, do you know anything about the Pudendal conditions and symptoms such as mine?

I'm not viewing my pelvic pain as a life sentence, I'm only 20 and very active, but I'm determined to find the cause and overcome it. So I believe building up my understanding of different possibilities will help.

For 20 years I had a perfectly normal anatomy and this has really diminished my life...I can't understand why it isn't a more talked about issue, people are really suffering from this and the treatment seems to be elusive.

Thanks much, I genuinely thank you for your service. If I overcome my idiopathic discomfort, I will be sure to let you know what worked for me, hopefully to help others.

Warm Regards,

Patient Presenting With

Pain upon arousal and ejaculation
Vague discomfort in penis
aches in testis
Mild ED
Incomplete Emptying Sensation
Bowel/Bladder dysfunctions
Pressure feeling in Pelvic Area

Negative tests
Scrotal/Kidney Ultrasound
Digital Rectal Exam
Antibiotics/Flomax/NSAIDS offer zero relief
Hot baths and dietary changes help none

Hopefully my case can transcend the current belief that there is no curative route.

The "Stamey" test is another name for the same thing.  Since it rarely affects treatment, it is rarely done outside of a research setting.

There is no other "confirmatory test" as prostatitis is usually a diagnosis of excluding everything else.

While there is always research in medical problems like prostatitis, the bulk of research money does not go to urological disease and when it does, it tends to be focused on larger issues like prostate cancer.

As a urologist, problems involving the pudendal nerves are outside my area and while I know something about them, I do not specifically treat those problems.

The toughest problems to treat are those that deal exclusively with sensations and where every physical test is negative.


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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