Cystitis, urethritis, and prostatitis

Summary

This chapter focuses on pain in the bladder, urethra, and prostate. Interstitial cystitis is treated with heparinoids (e.g. pentosan polysulfate), botulinum toxin, or intravesical Bacillus Calmette-Guerin. There is some evidence for NSAID utility in prostatitis, but treatment for chronic prostatitis and male chronic inflammatory pelvic pain syndrome entails long-term therapy with drugs such as alpha-blockers and immuno-modulators. Antibiotics form the mainstay of urethritis treatment, with pain relief expected within seven days of instituting treatment. The best-known urinary tract anesthetic for acute care use is phenazopyridine. Ibuprofen does not reduce the dysuria or rectal pain associated with radiation therapy for prostatic cancer. However, there is some evidence for occasional NSAID utility in relieving non-infectious chronic prostatitis during the absence of other evidence for NSAIDs or other analgesics, patients with refractory pain from infectious cystitis, urethritis, or prostatitis may require opioids for relief.