Chronic prostatitis (chronic pelvic pain syndrome in men)

Case history

A 34-year-old male presents with a 4-year history of pain (visual analog scale score of 3 to 6) in the suprapubic area with radiation to the genitals, including penile tip and perineum. He has previously been treated for urinary tract and prostate infections several times with multiple antibiotics despite lack of a clear diagnosis of infection in the urine. In addition, antibiotics did not significantly change the symptoms. Longer periods of walking can alleviate the pain whereas sitting for long periods, especially on cold surfaces, worsens the pain. He also reports micturition problems, including straining, intermittency, and reduced stream. Clinical exam is unremarkable other than painful palpation of the prostate after passage of a hyperactive rectal sphincter. After exclusion of infection by urinalysis, urine culture, and STI screening, a flexible cystoscopy is performed to exclude anatomic obstruction.