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Key Features

  • Prostatodynia is a noninflammatory disorder causing prostatic discomfort

  • Affects young and middle-aged men

  • Has variable causes, including voiding dysfunction and over-facilitated pelvic floor musculature

Clinical Findings

  • Variable

    • No history of urinary tract infections

    • Hesitancy and interruption of flow

    • Lifelong history of voiding difficulty

  • Physical examination is unremarkable, except increased anal sphincter tone and periprostatic tenderness may be observed

Diagnosis

  • Urinalysis: normal

  • Expressed prostatic secretions: normal numbers of leukocytes

  • Urodynamic testing

    • Dysfunctional voiding (detrusor contraction without urethral relaxation, high urethral pressures, spasms of the urinary sphincter)

    • Indicated in patients failing empiric treatment

  • Differential diagnosis

    • Acute cystitis, other prostatitis syndromes

    • Acute bacterial prostatitis

    • Chronic bacterial prostatitis

    • Nonbacterial prostatitis

Treatment

  • α-Blocking agents: terazosin, 1–10 mg once daily orally; or doxazosin, 1–8 mg once daily orally

  • Anticholinergics

  • Diazepam

  • Biofeedback techniques

  • Sitz baths

  • Prognosis is variable depending on the specific cause

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