This Page Intentionally Left Blank - Int Medical

188
Cystitis, urethritis, and prostatitis
BENJAMIN A. WHITE AND STEPHEN H. THOMAS
n Agents
n Antibiotics
n Phenazopyridine
n Antispasmotics
n Petrolatum jelly
n Evidence
The evidence addressing analgesia for the lower urinary tract is surprisingly
sparse. When the search is limited to the infection-associated inflammatory
pain most likely to be encountered in the ED, there are virtually no guiding
RCT data. However, painful conditions of the genitourinary tract are quite
commonly encountered. The variety of potential etiologies for pain prevent
detailed consideration of some diagnoses. This chapter focuses on pain in the
bladder, urethra, and prostate. Uterine pain is addressed in other chapters;
pain from pelvic inflammatory disease is virtually unaddressed in the literature
and is considered in the chapter on undifferentiated abdominal
pain (p. 392).
Chronic conditions such as interstitial cystitis and chronic amicrobial
prostatitis (male chronic inflammatory pelvic pain) are best treated with
mild oral analgesics from the ED, with specific therapy left to the follow-up
physicians. Treatment usually involves medications well outside the realm of
acute care. Interstitial cystitis is treated with heparinoids (e.g. pentosan
polysulfate), botulinum toxin, or intravesical Bacillus Calmette-Guerin. 1–3
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 immunomodulators.
4–7 The ED physician who is understandably reluctant to institute
such agents may wish to prescribe, instead, an intermediate course of