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Dolor pélvico
The chronic pelvic pain is a frequent clinical entity that includes a multitude of problems that derive in chronic pelvic pain and / or genital pain


The symptoms that you may experience in case of having this illness, are:
Perineal discomfort or pain 
Pain with the ejaculation  

Discomfort and pain down the back 

Orchialgia
Urinary frequency
Difficulty to begin to urinate
Smarting when urinating
Penis pain

  Litiasis renal

El dolor pélvico crónico puede dividirse en las siguientes categorías:
Category I (previously denominated "acute prostatitis"). This condition is a severe infection of the prostate gland and in fact it is not a chronic condition. It can also conduct a urinary tract infection. Fever, chills, and the urinary retention (inability to urinate) can happen because they are initial symptoms, requiring hospitalization for treatment with intravenous antibiotics.

Category II (previously denominated as "chronic bacterial prostatitis"). The patients with this affection present some or all the symptoms mentioned. In this case, the infection is located inside the canal of the prostate gland. Typically, the patients with this illness usually have intermittent urinary infections when the bacteria pass from the prostate to the urine. The treatment generally implies antibiotics during many weeks. This treatment is difficult to be followed by many patients. However, the reason of a long treatment with antibiotics is very simple, the antibiotic reach a little penetration in the prostate gland and the bacteria are sometimes inside small calculus or stones that act as bacteria repositories, that is if we remove them you will be cured..

Category III, the chronic pelvic pain syndrome. It is the more common cause of pelvic pain in the men, and it represents the great majority of the visits of the patients. It is divided in two subcategories:
Category A(before denominated nonbacterial prostatitis or abacterian prostatitis." This kind of prostatitis is characterized by a prostate inflammation without infection
  Esta forma de prostatitis se caracteriza por la presencia de inflamación en la próstata sin infección

Category B(previously denominated "prostatodynia ")
  This kind of chronic pelvic pain seems to have little to do with the prostate; it may probably be related to nerves malfunction and / or a problem with the pelvic floor muscles

Category IV The patients with prostatitis falling in the Category IV don't present symptoms. In this case, the inflammation of the prostate tissue and / or its secretions, are casually found in the evaluation of other urologic problems (for example, during the infertility evaluation or during a prostate cancer test). There is not treatment, it is not necessary a monitoring.


What will we do if you ask for advice about pelvic pain?
We will do a detailed clinical history and a physical examination. This is the most important part of your visit; it provides a vision of all tests resulting in orientation to know what therapies will probably be useful. The patients often have been evaluated by many doctors in the past. It is necessary to bring any test made in the past.

Laboratory tests: they can include a urine analysis, a urine cultivation, blood tests (including the prostate-specific antigen) and in some cases, a urine cytology (an exam to detect cancerous cells in the urinary tract). A "prostate massage" can be carried out during the physical examination. This procedure is a little uncomfortable, since it implies to press the prostate during a digital.rectal exam. The seminal liquid obtained in this examination or in the urine, obtained after the examination, can give hints for your diagnosis. Surprisingly, some patients feel a significant relief from the symptoms after this procedure.

Other tests recommended, include:
Tests to detect sexual transmission diseases
Evaluation of the voiding of the bladder. It is usually carried out with a simple ultrasound in the clinic
 
The urodynamic evaluation. This is a test that evaluates the function of the bladder and it can also provide information about the muscles of the pelvic floor 
 
Cystoscopy. This procedure consists on passing a flexible device with a lens, through the urethra toward the bladder. The cystoscopy can provide information about the inflammation, scars, cancer, calculus in the bladder or prostate growth
 
Ultrasound tests. They can include prostate, scrotum and / or kidneys echography 
TAC or magnetic resonance of abdomen and / or pelvis  

Treatment options
The Treatment of the chronic pelvic pain is individualized for each patient and it is based mainly on the diagnosis and on the tolerance to administered medications or other required therapies. The treatments are, therefore, very varied. These can include:
Changes in the diet
Modification of the behavior
Acupuncture
Therapy with antibiotics, anti-inflammatories, anesthetics for the urinary tract, alpha blockers and antiespasmodic agents for the bladder, muscle relaxant, antihistamine drugs, anticonvulsory agents, antidepressant therapy (many agents in this group are suitable for "neuropathic pain") ,atypical opioids, Narcotics therapy (in general, given by pain treatment centers), Physical Therapy, Injection to the affected muscular group, pudendal nerve blocking, Botox ®, urethral suppository, thermotherapy of Thermotherapy
 

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