PN or Prostatitis…two DRs and each thinks something differen

[ADman]

Hi all,

Very happy to have found this community. I come to you today seeking advice about diagnosis, along with some recent treatment issues.

Quick backstory: Had a small inguinal hernia that was repaired in March (laparoscopic/robotic). About three or so weeks after the surgery, I began to get burning pain in my urethra and perineum, coupled with a dull ache in my left testicle. The burning pain in the urethra would be worse about 30-60 seconds AFTER urination, but then persist for awhile. I would also have pain more while sitting and sometime felt the “golf ball effect” where it was as though I was sitting on an object. Ran urinalysis which came back negative. My PCP suggested it might be pudendal nerve related, especially because I am a casual cyclist and would sometimes get numbness in the groin after a 35/40 minute ride. She prescribed Gabapentin. At the same time, she referred me to a urologist because of the testicle pain, just to be safe.

Urologist appointment took forever to schedule, so I had been managing pain with the Gabapentin for weeks. Brought things down to a 2 or 3 on 10pt scale. Urologist listened to my story and said “definitely prostatitis.”. As I’m only 35, he decided to save me from the pain of a digital rectal exam and just prescribe a 4 week course of antibiotics (Doxycycline). I was told to get off the Gabapentin so we could make sure the Doxy was helping. Within two days my symptoms were worse and then eventually they worst they’ve been (burning urethra, perineum, etc.). I decided to get off the antibiotics today and have been back on the Gabapentin for a few days. Felt much better even after just one day off the antibiotics.

My big questions for this group:

Any history with hernia mesh surgery causing Pudendal issues?
Any history with antibiotics making Pudendal nerve pain worse? Or counteracting Gabapentin?
Any advice on the best next steps? I’m trying to schedule Physical Therapy, which was the initial suggestion of my PCP before the Urologist’s diagnosis. She suggested Gabapentin until I go to Physical Therapy and see if I can get things under control. My pain has always been about a 3-5 on 10pt scale, so things are fairly manageable.

Thank you for any and all insight!

[stephanies]

ADMan,

As soon as I read that you had a hernia repair I wondered about mesh. However, it sounds like you had issues prior to then from cycling. Perhaps the surgery itself triggered an existing issue to become more symptomatic. I don’t know about PT in your situation, I guess it’s worth a try as long as it doesn’t increase the pain. I don’t know at what point doctors consider mesh removal and if you would be able to do that locally or should see an expert. Keep us posted on your results from PT.

Stephanies