The article entitled, Male Pelvic Pain: Beyond Urology and Chronic Prostatitis, published in Current Rheumatology Reviews, Vol. 12, No. 2, 2015, was the summation of my 25 year subspecialty career and one of my life crusades.
As Dr. Novick’s special fellow, I became a general office based urologist. The volume and diversity of patients seen at Glickman Urological Institute at the Cleveland Clinic provided me with a great and immediate education in general urology and outpatient procedures. It also made me realize there was a great need for specialized care of men suffering from pelvic and genital pain. In the mid 1990’s, it became very clear to me (and one of my mentors, Dr. Elroy Kursh) that prostatitis, epididymitis and urethritis were most often misused terms to describe patients’ symptoms which were caused by something other than an infection or disorder of any urological organ.
In 1997, I decided to stop prescribing antibiotics empirically whenever my microscopic analysis of the urine was negative and the patient was afebrile. I was seeing about 350 “prostatitis” patients per year, so that meant that around 320 or more patients were NOT receiving antibiotics. Initially, I was scared to death! I had insomnia for three months because I was not practicing within “The standard of Care.” Nevertheless, I knew I was doing the right thing. This and many other practices, like knee jerk PSA screening, taught me the difference between practicing medicine legally (Standard of Care) and practicing ethically (Based on my thoughtful interviews and meticulous physical examinations).
I began prescribing specialized physical therapy in 1996, to those patients in whom I identified connective tissue abnormalities and myofascial trigger points consistent with their symptomology. I had to... (Continue Reading the full article at www.urotoday.com)