If you are searching for a prostatitis specialist in London, the chances are you have already been through the standard treatment pathway — and it has not worked.
Most men presenting to me with prostatitis have had one, two, or three courses of antibiotics. Their urine cultures came back negative. The pain persisted. They were told to try another antibiotic, or that there was nothing more to be done. Neither response reflects the current evidence on prostatitis management.
The reason this pattern is so common is straightforward: approximately 90% of all prostatitis diagnoses are Category III — chronic pelvic pain syndrome (CPPS) — which is not a bacterial infection. Antibiotics have no therapeutic target. They do not work because there is no bacteria to eliminate.
What is needed is a specialist who correctly establishes which category of prostatitis you have before recommending treatment — and who has access to the treatments that actually address Category III. This is what I do at Shockwave ReVibe Clinic, Notting Hill Gate. See also our Prostatitis Treatment service page.
"Antibiotics remain the most commonly prescribed treatment for all prostatitis presentations — because many practitioners do not perform the diagnostic workup needed to distinguish between categories."
The Four Categories of Prostatitis — Why Getting This Right Matters
The NIH classification system divides prostatitis into four distinct categories. Treatment differs completely between them — which is why accurate categorisation is the essential first step.
Category I — Acute Bacterial Prostatitis
Sudden onset bacterial infection of the prostate. Presents with fever, rigors, severe pelvic pain, and urinary symptoms — typically requiring urgent assessment and antibiotic treatment. Uncommon. Accounts for less than 5% of prostatitis presentations.
Category II — Chronic Bacterial Prostatitis
Recurrent bacterial infection of the prostate. Confirmed by positive bacterial cultures of urine or prostatic fluid. Appropriate prolonged antibiotic therapy (4-6 weeks) is effective. Less common than Category III.
Category III — Chronic Pelvic Pain Syndrome (CPPS)
The most common category — accounting for approximately 90% of all prostatitis diagnoses. (Schaeffer AJ, Journal of Urology, 2004) Characterised by persistent pelvic pain for more than three months in the absence of bacterial infection.
Category IV — Asymptomatic Inflammatory Prostatitis
Incidental finding — prostate inflammation discovered during investigation for another condition (elevated PSA, infertility workup). No symptoms. Typically requires no active treatment but warrants monitoring.
Symptoms of Prostatitis
Prostatitis symptoms vary by category and are assessed using the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) — the validated clinical scoring tool that measures severity across three domains: pain, urinary symptoms, and quality of life.
Pain symptoms:
- Persistent perineal pain or discomfort (between scrotum and anus)
- Lower abdominal or suprapubic pain
- Testicular or scrotal discomfort
- Pain at the tip of the penis
- Pain during or after ejaculation
- Discomfort when sitting for extended periods
- Lower back pain without spinal cause
Urinary symptoms:
- Urgency and frequency
- Incomplete bladder emptying
- Weak or interrupted urine flow
- Pain on urination
Associated symptoms:
- Erectile dysfunction — present in a significant proportion of Category III patients (see our guide to ED causes)
- Premature ejaculation — see our PE treatment guide
- Fatigue and sleep disturbance
- Anxiety and depression secondary to chronic pain
The overlap between these symptoms and other urological conditions — bacterial prostatitis, bladder pathology, urethral stricture — underscores why differential diagnosis by a specialist is essential before treatment begins.
Why Pelvic Pain Urologists and GPs Approach This Differently
A GP consultation for pelvic pain symptoms will typically result in a urine dipstick, possibly a midstream urine culture, and — most commonly — an antibiotic prescription. This is appropriate for Category I and II presentations. For Category III, it is not.
The reasons for this are systemic rather than a reflection of individual GP competence:
- A standard GP appointment does not allow time for the thorough history and NIH-CPSI assessment needed to properly evaluate prostatitis
- GPs do not routinely have access to the specialist investigations (prostatic fluid analysis, urodynamics, perineal ultrasound) that contribute to differential diagnosis in complex cases
- Focal shockwave therapy — the most clinically validated intervention for Category III — is not available through NHS primary care
A specialist urology consultation changes the clinical picture entirely. Dr Bahl performs a comprehensive assessment — including NIH-CPSI scoring, review of previous cultures and investigations, relevant blood tests, and where indicated clinical examination — before any treatment recommendation is made. See our Men's Urology consultation.
How Focal Shockwave Therapy Treats CPPS
For Category III prostatitis, focal shockwave therapy is the most clinically validated non-invasive treatment available. It addresses the underlying pathophysiology of CPPS — chronic tissue ischaemia, pelvic floor trigger points, and neurogenic inflammation — rather than managing symptoms pharmacologically. See our guide to how focal shockwave therapy works for the underlying mechanism, and our full CPPS specialist's guide.
- Angiogenesis — acoustic stimulation promotes new blood vessel formation in the chronically ischaemic pelvic tissue, restoring the blood supply fundamental to biological regeneration. (Wang CJ et al., Journal of Orthopaedic Research, 2002)
- Anti-inflammatory effect — shockwave therapy suppresses the inflammatory mediators (prostaglandin E2, substance P) that drive the chronic pain cycle in CPPS
- Trigger point dissolution — focused acoustic energy disrupts myofascial trigger points in the pelvic floor musculature, the hypertonic muscle bands that generate referred pain throughout the perineum and pelvis
- Pain modulation — direct analgesic effect through hyperstimulation analgesia and substance P reduction, addressing the neurogenic sensitisation that perpetuates chronic pelvic pain
At Shockwave ReVibe Clinic, every CPPS treatment is delivered using the EMS Dolorclast Focal Shockwave system — the same class of device used in the published clinical trials.
The Evidence
Zimmermann et al., 2018 — European Urology. The landmark randomised controlled trial for focal shockwave therapy in CPPS. 78% of patients receiving active treatment achieved a clinically significant reduction in NIH-CPSI scores — a reduction of 6 or more points. The sham group showed no significant improvement. Results were maintained at 12-week follow-up.
Vahdatpour et al., 2013 — Advanced Biomedical Research. Double-blind RCT demonstrating significant improvement in NIH-CPSI total scores, pain domain, and quality of life scores in men with refractory CPPS following shockwave therapy, compared to sham at both 4-week and 12-week follow-up.
Moayednia et al., 2014 — Journal of Research in Medical Sciences. Significant improvement in pain and quality of life scores at 3-month follow-up in men with Category III CPPS following shockwave therapy.
What the Consultation Involves
- Comprehensive specialist assessment — Dr Bahl takes a thorough urological and symptom history: duration of symptoms, previous treatments, antibiotic history, culture results, and relevant investigations. The NIH-CPSI is completed at baseline to quantify severity across all three domains.
- Differential diagnosis — CPPS symptoms overlap with several other urological conditions. Dr Bahl establishes the correct diagnosis, ruling out bacterial prostatitis, bladder pathology, and other conditions, before any treatment is recommended. This is not a formality. It determines the treatment pathway.
- Category-appropriate treatment — for Category I and II (bacterial): appropriate antibiotic prescription based on culture and sensitivity. For Category III (CPPS): focal shockwave therapy, typically 6-8 sessions delivered weekly or bi-weekly (see our guide to session numbers by condition). For Category IV: monitoring and investigation of the underlying reason for discovery.
- Progress monitoring — NIH-CPSI scores are reassessed during and after the treatment course to track improvement objectively. Treatment protocol adjusted based on clinical response.
Initial consultation: £59. No referral needed.
Prostatitis Treatment Comparison
| Treatment | Effective for Category III | Addresses Cause | Evidence Quality |
|---|---|---|---|
| Antibiotics | No | No | Not effective for non-bacterial |
| Alpha-blockers | Partially (urinary symptoms) | No | Moderate — symptom relief only |
| Anti-inflammatories | Partially | No | Moderate — short-term relief |
| Focal Shockwave Therapy | Yes | Yes | Strong — multiple RCTs |
| Pelvic floor physiotherapy | Partially | Partially | Moderate |
| Surgery | Not indicated | N/A | Not appropriate for Category III |
Dr Kishore Bahl
Every prostatitis consultation at Shockwave ReVibe Clinic starts with establishing the correct category — not another antibiotic prescription. Read our complete guide to CPPS treatment →
Frequently Asked Questions
What is the difference between prostatitis and CPPS?
CPPS (Chronic Pelvic Pain Syndrome) is Category III prostatitis — the most common type, accounting for approximately 90% of all prostatitis diagnoses. The terms are used interchangeably. The critical clinical distinction is that Category III is not bacterial, which is why antibiotics are ineffective for most men diagnosed with prostatitis.
Why hasn't my prostatitis improved with antibiotics?
Because you almost certainly have Category III CPPS — a non-bacterial condition for which antibiotics have no therapeutic target. If your urine cultures have been negative and multiple antibiotic courses have not produced lasting improvement, a specialist urology assessment is the appropriate next step.
How is CPPS diagnosed?
Diagnosis is clinical — based on comprehensive history, symptom scoring using the NIH-CPSI, exclusion of bacterial infection through culture, and clinical examination. There is no single diagnostic test. This is why a thorough specialist assessment is essential — it cannot be done adequately in a standard GP appointment.
Does shockwave therapy work for prostatitis?
For Category III CPPS — yes. A 2018 RCT demonstrated 78% of patients achieved clinically significant improvement following focal shockwave therapy. It is not appropriate for bacterial prostatitis (Categories I and II), which requires antibiotic treatment.
How many sessions are needed?
Typically 6-8 sessions for Category III CPPS, delivered weekly or bi-weekly. NIH-CPSI scores are reassessed during the course to track progress and adjust the protocol if needed.
Can prostatitis cause erectile dysfunction?
Yes. ED is present in a significant proportion of men with Category III CPPS — through both physical mechanisms (chronic pelvic inflammation affecting penile vasculature) and psychological mechanisms (chronic pain and anxiety). Effective treatment of CPPS typically improves associated sexual symptoms.
Do I need a GP referral?
No. You can book directly with Dr Bahl without a GP referral. Initial consultation: £59. Everything is completely confidential.
Is the clinic in London?
Yes — 22 Notting Hill Gate, London W11 3JE. Two minutes from Notting Hill Gate tube station (Central, Circle, and District lines).
Clinical References
- Schaeffer AJ (2004). Epidemiology and demographics of prostatitis. Journal of Urology, 172(5): S3-S5.
- Zimmermann R et al. (2018). Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males. European Urology, 73(1): 74-81.
- Vahdatpour B et al. (2013). Efficacy of extracorporeal shock wave therapy in the treatment of chronic pelvic pain syndrome. Advanced Biomedical Research, 2: 49.
- Moayednia A et al. (2014). Long-term effect of extracorporeal shock wave therapy on the treatment of chronic pelvic pain syndrome. Journal of Research in Medical Sciences, 19(4): 293-296.
- Wang CJ et al. (2002). Shock wave therapy induces neovascularisation at the tendon-bone junction. Journal of Orthopaedic Research, 21(6): 984-989.
- European Association of Urology (2024). EAU Guidelines on Sexual and Reproductive Health. EAU Guidelines Office, Arnhem, The Netherlands.
Dr Kishore Bahl is a Specialist Grade Doctor in Urology (GMC Registration: 6070860) and founder of Shockwave ReVibe Clinic, 22 Notting Hill Gate, London W11 3JE. To book a consultation, call 020 3004 0564 or visit shockwave-revibe.co.uk.
Last reviewed: September 2026