Chronic Pelvic Pain Syndrome (CPPS) is commonly diagnosed with debilitating impacts on patients, yet its aetiology remains unclear. Intraprostatic urinary reflux (IPUR) is a recognised risk factor for CPPS, however remains a diagnostic challenge. We present a case series demonstrating how Phenazopyridine, known to cause urine discolouration, can help identify IPUR. We hypothesise that in IPUR, discoloured urine mixes with intraprostatic semen, causing persistent semen discolouration after stopping Phenazopyridine.

Five CPPS patients were treated with Phenazopyridine and asked to monitor semen colour after discontinuation. The same test was performed on three healthy control subjects. This study received Institutional Review Board approval.

Of the five patients, four had positive results showing persistent semen discolouration. One underwent Video Urodynamic Study, with evidence of detrusor sphincter dyssynergia. These four patients were trialled on a combination of either Extracorporeal Shockwave Therapy, Baclofen, or urethral sphincter Botox injection, with favourable outcomes. One patient with a negative test result showed improvement on Tamsulosin alone, without any need for further treatment. All controls had negative results.

Our case series shows that Phenazopyridine can be a simple, non-invasive tool to suggest underlying IPUR. This allows us to gain insights into disease aetiology, and guide clinical management.