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Acute and chronic prostatitis discussion. Arnon Krongrad, MD, moderator.

Dr Krongrad,

Epididymitis has long been associated with chronic prostatitis; in fact, most urologist I have seen down the years have said epididymitis in itself is a symptom of chronic prostatitis.

As a last resort, if I opt to have my c.p. treated by radical prostate removal, would that also cure the epidymitis? Or would I be left in the unenviable position of having no prostate gland after surgery, yet still suffering the severe testicle pain which I suffer now?

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Chris,

The short answers are:

1) radical prostatectomy means removal of the entire prostate and both seminal vesicles. So if you have a radical prostatectomy then no more SVs.

2) Given how few radical prostatectomies have been done for chronic prostatitis we have no idea if the symptoms are coming from the prostate or the SVs or both. Given the answer to one, the issue is moot if you have a radical prostatectomy.

3) The issue of "where is it really" came up with Mr. Radford. He had been sent to me for a seminal vesiculectomy. I advised against it on the grounds that there was no way in the world to know that his pain was coming from the SVs and not the prostate. He accepted the argument and the rest is history. Everything came out and his symptoms disappeared.
Dr Krongrad,

You don't seem to have answered the question. To emphasise the seriousness of the condition, here is a similar question from another prostate sufferer from a different forum (I have edited the question for purposes of clarity):

The Epididymitis question posted on Krongrad's forum is exactly what I was going to ask. That is my current situation. Terrible testicle pain that is unrelenting. I would get rid of both nuts tomorrow if I knew my pain would be completely gone. I had spermatic cord denervation surgeries on both sides which gave me relief for about two months. Those two months were like heaven. I wish I knew if the infection in my prostate is causing the ball pain. I would hate to remove the prostate and still have ball pain. I would then jump off a bridge.

Maybe the question is too difficult for you to answer, Dr Krongrad. But what it does show in graphic detail is just how difficult chronic prostatitis is to treat, and probably why 99.9% of urologist prefer treating prostate cancer, which they find much easier and far less complex to deal with (and maybe more profitable too).
Chris,

I may indeed not be understanding the question. For one, I am getting a bit lost in the terms prostatitis, epididymitis, and what I think your source is referring to as orchitis as evidenced in testicular pain. The terms are not synonymous and I believe what you and I are trying to get at is cause and effect. For example, does prostatitis and/or epididymitis cause pain that is perceived to be testicular in origin when in fact it is not testicular in origin [what we call referred pain]? Is that the question? Please help me to understand.

I am traveling for a few days and may be unusually slow in responding.

Thank you.
Dr Krongrad,

Thank you for your open-minded response. As far as I know, Orchitis is an inflammation of one or both testis, accompanied by swelling, pain, fever, and a sensation of heaviness in the affected area. In my opinion, I don't have Orchitis, because I have no swelling or fever. My symptoms are pain and discomfort in both testis at all times.

On a recent trip to China, I sought treatment from a professor of urology. The professor examined both testis and said that I had epidimytis; as soon as he put any pressure on any part of the testis, I was in severe distress. I am sure that this was not a "referred pain", as you put it; but a very real, bone-shuddering pain which originated in the epididymis. The professor said that epididymitis is an effect of chronic prostatitis, and that both illnesses were closely related.

Which brings me back to my original question: would removal of the prostate also solve the epididymis problem? If it would, it would be an extremely attractive proposition for me.

In medical jargon "itis" means inflammation. For example, meningitis is inflammation of the meninges and hepatitis is inflammation of the liver.

We should be very careful to distinguish anatomical/histological inflammation from clinical "inflammation." Consider that prostatitis classifications take this into account. For example, type I is acute infectious prostatitis; type II is chronic infectious prostatitis; type III is not infectious but clinically symptomatic "prostatitis;" type IV is asymptomatic but anatomical true histological prostatitis.

With that intro ... back to your question. You are describing intra-scrotal tenderness that is presumably due to epididymal inflammation (infiltration of the epididymis with inflammatory cells). In other words, we are assuming clinical epididymitis.

You ask if the sensations you feel, which we assume are epididymitis, are affected by the prostate and what may or may not be histological prostatitis or clinical prostatitis. In other words, does prostatic disorder refer pain to the epididymis. Answer: I do not know.

Keep in mind that there are no studies of prostatectomy for prostatitis; there are no studies of prostatectomy for epididymitis. To the best of my knowledge there are at best case reports like those of Mr. Radford. So there is no science to back up an assertion that removing the prostate relieves men of scrotal pain. I am not saying it would not; I am saying we do not know one way or the other.

On a related note ...

I have now done another prostatectomy, this time for a man who had two previous partial prostatectomies for 20 years of pelvic pain, "funiness," and burning; he got no relief from those partial prostatectomies. He also complained of pain in his right foot that he thinks was related to the pelvic pain.

He is three weeks post op from I refer to as a "salvage" prostatectomy. His symptoms are going away quickly, including the "funiness" and the pain in his foot. Does "prostate pain" refer elsewhere including epididymis and foot? That is the question for which we have no answer. All we have is one man's suggestion that it can.
thank you doctor for being honest. i would rather you tell us you dont know. then to tell us a lie like many others have and we wind up worse off. i think you are doing us a great service on this board and taking the time to answer questions.

GOD BLESS US ALL!
Did your latest patient symptoms went away?
Did your latest patient symptoms went away?

Yes. They have gone away after 20 years.
Yes. They have gone away after 20 years.
Great news! Can't wait to read his testimony.
Another, early happy customer who had it done in France-the pioneers of the LRP.

http://www.cancer.org/asp/messageBoards/msg_global.asp?navToScreen=...

Dr. Krongrad it would be very interesting to screen people who apart from prostatitis have also epidydimits present and what happens to them post-operatively?

is the epidydimits gone after prostatectomy or due the bacteria trap in the testicles and cause further problems?

I am interested since i suffer from both prostatitis + epidydimitis and would like to know if a surgery would help this

 

moreover there are many cases of post-operative epidydimits, how is this treated today?

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