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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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Epidydimitis used to be a consequence of transurethral-prostatectomy (TURP) when that technique was first developed. For that reason, back in the early days of TURP, the operation used to start with vasectomy. Leaving that historical note aside, I am not aware of prostate operations that cure epididymitis. I can think of one patient with chronic prostatitis who had concurrent epididymal pain whose pelvic and other typical prostatitis symptoms completely went away with prostatectomy but whose scrotal/epididymal pains persisted. Based on all this composite knowledge, I do not know of a basis to believe that prostate surgery will cause reductions of scrotal pain and/or epididymitis. If anyone knows of examples of prostate surgery curing scrotal pain, please share.

Mark, I just noticed your post from 2008. Click here to read the patient's story of prostate surgeries.

Chris, I've re-read my answers above. Looks like I substituted seminal vesicles for epididymis. Sorry for any confusion.

So does this mean that epididymitis is irrelevant to prostatitis?  Don't inflammation from the prostate regularly spread down the epididymis??

I ve heard of many cases of people with epididymitis who had their epididymis surgically removed but still problems with pain in their testicles and inflammations kept coming. I even know of one person who had both testicles removed due to testicular pains but still radiating pain continued and he ended up having prostate massages to soothe that in the end.

 

Why wouldn't a prostate surgery improve or lessen epididymal swelling, if we consider that the basic bacterial/inflammatory burden stems from the prostate??

When i had prostate massages at the peak of them, my epididymal and prostate inflammation went down altogether, but at the end of the treatment they all came back and now im opting for prostate removal

 

It's important to separate theory from proof of theory. And keep terms clear. So first of all, while bacteria and viruses can spread, I'm not sure I'd think of inflammation as spreading, except perhaps secondarily as a reaction to bacteria and viruses spreading. Secondly, while bacteria and viruses may in theory spread retrograde from the prostate, through the vas, to the epidydimis, I'm not sure how one would prove that mode of transmission. It's certainly possible that they are blood-borne and affect one or both without any direct vasal transmission.

 

One can consider the "basic bacterial/inflammatory burden" anywhere one wants. But is there any proof of such a concept? More to the point, regardless of the theoretical construct, are there any empirical data to support the construct?

Are there data to show prostate surgery relieving scrotal/epididymal/testicular pains? If so, please share.

 

I guess you're saying your symptoms diminished with prostate massage, including scrotal symptoms? If so, why not continue with massage?

No, that is why i am asking you sir, if you have any data of patients that presented to you with prostatitis or prostate cancer along with epidimytis who got relieve of the epididymitis and their testicular pains/redness after you removed their prostate?

As i understand you say no?? So their epididymis continues post prostatectomy??

Is it easier treatable after the prostate is removed?

Or are we talking about two different entities completely?

Most docs i have consulted with told me epididymitis stems from prostatitis somehow, thats whre it feeds from in terms of bacterial spreading. I am not sure about the viral complexity.

Massages worked for a while then they stopped working and my prostate inflammed back, actually to its original pre-massage contition exactly (26 cc)- its like it never took place !!!

 

Other than the patient I mentioned above, whose pelvic pains disappeared but whose scrotal/epididymal pains did not disappear, I have no data on any other such patient. I am aware of no data or case to support the notion that prostate surgery improves epididymitis.

Well, thats not very good then, at least for me..

I wonder all them cancer (most of which could be previously BPH patients) how they coped for in case they had epididymitis, i mean what did they do after the prostate surgery, did they get back to antibiotics or anti-inflammatories?

It strikes me very strangely that no-one reported this, is it of no interest at all?

 

You're talking about events occuring at the dawn of the antibiotic era. Not sure it's of any relevance to today, other than to say that prostate surgery can cause epididymitis (which is the opposite of what you are asking about: can prostate surgery cure epididymitis?).

Why are you referring to antibiotics in connection to our discussion? I don't think they belong to my prostate era, at least my chronic prostate/epididymal era. They made me much worse despite trying them in various combinations/dosages throughout all them years.

The cases I referred to before -- epididymitis after TURP, an operation for BPH, which was surely caused by retrograde transmission of bacteria through the vas from the prostate to the epididymis -- were in the early days of TURP, which partly overlapped with the beginning of the antibiotic era (remember penicillin, the first antibiotic was discovered in the late 1920s). It was merely a historical reference to indicate that these events belong to days gone by.

 

It's not a reference to your situation. I do not understand your situation, how finasteride may have gotten you there, or the possible role of bacteria in possibly causing your symptoms, or the possible role of antibiotics in resolving or exacerbating your symptoms. These are things you might want to review with your doctors.

My doctors have gone as far as possible. Now its a matter of science fiction to fix us i guess.

We know that our 5-ar II enzyme is really depressed post-finasteride, in some it is completely deactivated.

We also have documented prostate inflammation during and post-finasteride use with trans-rectal ultrasounds. 

The question is what we do from now on?

The answer is probably.. nothing.. Wait to develop cancers, turn into women etc etc..Some have commited suicide, others performed penile implantation surgeries, others got serious lifelong side effects from huge doses of testosterone and cortisol in order to continue living. Other' ended in the psych ward. The problem is that no-one knows what to do, or how to treat this awful condition. Most are experimenting and turn us into guinea pigs.

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