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

Dr. Krongrad, is there a difference in bi lateral nerve sparing with no cancer (ie prostatitis) and those who have cancer? What I mean is, can you leave a larger prostate facia behind when cancer is not a risk, meaning less heat damage to nerves as more space between cautery and nerves, ie less thermal transfer?

Please correct me if my question doesnt make sense.

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Nik, There is no real difference in the techniques. In any event, I use harmonic dissection, not cautery (much less heat). And in any event, the real issue in assessemnt of risk of erectile dysfunction is the overall health and age fo the patient. I do not believe that the micro-differences you are asking about are anywhere as material to the questin as those and some other clinical patient characteristics. Arnon
Thanks for your answer Dr. Krongrad, harmonic dissection certainly seems superior in terms of any possible thermal damage. So I guess the best thing a patient can do within his control before LRP are regular pelvic floor excersises & to get as fit as possible. Swimming is the only excersise I can still do with intensity, without worsening the prostatitis.
Dr Krongrad, thanks for answering questions so readily. It's greatly appreciated (even when I don't understand the question!). Could you tell us how the research study of prostate removal for chronic prostatitis is going? Are you doing many operations for this, and with what degree of success? I have a feeling that it may be difficult to get many people who are willing to undergo the procedure.
True. Not many people even know about the cases of such men as Radford and Ike and fewer still know about the trial. In any event, we have now accumulated a number of cases, including the ones cited on the left column of the home page, that showed dramatic and durable relief of symtoms.
Hey,

I think hopefully once the study is published it will give sufferers another avenue of treatment (actually a cure) for the condition. I also think once people have tried the traditional treatments that do not work for many sufferers a lot of people actually do and would consider having surgery. Thats just what I think.
I am one of the ones seriously thinking about this. I am in the middle of the 1st cycle of IVF at the moment (going to do 3 cycles if needed)with my partner so right now its out of the question (prostatitis has made my fertility very low). I have just lost my "sitting down" engineer job due to redundancy, so I am also weighing up looking for a new career which does not involve sitting for long periods-the worst thing for my symptoms.
I am working my way through any last treatments or lifestyle changes before deciding to do LRP. I do really believe its the only "one off cure" instead of paying for a lifetime of symptom reducing treatments, pain control, injections etc. I also believe that in the large majority of cases this is a prostate centered problem, not a pelvic floor muscular problem. This disease is a prison. It plays with your mind, destroys your social life, holidays, career, sleep pattern & ability to sit comfortably. Chances are at some time later in life this could lead to cancer anyway, so you will still end up doing LRP when your older and recovery is slower. Whats the first thing anyone says to you when you arrive for a business meeting or any kind of social function "TAKE A SEAT" or "PLEASE SIT DOWN" or "MAKE YOURSELF COMFORTABLE". After a few years of prostatitis I get fed up with hearing it.......!!!!!
Great post Nik! you describe very well the scars of this debilitating condition.

I hope this study will be able to draw a tendency of effectiveness according to the type of prostatitis (CP II, IIIA, IIIB).

Nik said:
I am one of the ones seriously thinking about this. I am in the middle of the 1st cycle of IVF at the moment (going to do 3 cycles if needed)with my partner so right now its out of the question (prostatitis has made my fertility very low). I have just lost my "sitting down" engineer job due to redundancy, so I am also weighing up looking for a new career which does not involve sitting for long periods-the worst thing for my symptoms.
I am working my way through any last treatments or lifestyle changes before deciding to do LRP. I do really believe its the only "one off cure" instead of paying for a lifetime of symptom reducing treatments, pain control, injections etc. I also believe that in the large majority of cases this is a prostate centered problem, not a pelvic floor muscular problem. This disease is a prison. It plays with your mind, destroys your social life, holidays, career, sleep pattern & ability to sit comfortably. Chances are at some time later in life this could lead to cancer anyway, so you will still end up doing LRP when your older and recovery is slower. Whats the first thing anyone says to you when you arrive for a business meeting or any kind of social function "TAKE A SEAT" or "PLEASE SIT DOWN" or "MAKE YOURSELF COMFORTABLE". After a few years of prostatitis I get fed up with hearing it.......!!!!!
Funny you mention that.

This week I operated on a man with a 6-year history of severe prostatitis. How severe? He wound up having spinal fusion and then a second operation to remove hardware that actually did nothing for him. He was unable to sit, including at the neurosurgeon's office.

The only good news that since his LRP a few days ago he has been symptom free, able to sit and lie down comfortably off Percocet for the first time in years.
Thanks for the info Dr Krongrad. It never ceases to amaze me what lengths some doctors/surgeons go to "not to remove a mans prostate" unless it will kill him, even if there is a reasonable chance of resolution. What will they do next, send him to a brain surgeon to remove the part of the brain that feels pain? Anything but remove the prostate....!!!! LOL.

Arnon Krongrad, MD said:
Funny you mention that.
This week I operated on a man with a 6-year history of severe prostatitis. How severe? He wound up having spinal fusion and then a second operation to remove hardware that actually did nothing for him. He was unable to sit, including at the neurosurgeon's office. The only good news that since his LRP a few days ago he has been symptom free, able to sit and lie down comfortably off Percocet for the first time in years.
In fairness, I think the spine surgeon was facing a reality in which the prostate is generally not thought to be a source of back pain. It's not that he was avoiding to take it out (not that he is qualified), but that he probably never even thought about the prostate as he was evaluating the man who became my patient. Neither had the patient at that point. The reality is that prostatitis is a condition that is generally very poorly understood and very much under-appreciated, all the more so by doctors who are not urologists (including spine surgeons). What you are asking is akin to asking mere mortals living in 1492 to accept that the earth is rounded. It's beyond their abilities because it has simply never before been suggested.

I asked my patient to go back to his spine surgeon and share developments with him. Maybe one day his report will mean that some unlucky man will be spared a needless spine operation.

In the case we are discussing, the man looked physically normal. His pelvic anatomy looked physically normal. His prostate was normal to the pathologist: no cancer, no inflammation. Yet mere hours post op, lying flat and comfortable for the first time in years, he reported feeling as if a softball had been removed from his rectum. He later reported that his back pain has disappeared. This is a virtually identical report to the one issued by Radford, who likewise was comfortably supine for the first time in years and who said simply "it feels like someone pulled a golf ball out of my ass." Why is this so? I cannot tell you. All I know is that removing the prostate gave them the relief they so desperately wanted.
Very interesting Dr Krongrad. You, mention the patient had a normal small prostate yet the surgery cured him. This goes to show a normal looking prostate with no inflammation detected can still cause miserable prostatitis. Pelvic floor disorder would have been this guy’s diagnosis in the current leading authority for prostatitis. Years of painfull pt would have been his prescription.I doubt a pt would have cured this guy. Hopefully this man will post after he recovers. Thanks for the interesting post Dr K. So the lesson here is a normal appearing prostate can indeed cause prostatitis symptoms. This is big news and helps me understand my condition.
He is not unique, Mike. What we are saying is that there is a distinction between histological and clinical prostatitis, which is not really new. The mystery is why many men have the symptoms we refer to as "clinical prostatitis." And why, as in his case as well as such cases as Ike's and Radford's, the symptoms were completely eliminated by prostatectomy.

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