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

I wonder if anyone can give me advice/an opinion about this. My question is about testicular pain. I know that prostatitis causes testicular pain. Is this the same as epididymitis? I have chronic prostatitis, but also have chronic epididymitis. That is, ultrasound shows inflammation of the epididymis, and the pain is quite location specific - if the doctor touches that particular spot it's very painful. To what extent are the two things connected, or are they separate issues? The reason I'm asking, of course, is to determine whether if I had my prostate removed would that help the epididymitis problem? Or will I continue to have testicular pain, even if the prostate problem is resolved? Does anyone else have this problem or had it resolved with LRP?

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In the old days of transurethral prostatectomy, the operation would begin with a vasectomy. This cut down the risk of epididymitis from retrograde migration of bacteria into the epididymis and testis. In other words, there is actually a physical connection of the prostate and the epididymis and testis.

The connection of prostatitis symptoms to symptoms arising from the epididymis and testis is less obvious. While many prostatitis patients have scrotal discomfort, the relationship is not clear. Even less clear is the likelihood that curing the prostatitis (perineal pain, urethral pain, suprapubic pain) will get rid of the scrotal complaints. There are simply no data that I know of relating to this. You probably cannot count on prostatitis relief bringing epididymal relief.

As to testicular and epidydimal pain, those two may be hard to distinguish, as is common with all visceral pains: They can be very hard to localize.

You may want to read about a patient with prostatitis, irritable bowels, and epididymis pain.
Thanks for the information, doctor. It's certainly difficult to isolate the source of pain. It's true that when my prostatitis symptoms are worst, so is my epidydimal pain. Perhaps one option may be to try spermatic cord denervation first, as it's a simpler procedure. However, I hear that some guys have problems after that operation too.
All surgical procedures carry risk. Among the reported risks of spermatic cord denervation are testicular atrophy, woulnd infection, hydrocele, and treatment failure.

I am aware of only one patient who had both laparoscopic radical prostatectomy (LRP) and spermatic cord denervation. He had the LRP first and now reports relief of his prostatitis symptoms (he's still in the early weeks post-op). However, his scrotal pains did not improve. He reports that they are persistent after spermatic cord denervation, which he chose to have a few weeks after the LRP. This experience of one patient only shows that prostatitis and epididymitis/orchitis can be separable clinical problems.

I would not go into either one expecting both to be solved. If they are, wonderful.
Thanks again, doctor. Perhaps with time your patient's epididymal pain will resolve itself. I guess he was on such an 'up' after the resolution of his prostatitis pain that he thought he'd go the whole way and have denervation too. I wish him good luck (and myself, too!).
Varicocele is often found with prostatitis too, as in my case on the left side of the scrotum. Interestingly my prostatitis and heavily calcified seminal vesicle is also on the left. Varicocele can also cause testicular pain although not in all sufferers. This may also be contributing to my infertility. There is also surgery for Varicocele too if this is found. There are two procedures, Varicocelectomy or Embolization.

http://en.wikipedia.org/wiki/Varicocele





You may be interested in a new story about a patient whose testicular pain resolved after his prostatitis surgery.
That's certainly very encouraging. I've always felt that most of my testicular pain was stemming from my prostate in some way. I've no rational explanation for that, other than a 'feeling', instinct or whatever.
Has anyone ever had nerve pains in the inner thigh, down to the knee with their testicular pain?  My epididymitis has seemed to flare up again, but I am getting intense nerve pain (stabbing and burning) down to the knee as well.....
A number of my patients have reported pain in the thighs. A couple have reported pain in the feet. One reported pain in the armpit. All associated with flareups.

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