Radical Surgery to Treat Prostatitis

Health Professional

I was recently contacted by another urologist who asked me a very interesting question - Are you aware of using a radical prostatectomy to treat prostatitis? Prostatitis is an infection or inflammation of the prostate gland. There are different grades of prostatitis. Acute bacterial prostatitis develops when a bacteria grows inside the cells of the prostate causing fevers and severe burning when urinating. Chronic bacterial prostatitis develops when the bacteria returns to the prostate cells but the symptoms are not as severe. The man may have a low grade temperature, some discomfort when he urinates, and aches of the genitalia. These are very curable with antibiotics. Chronic non-bacterial prostatitis occurs when inflammatory cells are present in the prostate cells, not bacteria. This can occur in men after trauma, prolonged sitting, recent viral syndrome and previous bouts of bacterial prostatitis. This is the most common type of prostatitis that I see in private practice. Men generally complain of a generalized ache of the genitalia, pain in the perineum, blood in the ejaculate, low back pain, pain with ejaculation and a slow stream. This can be very annoying and even debilitating for men.

The typical treatment for chronic non-bacterial prostatitis varies from urologist to urologist. We tend to offer antibiotics such as levaquin, anti-inflammatory medications such as Motrin or Celebrex and prostate medications such as Flomax. I would say that 80% of men see improvement with antibiotics and anti-inflammatory medications. The remaining 20% may require prolonged antibiotics and a further work-up. This would include a prostate ultrasound and cystoscopy. Surgery is usually the last option for this ailment. A transurethral resection of the prostate (TURP) is a method of scraping out the inner portion of the prostate gland. It's like removing the pulp of an orange while leaving the outer rind intact. The idea is to remove the inflamed tissue and allow the prostate to heal. This can be very effective and men notice improved symptoms.

Now, let's address this urologist's question. Can radically removing the prostate cure prostatitis. Here's the story: a 55-year-old man with chronic non-bacterial prostatitis had 8 years of perineal pain, blood in the ejaculation and painful orgasms. He was treated by multiple urologists and failed multiple medical treatments including multiple antibiotics. This urologist performed a laparoscopic radical prostatectomy for the symptoms associated with prostatitis. He claims the patient had immediate control of his urine, spontaneous erections and complete resolution of his symptoms.

This is very controversial and I cannot find any reports studying the use of a radical prostatectomy to treat prostatitis. Nevertheless, it is intriguing. The recent advances in laparosopy and robotic surgery to cure prostate cancer may give urologists another way to treat debilitating prostatitis. I am curious to know if men would be willing to have this surgery to cure chronic prostatitis.