Surgery for Chronic Prostatitis


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Six men with severely symptomatic, treatment-resistant chronic prostatitis achieved resolution of their disease after undergoing laparoscopic radical prostatectomy, according to results of an ongoing, prospective Phase II clinical trial. The results were published in the April 2011 issue of UroToday International Journal.

Laparoscopic radical prostatectomy is a minimally invasive surgical procedure in which surgeons need to make only four to five tiny incisions to remove the prostate gland. After carbon dioxide is injected into the abdominal cavity to lift the abdominal wall to allow the surgeon a better view, he or she uses an instrument called a laparoscope to precisely dissect the prostate gland, seminal vesicles, and vas deferens and remove them through one of the incisions. Unlike traditional radical prostatectomy, which requires a large incision and long recovery period, laparoscopic prostatectomy is associated with a faster recovery, tiny incisions, less pain, and less risk of infection.

The six men in the study (average age, 48.5 years) had been suffering with chronic prostatitis for a mean of 6.5 years (range, 3-31 years) and were otherwise healthy. Some of the symptoms they experienced included groin, perineal, scrotal, back urethral, and/or armpit pain, in addition to fatigue, irritable bowels, depression, weakness, malaise, body aches, impaired cognition, and impaired social interactions.

Prior to undergoing laparoscopic radical prostatectomy, all the men had failed to get relief from a variety of medical, surgical, and complementary therapies, including but not limited to antibiotics, alpha-blockers, narcotics, physical therapy, prostate massage, and various surgeries. Each man had consulted up to 20 medical and complementary health professionals.

Investigators used the Chronic Prostatitis Symptom Index (CPSI) to determine each patient’s symptom severity prior to and at 1, 3, 6, and 12 months after laparoscopic radical prostatectomy, which was uncomplicated in all six cases. The median CPSI score before surgery was 35, and by 6 months postsurgery it was 10, which was significantly lower than pre-surgery scores. At 12 months the CPSI score was 7.5.

The study’s authors point out that theirs are preliminary results, and that “there is little knowledge of the durability of symptomatic relief beyond 1 year.” They also note that other treatments for chronic prostatitis are usually safer and less costly. Therefore laparoscopic radical prostatectomy “should be seen as potentially appropriate as a treatment of last resort for those patients who have failed many other options,” especially as radical prostatectomy causes infertility and is associated with the risk of urinary incontinence, erectile dysfunction, and other complications.

However, the investigators also conclude that this trial suggests that laparoscopic radical prostatectomy may offer symptomatic relief “for carefully selected patients whose quality of life is clearly very low and who have failed other treatments.”

Read more in our Prostatitis Health Center.

Reference

Krongrad A, Lai S. Laparoscopic prostatectomy for severely symptomatic, treatment-refractory chronic prostatitis: preliminary observations from an ongoing Phase II clinical trial. UroToday Intl J 2011 Apr; 4(2):  art 30.