A leading Uro in the Uk views on prostatitis

[graeme]

As he answers one guys question about his prostatitis symptoms !

Dear ******

Firstly, how old are you, if you are less than 40ish then the PSA is of little
value as prostate cancer is very rare in younger men, also the PSA is a non
specific test and will vary due to a range of circumstances

This is just some background, sorry to those who have read it before!!

Many patients I see are at their “wits end” they can’t work, their marriage is
failing they are in constant pain and some have been told by their clinician “go
away and live with it”

Prostatitis is an inflammation of the prostate gland, which forms part of the
reproductive system however; local structures such as nerves, muscles & blood
vessels may have an impact on this condition. It is very difficult for a
clinician to make a firm diagnosis such as abacterial or chronic prostatitis;
"Chronic Pelvic Pain Syndrome" etc without doing some investigations such as
Stamey localisation test even then it can be difficult! On the other hand acute
prostatitis is normally quite straightforward to diagnose.

Quite often prostatitis is diagnosed as a urinary tract infection (UTI) which,
are not very common in men due to the length of the urethra therefore; urinary
symptoms should in my opinion be investigated more fully than just a urine test,
which more often than not comes back from the laboratory as negative due to the
type of microbiology employed for example a UTI may well be due to other
conditions such as sexually transmitted infection, which must be excluded using
other tests

The aetiology of prostatitis is poorly understood, we know that it may be
caused by infections such as E. coli, Chlamydia, Mycoplasma, Ureaplasma spp and
a range of other microbes however; Prostatitis can be caused by stone/crystal
formation, reflux of urine, autoimmune disease, (molecular mimicry) inflammation
of the nerves supplying that area, pelvic floor tension etc.


The prostate is a gland situated underneath the bladder (the bladder neck) and
is perforated by the first portion of the urethra. The two ejaculatory ducts
enter the upper part of the prostate from behind, travel through the gland and
open into the urethra on a small protuberance (3-4 mm) of the urethral mucosa
called the verumontanum ("veru"). This structure is critical because of the
convergence of several other structures:

Between the two openings of the ejaculatory ducts, we find the opening of the
utricle; The appearance of the utricle can vary widely from a tiny dimple in the
veru to a long narrow duct extending deep into the prostatic tissue parallel to
the ejaculatory ducts in the midline. In some individuals, this duct obliterates
forming a cyst in the prostate, rarely the cause of symptoms identical to those
of "chronic prostatitis".

The prostatic acini produce a fluid that, at orgasm, is expelled from the acini
by contraction of the prostatic smooth muscle tissue surrounding these acini.
The composition of prostatic fluid is complex and is vital for the well being of
the spermatic cells outside the body and severe alteration, like in certain
forms of
chronic prostatitis, can reduce fertility by forming antibodies that stick the
sperm together or affecting the quality of the fluid and thus its function


Symptoms

The range of symptoms is varied and any combination can occur, they are not in
order of frequency but they are most common that have been described to me over
the years!!

Occasional vague discomfort in the testicles, urethra, lower abdomen, and back
Getting up at night and having a wee more than a couple of times
Problems starting or finishing a wee
Pain or stinging during a wee
Discharge from the penis (seen as pus or stains in the underpants)
Pain/aching in the low abdominal area
Pain/aching in the testicles
Pain/aching in the area between the anus and scrotum
Pain/aching in the lower back area
Pain/aching down the front or sides of the leg's
Pain/aching during ejaculation
Blood in the semen
Patients might refer to sitting on a golf ball
Pain/aching after driving or sitting for a time
Can't sit in a meeting without worrying about having to wee
Lack of Libido
Fertility issues

Some men report, a pain /burning in the bladder, also they may suffer with an
irritable bowel

Pain or discomfort on ejaculation is quite common & is due to the prostate
contracting which expresses prostatic fluid into the ejaculatory ducts, in doing
so the prostate becomes inflamed (similar to pressing a spot). Many men describe
that they stop having sex due to prostate pain and the constant aching post
ejaculation.

Treatment

Various therapies have been applied to the problem such as Massage & Drugs but
we should also reduce stress and tension both of which affect the pelvic floor
muscles. The most common treatment is the use of antibiotics for approximately
six weeks with or without massage; I favour the use of massage as this help with
the penetration of the antibiotic into congested areas of the gland

Quite a few men say that prostatic massage helps with symptoms, this at first
seems a little confusing when you consider that the massage has a similar effect
to the ejaculation during sexual activity, however the massage is very vigorous
and if performed properly the massage will extend all over the prostate gland
expressing a great deal of its contents also during this process any
micro-abscess or blockage present may burst or dislodged reducing the
inflammation.

Chronic pelvic pain syndrome may respond to physiotherapy that realigns the
pelvis or works on trigger points that reduce the pain. I have often been asked
if surgery helps the condition, the answer is not simple, however I am yet to
find a patient that has responded to this form of treatment for “prostatitis” of
course it maybe necessary in other forms of prostate pathology such as cancer or
benign prostatic hypertrophy (BPH).

Trigger point therapy

As with all disease it is very important to have a good diet that is composed of
at least 2 litres of water per day, a varity of fresh produce such as broccoli,
cabbage, onions, mixed green & other vegetables, garlic, salads, tomatoes, olive
oils, oily fish, lean meat even some good red wine, it maybe necessary to add in
a supplement such as zinc or fish body oils, however it is also important to
reduce salt, fats and refined sugars/carbohydrates

In conclusion if you have persistent urinary symptoms or symptoms described in
this article, talk to your general practitioner and explore your condition and
if you don’t feel as though you have been fully understood then ask for a second
opinion.

Hope this helps

[webslave]

Oh dear, more rubbish from members of the medical profession who are not paying attention to research!

Prostatitis is an inflammation of the prostate gland, which forms part of the
reproductive system

95% of men with chronic prostatitis / chronic pelvic pain syndrome IIIa and IIIb have little or no inflammation in the tissue of their prostates.

It is very difficult for a clinician to make a firm diagnosis such as abacterial or chronic prostatitis; "Chronic Pelvic Pain Syndrome" etc without doing some investigations such as Stamey localisation

Recent research has shown the Stamey test is useless in diagnosis.

The aetiology of prostatitis is poorly understood, we know that it may be caused by infections such as E. coli, Chlamydia, Mycoplasma, Ureaplasma spp and a range of other microbes however

Now he is talking about chronic and acute bacterial prostatitis, whereas he started this article talking about chronic prostatitis / chronic pelvic pain syndrome (eg men told by their clinician “go
away and live with it”).

Prostatitis can be caused by stone/crystal formation, reflux of urine, autoimmune disease, (molecular mimicry) inflammation of the nerves supplying that area, pelvic floor tension etc.

Stone formation, urine reflux, autoimmunity are all completely lacking in solid research support.

In some individuals, this duct obliterates forming a cyst in the prostate, rarely the cause of symptoms identical to those of "chronic prostatitis".

Utricular cysts are rare.

Discharge from the penis (seen as pus or stains in the underpants)

Pus stains in underpants and discharges are not a normal symptom of chronic nonbacterial prostatitis (CPPS).

Can't sit in a meeting without worrying about having to wee

More typical of IC than CPPS.

Fertility issues

Rubbish. There is no support for this statement in the literature.

Pain or discomfort on ejaculation is quite common & is due to the prostate contracting which expresses prostatic fluid into the ejaculatory ducts, in doing so the prostate becomes inflamed (similar to pressing a spot). Many men describe that they stop having sex due to prostate pain and the constant aching post ejaculation.

Totally incorrect, and those men who consciously relax during ejaculation and in so doing remove the post ejaculatory pain know that this is rubbish, and that the pain is originating from the nerves and muscles connected to and surrounding the prostate.

I favour the use of massage as this help with the penetration of the antibiotic into congested areas of the gland

Adequate penetration without massage has been proved again and again in studies. Massage is not necessary to get antibiotics into the prostate.

Quite a few men say that prostatic massage helps with symptoms, this at first seems a little confusing when you consider that the massage has a similar effect to the ejaculation during sexual activity, however the massage is very vigorous and if performed properly the massage will extend all over the prostate gland expressing a great deal of its contents also during this process any micro-abscess or blockage present may burst or dislodged reducing the inflammation.

Please, give a research reference for this! Looks like he has visited the "other' site and swallowed their BS story hook, line and sinker.

I have often been asked if surgery helps the condition, the answer is not simple

What! The answer is very simple. It is "no".

Trigger point therapy

As with all disease it is very important to have a good diet that is composed of at least 2 litres of water per day, a varity of fresh produce such as broccoli, cabbage, onions, mixed green & other vegetables, garlic, salads, tomatoes, olive oils, oily fish, lean meat even some good red wine, it maybe necessary to add in a supplement such as zinc or fish body oils, however it is also important to reduce salt, fats and refined sugars/carbohydrates

That's the first time I've seen trigger point therapy described as a diet. :laugh:

Hope this helps

It didn't.

Sheez, and he calls himself a doctor?

[Richard.N]

As he answers one guys question about his prostatitis symptoms !

Why are you surprised?

[graeme]

In fact this uro is the reason I don't post on there anymore. When trying for a baby with my wife after 6 months I asked him on there (like I also did on here) if I'd be infertile due to this disease. His simple answer was "yes".

Then webslave answered the same question with a simple "no". I now have a 10 month son

He may mean well but scares people to death on the British forum :sad:

[garyholc]

Webslave should be the UK's leading person on Prostatitis!!!

[Richard.N]

He may mean well but scares people to death on the British forum :sad:

Ah - I didn't realise this is from the BPSA forum. Now I am surprised - I thought it was one of those day-time-TV pundits.

What's the chap's name?

[webslave]

Webslave should be the UK's leading person on Prostatitis!!!

Thanks, but all I know about is this disorder, and even then not to the extent I could, if I had a medical degree. It is disappointing though, to see how many MDs and even uros just don't care enough to keep abreast of things.

[graeme]

simon rattenbury

and They all thank him for his advice

what chance do us guys in the UK have ,with scaremongering ill advice from our uro,s

[Richard.N]

simon rattenbury

and They all thank him for his advice

what chance do us guys in the UK have ,with scaremongering ill advice from our uro,s

Oh. Him.

I do remember him. He was one of the reasons I stopped posting there. Is he actually a urologist? I seem to remember he was a microbiologist. Not that it makes much difference to the men who are taking his advice.

[webslave]

"Simon Rattenbury, a microbiologist and male fertility scientist at the Royal Free Hospital, London"
http://www.telegraph.co.uk/health/main. ... fert13.xml

"Dr Simon Rattenbury PhD C.Biol M.I.Biol MBA FIBMS - Clinical Microbiologist
Simon Rattenbury trained in Microbiology at University College London and the University of Surrey. Simon became Chartered Scientist in 1991 and is an authority on male accessory gland infection and prostatitis. He has a special interest in Mycoplasma/Ureaplasma infection of the prostate and genitourinary tract in general. He is currently Scientific Head of Service and Service Manager for the Department of Microbiology at The Royal Free NHS Trust in Hampstead."



http://www.andrologysolutions.co.uk/wp- ... on_100.jpg

In other words, he has no business handing out advice the way he does above.

[Richard.N]

...almost as if he has a vested interest in skewing perspectives towards CPPS. No - wait...