My Penis Stuff

Examples

Klonopin (clonazepam), Valium (diazepam), Ativan (lorazepam)

How It Works

Anxiolytic medications may reduce pain in the same way they reduce anxiety.

What To Think About

These medications may be used in combination with alpha-blockers, which relax the muscles in the prostate.

These medications do not cure problems with anxiety that may have contributed to prostatitis. Curing an underlying problem with anxiety may require counseling with a psychiatrist or psychologist.

This class of medications can be habit-forming. Long-term use of these medications to treat a chronic health problem is not usually recommended.

This procedure involves removal of part of the prostate gland through the urethra.

A long, thin tube with a viewing instrument (cytoscope) attached is inserted into the urethra. Prostate tissue is removed through the cytoscope.

What To Expect After Surgery

You are usually hospitalized for 2 to 3 days. Complete recovery generally requires 3 to 4 weeks.

Why It Is Done

This surgery may be done for:

• Chronic bacterial prostatitis that resists antibiotic treatment, with or without infected prostate stones (prostatic calculi).
• Repeated urinary tract infections because of another prostate problem for which surgery may be appropriate, such as prostate enlargement (benign prostatic hyperplasia, or BPH).

How Well It Works

Few men with chronic bacterial prostatitis have their symptoms improve after this surgery.

Risks

• Urinary incontinence
• Inability to get or maintain an erection (erectile dysfunction)

What To Think About

To eliminate category II (chronic bacterial) prostatitis successfully, the surgery must completely remove the portion of the prostate that contains the infection.

A radical prostatectomy is an operation to remove the prostate gland and some of the tissue around it. It is done to remove prostate cancer. This operation may be done by open surgery or by laparoscopic surgery through small incisions.

Laparoscopic surgery is most often done by hand. A few doctors now do it by guiding robotic arms that hold the surgery tools. This is called robot-assisted prostatectomy.

Open surgery

In open surgery, the surgeon uses an incision to reach the prostate gland. Depending on the case, the incision is made either in the lower belly or in the groin between the anus and the penis.

When the incision is made in the lower belly, it is called the retropubic approach. A radical prostatectomy using the retropubic approach is the most common treatment for prostate cancer. In this procedure, the surgeon may also remove lymph nodes in the area so that they can be tested for cancer.

When the incision is made in the groin, it is called the perineal approach. The recovery time after this surgery may be shorter than with the retropubic approach. If the surgeon wants to remove lymph nodes for testing, he or she must make a separate incision. If the lymph nodes are believed to be free of cancer based on the grade of the cancer and results of the PSA test, the surgeon may skip the lymph node removal.

Laparoscopic surgery

For laparoscopic surgery, the surgeon makes several small incisions in the belly. A lighted viewing instrument called a laparoscope is inserted into one of the incisions. The surgeon uses special instruments to reach and remove the prostate through the other incisions.

Men who have laparoscopic surgery tend to lose less blood during the operation and to recover faster than men who have open surgery. Laparoscopic prostatectomy is not yet widely available, and because it is a relatively new technique, no results from long-term follow-up after treatment are available.

The main goal of either type of surgery is to remove all the cancer. Sometimes that means removing the prostate as well as the tissues around it, including a set of nerves to the penis that affect the man’s ability to have an erection. Some tumors can be removed using a nerve-sparing technique, which means carefully cutting around those nerves to leave them intact. Nerve-sparing surgery sometimes preserves the man’s ability to have an erection.

What To Expect After Surgery

Prostatectomy usually requires general anesthesia and a hospital stay of 2 to 4 days. A thin, flexible tube called a catheter usually is left in your bladder to drain your urine for 1 to 3 weeks. Your doctor will give you instructions about how to care for your catheter at home. Bladder control can be poor for a few months after the catheter is removed.

Although prostatectomy often removes all cancer cells, it is important to receive follow-up care, which may lead to early identification and treatment if your cancer comes back. Your regular follow-up program may include:

• Physical exams.
• Prostate-specific antigen (PSA) tests, to monitor PSA levels and to measure the speed of any changes in those levels.
• Digital rectal exams.
• Biopsies as needed, to examine suspicious tissue.

Why It Is Done

Radical prostatectomy is most often used if testing shows that the cancer has not spread outside the prostate (stages I and II).

Although radical prostatectomy is occasionally used to relieve urinary obstruction in men with more advanced (stage III) cancer, a different operation, called a transurethral resection of the prostate (TURP), is most often used for that purpose. Surgery usually is not considered a cure for advanced cancer, but it can help relieve symptoms.

How Well It Works

Radical prostatectomy is generally effective in treating prostate cancer that has not spread. This is called early-stage cancer. Following surgery, the stage of the cancer can be determined based on how far it has spread. PSA levels will drop almost to zero if the surgery successfully removes the cancer and the cancer has not spread. If cancer has spread, advanced cancer may develop even after the prostate has been removed.

Compared with watchful waiting for early-stage cancer, radical prostatectomy lowers the risk that the cancer will grow or spread. And it lowers the long-term risks of death from cancer. This is important to know if you expect to live 10 or more years. (If you are already in poor health or are in your later years and you have an early-stage prostate cancer, it may not grow or spread during your lifetime.)

Risks

Erection problems

Up to 80% of men experience erection problems after a prostatectomy. The nerves that control a man’s ability to have an erection lie next to the prostate gland. They often are damaged or removed during surgery. In the months and years after surgery, most men who had erection problems after prostatectomy are able to regain their ability to have erections:

• 76% of men younger than 60
• 56% of men age 60 to 65
• 47% of men older than 65

Recovery depends on:⁵

• Whether the man was able to have an erection before surgery.
• How the surgery affected the nerves that control erections.
• How old the man was at the time of surgery.

Urinary incontinence

Up to half of all men who have a radical prostatectomy develop urinary incontinence, ranging from a need to wear urinary incontinence pads to occasional dribbling. Studies show that one year later, between 15% and 50% of men report urinary problems.

The urethra—the tube that carries urine from your bladder—runs through the middle of the doughnut-shaped prostate gland. In order to remove the prostate, the surgeon must cut the urethra and later reconnect it to the bladder. Evidence shows that the greater the surgeon’s experience and skill in making this reconnection, the lower the rate of incontinence.

Some men may require treatment for incontinence after prostatectomy, if urinary leakage continues longer than 1 year.

Complications

Radical prostatectomy is major surgery, so it carries the same general risks as other major operations, including heart problems, blood clots, allergic reaction to anesthesia, blood loss, and infection of the wound.

These additional complications can be caused by radical prostatectomy:

• Erection problems
• Urinary incontinence
• Damage to the urethra
• Damage to the rectum

What To Think About

A surgeon who is new to laparoscopy can take 80 to 100 surgeries before mastering prostatectomy. Before choosing the surgeon and type of surgery you will have, look for a surgeon with the most experience and surgery success. This can help lower your risks of problems after surgery.

When considering prostatectomy, take into account your personal wishes, age, other medical conditions you may have, the stage and grade of your cancer, and your PSA level. Radiation treatment or watching and waiting may be reasonable alternatives.

Robot-assisted prostatectomy may be best suited to a younger man in good health with a small prostate and a small, lower-grade cancer. This technology is not yet widely used.

Surgery may completely remove your prostate cancer. However, it is not possible to know ahead of time whether the cancer has spread beyond the prostate and is not curable with surgery alone.

Prostate cancer often spreads to the nerves that surround the prostate. These nerves control a man’s ability to have an erection. When the nerves are removed along with the cancer, the man will most likely have erection problems. A nerve graft sometimes may be done to reduce this chance. For this, the surgeon removes part of a nerve that goes down the back of the leg and attaches it to the nerves where the prostate gland was. This surgery seems to be helpful for some men, but not for all. More research is needed to see how well this surgery works to preserve the man’s ability to have an erection.

Prostatitis is swelling or infection of the prostate gland. It often hurts. The prostate gland sits just below a man’s bladder and makes part of the fluid for semen. In young men, the prostate is about the size of a walnut. It usually grows larger as you grow older.

There are several types of prostatitis. They vary based on how long a man has had the problem and what kind of symptoms he has.

What causes prostatitis?

Sometimes prostatitis is caused by bacteria, but often the cause is not known.

What are the symptoms?

Symptoms of long-term (chronic) prostatitis are often mild and start slowly over weeks or months. They may include:

• An urge to urinate often. But you may pass only small amounts of urine.
• A burning pain when you urinate.
• A problem starting the urine stream, urinating in waves rather than in a steady stream, urine flow that is weaker than normal, and dribbling after urinating.
• Waking up at night to urinate often.
• A feeling of not completely emptying your bladder.
• Pain in your lower back, in the area between the testicles and anus, in the lower belly or upper thighs, or above the pubic area. Pain may be worse during a bowel movement.
• Some pain during or after ejaculation.
• Pain in the tip of your penis.

Symptoms of acute prostatitis are the same, but they start suddenly and are severe. They may also include a fever and chills.

Some men may have no symptoms.

How is prostatitis diagnosed?

A doctor can often tell if you have prostatitis by asking about your symptoms and past health. He or she will also do a physical exam, including a digital rectal exam. In this test, the doctor puts a gloved, lubricated finger in your rectum to feel your prostate. You may also need blood and urine tests to find out which type of prostatitis you have or to look for another cause of your problems.

How is it treated?

Prostatitis caused by bacteria is treated with antibiotics and self-care. If it is not caused by bacteria, it usually gets better with home treatment.

Home treatment includes drinking plenty of fluids and getting lots of rest. Taking over-the-counter pain relievers can also help.

Your doctor may prescribe medicine to control pain and reduce swelling. He or she may also prescribe medicine to soften your stool and relax your bladder muscles.

Surgery is rarely used to treat prostatitis.

Prostatitis is a usually painful condition of the prostate gland, the small walnut-shaped organ that lies just below a man’s bladder. The prostate gland produces most of the fluid in semen.

Often the cause of prostatitis is not known. Many men with prostatitis have no signs of inflammation, so no exact cause can be determined. Prostatitis may be caused by an infection or by inflammation not related to infection. It may be acute (short-term) or chronic (long-term).

Symptoms of prostatitis include:

• An urge to urinate often but passing only small amounts of urine; feeling an urgent need to urinate; a burning sensation when urinating; and the inability to empty the bladder completely.
• Difficulty starting urination, interrupted flow (urinating in waves instead of in a steady stream), weaker-than-normal urine flow, and dribbling after urinating.
• Pain or discomfort in the lower back; in the area between the scrotum and the anus; in the lower abdomen, scrotum, or upper thighs; or above the pubic area.
• Excessive urinating at night.
• Prostate pain or vague discomfort on ejaculation.

Treatment for prostatitis varies according to the cause. In many cases, medication is needed.

You or someone you know may have been diagnosed as having a type of prostatitis, a common and painful disease of the prostate gland and its surrounding structures. The following has been designed to answer your questions about prostatitis.

What is the prostate?

The prostate is a part of the male reproductive system, is about the same size and shape of a walnut and weighs about an ounce. It is located below the bladder and in front of the rectum and surrounds the urethra, the tube-like structure that carries urine from the bladder out through the penis. The main function of the prostate is to produce ejaculatory fluid.

What are the different types of prostatitis and their causes?

Acute bacterial prostatitis is the least common type of prostatitis and is always caused by bacterial infection. It is usually easy to diagnose because of the typical symptoms and signs. It is a severe urinary tract infection associated often with fevers and chills, and a visit to a doctor or hospital is required. Acute bacterial prostatitis can affect any age group but commonly occurs in older and middle-aged men. Another type that is caused by bacterial infection is chronic bacterial prostatitis which is characterized by recurrent urinary tract infections in men. When symptoms do appear, they are generally less severe than acute bacterial prostatitis and rarely have fever, but often recur. This condition can also affect any age group but is most common in young and middle-aged men.

Nonbacterial prostatitis and prostatodynia, now properly referred to as chronic pelvic pain syndrome, are the most common types of prostatitis. The exact cause of these non-bacterial prostatitis conditions is not known, but may be due to persistent infection, inflammation and/or pelvic muscle spasm. Inflammation in the prostate can also occur without symptoms.

What causes prostatitis?

The bacteria that cause acute and chronic bacterial prostatitis get into the prostate from the urethra by backward flow of infected urine into the prostate ducts. Bacterial prostatitis is not contagious and is not considered to be a sexually transmitted disease. A sexual partner cannot catch this infection.

Certain conditions or medical procedures increase the risk of contracting bacterial prostatitis. There is a higher risk if the man has recently had a catheter or other instrument inserted into his urethra, an abnormality of his urinary tract or a recent bladder infection.

Chronic prostatitis/chronic pelvic pain syndrome may be caused by atypical organisms such as chlamydia, mycoplasma (which may be transmitted by sexual contact) ureaplasma or may also be due to a chemical or immunologic reaction to an initial injury, The nerves and muscles in the pelvis may cause pain in the area, either as a response to the prostate infection or inflammation or as an isolated problem itself.

What are the symptoms of prostatitis?

The symptoms of the various prostatitis syndromes depends upon the category.

In acute bacterial prostatitis, the symptoms are severe and sudden and may cause the patient to seek emergency medical care. Chills, fever, severe burning during urination and the inability to completely empty the bladder are common.

In chronic bacterial prostatitis, the symptoms are similar but do not produce fever. They include: burning during urination; urinary frequency, especially at night; perineal, testicular, bladder and low back pain; and painful ejaculation. The condition can be episodic, with flare-ups and remissions, associated with infection, treatment and subsequent recurrence.

The symptoms of chronic prostatitis/chronic pelvic pain syndrome include difficult and sometimes painful urination, discomfort or pain in the perineum, bladder, testicles and penis as well as difficult and painful ejaculation. In some cases, these symptoms can be indistinguishable from those described above for chronic bacterial prostatitis.

How is prostatitis diagnosed?

The correct diagnosis is very important because the treatment is different for the different types of prostatitis syndromes. In addition, it is extremely important to make sure that the symptoms are not caused by other conditions such as urethritis, cystitis, an enlarged prostate or cancer. To help make an accurate diagnosis, several types of examinations are useful.

To examine the prostate gland, the physician will perform a digital rectal examination (DRE). This is a simple examination in which the doctor will pass a lubricated, gloved finger into the rectum. Because the prostate is located just in front of the rectum, it can be easily pressed. The physician will be able to determine whether the prostate is enlarged or tender. Lumps or firm areas can suggest the presence of prostate cancer. The physician will also assess the degree of pain or discomfort the patient experiences as he presses the muscles and ligaments of the pelvic floor and perineum. If a man has prostatitis, this examination may produce momentary pain or discomfort but it causes neither damage nor significant prolonged pain.

If the physician requires a closer look at the prostate gland or decides that a biopsy is necessary, he may order a transrectal ultrasound, which allows him to visualize the prostate gland. If you are at risk for cancer, your physician will consider ordering a PSA test. During a prostate infection however, the PSA can be falsely elevated.

If your physician suspects that you have prostatitis or one of the other prostate problems, he may refer you to a urologist, a doctor who specializes in diseases of the urinary tract and male reproductive system, to confirm the diagnosis.

The urologist will repeat some of the examinations already performed by the first physician. The urologist will also assess the degree of pain or discomfort the patient experiences as he presses the prostate. The urologist may analyze various urine specimens as well as a specimen of prostatic fluid obtained by massaging the prostate gland during the DRE. The various urine specimens and prostatic fluid will be analyzed for signs of inflammation and infection. These samples may help the urologist determine whether your problem is inflammation or infection and whether the problem is in the urethra, bladder or prostate.

Other tests the urologist may consider employing include cystoscopy in which a small telescope is passed through the urethra into the bladder permitting examination of the urethra, prostate and bladder. The urologist may also order urine flow studies, which help measure the strength of your urine flow and any obstruction caused by the prostate, urethra or pelvic muscles.

How should prostatitis be treated?

Your treatment depends on the type of prostatitis you have.

If acute bacterial prostatitis is diagnosed, the patient will need to take antibiotics for a minimum of 14 days. Sometimes, this means being admitted to the hospital and being given intravenous antibiotics. A catheter is sometimes required if the patient has difficulty urinating. Almost all acute infections can be cured with this treatment. Frequently, the antibiotics will be continued for as long as four weeks.

If chronic bacterial prostatitis is diagnosed, the patient will require antibiotics for a longer period of time, usually four to 12 weeks. About 75 percent of all cases of chronic bacterial prostatitis clear up with this treatment. Sometimes the symptoms recur and antibiotic therapy is again required. For cases that do not respond to this treatment, long-term, low dose antibiotic therapy may be recommended to relieve the symptoms. Other medications (such as those used for nonbacterial prostatitis) or other treatments (e.g., prostate massage therapy) may also be used in difficult cases. In some rare cases, surgery on either the urethra or prostate may be recommended. There must be a specific anatomic problem, such as scar tissue in the urethra, for any surgery aimed at improving prostatitis to be effective.

The patient may not need antibiotics, if they are diagnosed with chronic pelvic pain syndrome. Frequently, physicians have difficulty trying to decide whether a patient has bacterial or nonbacterial prostatitis. This is because of the difficulties in obtaining a specimen and, sometimes, previous antibiotic therapy obscures the diagnosis. An organism that responds to antibiotics, but is difficult to diagnose may also cause chronic pelvic pain syndrome. For these reasons, antibiotics may be prescribed, at least initially, even when a definitive diagnosis of bacterial prostatitis has not been made with the appropriate tests. Your response to the antibiotic therapy will decide whether or not it should be continued. Many patients without a true infection may feel better during antibiotic therapy because many antibiotics have direct anti-inflammatory effects. Depending on your symptoms you may receive one of a variety of other treatments. These may consist of alpha-blockers, anti-inflammatory drugs, muscle relaxants, plant extracts (quercetin and/or bee pollen) and repetitive prostatic massage (to drain the prostate ducts).

Various heat therapies, biofeedback and relaxation exercises may alleviate some of the symptoms. You may be advised to discontinue some foods (e.g. spicy) and drinks (e.g. caffeinated, acidic) and avoid circumstances (e.g. bicycle riding) that exacerbate the problem. Once a correct diagnosis has been made, one of the best therapies may be that of reassurance that the patient does not have a life threatening condition.

Treatment for aysmptomatic prostatatic inflammation is usually not required.

Why do physicians have trouble diagnosing prostatitis?

The diagnosis of the various types of prostatitis can be very difficult and sometimes quite frustrating for the patient and his physician. The symptoms are variable and there is much overlap in symptoms between the various types of prostatitis. Once the patient has been treated with antibiotics, it can be difficult to differentiate a bacterial prostatitis from chronic pelvic pain syndrome.

How will prostatitis affect a patient?

Prostatitis is an extremely frustrating disease for both the patient and his physician. It can seriously affect a patient’s quality of life. The correct diagnosis of the prostatitis problem is difficult and it cannot always be cured. However, prostatitis is a treatable disease and one can usually get relief from major symptoms by following the recommended treatment.

Why are some patients not cured after they have been diagnosed with prostatitis?

Most cases of acute bacterial prostatitis respond completely to therapy. Unfortunately, the treatment for the chronic prostatitis syndrome is far from perfect. Patients with chronic bacterial prostatitis can have persistence of their infectious problem despite antibiotic use. This is because of the difficulty antibiotics have in penetrating the prostate gland to completely kill all the bacteria deep within the prostatic ducts. Repetitive or frequent prostate massages or use of alpha blockers may be helpful in these cases. The patients who have had chronic bacterial prostatitis and have been cured are susceptible to recurrences. Many patients with chronic prostatitis/chronic pelvic pain syndrome fail therapy. The physician may employ a multi-modal approach to therapy (more than one treatment at a time). Patients may find that they have to learn to live, and cope with their symptoms while the inflammation hopefully “burns itself out.”

What are some of the most important facts about prostatitis?

• Correct diagnosis is the key to the management of prostatitis.
• Prostatitis cannot always be cured but can be managed.
• Treatment should be followed even if symptoms have improved.
• Patients with prostatitis are not at higher risk for developing prostate cancer.
• There is no reason to discontinue normal sexual relations unless they are uncomfortable, usually during an acute phase.
• One can live a reasonably normal life with prostatitis.