Recurrent/chronic bacterial prostatitis and surgery

I suspect this for myself too. How do you confirm that it's CBP or recurrent prostatitis. What are the symptoms you are having that are different than BPH. Have you cultured a microbe --in what and how?

I also worry about any procedures for enlarged prostate (which I also have) that would limit an ability to treat prostatitis or may cause a flare up of prostatitis.

Interested in this topic.

Vin,

As a fellow sufferer of chronic prostatitis (CP), I know how disheartening this condition can be. I'm not a medical professional but have attempted to approach possible solutions (and/or management) of chronic prostatitis as thoroughly and scientifically as is possible. I've done quite a bit of reading and research over the years. With that in mind, and acknowledging that much of this is specific to my experience (and thus anecdotal), hopefully this helps:

1.) Antibiotics are very rarely a solution to CP, and whether your case is bacterial in nature or based around another root cause is very difficult to conclude. I've seen well-trained, competent Urologists over the years and all have agreed. I think you're onto something, in terms of wandering about scar tissue, etc. The prostate is a dense mass of an 'organ' - how are the antibiotics going to penetrate the tissue?

This is not to discourage you from getting seminal fluid samples (i.e. having your Urologist 'milk' your prostate) cultured or going a step farther and submitting a semen sample for testing. You mention in your post that the problem might be bacterial. Lab tests might give you something conclusive on this front, but in practical terms, I don't think antibiotic treatment alone holds much promise as a long term solution or management strategy for this condition. Moreover, there are potential negative impacts to your microbiome, not to mention increased risk of developing antibiotic resistance.

2.) Prostatic drainage can be a highly effective option for CP, either alone or in conjunction with other treatment options. Anyone who has suffered with this condition for any length of time and done some research has likely encountered accounts of the Filipino doctor (Rios, I believe) who pioneered the drainage + intravenous IV antibiotic treatment that's helped many people.

You don't have to go to the Philippines to try this. I've used drainage to great effect over 20 years of having prostate issues. While not necessarily a cure, it goes farther than any other approach I've encountered to keep symptoms minimal. The biggest hurdle is finding someone to help with it regularly. If this presents an issue for you, there are many accounts out there of men who have figured out how to do it themselves (helps to have long fingers, apparently). Google/YouTube. The greatest benefit is immediate relief of symptoms.

3.) The right supplements can also be beneficial, but the results aren't as immediate as with drainage. There are many of these on the market. I'm not endorsing any particular brand, but I've have good results with beta-sisterol and products with activated Quercitin. There are products out there that blend a number of different ingredients that claim to help prostate conditions. You'll want to do your own research and sort out which seem credible. Without doing a search, a handful of naturally occurring substances have been studied and written about in peer-reviewed scientific journals. I think, for example, that Saw Palmetto has been proven to help with BPH (though I've seen no benefit with it for prostatitis).

4.) What leads you to believe you have an ejaculatory duct obstruction? You very well might, just curious. In my experience with prostatitis, there are numerous associated secondary conditions. This is well established in the literature. I've had several bouts of epididymitis over the last five years, both of which resolved after some time. My Urologist prescribed antibiotics for the first case, to no effect. The second time, I simply waited, did a bit of massage, ran hot water over the effected areas in the shower and tried to stand as much as possible. It wasn't fun or quick, but after about 3 1/2 weeks, it resolved. I've also had a few cases of seminal vesicle inflammation, though with those, there seems to be a behavioural element involved. I still suspect that these are ultimately related to CP, which is to say, without having CP they would never have occurred.

5.) I'd consider trying drainage with supplements or even perhaps in conjunction with one regimen of antibiotics prior to considering surgical options. There's a wealth of information out there on TUR/TURP, ranging from highly positive to no tangible benefit to made things worse. The outcomes are too ambiguous for something that's irreversible - that's my biggest issue. Of course it's a personal decision and some people have had good results.

Hopefully this helps. Keep experimenting - you'll land on something that works for you. Best of luck!