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Editorial Comments
TOTAL PROSTATOSENHNAL VESICULECTOMY FOR FERJNEAL PAIN
lished, the treatment of this will remain empirical.
process
REFERENCES 1. Stamey, T. A.: Pathogenesis and Treatment of Urinary Tract
Infections. Baltimore: Williams & Wilkins, 1980. 2. Meares, E. M., Jr.: Prostatitis syndromes: new perspectives about old woes. J. Urol., 123: 141, 1980. 3. Krieger, J. N.: Prostatitis syndromes: pathophysiology, differential diagnosis, and treatment. Sex. Trans. Dis., 11: 100, 1984. 4. McNeal, J. E.: Regional morphology and pathology of the prostate. Amer. J. Clin. Path., 49: 347, 1968.
EDITORIAL COMMENTS Total prostatectomy has been helpful in my experience in rare cases as proposed by the authors. Despite the fact that this information is old and only rarely applicable, the publication of these data is useful to fortify the stance of urologists who perform this operation in a desperate attempt to cure the patient with chronic perinea! pain. This procedure has been advocated previously so that the article does not present new information. However, with the advent of nerve sparing techniques of total prostatectomy it is likely that the operation can be conducted with a minimal degree of morbidity. In fact, in this article 3 patients were potent before total prostatic removal. Of these 3 patients 2 have had adequate sexual activity after the procedure. This operation should not be considered a panacea for all individuals with perinea! pain. However, when patients have been managed with all available techniques and have had psychiatric consultation with concurrence, the application of nerve sparing radical prostatectomy is legitimate. Carl A. Olsson Department of Urology Columbia-Presbyterian Medical Center New York, New York
411
Having spent more years than I care to remember seeing patients with nonbacterial prostatitis and prostatodynia, a number of whom had debilitating perinea! pain, radical prostatectomy seems to me to be a radical solution for men with this syndrome. It reminds me somewhat of the recommendation for seminal vesiculectomy in similar patients who have ejaculatory discomfort. My guess is that these patieiits need a psychiatrist (only 2 of the 5 actually saw one) more than they need a surgeon. Thomas A. Stamey Division of Urology Stanford Medical Center Stanford, California The authors describe 5 patients with symptoms of chronic prostatitis so severe and recalcitrant to treatment that they underwent radical prostatoseminal vesiculectomy. They report a favorable outcome with followup of 1 to 3 years. One's initial reaction upon reading this article is to fear that this radical approach to a common problem might easily be misused. However, the authors issue a strong caveat and propose selection criteria so stringent as to disqualify all but the rare patient. This, and the necessity for psychiatric consultation, cannot be emphasized too strongly. Of particular interest is the fact that each of these 5 patients had undergone transurethral resection of the prostate (2 more than once) at a young age (less than 50 years). Prostatitis is never an indication for transurethral resection of the prostate. Certainly, when performed in men in their thirties and forties this procedure must be suspected of contributing to the persistent symptoms-indeed, even of causing the state of desperation when the radical operation reported is considered. This study appropriately argues against transurethral resection of the prostate in the management of prostatitis, especially in men so young. Emil A. Tanagho Department of Urology University of California San Francisco, California
lished, the treatment of this will remain empirical.
process
REFERENCES 1. Stamey, T. A.: Pathogenesis and Treatment of Urinary Tract
Infections. Baltimore: Williams & Wilkins, 1980. 2. Meares, E. M., Jr.: Prostatitis syndromes: new perspectives about old woes. J. Urol., 123: 141, 1980. 3. Krieger, J. N.: Prostatitis syndromes: pathophysiology, differential diagnosis, and treatment. Sex. Trans. Dis., 11: 100, 1984. 4. McNeal, J. E.: Regional morphology and pathology of the prostate. Amer. J. Clin. Path., 49: 347, 1968.
EDITORIAL COMMENTS Total prostatectomy has been helpful in my experience in rare cases as proposed by the authors. Despite the fact that this information is old and only rarely applicable, the publication of these data is useful to fortify the stance of urologists who perform this operation in a desperate attempt to cure the patient with chronic perinea! pain. This procedure has been advocated previously so that the article does not present new information. However, with the advent of nerve sparing techniques of total prostatectomy it is likely that the operation can be conducted with a minimal degree of morbidity. In fact, in this article 3 patients were potent before total prostatic removal. Of these 3 patients 2 have had adequate sexual activity after the procedure. This operation should not be considered a panacea for all individuals with perinea! pain. However, when patients have been managed with all available techniques and have had psychiatric consultation with concurrence, the application of nerve sparing radical prostatectomy is legitimate. Carl A. Olsson Department of Urology Columbia-Presbyterian Medical Center New York, New York
411
Having spent more years than I care to remember seeing patients with nonbacterial prostatitis and prostatodynia, a number of whom had debilitating perinea! pain, radical prostatectomy seems to me to be a radical solution for men with this syndrome. It reminds me somewhat of the recommendation for seminal vesiculectomy in similar patients who have ejaculatory discomfort. My guess is that these patieiits need a psychiatrist (only 2 of the 5 actually saw one) more than they need a surgeon. Thomas A. Stamey Division of Urology Stanford Medical Center Stanford, California The authors describe 5 patients with symptoms of chronic prostatitis so severe and recalcitrant to treatment that they underwent radical prostatoseminal vesiculectomy. They report a favorable outcome with followup of 1 to 3 years. One's initial reaction upon reading this article is to fear that this radical approach to a common problem might easily be misused. However, the authors issue a strong caveat and propose selection criteria so stringent as to disqualify all but the rare patient. This, and the necessity for psychiatric consultation, cannot be emphasized too strongly. Of particular interest is the fact that each of these 5 patients had undergone transurethral resection of the prostate (2 more than once) at a young age (less than 50 years). Prostatitis is never an indication for transurethral resection of the prostate. Certainly, when performed in men in their thirties and forties this procedure must be suspected of contributing to the persistent symptoms-indeed, even of causing the state of desperation when the radical operation reported is considered. This study appropriately argues against transurethral resection of the prostate in the management of prostatitis, especially in men so young. Emil A. Tanagho Department of Urology University of California San Francisco, California