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This is the case of a 78 years old man who underwent a radical prostatectomy with nerve sparring after being diagnosed with chronic prostatitis. Recently, he had been repeatedly treated with antibiotics for bacterial prostatitis.

He had already undergone various treatments within Japan, and even sought care abroad, including in China and the Philippines.

At his second visit, he expressed a desire to live his remaining years free from the burden of prostatitis.

Upon examination, tenderness was found in both the prostate and the left obturator internus muscle, leading to a diagnosis of prostatitis and myofascial pelvic pain syndrome (MPPS).

The surgery was performed laparoscopically, preserving bilateral nerves, and he was discharged a week after the procedure. His follow-up visit showed significant symptom relief, but he continued to experience one-third of the original symptoms, particularly pain during defecation and a sensation of incomplete bowel evacuation. Tenderness was noted in the left obturator internus muscle, especially around the ischial area, and pressing on it triggered the urge to defecate.

Going forward, we plan to follow up with pelvic floor rehabilitation, and if there is no improvement, we will consider additional options like magnetic stimulation, hydrorelease, or Alcock canal decompression surgery.

What we learned this time is that the pathology results did not match the clinical symptoms at all!
The prostate showed only “very mild inflammation.” There were no abnormal findings related to nerves or blood vessels either.

So, why did the pain improve?

While the exact answer is unclear, one possibility is that the loop of tension or inflammation in the fascia (connective tissue) surrounding the prostate may have been released. We also considered the possibility that bacterial prostatitis could have led to inflammation or fibrosis of the surrounding fascia.

This made me realize once again how important it is to focus more on the connective tissue in treatment.

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