Ask a doctor on the topic of Urology

Chronic pain for 10 years - right salivary gland?

May 2, 2021 | 35,00 EUR | answered by Dr. Med. Thomas Kreutzig

Dear Sir or Madam,

since my 19th birthday - around 10 years ago - I have been suffering from chronic pain in the right perineal area (male), which started shortly after I moved out of my parents' house, intensified over a few days, and are now constant. The pain is not affected by movement or pressure, but can often be triggered shortly after urination and ejaculation. After that, the pain is most intense for several hours. Sometimes it disappears for hours. On a pain scale of 1-10, I would rate it around a 3.

Since the first occurrence, many examinations and interventions have been conducted:
Proctological: digital examinations, ultrasound, MRI defecography, examination under anesthesia. Previous findings: pilonidal sinus (removed twice), chronic anal fissure (removed in connection with pilonidal sinus)
Urological: digital examination, MRI (without contrast agent), ultrasound, sperm, urine, and blood samples.

The only finding pointing to something concrete is from the pelvic floor MRI from about a year ago with the simple line in the report: "Minimal free fluid in the rectovesical space. ... possible indication of an inflammatory abdominal process".
As I am now open to very experimental procedures, I would agree to the removal of the right seminal vesicle. I see a high chance here that at least the pain can be relieved, and not all sexual functions will be lost. Since the pain is related to urological functions, it is unilateral, and no other function is impaired, I am forced to advise the removal of the right seminal vesicle as a layman.

My body data:
- 29 years old, male
- 1.70m
- no other complaints
- 65kg weight

Here are my questions:
- Is it technically possible to remove a single seminal vesicle?
- Is it possible at all, even if I provide the doctor with a waiver of liability?
- Will the statutory health insurance cover this? If not, what are the estimated costs?
- What risks can arise from the surgery and the absence of a seminal vesicle?
- How long would the healing time be after the surgery?
- Is there anything else that could be considered in my situation, something that could be treated more cautiously, possibly even experimentally?
- Do you have any advice on what else could be done in my situation?

Dr. Med. Thomas Kreutzig

An isolated removal of the right seminal gland is technically possible, if only the surgical robot were an option here. However, overall such a procedure seems hardly sensible to me, as the prospects for symptom relief must be considered rather low. Your symptoms sound more like an inadequately treated prostate infection, so it would be more sensible to undergo a truly long-term antibiotic therapy, if that has not been done yet or if it was not done with the right antibiotics. The findings of the MRI do not justify such an invasive procedure in the slightest. Best regards, Dr. Thomas Kreutzig-Langenfeld