Dr. P. GEORGIADIS

Surgeon Urologist - Andrologist
Greek English




Treatment of chronic prostatitis

Diagnosis

Experience and special training in the problem of chronic prostatitis are essential for the correct diagnosis and a full evaluation of the disease. The diagnosis must be based on the following elements:

  • Medical history of the patient: Careful collection and assessment of the patient's history are necessary in order to properly evaluate what the patient mentions to the doctor with regards to the disease. In addition, this allows the doctor to detect issues or symptoms that the patient may not be aware of (due to growing used to them); this naturally requires extensive knowledge from the doctor’s side.

  • Digital rectal examination of the prostate: Careful clinical assessment of the urogenital system (testicles, penis, prostate). The DRΕ (digital rectal examination) of the prostate is extremely important since it provides crucial information such as the texture of the glandular tissue, the corresponding susceptibility at inflammatory sites as well as information about the size of the gland. Lastly, it enables the secretion of prostatic fluid which is used for further specialized examinations.

  • Uroflowmetry: The uroflowmetric control provides important information on the quality of urination such as strength, quantity, time, etc.
     
  • Ultrasound examination: The ultrasound examination of the kidneys and bladder provides information about possible complications of the disease. There are quite a few cases where there are stone concretions or kidney stones; these are typically formed as a result of poor quality of urination which is caused by problems in the prostate.

  • Testicular ultrasound: Testicular ultrasonography in both testicles to check for possible spreading of the infection, which provides relevant information for the epididymides and the scrotal sac.

  • Transrectal Ultrasonography: The transrectal ultrasonography of the prostate, which is the main examination for the full objective picture on possible changes in the prostate, measures the echogenicity of the parenchyma, the vasculature at the damaged areas and shows possible calcifications and their location. Furthermore, it is used to estimate the size of the gland, track the presence of inflammation in the seminal vesicles, spot possible dilatation of the utricle cyst or to find calculi of the ejaculatory ducts etc.
     
  • Culture of semen and prostate fluid: The microbiological tests of sperm and prostatic fluid (after prostate massage) complement the examination, but they do not constitute sufficient evidence that may let someone securely confirm the existence of either the inflammation or the agent causing the inflammation. In some cases (20% - 30%), the causative factors are not revealed (i.e. the microbes responsible for the inflammation) from these exams and in several cases about (3%-5%), neither are the indications (e.g. pus cells) that would otherwise indicate the presence of the inflammation - prostatitis.

  • Urethral Cystoscopy: In the cases of urethral complications with clear problems in urination, the examination can be complemented with a special endoscopic process which is the urethral cystoscopy – this way the doctor can look for the possible existence of intraluminal urethral stricture or bladder neck obstruction.

  • Penile arteries triplex: In the cases of erectile dysfunction, a special examination is performed (usually at the initial diagnosis) which is the penile arteries triplex – this is performed especially if there are also other special conditions (e.g. hypertension, diabetes mellitus, hypercholesterolemia etc.).

  • Spermiogram and hormonal examination: In cases of sperm infertility, a complete semen analysis and a targeted hormonal examination are often necessary tests for a complete diagnosis.

  • Dynamic transrectal ultrasonography of urination: In cases of suspected (active or passive) intraprostatic reflux of urine, the dynamic recording of the phase of the urination with the transrectal ultrasonography is the test of choice.

Objectives of Therapy for Chronic Prostatitis

This is the most important and also difficult chapter of the chronic prostate inflammation.
In order to understand what we refer to as therapy is to understand the difference between radical treatment and simply decreasing or covering the symptoms (typically for a brief period of time). 
 
Great responsibility lies with many fellow urologists who do not tell the absolute truth to the patients either because they are not making a proper diagnosis (maybe due to ignorance about the subject) or because they just do not know how to solve the problem. As a consequence, they typically attempt to downplay the severity of the disease in order to make the patient feel psychologically better or simply administer medicines for the semi-probable and temporary improvement of the symptoms. In many cases they omit to inform the patients about their condition and stop at the temporary coating of the problem. Since the problem has only one solution and that is none other than the radical and complete treatment, the goals of the therapeutic protocol are: 

  • Complete elimination of the microorganisms that created the inflammation.
  • Removal of the blockage in the tubes (veins) at the prostate gland level, the seminal vesicles and of the epididymis.
  • Removal of the purulent secretion and of the micro-stones from the obstructed prostatic vesicles that cause inflammations.
  • Recovery of the natural structure, size and function of the prostate gland.
  • Complete elimination of the chronic prostatitis symptoms of the patient.
  • Restoration and maintenance of the physical strength, sexual capacity and fertility of the patient.
  • Restoration and maintenance of the psychological balance of the patient.
  • Lasting recovery without relapse of symptoms.

 

 

Treatment of Chronic Prostatitis

The initial treatment of non-complicated chronic prostatitis is done by the intake of antibiotics for a period no less than a month. This should only be applied in cases where both clinical and detailed ultrasound examinations indicate that the inflammation has progressed for no more than 6-9 months. At this point we must be very careful with our assessment, otherwise we risk loading the patient's body with drugs for one or more months without any practical effect. If after solely using antibiotics we repeat clinical and ultrasound examinations (possibly microbiological too) and these show that the inflammations persist (despite the partial or complete resolution of observable symptoms), the next treatment method of chronic prostatitis should be radical.
 
Alternatively, there is a serious likelihood of progressive worsening of the inflammation, which in the next period will be reflected by the reappearance of symptoms and possibly the aforementioned side effects (e.g. erectile dysfunction, infertility, urinary dysfunction etc.). These side effects are very likely to become the dominant problem that will ultimately cause the patient to visit the urologist and look anxiously for treatment.

In all my (25+) years of clinical experience and involvement with the problem of the chronic inflammation in the prostate, the only treatment that solves the problem by achieving almost all the aforementioned requirements is the combination of an antimicrobial and anti-inflammatory treatment along with finger compression gland therapy adapted to the requirements of each kind of prostatic inflammation (i.e. specific for each patient). We name our protocol finger pressure unblocking curative prostate treatment.

The aim of this special treatment is to break all the hard and organized foci of the inflammations in the prostate, lead to the removal of the obstructions and allow the smooth flow of the prostatic fluid on every glandular tube. Furthermore, the treatment aims to the restoration of microvascular circulation in the glandular tissue, the full removal of the microbial cores and the natural restoration of the proper immune response of the body to the healthy prostate glandular tissue.

This method leads to results that are considered impressive with a healing rate of chronic prostatitis of 92%-96%.

In very few cases (less than 5%-6%), where despite of the aforementioned treatment:
a) The symptoms of chronic prostatitis have not been fully eliminated.
b) Minimal microbes persist in the culture of the prostatic fluid (after prostatic pressure).
c) Despite the elimination of the microbes, the leukocytes insist on existing (even if they are reduced).
d) Despite a complete elimination of germs and leukocytes, there are still hot spots in the transrectal ultrasound.
e) There are multiple remaining calcifications possibly forming microbes
 

then intraprostatic and / or possibly (seminal) intravesical mixture injections consisting of 4-5 drugs with antimicrobial and anti-inflammatory properties are used.

The components of the mixture are carefully selected based on antibiograms after thorough prostatic fluid – sperm cultures. With the aid of the guided transrectal ultrasonography, in a number of one to three (1-3) sessions with a time difference of 15 to 20 days between, a definitive solution is achieved to the persistent problem of the prostate disease. Practically, the concentrations of drugs in the already reconstructed (through the aforementioned finger-pressure protocol) prostate tissue reach up to 1000 times more, compared with those obtained when the drugs are taken orally (per os).

Alternative treatment of chronic prostatitis - intraprostatic injections

An alternative for those who fail to follow the digital rectal treatment such as:

  • Patients with limited time available due to workload
  • Patients with high sensitivity to digital pressure
  • Elderly (patients above the ages 60-80).

are the intraprostatic injections with a mixture of anti-microbial and anti-inflammatory substances that are usually applied once a month, with an average total number of times ranging from 3 to 6. In cases where the patient suffers for several years (e.g. 20 to 25) from chronic prostatitis or the prostate size exceeds 60-70 grams and the prostate tissue lesions are quite advanced, it may take up to 10 repetitions.

The intraprostatic injections are made with the use of the special transrectal ultrasound head onto which a guide is adjusted so that the puncture needle can inject drugs in the places where the major chronic inflammatory lesions of the prostate parenchyma were photographed. The number of intraprostatic injections needed is determined by improving image of the intraprostatic lesions, which can be seen through the transrectal ultrasonography examination that always takes place one month after each injection.



Picture. 4 Intraprostatic infusion of antimicrobials.
This treatment of the chronic prostatitis is based on the fact that the efficacy of the antimicrobial drugs increases hundreds of times when they are inserted by injection in the lesioned areas of the prostate, with an estimate of 500-1000 times better concentration and diffusion. Typically, the antimicrobial mixture contains a number of antibiotics and antiinflammatory agents that cover the full range of potential microbes that cause chronic prostatitis.

Usually, after the first intraprostatic injection the patient sees a significant improvement ranging from 40% to 50%, mainly at the irritating symptoms such as pain, frequent urination, burning sensation during urination etc. For the obstructive problems such as the difficulty in urination, the improvement rate is typically lower. On average, 70% to 80% of the patients see significant improvements after 3-4 injections.

This therapy represents a good alternative, which however does not lead to the complete cure of the chronic prostatitis. Nevertheless, it comes with very good results with regards to the removal of the major or persistent discomforts that have brought about changes in the quality of the patient’s life. Generally, the disease improvement rates are around 65% to 70%.