"A simple but effective strategy for diagnosis and treatment of prostatitis can provide symptom relief and cures for difficult cases if urologists are willing to reconsider some long-abandoned concepts, a Canadian urologist said here," writes Urology Times> contributing editor Charles Bankhead in the opening paragraph of an article in that publication's November, 1997 edition. Datelined from the International Society of urology 24th Congress, the article outlined a presentation by Dr. Curtis Nickel, M.D. , Professor of Urology at Queens University in Kingston, Ontario, Canada.
"Prostatitic massage combined with aggressive antibiotic therapy can help many patients with chronic forms of prostatitis, both bacterial and non-bacterial in etiology," Bankhead said Nickel said. Bankhead paraphrased Nickel as having said improvements in prostatitis care by urologists will only come about "when the urology community is willing to embrace prostatitis as a major health problem."
"'As a profession, we're embarrassed about this disease. We try to hide it and hope it doesn't come and bother us in the clinic. But the more we try to ignore this disease, the more it sticks out like a sore thumb,'" Bankhead's Urology Times article quoted Nickel as having said.
The article paraphrased Nickel to the effect that prostatitis was indeed common -- something prostatitis patients don't need to be told. But it contained a quote from Nickel blasting the Stamey-Mears classification of prostatitis that has been the rote answer for Urologists for 25 years.
"'The reality is that we all know that the classification system we've been using for the past 25 years creates confusion and frustration. The system does not provide guidance for the treatment of patients who present tous on a daily basis.'" Bankhead cited Nickel.
Nickel endorsed the NIH's system of classification of prostatitis, in which any prostatitis not shown to be bacterial is classified as "male chronic pelvic pain syndrome."
"'The fact is that prostatitis is a difficult, frustrating, and confusing desease to treat," UT quoted Dr. Nickel. "'Practicing urologists have told me that in survey after survey.""
The publication cited Dr. Nickel practice of culturing urine taken after vigorous prostatitis massage. It noted that Nickel still doesn't find bacteria very often, and that he recommends trying antibiotics for 4-6 weeks empirically. However, it said Nickel recommends agains further use of antibiotic if that much doesn't help.
Nickel also uses Alpha blockers (Hytrin, etc.) on his patients who do not respond to antibiotics. The article concluded by paraphrasing Nickel that urologists should "keep and open mind to the options."
"'Repetitive prostate massage works,'" the article quoted Nickel. "'Combine it with potent quinolone antibiotics, and we have something that helps many patients.""
(The full text of UT 's copytrighted article is not available on-line. Urology Times is published in Cleveland, OH by Advanstar Communications, and has a licensing arrangement with a publisher in Canada which re-publishes some of its articles for the Canadian urology market. The name of their journal is Urology Times of Canada. The article in question was published in the November 1997 issue of Urology Times
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