"Chronic Prostatitis": part 5


by Ivo Tarfusser, MD (© 1996)

In this section, the author does not want to explore the vast field of "alternative"medical treatment with herbs, homoeopathy and alike. The documentation of thesemethods is very poor or inexistent. Their wide-spread use is only explainable bythe disappointment many patients experience from conventional treatment. Thefrustration is not only confined to the patients, but also to their doctors whoare not supplied with efficient guide-lines of diagnosis and treatment by theofficial researching medicine. Therefore, many urologists tend towards anihilistic attitude after the failure of their initial treatment attempts,informing the patient that he has to live with his problem. In the following, Iwill list the therapeutical measures I have adopted through the past 7-8 years.Being this a field almost totally neglected by scientific papers, many of thepoints of view are personal and not officially supported. I hope they can be asource of ideas which may incite interested urologists to dig, judiciously,deeper into the matter or, at least, start a discussion.

  1. Keep warm!
    Warmth will reflectorily relax smallsmooth muscle fibers which are present everywhere in the prostate and theseminal tract. The relaxation of these muscular tissue components will help toopen up the outlet zone of the prostatic and ejaculatory ducts, reducing theoutlet resistance which improves drainage of more or less inflamed secretionsand detritus. Less contraction will reduce the metabolism of the smooth musclecells, leading to better tissue oxygenation and recovery of the muscle cells andlessening edema; it reduces tissue pressure inside the prostate and intraluminalpressure inside the prostatic glands and seminal vesicles. Therefore, the oftenrecommendated hot sitz baths are, without doubt, rational and often veryhelpful, and can be resolutive in certain cases.

  2. Regular sexual life:
    The seminal tract (prostate,seminal vesicles, epididymitis) can only be drained by ejaculation. Clearingthis tract regularely from secretions is very important, more especially if thesecretions are physically, chemically or biologically altered by an inflammatoryprocess (alterations in density, pH, electrolytes, nutrients; high content ofwhite blood cells, microorganisms). Many patients with discomfort in theperigenital area tend to avoid sexual engagement, inconsciously worsening thecondition.

  3. Drugs
    Three types of drugs are usually employedin "CP"

  4. Prostatic massage:
    The rationale of thisprocedure is to try to expel dense inspissated prostatic secretion and/or toforce an obstructed outled duct. In order to avoid damage to the integrity of aprostatic acinus which could lead to worsening of the inflammation, it should bedone with care, and in my opinion, not before the patient has had hot baths anddrugs for a couple of days. It seems very helpful in those patients in whom TRUShas shown a sectorial edema in the prostate. In my experience, patients withmassive calcifications in the veru-region are rarely helped by this manouver;this seems understandable, as those calcifications cannot be removed by massage,but, on the contrary, manipulation can traumatize this area and worsen thesituation. I see my patients 2-3 times a week for a total of about 6-8 sessions.

  5. Surgery:
    Surgery is controversial in "chronicprostatitis". Some advocate a "radical" TURP (transurethralprostatic resection) for patients with uncurable Chronic Bacterial Prostatitis,but those cases are few, and for the "big bulk" of NonbacterialProstatitis and Prostatodynia, surgery has never had a place in the treatmentarsenal. In the author's opinion, the Drach-classification cannot constitute abase for decision (or at least not the only one) as far as treatment isconcerned. In the past years, I have operated on quite a few patients with NPDand PDy, using targeted, in some cases, new procedures in selected patients,basing the indications for surgical treatment on:
    a. the intensityof symptoms: Of course, only patients with heavy discomfort which does notsubside after conventional treatment can be considered as candidates forsurgery.
    b. the age of the patient: In young men, fertility isan important concern: a heavily pathologic spermiogram will strenghthen theindication for surgery (and indicate the type of procedure to adopt), a normalspermiogram would make me cautious.
    c. the ultrasonographicevaluation at TRUS: determinant for the appreciation of the underlyingpathogenetic mechanism of the disorder and for the choice of the procedure.


    As a rule, surgeryshould only be considered in patients with severe persisting symptoms whichdecisively interfere with normal quality of life. Pain is more likely tosubside after surgery than frequent urge of voiding. The more severe thecondition, the better the results. The least invasive procedure likely toresolve the problem should be chosen. One has to be conscious of the fact thatthe operation not always does or has to remove all inflamed or pathologicallyaltered tissue. Many times, the procedure eliminates obstruction or astrategical area, improving the chances of the inflamed or chronically dilatedzones to normalize. It is also useful to bare in mind that a condition whichpre-exists for years may take time to cure, and sometimes, the symptoms, thoughimproving, may not disappear completely.

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