The Cure for Non-bacterial Prostatitis, Prostatodynia, and BPH in the
Philippines. Currently in the USA 95% or more of all patients with
chronic prostatitis syndromes with symptoms of pain, obstructive
symptoms, irritative voiding, or sexual dysfunction are labeled as
non-bacterial prostatitis or prostatodynia. Because of discussions on
the Internet newsgroup sci.med.prostate.prostatitis there has
been a stampede of North Americans to the Philippines to get treatment
for these "incurable" diseases. An important anecdote is that of a
patient who had been to multiple urologists, and participated in an NIH
funded study, but was told there was nothing that could be done for
him. He reported being cured in the
Philippines as have many others.
As the original proponent for the newsgroup, I went to Manila to
investigate these procedures. At Dr. A. E. Feliciano's clinic patients
are not categorized on the basis of one EPS determination as done
in the USA. Rather, prostatic massage is done every other day
throughout therapy. In patients that would be labeled prostatodynia in
the USA the WBC/HPF almost always rises over 10 by the fourth
massage as deeply obstructed and infected ducts are drained. In
"non-bacterial" prostatitis patients and prostatodynia patients,
bacteria can almost always been seen as the prostate drainages are
continued and obstructed ducts are finally opened up, releasing high
numbers of white blood cells and bacteria. An anatomical key to the
success of prostatic drainage is that almost all prostatic ducts are
posterior and palpable. The anterior prostate is almost all smooth
muscle and vestigial ducts. Thus the entire prostate can be drained
via Digital Rectal Exam (DRE).
The WBC/HPF of a group of patients through a series of drainages
would end up looking remarkably like a bell curve in patients with
prostatitis syndromes. As the patients were treated with
antibiotics and every other day prostatic drainage, the WBC count would
often be less then ten at the first DRE, rise to near 50/HPF or higher
in several spikes, and then drop to less than ten as symptoms
resolved, usually on about the 16th day of treatment, but taking as
long as six weeks.
The laboratory workup for prostatitis syndromes in the
Philippines was extensive. Two urethral swabs are obtained. The first
is used for a gram stain. The second urethral swab is used for
chlamydia detection by immunoflourescence. It is believed to be
important that the specimen for chlamydia immunoflourescence be
collected second, as the first swab has a "drying" effect on the
urethral mucosa, and the second swab is thus more likely to collect
epithelial cells, where mycoplasma live, by friction.
The DRE is performed and prostatic drainage is done until a drop
of fluid appears at the urethral meatus. The first drop of prostatic
fluid is collected for a gram stain. The drop is thinned out on the
slide with an applicator stick and gram stained. The gram stain
specimen is studied for number of white blood cells, bacteria, and the
presence of fungi.
The second drop of EPS is tested for pH, and then prepared as a
wet mount. This slide is studied for the presence of trichomonas and
fungi.
Cultures are collected next. Using 4 swabs the urethra is opened
and milked and specimens are collected in order for: aerobic culture,
anaerobic culture, trichomonas, and mycoplasma/ureaplasma.
The patient is then asked to urinate and a standard urinalysis is
done to rule out UTI. Next a standard semen analysis is done.
Every two days during treatment the patient returns for
evaluation and prostatic massage, with drainage of prostatic fluid.
Great detail is paid to the technique of prostatic drainage.
At the second visit, a swab for urethral gram stain is done again
if the first urethral gram stain had white blood cells present. If no
white blood cells were present the urethral gram stain is not repeated.
If the first urethral swab did have pus cells then it is repeated at
each visit until the white cells disappear.
Also at the second visit, DRE is performed with emphasis on
therapeutic prostatic massage. The first drop of prostatic fluid is
obtained and thinned out on a slide for gram stain. The second drop is
tested for pH. At a minimum, after prostatic drainage, the gram stain
and pH determination will be followed every two days until the end of
treatment. Repeat cultures are done whenever the patient does not
appear to be responding appropriately to treatment, or during spikes of
WBC/HPF.
According to test results the patients are put on antibiotics.
While in the USA controversy rages over whether gram positive bacteria
cause prostatitis, there is no controversy in the Philippines about
gram positives causing prostatitis. It is believed that the gram
stains prove these organisms to be pathogens. Staphylococcus and
Streptococcus are treated just as any other bacteria would be according
to antibiotic sensitivities. Typically patients are given ofloxacin as
the most commonly used antibiotic.
Minocycline or doxycycline are used for Chlamydia. When the WBC count
peaks on the bell shaped curved, 2 grams of metronidazole are given as
a single dose to cover fastidious anaerobes that may not be
easily cultured--similar to the way pelvic inflammatory disease in
women is now treated with anti-anaerobic therapy empirically. At the
end of therapy when the WBC count drops close to zero, often
budding fungi can be seen in the EPS gram stain, and antifungals such
as diflucan are given.
By the end of treatment, the WBC count in the prostatic fluid has
dropped to less than ten, the pH of the prostatic fluid has dropped to
below 7.0, the cultures or immunoflourescence are all negative, and
the patient is asymptomatic.
The historical experience in the Philippines is that every other
day prostatic drainage is optimal.
Other regimens with longer intervals between drainages has resulted in
higher failure rates. Doing drainage daily did not improve the cure
rates in their experience.
Because of the poor discrimination between BPH and prostatitis,
these procedures also worked remarkably well on patients that presented
to the clinic who had been labeled as BPH, and were seeking to
avoid surgery (TURP).
These treatment procedures for chronic "non-bacterial"
prostatitis, and prostatodynia are simple
and elegant, and combine already known diagnostic and treatment
regimens. Since "non-bacterial" prostatitis, prostatodynia, and "BPH"
are the most common prostate disorders these techniques deserve further
investigation by the industrialized world.
Brad H, MD
