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A new treatment option for prostatitis/prostatodynia?




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The management of patients with chronic pelvic pain attributed to chronic prostatitis has long been rather unsatisfactory. Even prolonged treatment with an aminoquinolone, such as ciprofloxacin, and an anti-inflammatory agent, or, alternatively an alpha blocker, seldom results in rapid resolution of the symptoms, and is commonly completely ineffective.

We recently encountered a patient, effectively disabled by prostatodynia, unresponsive to standard treatment, who had been taking morphine to control the pain from 2001 – 2008. He was unable to tolerate non-steroidal anti-inflammatory analgesics. In 2008 he was prescribed initially 10 mgs, then 20 mgs daily, of the phosphodiesterase type 5 (PDE5) inhibitor tadalafil, with immediate marked improvement of his symptoms. On cessation of the medication on 4 separate occasions, his symptoms returned; recommencement of treatment each time, with 5 mgs tadalafil daily, has resulted in similar persisting improvement of his symptoms, and he has been able to discontinue treatment with morphine. As a direct consequence of the conversation with this individual we have prescribed tadalafil 5 mgs daily in several of our patients with prostatitis; so far with uniformly beneficial results. Of course, we should point out that this is an off-label indication for this medication.  

However, in addition to the symptom of pelvic pain, many men suffering from chronic abacterial prostatitis/prostatodynia also complain of associated lower urinary tract symptoms and ejaculatory discomfort. Consequently treatment with tadalafil at a dose of 5 mgs per day for a period of time would seem logical. It could be surmised that many of its beneficial effects might stem from an improvement of blood flow to pelvic organs as a consequence of its anti-inflammatory and vasodilatory activity, as well as a relaxant effect on smooth muscle, as has been previously suggested in the case of lower urinary tract symptoms by Karl-Eric Andersson and others.

Clearly the hypothesis that daily treatment with a PDE5 inhibitor might be beneficial in men suffering from the prevalent condition of chronic abacterial prostatitis/prostatodynia needs to be formally tested in the context of a randomized controlled trial. If the results of such a study were to prove positive the quality of life of very many sufferers of this disorder might be significantly improved. One might also speculate that it could provide a concomitant benefit to the partners of these often very unhappy men. 

Read the full BJUI article

Roger Kirby, The Prostate Centre
Culley Carson III
, The University of North Carolina
Prokar Dasgupta
The Prostate Centre, Guy’s Hospital, King’s College London

 

  1. Mike Kirby
    The pathogenetic mechanisms underlying pelvic pain syndrome are ill understood but it is likely that multiple mechanisms are involved including alteration of the nitric oxide (NO)-cyclic guanosine monophosphate (cGMP) pathway; enhancement of RhoA–Rho-kinase (ROCK) signalling; autonomic hyperactivity; and pelvic atherosclerosis. Additional contributing factors such as chronic inflammation and sex steroid ratio imbalance often linked to the metabolic syndrome may also play a role . Further research of the common pathways linking these mechanisms should allow a better understanding of the pathophysiology of pelvic pain syndrome, and perhaps it is not surprising that PDE5 inhibitors are helpful. I also have anecdotal experience of similar positive benefit in a small number of patients with chronic pelvic pain.
  2. Culley carson
    While the case reported is not a double blind placebo controlled trial, it may generate one. To date all of the evidence based trials for prostatitis and chronic prostate pain syndromes have generated, at best, equivacol results. Antibiotics are not successful, alphablockers are poor and 5 ARIs are also poor in their response. In the meantime, urologists are faced with these difficult patients on a daily basis and have little to offer. These men are often profoundly effected by these symptoms. Having another option for treatment will help urologists and their patients deal with this difficult malady. Ther is good theoretical bases for the effectiveness including the anti inflammatory properties of PDE5 i medications and the increase in pelvic blood flow postulated for these drugs.

    Clearly there is a need for a large scale double blind study to confirm the use of these agents, their minimal side effects and overall safety make them a good option today.
  3. Mark Frydenberg
    Fascinating article for a very disabling condition , which I often attribute to a pelvic loor dysfunction rather than a true bacterial on non bacterial inflammtion . It is certainly encouraging that another option is available to try for these men who are often suffering significantly.
  4. Julian Shah
    Prostatitis is a Cinderella condition which does not usually incite enthusiasm amongst health professionals. I have been running a Prostatitis Clinic for a few years now and the most effective treatment has been regular (urologist) prostatic massage. Although this is in no way a controlled study, many patients have derived significant benefit and relief of symptoms. I recommend to my colleagues this treatment for their patients.
  5. Arqile Gjikondi
    A BRILIANT METHOD FOR PROSTATITIS CURE

    Dr.Arqile Gjikondi
    Nefrologist..Tirana - Albania

    MY 7 YEARS EXPERIENCE ON THE TREATMENT OF CHRONIC PROSTATITS TO MY CLINIC ON TIRANA-ALBANIA….
    There are 7 years that I am treating my patient by a method that I named - two modal rectal treatments.
    I began to treat the chronic prostatitis 17 years ago to the Central Army Hospital Tirana, when I worked as a nephrologist for about 26 years. The 10 first years, I use intensively the academically traditional methods of treatment (antibiotics, non steroidal anti-inflammatories, alfa 1 blockers), with no significant results. Then I began to use the massage of the prostate (good temporary results), intraprostatic injections (good results, but, too painful, complicated and costly method).
    7 years ago I began to use the 2 modal rectal method. It is a VERY LOGICAL anatomical treatment with excellent results and too easy to perform without pain, no complications, no any adverse effects and very cheap in comparison of the other methods of treatment (about 400 patients).
    The logical approach… the antibiotics taken by Mouth route did not arrive with a good concentration on the prostate and pelvic organs (seminal vesicles, muscular pelvic tissues etc.)
    So... I use the rectal route to insert the antibiotics (not intraprostatic injections). The rectal mucosa is a very capable of absorbing the liquids, (in this case antibiotics) and send them directly to the nearest, atached organs (in this case prostate and other pelvic organs) via rectal vessels network, unchanged and with a very high concentration.
    I use the different antibiotics, each day (for 10 days) with a rectal wash syringe (similar with a micro enema). The patient must stay lay down at his bed for 30 min.
    The concept is that the antibiotic, will be absorbed by rectal mucosa and it will be spread to the prostate and pelvic tissues unchanged with a very great concentration (hundred times more than the mouth route)
    There is no need for the use of the cortisone or other drugs, only antibiotics, (usually 4-5 kind of antibiotics) with very small doses, so there are not adverse effects or complications.
    This is first mode of treatment, but I use and the second treatment immediately after each of the antibiotic insertion.
    The second treatment consist at the concomitant use of a special device, which is a rectal heater. It is a small probe (a finger size one) connected with a heater device (you can buy this device in your country or other country shop, online, easily). This probe is inserted in the anus immediately after the antibiotics insertion, and rest in the anus for 30 minutes (the time during the antibiotics are absorbed by rectal mucosa). The probe is heated at about 40-45 degrees Celsius. This probe ensure a very good antibiotics absorption, magnetic massage, improvement of prostate and surrounding tissues shrinking, vascular network etc.
    Some years ago, I use this anal heater device, alone without antibiotics. There were some very good results, but with the combination heater with anal antibiotics there are very quick, long-term, excellent results. I don’t know exactly ..why.. this combination works so well.
    The treatment consists of 10-15 days treatment, 30 min for each session.
    The improvement is a very quick within 3-5 first days. After the completion of this rectal 10 days treatment, WHAT HAPPEN???
    Usually after the treatment finished, the pain symptoms disappear 90-100% for a long time (years) or forever.
    The voiding iritative symptoms (dysuria, frequency, urgency) disappear at 70-100%, usually after 10 days for 3-4 weeks.
    The ejaculate symptoms, disappear during 10 days for 3-4 weeks
    The impotence ,erection disturbances, disappearing for 3-8 weeks after the treatment
    Psychological symptoms (fear, fatigue, panic,d esperation, depression etc) resolve immediately after the treatment.
    By my 7 years experience, about 85% of the patients are completely recovered (symptom free) for follow up of 2 years.
    The remaining (15%), have some small relapses, too easy to treat only by mouth medications (traditional ones — antibiotics, alfa-1 blockers, pain killers, zinc, magnesium or herbal substances etc)
    The best results are achieving with young adults 18-50 years old.
    I know, it is very difficult to believe those excellent results. I need a 3 years experience to believe it myself. To my practical work there are too many patients suffering for 2-10 years from chronic prostatitis. Nowadays they are symptom free or with small temporary relapses specially in the winter or spring season.

    This method is too simple, too easy, to be such excellent in short- and long-term results.
    Often the simple things are the best solutions.
    This method can be performed by each patient in his own home with nurse assistance or his wife or friend. Just need to bay some ampoules of antibiotics, an enema syringe and of course the anal heater device. No more expensive travelling, hotels, doctors bills, time consuming etc..
    My inspiration for this work and treatment is due to the work and concepts of Prof. Dr. Federico Guercini (Italy) Prof. Dr. Atila Toth (USA), Prof. Dr. Daniel Shoske (USA), Manila Protocol

    Always I am wondering why the other doctors (urologists) don’t use this anal route for antibiotic administration. I don’t find the answer yet.

    I apologize for my English writing mistakes. I am aware that this is a very short article prepare only for prostatic sufferers, not for medical members. Please feel free to write me any questions about this article.
    With Respect
    Dr.Arqile Gjikondi
    Tirana Albania e=mail [email protected]

    ANAL PROBE HEATER AND HEATER DEVICE
    WASH RECTAL SYRINGE 60ml
    THE MICRO-ENEMA WITH ANTIB
  6. Roman
    I have had chronic bacterial prostatitis since 2007 it is a nightmare for me been to a few urologist had cystoscope done on me been on antibiotics for 120 days doxycycline 2 a day sulfamethoxazole nothing helps, im in pain all the time, my life feels like its over, I have a hard time ping every day pelvic pain where can I purchase rectum antibiotics and where can I purchase a rectum heater.thank you hop you can help me
  7. Arqile Gjikondi
    A Brillant Novel New Approach to Chronic Prostatitis/Chronic Pelvic Pain Syndrome

    Dr.Arqile Gjikondi
    Nephrologist – Tirana, Albania


    English Edit- Dr. Eric Michael Teplicki
    Anesthesiology – Miami, Florida

    This is a summary of my seven years of experience in treating patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). During the past three years I have developed a method with a substantial cure/alleviation rate. This is a method that I coined – the Two Model Rectal Treatment.

    I began treating this syndrome about seventeen years ago during my time in the Central Army Hospital in Tirana, Albania. There I worked as a Nephrologist for about twenty-six years. The first ten years, I used extensively the academic traditional approach to the condition (antibiotics, nonsteroidal anti-inflammatory, and alpha-1 blockers), with no significant results. Then I began to incorporate rectal massage and prostate massage, good temporary results but nothing long-term. Afterwards, I tried intraprostatic injections (good results, but too painful, complicated, and it was a very costly method).

    Seven years ago I began using what I coined later as the Two Model Rectal Method. It is a VERY LOGICAL anatomical treatment with excellent results. It is extremely easy to perform and has minimal complications, virtually no pain, and is also very cheap in comparison to the other traditional modalities. To date, I have seen success with about four hundred patients – and still counting. In my eyes, success is actually curing the patient of pain – not just minor point reductions in the overall symptomatic index score that the NHI provides.

    The traditional approach of taking the antibiotics by mouth did not arrive with high enough concentrations inside the prostate and other pelvic organs (seminal vesicles, muscular pelvic tissues, etc.) to do any good. Thus, I decided to try the rectal route. The rectal mucosa is a very capable of absorbing the liquids (in this case the antibiotics) and send them directly to the nearest attached organs (prostate and other pelvic organs) via the rectal/pelvic vessel plexus. This route offers very high concentrations above MIC of many organisms directly into the prostate simply via mass effect.

    I use different antibiotics for each day for ten total days with a rectal wash syringe (similar to a micro enema). The patient must lie down on his/her shoulder while the antibiotics are diffusing in (30 minutes in total).

    Again, the concept is that the antibiotic will be absorbed by the rectal mucosa and it will be spread throughout the prostate and pelvic tissues unchanged with high concentrations (several times higher than oral route). What I have seen is that there is actually no need for other medication, i.e. steroids, simply the antibiotics. I use different kinds of antibiotics in very small doses, so there are no adverse effects or complications. This is first mode of treatment. The second mode is the rectal heater.

    The rectal heater is a small probe (a finger size one) connected with a heater device (you can buy this device in your country or if unavailable online via China, Ukraine, etc.). This probe is inserted in the anus immediately after the antibiotics, and left to rest in the anus for 30 minutes (during that time the antibiotics are absorbed by the rectal mucosa).

    The probe is heated to about 40-45 degrees Celsius. The probe has many advantages including increased antibiotic absorption, magnetic massage, improvement of prostate and surrounding tissue blood flow, and improvement of shrinking of the actual prostatic tissue. Some years ago, I used this anal heater device alone without antibiotics. There were some very good results, but the combination of the heater with rectal antibiotics proved to have quick, long-term, and excellent results. I don’t know exactly why the combination works so well but I do have theories that may explain it.

    The treatment consists of ten-fifteen days antibiotic protocol. Each of which lasts approximately 30 min. The improvement is usually very quick within three to five days. After the completion of this protocol… what happens? Usually after the treatment finishes, the pain symptoms of my patients started disappearing 90-100% for a long time (years) or forever. The voiding symptoms (dysuria, frequency, urgency) started disappearing at 70-100%, usually after 10 days and continued to improve up to four weeks afterwards. The post-ejaculate pain symptoms disappeared within 3-4 weeks post treatment. The impotence, erection disturbances, disappeared within 3-8 weeks after treatment. Psychological symptoms (fear, fatigue, panic, desperation, depression, etc) resolve immediately after the treatment – once the patient starts realizing the protocol is working.

    In my seven years of experience with trial and error this particular protocol, about 85% of the patients are completely recovered (symptom free) for follow up of 2 years. The remaining (15%), have small relapses, which are actually easily treated with traditional medications (oral antibiotics, alpha-1 blockers, pain killers, zinc, magnesium, herbal substances, etc). The best results I have seen came from young adults 18-50 years old.

    Quaity of Life,,is improvement about 90-100% (this is the most important thing,by my opinion)

    I know it is very difficult to believe these excellent results. I needed three years of proven clinical experience to believe it myself. In my eyes and clinical exposure, there are too many patients suffering from this debilitating illness for far too long (2-10 years from Chronic Prostatitis/Chronic Pelvic Pain Syndrome). Nowadays, the ones I have treated are symptom free or with small temporary relapses.

    I have heard critics say that this method is too simple, too easy, to have such excellent short- and long-term results. My response is often the simple things are the best solutions. The beauty of this protocol is that each patient in his own home can perform it with the assistance of a partner, friend, or family member. All that is required are some ampoules of antibiotics, an enema syringe, and of course the anal heater device. No more expensive traveling, hotels, doctors bills, injections, frustration, time consumption, etc. No more suffering.

    My inspiration for this work and treatment is due to the work and concepts of Dr. Federico Guercini (Italy), Dr. Atila Toth (USA), Dr. Daniel Shoske (USA), and the Manila Protocol (Philippines). A special thanks to Dr. Eric Michael Teplicki (USA) for his help in editing this article and continued research and support in the field. Dr. Teplicki has also come up with some novel ideas of integrating infection, inflammation, pelvic floor dysregulation, and neural integration as a spectrum of the illness as opposed to the long term thinking that each entity is the cause of the condition independently.

    I always wondered why other doctors (urologists) have not used this route for antibiotic administration – I still haven’t found the answer yet.

    This article is meant for patients suffering from CP/CPPS and not for physicians. However, if you are a patient or a physician and are intrigued about the above please feel free to contact me.

    With Respect, Dr.Arqile Gjikondi
    Tirana Albania e=mail [email protected]
    Fb..gjok kondi
    Fb page chronic prostatitis.new treatment
    Skype….agjikondi gjikondi
    English Edit-
    Dr. Eric Michael Teplicki
    [email protected]

  8. shaq
    Hi Dr Arqile,
    What type of antibiotics you used and in what concentration/amount?
    Regards.
  9. Georg Schauer
    Hi, That's sounds all very logical. The type and amount of antibiotics would be very important to know. But there are antiboitic suppositories around. Why doctors never use them for Prostatitis. I used rheumatic suppositories with some success Regards

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