Effective Regimen for Treatment of Chronic Prostatitis
| Diagnosis of prostatitis
Treatment of prostatitis
A well-tried remedy which definitely helps those suffering from prostatitis – Israeli pills Sulfa-P
Leading medical centers of Israel dealing with problems of chronic prostatitis developed various treatment regimens involving use of both antibiotics and other antimicrobial agents. Since regular sex life contributes to active drainage of the prostate gland, specialists of our center
Alishech, as well as all other urologists dealing with this problem highly recommend their patients to keep it on in spite of the treatment.
Based on their long-term experience of treating hundreds of patients suffering from chronic prostatitis, Alishech professionals recommend administering nine week combination therapy using sulfanilamides.
If symptoms of dysuria (urination disorder) are present, it is recommended to take Xatral XL 10mg for the first 10 days of Sulfa-P course in order to ease painful urination. When taking Sulfa-P course, symptoms disappear within the first 10-12 days in most cases but it is not enough.
When administering this treatment regimen, remission usually lasts for 6-8 months.
If symptoms appear again, an additional course of Sulfa-P is administered.
Sulfa-P is produced in Israeli pharmacies only on a by-order basis and is delivered in a parcel by express mail to all countries. For the order and delivery of Sulfa-P
International Quality Certificate
. Complies with SI ISO 9001:2008
. License No. 56855.
Each pill of Sulfa-P-Formula contains:
• Sulfamethoxazole -500 mg (sulfanilamides
• Bio-complex (microelements) of the Dead Sea
Side effects such as headaches and diarrhea may occur in patients sensitive to sulfanilamides
In order to prevent intestinal flora disorder (dysbacteriosis), we recommend to take Bio 25 dietary supplement one capsule with dinner once every two days
The combination therapy involves taking Sulfa-P pills (Sulfa-P-Formula) as follows:
1 pill 2 times a day (morning and evening)
for three weeks
Afterwards, 1 pill once a day (at night)
for three weeks
Afterwards, half a pill once a day (at night)
for three weeks
Pills should be taken 30 minutes after a meal
Professionals believe that the time required to cure chronic prostatitis approximately equals to the period during which the patient has been suffering from this disease. Thus, if the diagnosis was first made a year ago, treatment will last for 1 year, if the diagnosis was made 3 years ago, treatment will take 3 years, etc. Therefore, such courses should be made several times and each of you can use this rule to make a rough estimate how much time you will need to recover. As a rule, treatment of prostatitis fails more often when more time has passed since the disease onset.
Feel free to ask questions concerning treatment to an Israeli doctor: firstname.lastname@example.org
Delivery to any city in the word; delivery time is 2-14 days after payment.
*The delivery of medications is possible only on the prescription of a doctor from the clinic Alisheh VMC.
*If the parcel has not been delivered, the receiver will be refunded the full order amount. The receiver may cancel the order if the order has been paid for through the PayPal system installed on the website.
* If a parcel is rejected by the receiver after its reception, the return will not be accepted.
* Alishech shall not be liable for product misuse.
* Patients taking the aforementioned remedy know that they suffer from the aforementioned disease.
* Having chosen to purchase the aforementioned remedy, the customer is enabled to receive treatment with Israeli remedies without coming to Israel (which allows a significant reduction of expenses).
The term “prostatitis” comprises different inflammatory diseases of the prostate gland including not only acute and chronic bacterial infections but also cases when the prostate gland is inflamed but the causative agent is not found. The current literature describes more than 20 classifications of prostatitis based on different approaches (etiological, pathogenetic, morphological, according to the ways of permeation, etc.).
We will use the classification based on clinical findings and laboratory studies.
In order to diagnose bacterial, chronic or abacterial prostatitis, the first pass and midstream urine as well as prostate gland secretion obtained after its massage are studied. The number of white cells in the obtained samples is calculated and it is referred to inoculation.
Thus, prostatitis can be classified into:
1. Acute prostatitis
2. Chronic prostatitis
3. Abacterial prostatitis
Besides, there is an additional condition – prostadynia
Prostadynia is referred to when there is a clinical pattern of prostatitis with negative results of urine inoculation and in the absence of any signs of the prostate gland inflammation (normal white blood cell count in the gland secretion). The infectious etiology of the disease is highly doubtful, so antimicrobial therapy is not indicated.
Prostodynia as a nosological entity, was excluded by American authors from the prostatitis classification in 1999. Its position was taken by chronic prostatitis without any clinical signs, i.e. an inflammatory process detected incidentally during examination of male sexual partners of women suffering from inflammation of the lower urinary tract as well as during examination under the IVF programme (this form used to be called asymptomatic bacteriospermia (ABS)).
Some authors distinguish the form of CP after adenomectomy. It should be noted that in case of benign prostate hyperplasia, when a targeted study is performed, concurrent chronic prostatitis is found in almost 90% cases although no clinic signs were found in most of these men and they had never been diagnosed with this disease before.
1. Acute Bacterial Prostatitis
Young men having active sex life usually suffered from this disease. Acute bacterial prostatitis in elderly men is usually caused by catheterization of the urinary bladder performed because of urine retention caused by prostate enlargement. In younger men acute prostatitis can be caused by catheterization performed because of surgical interference or if a patient is kept in an intensive care ward as a result of burns or injuries to monitor the fluid balance of the body. The diagnosis of acute bacterial prostatitis is made based on the typical clinic pattern: fever and chills with painful urination (Xatralxl 10 mg Helps in case of urination disorders) In such cases, when performing urine tests, leukocyturia and bacteriuria are present. When performing physical examination, the prostate gland is very tender and tuberous to the touch. After its palpation even a slight pressure usually causes discharge of purulent secretion which contains a lot of bacteria and white blood cells.
Massage of the inflamed prostate gland is dangerous because it can cause bacteriaemia and urosepsis. For this reason, when acute prostatitis is suspected, digital investigation of the prostate must be very easy and should be avoided, especially since diagnose can be easily made by means of microscopy of a gram stained urine swab.
The most common causative agents of acute bacterial prostatitis are gram negative bacteria (Escherichiacoli and Klebsiellaspp.). Most medications used for treating prostatitis permeate into the inflamed tissue of the prostate gland easier that into healthy tissue, therefore, when administering pharmaceutical treatment, there is rapid improvement.
The range of causative agents of hospital-acquired infections, associated with bladder catheterization is considerably wider. They comprise gram-negative rods and enterococci. In such cases microscopy of a gram stained urine swab is particularly informative. The prognosis for the disease is favourable though some complications may occur: abscess of the prostate gland, epididymo-orchitis, vesiculitis, urosepsis and transition of prostatitis into chronic form.
When antibiotics appeared, incidence of acute bacterial prostatitis reduced dramatically and it occurs very rarely nowadays.
2. Chronic Bacterial Prostatitis (CBP)
CBP is not very common as well, though every other man complaining of urination disorders such as burning, frequent or painful urination is diagnosed with it. All these urination disorders are defined as “prostatism” in professional literature. Chronic prostatitis is characterized by asymptomatic course with occasional aggravations. When palpating, the prostate gland is not changed though prostatism symptoms can appear rather often: sometimes several times a year.
It should be noted that chronic bacterial prostatitis should be suspected in each middle-aged man with a recurrent urinary tract infection.
A lower urinary tract infection, especially if it is limited to cystitis (inflammation of the urinary bladder mucous membrane) responds to treatment rather well because concentration of most antibacterial drugs in urine is higher than that in blood. Since the critical level of a medication is usually determined based on its serum concentration, a causative agent formally classified as a resistant one may turn out to be sensitive to the high concentration of the drug in urine. Chronic prostatitis responds to treatment extremely poorly because most antibacterial drugs cannot permeate into the prostate gland tissue.
Considering the diversity of complaints in patients with chronic prostatitis, I-PSS (International Prostata Syndrom System) was proposed for standardization and subjective symptomatology.
Chronic prostatitis has a rather typical pattern of the main symptoms:
1. Pain syndrome which is characterized by pain in the perineum, sacrum and/or testicle. Sometimes pain can be quite intensive impeding daily activities.
2. Urination disorders:
Since infection penetrates into the bladder, this results in urgency of urination, frequent and painful urination as well as:
• sense of incomplete emptying of the bladder after urination
• need to urinate sooner than two hours after previous urination
• stuttering urination
• bladder control problems
• slow or weak urine stream
• need to make an effort to start urination
• night time urination more than 2 times per night,
All these symptoms also occur in elderly men with benign enlargement of the prostate gland
3. Sexual function disorder:
Professional literature contains reports that an inflammatory process in the prostate leads to sexual function disorder, but it is not quite correct. It is more likely that reduction of the sexual function in such cases is associated with decrease in desire. Indeed, when there is some discomfort such as burning or pain, one just cannot think about pleasure! Therefore, medical specialists believe that if a patient with CP suffers from reduction of the sexual function, it is a psychological problem, and this function can be restored by proper treatment. The prostate gland does not have any function in erection. It affects orgasm because the sense of orgasm is caused by a spasm of the prostate part of urethra and the glandular tissue of the gland itself. This, by the way, accounts for the fact that the sense of orgasm subsides with age: the amount of the glandular tissue in the prostate gland decreases with age.
The main patients’ complaints of the sexual function disorder with CP are usually as follows:
• short lasting erection
• pain during ejaculation
• partial weakening of erection
• the most common complaint is that of the loss of interest in sex (decrease in libido).
4. According to different authors’ data, deviations from normal psychological profile are noted in approximately 80% patients with chronic prostatitis which allows distinguishing the fourth syndrome – a neurotic one. It is believed that most patients diagnosed with chronic prostatitis in fact suffer from posterior urethritis or, as it is called nowadays, nonspecific inflammation of lower urinary tract caused by Chlamydia or Micoplasma. There are a lot of scientific researches confirming this version.
Antimicrobial therapy rapidly relieves the symptoms but seldom eliminates the center of infection in the prostate gland itself (this is especially true for young sexually active men). It is accounted for by the fact that most medications poorly permeate into the gland where pH is reduced because of the inflammation; besides, only drug substances bound to lipids, i.e. those that are liposoluble, can permeate into the prostate gland.
Concentration of most antibacterial drugs in the interstitial fluid equals to the serum concentration of the free drug. If permeation of the medication into the site of infection is hindered, long-term treatment with high doses of medications is required. Besides, even if the medication penetrates well into the site of infection, its effect is often hampered by the acid environment and cell debris.
Among inhibitors of folic acid synthesis the most commonly used are sulfanilamides because they suppress synthesis of DNA and RNA nucleotide precursors, the most frequent causative agents of inflammation.
The most efficient remedies for treating CP are fluoroquinolones (ciprofloxacin and ofloxacin).
3. Abacterial Prostatitis
If a patient has prostatitis with high white blood cell count in the prostate gland secretion and the urine obtained after the gland massage, but with negative results of the urine inoculation and no recurrent bacterial prostatitis in the past medical history, he is diagnosed with abacterial prostatitis.
Since young men having active sex life usually suffer from abacterial prostatitis, it is often preceded by non-gonococcal urethritis. The causative agent is considered to be sexually transmissible.
Efficiency of the antimicrobial therapy for this disease has not been proved though improvement in clinical findings can be seen in half of patients. In most patients there is an improvement after 4-6 week treatment course.
The most accurate methods of diagnostics are those based on inoculation of biological material for selective media or cell cultures.
Laboratory diagnostics of chronic prostatitis comprises bacteriological study of the prostate gland secretion, urine and ejaculate. Microscopic examination of the prostate gland secretion is the main laboratory test. Primary focus is on presence of white blood cells in it. Most researchers acknowledge the value of their high count while content of more than 10 –20 white blood cells in the prostate gland secretion per field of vision with the relevant clinic pattern is a sign of an inflammatory process.
I. When visiting a doctor, diagnostic procedures are as follows:
1. History taking with the main focus on the following:
- range of complaints
- their intensity
- their emotional colouring
- frequency of urination
- “urethral” complaints
- disease duration
- recurring frequency
- the nature of the treatment which has been provided before, its effectiveness
2. Examination of external genitals, digital investigation of the prostate gland:
- evaluation of the overall status and sexual characters
- examination and palpation of external genitals
- presence of secretion discharged from the urethra, its color and consistency
- digital investigation of the prostate and diagnostic massage
The following is evaluated:
- sharpness of the PG border
- its size
- distinctiveness of the median sulcus
- симметричность левой и правой долей symmetry of the right and left lobes
- presence of infiltrates
- presence of nodes
- presence of fluctuating foci
- intensity and distribution of pain senses
II. Laboratory methods of diagnostics aimed at detection of inflammation and determining its activity.
Administration of laboratory methods in diagnostics comprises the following:
1. Ultrasonic examination of the prostate
When performing the examination, the following is evaluated:
- presence of focal or diffuse changes
- presence of calcifications
2. Urodynamic examinations
3. Urethrocystoscopy (if necessary)
4. X-ray methods such as IVP or CT (if necessary).
Ultrasonic examination allows complimenting the information obtained after examination of the patient and laboratory diagnostics significantly. Establishing any criteria allowing diagnosing chronic prostatitis based on ultrasonic examination only is doubtful.
Treatment of Prostatitis
As it has been stated above, not all antibacterial drugs, even the most advanced ones, are suitable for treating chronic prostatitis (not all of them permeate into the prostate gland). Therefore, the choice of medications is always limited. There are several reasons for this:
1. In an inflamed prostate gland рН becomes considerably lower than that in a normal one which hinders the effect of the drug substances.
2. The most important thing: in order to permeate into the prostate gland, during the chemical reaction molecules of the drug substances have to be able to bind to lipids entering and leaving the prostate gland freely, i.e. they have to be liposoluble and should not bind to plasma proteins.
In particular, concentrations of most beta-lactam antibiotics and aminoglycosides in the prostate gland tissue amount for less than 10% of their concentration in blood. For this reason, these drugs cannot be used to treat bacterial prostatitis. Macrolide antibiotics while permeating well into the gland tissue are however not active against gram-negative bacteria – the main etiological agents in prostatitis, that is why their use for treating prostatitis can hardly be considered reasonable.
3. Another cause of insufficient permeation of antibacterial drugs into the tissue of the inflamed prostate is the barrier function of the prostatic epithelium hampering their diffusion from the blood plasma to the focus of inflammation and disorder of microcirculation in the prostate gland which does not contribute to increase in concentration of antibacterial drugs in the parenchyma and the lumen of the prostate ducts.
4. Moreover, absorption of the medication is affected by formation of microcolonies by microorganisms in the lumen of ducts, which have a lipopolysaccharide membrane or a coating of antibodies. Thus, microorganisms remain inaccessible for antibiotics while low concentrations of antibiotics are known to create favourable conditions for producing antibiotic-resistant strains.
At the first stage of treatment of patients with prostatitis, the main focus is on elimination of the inflammatory process in the prostate gland and provisional psychotherapy (elimination of emotional disorders, creation of therapeutic prospect, working with patients’ wives). Objectives of the following stages include final elimination of the inflammatory process and normalization of sexual activity.
Among the main medications in treating CP there are sulfanilamide drugs able to accumulate in the prostate gland secretion in concentrations which are 5 – 10 times higher than those in the blood plasma. According to available data, these medications penetrate from the blood plasma to the gland secretion by means of ionic diffusion through lipid membranes of the prostatic epithelium. It is known that only unionized part of a medication is liposoluble.
In patients with chronic prostatitis the relation of pH of the blood plasma to that of the prostate gland secretion is reversed: the secretion has a much higher alkaline reaction (8.4) than the blood plasma. The level of the medication in the secretion acidic environment is considerably higher than that in the alkaline environment. Many researchers of this problem believe and clinical experience shows that since the gland secretion of men suffering from chronic prostatitis has more alkaline environment compared to the blood plasma, concentration of the medication in saliva can correlate in the best way with the expected level of this medication in the prostate gland secretion of a patient with chronic prostatitis.
Problems resulting from the inflammation caused by microorganisms: anatomic impairments, neurotrophic disorders, congestion and aseptic degradation of the secretion as well as autoallergic processes, in their turn, become factors maintaining the inflammatory condition of the prostate gland creating favourable conditions for secondary invasion of wide-spread genital saprophytes which start demonstrating pathogenic properties in this environment.
Due to the fact that the ability of antibacterial drugs to cross the epithelial barrier is dictated by their lipophily and low degree of binding to plasma protein, only liposoluble antibiotics are recommended for use in treating chronic prostatitis. There are not so many medications of this kind. Antibiotics include first of all fluoroquinolones which are considered very efficient drugs and sulfanilamides which in spite of the fact that they have been used for decades prove themselves to be both very efficient in treating CP and cost-effective.
Sulfanilamides are structural analogues of paraaminobenzoic acid, one of three components of folic acid (the other two are pteridine and glutamate). At the first stage of folic acid synthesis paraaminobenzoic acid binds to pteridine with the participation of dihydropterosynthase enzyme. Sulfinamides compete with paraaminobenzoic acid for the active center of this enzyme. Selective action of sulfanilamides is accounted for by the fact that only bacteria synthesize folic acid while body cells require its input from outside.
In order to substantiate a rational antibacterial therapy of chronic prostatitis of infectious etiology, particular attention should be paid to the following aspects.
1. Polietiology of the disease: along with conventional typical uropathogens (Enterobacteriaceae, P.aeruginosa, Enterococcusspp.) a role of atypical microorganisms (micoplasma, ureaplasma, chlamidiae) is also possible.
2. Since not all antibacterial drugs permeate well into the tissue and secretion of the prostate gland and create concentrations there sufficient for suppressing the main infectious agents, strict selection of used drugs is required.
3. Sufficient duration of the use of antibacterial drugs – for at least 9 weeks followed by bacterial control is a mandatory condition of successful antibacterial treatment.
4. Elimination of the pain syndrome is one of the main objectives in treatment of CP.
5. Another important factor for providing drainage of normal secretions and pathological products from the prostate gland is establishing regular rate of sexual activity which contributes to drainage of the prostate gland which is compromised in most patients with chronic prostatitis as well as prostate massage as a curative measure though its efficiency has not been proved. For this purpose, the attending doctor often has to start with psychotherapy at the first stage to make regular sex life possible. The duration of the course and the intensity (and duration) of massages are dictated by the nature of changes in the gland and their dynamics during treatment detected palpatorily.
Most clinical researches carried out in recent years definitely show that treatment of chronic prostatitis should be long-term – 9-12 weeks, and such courses should be performed several times.
When analyzing literature dedicated to treatment of chronic proststitis one cannot fail to pay attention to results of numerous scientific works showing that antibiotics are able to provide sterilization of urine while infection can remain in the prostate gland tissue for a long time. This is what substantiates long-term courses of antibiotic treatment.