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Pioneering Care in Non-Surgical Treatment of Prostate Disorders

Date: Wed, 23 Apr 2003 18:35:21 GMT
From: MiamiNiceShyGuy <miaminiceshyguy@aol.com>
Subject: Manila Protocol

Before the advent of the Miami Protocol there was the Manila Protocol: This review summarizes the history of published results of the Manila Protocol of repetitive prostatic massage, intensive microbial diagnosis, and antimicrobial therapy. It concludes that the Manila Protocol currently has the highest published rates of clinical remission for all symptoms of chronic prostatitis.

1) Hennenfent BR, Feliciano Jr. AE: Clinical Remission of Chronic Refractory Pelvic Symptoms in Three Men. The Digital Urology Journal, July 24, 1998. Available at: http://www.hindawi.com/journals/tswj/2004/162942/abs/

Three American men with chronic prostatitis refractory to treatment in the USA were treated at the Manila Genitourinary Clinic with microbial diagnosis, antimicrobial therapy, and 19, 27,and 21 prostatic massages respectively. All three men, who were continuously symptomatic, underwent complete resolution of symptoms. At last follow-up at 29 months, 26 months, and 15 months respectively, after treatment, all men still remained asymptomatic. Conclusion: 3 of 3 men underwent complete remission of all symptoms.

2) Hennenfent BR and Feliciano AN: Release of Obstructive Prostatic Disease and Improvement of Erectile Dysfunction by Repetitive Prostatic Massage and Antimicrobial Therapy. The Digital Urology Journal October 5, 1998. Available at: http://www.hindawi.com/journals/tswj/2004/605701/abs/ A 69-year-old male presented to the Makati Genitourinary Clincic with for acute urinary obstruction with a urinary catheter in his bladder. He had been diagnosed with BPH by a urologist and had been told he needed surgery called TURP (transurethral resection of the prostate). He also complained of impotence, having had no erection for many years. The catheter was removed, the man was treated with 8 prostatic massages, was diagnosed with prostatitis, microbial tests were done, and antibiotics were given. His urinary symptoms completely resolved and his sexual function returned 60 – 70 percent. At last follow-up, the man has avoided surgery for over 5 years and at 5 years reported normal urination with only occaisional nocturia. Conclusion: 1 man avoided surgery for over 5 years and had lasting improvement of urinary symptoms with 60 – 70 percent improvement of impotence from the Manila Protocol.

3) Hennenfent BR and Feliciano Jr. AE: Changes in white blood cell counts in Men undergoing thrice-weekly prostatic massage, microbial diagnosis, and antimicrobial therapy for genitourinary complaints. The British Journal of Urology, 1998;81:370-376.Thirty-five men, average age 45 years, were treated with repetitive prostatic massage, extensive microbial diagnosis, and antimicrobial therapy. The expressed prostatic fluid (EPS) was examined a total of 347 times in these patients.Only 5 patients could be reached for follow-up at the time this retrospective chart review was done. Four of the five patients reported a complete resolution of symptoms, with the 5th patient – a diabetic, reporting continued sexual dysfunction. Conclusion: 4 of the 5 patients (80%) available for follow-up reported a lasting clincial remission of all symptoms.

4) Nickel JC, Downey J, Feliciano Jr. AE, Hennenfent BR: Repetitive prostatic massage therapy for chronic refractory prostatitis: the Philippine experience. Tech Urol. 1999 Sep;5(3):146-51.Importantly, this was a prospective study. Men with chronic refractory prostatitis who had been to many previous physicians, already received multiple rounds of antibitiotics, some of whom had undergone surgery and other procedures, and many who had been sick for years or decades were treated in Manila with prospective data collection in this study. This was truly a subset of “hopeless incurable men.” Twenty-two men entered treated. Follow-up out to two years was attempted (average follow-up was 17 months.) Five of the 22 patients had complete remission of symptoms. Overall, based on Subjective Global Assessment scores, 66.6 percent of the patients experienced marked, moderate, or mild improvement of their chronic prostatitis. Conclusion: 5 of 22 (23%) of men underwent a complete resolution of symptoms.

5) Shoskes DA and Zeitlin SI: Use of prostatic massage in combination with antibiotics in the treatment of chronic prostatitis. Prostate Cancer and Prostatic Diseases. May 1999, Volume 2, Number 3, Pages 159-162. At the Institute for Male Urology, Encino CA and the Division of Urology, Harbor-UCLA Medical Centre, Torrance, California, 73 men were treated with repetitive prostatic massage and antibiotic therapy. The average age of the group was 43.5 years and average duration of symptoms 6.7 years. Overall 40 percent of the patients underwent complete resolution of symptoms, 19 percent underwent complete resolution followed by a recurrence, 21 percent experienced some improvement and 21 percent had no improvement. Conclusion: 59 percent of men underwent a complete resolution of symptoms but 19 percent of the men relapsed over time.

6) Two other studies on the Manila Protocol are known to be in progress.

Final Conclusion: The Manila Protocol has appeared in the medical literature five times, including a case report, case series, retrospective study, and prospective study. It has been corroborated in 3 clinical settings by 6 different physicians. Authors have included the Manila physicians, Dr. Hennenfent, a Canadian urologist – J. Curtis Nickel, and an American urologist Daniel A. Shoskes, the latter two both National Institutes of Health funded physicians, who are part of the Chronic Pelvic Pain Collaborative Network. The Manila protocol has been corroborated at separate medical centers. One caveat, however, is that the original Manila doctors have never commented in the medical literature that the Manila Protocol has been reproduced properly at other centers. Another point is that Manila Protocol is far from mature, because the technique of prostate massage has not been clearly defined, many other diagnostic tests could be added if more research could be done, antibiotic studies are still needed, and many other issues need to be resolved. However, all studies have been consistent in that some patients underwent a complete remission of symptoms, and the majority of patients if not healed, experienced symptomatic improvement. Currently, the Manila Protocol appears to have the highest reported rate in the medical literature of men undergoing complete remission of symptoms or improvement of symptoms. If anyone knows of any other treatment displaying such favorable remission rates, please post them on the message board at www.ProstateTalk.com for our review. ProstateTalk.com sees evidence in the medical literature that chronic prostatitis may be caused by infection, urinary reflux into the prostate, semen reflux into the prostate, immune dysfunction, obstruction of prostatic ducts and acini, pelvic floor dysfunction, neurologic disease, autoimmune disease, hormonal disease, allergic processes, muscular disease, vascular disease, radiation seed implants, urinary catheters, spinal cord injury, and other etiologies. ProstateTalk.com is currently evaluating the world’s literature on chronic prostatitis on its message board.

End of PROSTATITIS Digest – 22 Apr 2003 to 23 Apr 2003 (#2003-116)