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A brief description of our treatment of prostatitis
As the main reason of development of severe prostatitis are small microabscesses (closed foci of pyoinflammation 1-2 mm in size), they should be removed. The original method of SANOS consists in solving this surgical problem without operation. The treatment comprises the following stages:
１．診断（2日間）
A general examination is made of the patient's physical and mental health, nervous system, immunity, urogenital system including thorough investigation of the prostate, rectum, spine. Hormonal tests and consultations of other specialists (otorhinolaryngologist, cardiologist, gastroenterologist, etc.) are performed if necessary.
２．排膿（10-15日間）
If the prostate is diagnosed to contain closed foci of purulent inflammation (microabscesses), the treatment starts with specially designed draining therapy under control of ultrasound and laboratory tests. This stage ends not earlier than the physician is absolutely sure of complete elimination of the inflammation products from the prostate. On the treatment day 7-8 when most of the microabscesses break, their pathogenic microflora is studied bacteriologically.
３．リハビリ
If the pathogenic microflora is detected, antibacterial therapy is initiated followed by rehabilitation (device treatment and medicines). At this stage therapeutic measures are aimed at elimination of congestion in the prostate, improvement of prostatic muscles tone, blood and lymph circulation, innervation. When it is necessary for an individual patient, an additional therapy is performed (immunostimulation, hormonal correction, etc.)
経直腸空気圧震動マッサージによる前立腺排膿法
With all the drawbacks indicated above, finger massage of the prostate is good in that it makes prostatic lobes to release secretion diminishing congestion in the prostate. But for secretion to go out, the ducts should be patent, that is be able to drain. But severely affected lobes have ducts corked with plugs. This means that inflammation products cannot leave the duct and therefore cannot be drained as a result of finger massage which only destroys the inflammation foci and spreads infection. Negative effects of finger massage can be corrected with our technique of prostatic drain using an original rectal pneumovibromassager PBM-P-01 "SANOS".
Figure 5. Rectal pneumovibromassager PBM-P-01 "SANOS"
空気圧震動マッサージは、前立腺の深さに亀裂がはいった直腸挿入棒を使用する。挿入棒は風船がついていて、空気圧ポンプで間欠的に空気が送り込まれてくる。空気は風船をリズミカルにふくらまし、亀裂を通って逃げていく。こうして前立腺はソフトにマッサージされる。風船は図6のよう、前立腺に陽圧と陰圧を交互にかける。
Figure 6. The shape of the pneumoimpulse from the device PBM-P-01.
The duration of the impulses and pauses, the pressure of the delivered air and the time of the procedure are regulated by an electron control device. 空気圧震動マッサージに先だって、特殊な液を尿道に注入し、漏れて来ないようにペニスを軽く縛っておく。 Then the rectal tip of the SANOS massanger is introduced into the rectum and the procedure with preset parameters of pneumoimpulse starts. The duration of the procedure is 10 minutes. The course consists of 10 to 15-20 sessions given daily or each other day. 空気圧震動マッサージ中は、 the waves of low-frequency vibration (the second component of the pneumoimpulse) transmitted from the pneumoballoon of the rectal tip to the prostatic gland generate sinusoidal vibrations in it with alternating fronts of positive and negative pressure. 前立腺は弾性な性質なので、周期に合わせて縮んだり膨らんだりする。尿道に注入した特殊な液が、それに合わせて出入りし、前立腺の排出管が開通する。 The first component of the pneumoimpulse also contributes to the drainage. Joint effect of the pneumoimpulse components potentiates the impact efficiency. During the procedure the patient feels mild vibration in the anal canal and no unpleasent feelings. The procedure is safe and painless. The pressure on the prostate in pneumovibromassage is 10 times less than in finger massage. Due to this the method is atraumatic. At present this treatment in severe chronic prostatitis has become basic in SANOS center. Contraindications include exacerbation of hemorrage, anal fissure. In such cases we use another original method - transurethral prostatic drainage using aspirator-electrostimulator Intraton-4.
Method of trans urethral drainage
Figure 7. Urologic electrostimulator-aspirator Intraton-4
Intraton-4 consists of vacuum aspiration and electrostimulation units. Prostate draining is conducted by means of a thin electrode-catheter painlessly led up to the prostate along the urethra. When it is connected with the vacuum aspiration unit, the latter produces strictly dosed rhythmic rarefaction (negative pressure + low-frequency vibration) aspirating pus and plugs from the lobes. After complete cleaning of the prostate, the gland is stimulated (like the heart, for example) by electroimpulses from the electrostimulation unit. Electrostimulation is indicated at the stage of rehabilitation treatment. The response to the treatment increases with combined use of both units of the Intraton-4 allowing both aspiration of lobular content and electrostimulation of the prostatic smooth muscles to recover their tone. Moreover, transurethral electrostimulation is important for male sexual function as it stimulates seminal tubercle and posterior urethral portion which serves a trigger erogenic zone. The procedure is associated with weak erotic feelings. We raise therapeutic response with additional physiotherapy (indicated below) and drugs. In some cases we use combination of transurethral and transrectal prostatic draining. This improves treatment effectiveness and reduces its duration.
Administration of the proteolytic enzymes
Prostatic lobular ducts are long and narrow. The pus they contain is highly viscous. As to the plugs, they are often dense (figure 8). All this may protract treatment.
Figure 8. Microscope picture of pus plug (magnification 60x)
To reduce the treatment duration, we developed an original enzyme therapy (systemic and local enzyme therapy). Using different methods of proteolytic enzymes delivery to the affected organ, we achieved a significant decrease in the pus viscosity and fusion of plugs. As a result, prostate cleaning was achieved 3 times more quickly. This enzyme therapy is practiced both in transurethral drainage and transrectal one.
List of other methods employed in our policy of chronic
prostatitis treatment
Our approach implies usage of the following methods in certain sequence and in certain indications:
transurethral vacuum aspiration of the prostate;
direct transurethral electrostimulation of the prostate;
transurethral vacuum aspiration combined with electrostimulation;
intraorganic (urethral, rectal, urethrorectal drug electrophoresis;
intraorganic (urethral, rectal, urethrorectal photophoresis of drugs (IR-laser);
intraorganic (rectal, urethral) and external phonophoresis of the drugs (ultrasound);
transrectal pneumovibromassage of the prostate;
transrectal combined physiotherapeutic impact on the prostate (electrostimulation+electrophoresis+photophoresis);
SHF therapy of the prostate;
sound stimulation of the urogenital organs;
IR-laser radiation of the urethra and prostate;
IR-laser radiation of the blood and thymus.
We also use other device treatments and effective drugs.
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このページを和訳したのは木村泌尿器皮膚科院長の木村明です。 和訳しようとした経緯及び途中で挫折した経緯はここをご覧ください。 これらの治療法が正しいと、木村が思っているわけでも、 これらの治療法を当院で行っているわけでもありません。 |