Specificity of Enzyme Therapy in Treatment of Late Inflammatory Forms of Prostatitis
Specificity of Enzyme Therapy in Treatment of Late Inflammatory Forms of Prostatitis and Their Complications by Streptokinase (SK), Urokinase (UK) or Tissue Plasminogen Activator (t-PA) Simultaneously
Janis  Zalkalns, professor, president of Latvian Enzymologists' Association
Pavels Ivdra, doctor-urologist, Riga clinical hospital "Gailezers"
Aija Zilevica, professor, president of Microbiologists' Association
Inara Ancupane, professor, president of Latvian Chlamydiologists' Association

Janis Zalkalns
 Pavels Ivdra
 Aija Zilevica
 Inara Ancupane

 

Within the period of 1981 - 2002, the Urology Ward of Riga clinical hospital "Gailezers" has treated 2042 chronic antibiotic-resistant prostatitis patients aged from 13 to 80 years. During this time various enzyme therapy methods have been acquired and specific features of enzymatic catalysis studied { 1, 2, 3, 4, 5}.

To provide regression processes of late inflammatory forms of prostatitis, paraprostatitis and their complications, such as connective tissue proliferations, fibrosis and sclerosis, there have simultaneously been administered streptokinase (SK), urokinase (UK) and tissue plasminogen activator (t-PA). The sanogenous response of the above-mentioned enzyme preparations does not mean to achieve a faster fibrinolytic or thrombolytic effect, but to provide a longstanding effect at the hypocoagulaemic threshold level, mostly in mixed-type, antibiotic-resistant, intracellular infections {6, 7, 8, 9}.

The late inflammatory forms of prostatitis due to chlamydia, uroplasmata, gardnerella, cytomegalovirus, Herpes simplex - 2 viruses and other pathogenous infections and their complications are manifest by multiform findings of subjective and objective syndromes. The difficulties in differential diagnostics arise just from the polymorphism of these syndromes. One and the same prostatitis patients may, not uncommonly, have syndromes and complaints of several clinical disorders simultaneously, which seem not to be related to the prostate.

On average, merely 25-30% of ill men, as soon as feeling pain or discomfort in the genital organs, decide to visit a urologist. But the majority, i.e. 70-75% of ill men, on the contrary, with unrecognized, latent small pelvic organ and the prostate inflammations, quite subjectively, judging only from the prevailing clinical syndrome, get into hands of some other physician by mistake and consequently receive symptomatic but not etiopathogenetic therapy.

The 3rd and 4th phases of prostatitis with connective tissue proliferation, with accompanying scarred deformation, gland tissue fibrosis and calcinates in the parenchyma or in the capsule do not comply with the routine therapy.

Urologists can treat prostatitis only in the 1st alternative phase and in the 2nd exudative inflammation phase in which antibiotics are effective. In the 3rd and 4th prostatitis phases with the evidence to antibiotic resistance, the regression of connective tissue proliferation and fibrosis is impossible to achieve without the administration of SK and t-PA. Subjective findings of prostatitis patients may get urologists confused. Prevailing syndromes of clinical disorders may mislead the doctors too, diverting them from the basic disease, i.e. chronic prostatitis. As a result, the patient does not receive the etiopathogenetic therapy but a symptomatic one,consequently - a syndrome is treated instead of the disease.

What are the syndromes that confuse both patients and doctors? 

Latent course of inflammation with the syndromes of general disorders, such as chronic fatigue, weakness, pain in the legs and muscles.

Chronic prostatitis with a syndrome of psycho- neurotic disorder.
The ill men, referred to psychiatrists, get psychotropic therapy, while the basic diseases - chronic prostatitis, paraprostatitis and the inflammation of urogenital venous plexus are not diagnosed or treated.

Chronic paraprostatitis with neurological complaints: radiculitis, the pain at the nape, sacrum, skeletal pain syndrome.

Chronic chlamydial prostatitis with cardiovascular disorder. The pain in the cardiac area at normal ECG ( there may be even chlamydial myocarditis).

Chronic prostatitis with a syndrome of gastroenteral disorder. Chlamydial prostatitis with chlamydial mesadenitis, perihepatitis, paraproctitis, paraprostatitis. A relatively pathogenic infection, Helicobacter pylori, through lymphogenous, hematogenous or translocatory way get from the rectum into the paraprostatic space and then into the prostate.

Chlamydial prostatitis with a pathologic climacteric syndrome. In general, males do not have the climax. If they do have, one should look for the inflammation in the organs of small pelvis.

Chronic prostatitis and the inflammation of urogenital venous plexus with dyscoagulaemic syndrome, erectile dysfunction, hypercoagulaemia, thrombo-embolic complications, myocardial infarction, brain stroke.

Antibiotic-resistance. Antibiotic therapy is ineffective.

Conclusion - Due to an incorrect diagnosis and symptomatic treatment, ill men get into a hopeless situation. They lose confidence in doctors.

How can a patient get out of this vicious circle?
Where can the ill men look for a special treatment with the most effective medicines?

These wonder drugs are fibrinolytic enzymes and their activators - SK, UK, t-PA, etc.

The enzyme therapy can be indicated by a doctor urologist - andrologist who is competent in the field of proteolytic enzyme biochemistry.

There may be concurrent syndromes of clinical disorders. When treating them by tissue plasminogen activators (UK, t-PA), one can achieve the regression of fibrotic and sclerotic inflammations.

Clinical Case: ( Case history Nr 27637 - 01)
Patient A. 37 yrs.old was hospitalized at the Urology Ward, the course of treatment - 35 days.

Complaints: Marked fatigue and weakness (Chronic fatigue syndrome), the pain in the left testis, pain in the urethra, pain in both knees. The patient complains of the pain in the backbone and in the area of lumbar and cervical vertebrae.Pains in the right substernal region after hepatitis and Gilbert's syndrome. In both groins the lumph nodes are enlarged and tender.

Case history shows the patient having suffered from chronic prostatitis for 9 years (since 1993) He had been treated at several leading urological clinics in Russia and had received all possible antichlamydial antibiotics though with no (+) sanogenous effect. Cytomegalovirus (CMV) antibodies IgG were found positive. Then he went to the USA and was treated there by some urologists. He was diagnosed Epstein-Barr virus, cytomegalovirus, ureaplasma urealyticum and antigen structures of Chlamydia trachomatis. Chlamydial antibodies in the blood 2 {+) in titre 1:16. The routine antibiotic therapy indicated by the USA specialists had been ineffective. Prior to the enzyme therapy the prostate was found deformed, asymmetrical due to typical paraprostatitis, with a smoothed sulcus posterior, of polymorphous consistency, diffusively painful.

Before administering the enzyme therapy with Actilyse and Streptokinase, we made a coagulogram and found a moderate hypocoagulaemia: blood coagulation time 15' (Lee&White), fibrinogen concentration in blood 180,0 g/l, increased spontaneous fibrinolysis 35,6%, retraction 11,1%, prothrombin index 66%.

Clinical diagnosis:
1) Urogenital chlamydiosis
2) Ureaplasmosis
3) Cytomegalovirus IgD antibodies (+) positive
4) Chronic mixed- infection prostatitis
5) Paraprostatitis
6) Inguinal lymphadenitis
7) Gilbert's syndrome
8) Chronic fatigue syndrome
9) Initial changes in the spinal vertebrae similar to deformative spondyloarthrosis at C 4-7 and L 4-5 levels
10) Antibiotic resistance (before the enzyme therapy course)
11) Dyscoagulaemia with hypofibrinogenaemia and pathologically increased spontaneous fibrinolysis (35,6%)

Having such a dyscoagulaemic syndrome, the fibrinolytic therapy with stretokinase, urokinase and tissue plasminogen activator (t-PA) seems to be contraindicated because of threats to hemorrhagic complications. But! The patient received the enzyme-antibiotic therapy for 34 days at Riga clinical hospital "Gailezers":

1) Actilyse (t-PA) 25 mg i/v 1-2 times a day for 18 days, the course contained 15 vials with 50 mg in each, altogether 750 mg
2) Streptokinase (SK_) 25 000 - 750 000 e.u. for 31 days, in total 10 385 000 units i/v (prior to Actilyse)
3) Heparin 5 000 u. 1 x a day i/v for 24 days, in total 39 000 u.
4) Papain enzyme tablets 3x 3 a day
5) Gentamycin 80 mg x 2 a day i/m for 15 days (30 amp.)
6) Doxycylin 0,1 x 2 per day for 30 days, 60 capsules
7) Erythromycin 0,1 x 2 a day i/v for 15 days = 30 amp.
8) Sumamed (azitromycin) 250 mg x 1 a day = 6 days
9) Rocephin 1,0 g i/m x 1 a day = 11 amp.
10) Sol. Zanocini 200 mg x 2 a day i/v for 9 days (18 vials)
11) Aevit caps. x 2-3 a day
12) Cycloferon 2,0 ml i/m every other day = 15 amp.

After the enzyme therapy with SK and t-PA, the coagulogram indices returned to norm: fibrinogen concentration 270mg%, prothrombin 80%, APTL - 38,6, INR - 1,23. As a result of the enzyme therapy, dyscoagulaemia regressed, hemorrhagic complications were not observed.

After the enzyme therapy with SK, t-PA and heparin, the pathologically increased spontaneous fibrinolysis from 35,6% - regressed and normalized to 15% (W=10-15%).

After completing the enzyme therapy, the prostate on palpation was found to be of normal size, symmetrical, well-outlined, smooth, elastic,with sulcus posterior restored, the lobes being not tender any more. Paraprostatitis had completely regressed.

Complaints completely disappeared. The patient was cured. Working abilities - restored.


CONCLUSIONS:

1. The enzyme therapy for late inflammatory forms of prostatis and their complications is started with SK, then followed by introducing antibiotics i/v and then going on with t-PA of 25 mg x 2 a day i/v, slowly, 3-4 hrs. and keeping up the coagulation tests at hypocoagulaemic threshold level as long as possible.

2. D-dimer test is non-informative either before or after introducing t-PA i/v in chronic prostatitis patients.

3. If an increased fibrinolytic activity within the range of 30-60% and hypofibrinogenaemia are diagnosed, then it presents evidence to dyscoagulaemia and dysfibrinogenaemia , and in such a case the enzyme therapy with SK, UK and tissue plasminogen activator (t-PA) is not contraindicated.

4. If the spontaneous fibrinolytic activity decreases up to 10-20% (which is the norm) after the therapy with SK and t-PA infusions, then this paradoxical reaction gives evidence to positive sanogenous reaction and allows to continue the enzyme therapy (the paradox means unconscious, incomprehensible reality).

5. In similar occassions SK may be indicated as the inhibitor of pathologically increased spontaneous fribrinolysis {11}, as the inhibitor of plasminogen activator.

6. The diagnostic test of spontaneous fibrinolytic activity has been known for about 25 years {4}, but as it often happens - the new thing used is the one long-forgotten.

7. In cases of late inflammatory forms of prostatitis and paraprostatitis and their complications, the enzyme therapy is mainly based on SK {10}.

In order to reduce the course of treatment by 2-3 times, the tissue plasminogen activator (t-PA) is indicated extra and, as a result, the so far ineffective antibiotics become effective because the antibiotic resistance is regressing.

8. When applying SK, UK, t-PA for the treatment, one can achieve the regression of inflammatory processes of tissue proliferation, fibrosis and sclerosis.

9. Doctors - urologists are not able to cure the late inflammatory forms of prostatitis and their complications, such as connective tissue proliferation, fibrosis and sclerosis. As a result, patients lose any hope to get cured and start looking for help by visiting various specialists.

10. Urologists' indicated routine therapeutic methods are effective exceptionally in the 1st and 2nd inflammatory phases (alterations and exudations), but not in the 3rd or 4th phases.

11. The prevalent syndromes of clinical disorders confuse not only the patients, but doctors as well. As a result, the syndromes are those that are treated, but not the disease.

12. Only 25% of patients are treated at the urologist's, mostly in the 1st and 2nd inflammatory phases.

13. Urologists are not able to cure the late inflammatory forms of the prostate and their complications, because they do not know the biochemical properties of enzymes and their activators and the nuances of pathogenetic enzyme therapy, as well as the threat of anaphylactic reaction.

LITERATURE:

  1. P.P.Ivdra
    "Sposob lecenia hroniceskogo prostatita i polovih rasstroistv"
    Avt.svid.SSSR No.486750, opublikovano 05.10.75, bjul. No.37
    Zajavka No. 1734462 s priobritjenijem ot 5 janvarja 1972 goda.

  2. P.Ivdra, E.Smiltens
    "Classification of chronic prostatitis following syndromes of affection", I Conference of Surgeons-Urologists of Baltic Republics in Riga, October 10-12,1973, 266.-268..pp

  3. P.P.Ivdra
    "Sposob lecenia hroniceskogo prostatita proteoliticeskimi fermentami i geparinom". Urogia i nefrologia, Moskva, Medicina, 1976 g. No.1, str. 44-46

  4. B.P.Baluda, Z.S.Barkagan, B.I.Kuznik
    Opredelenije estestvennovo lizisa fibrinovogo sgustka po M.A.Kotovshnikovoi i B.I.Kuzniku.v knige: Laboratornije metodi isledovanija sistemi gemostaza, Tomsk, 1980 g., str. 244-247.

  5. P.Ivdra, E.Platkajis, A.Miltins, I.Geldners, I.Ancupane.
    Clinical value of dynamics of streptokinase antibody level in antibiotic-resistant chlamydial prostatitis patients during enzyme therapy with streptokinase. 1999. http://www.expo.lv/gailes/streptokinase.htm  

  6. P.Ivdra, E.Platkajis
    Usage of tissue plasminogen activator in treatment of men pathological climacteric and prostatitis,1998. http://www.expo.lv/gailes/climax.htm

  7. P.Ivdra, A.Zilevica, A.Miltins, I.Ancupane.
    Role of tissue plasminogen activator (t-PA) in enzyme therapy of antibiotic-resistant chlamydial prostatitis. 1999.06.08. http://www.expo.lv/gailes/actilyse_prostatitis.htm

  8. E.Platkajis, P.Ivdra, I.Geldners
    Indications for enzyme therapy with streptase, urokinase and tissue plasminogen activator - t-PA in chlamydial prostatitis. 1998. http://www.expo.lv/gailes/prostatitis.htm

  9. P.Ivdra, A.Zilevica, A.Miltins, I.Ancupane, I.Geldners
    Chlamydial polyarthritis. Possibilities of enzyme therapy with streptokinase and plasminogen activator (t-PA) in chlamydial polyarthritis of urogenital origin. http://www.expo.lv/gailes/polyarthritis.htm

  10. P.Ivdra, G.Purmalis, A.Zilevica, I.Geldners, J.Zalkalns, I.Ancupane, A.Miltins  
    Streptokinase as plasminogen activation inhibitor for Chlamydial prostatitis patients. http://www.expo.lv/gailes/streptokinase1.htm


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