Viagra in Prostatitis Treatment
VIAGRA - SPECIFIC THERAPY FOR ERECTILE DYSFUNCTION
IN PATIENTS WITH CHRONIC CHLAMIDIAL PROSTATITIS
IN III-IV INFLAMMATION PHASE

Pavels Ivdra, Aija Zilevica, Alfreds Miltins, Inara Ancupane, Ivars Geldners
Riga Clinical Hospital "Gailezers", director E.Platkajis
LU Medical Faculty, Latvian Association of Physicians - Chlamydiologists

Pavels Ivdra
 Aija Zilevica
 Alfreds Miltins
 Inara Ancupane
 Ivars Geldners

Chlamydia trachomatis infection plays a dominant role in the etiopathogenesis of erectile dysfunction and impotence. In the alternative and exudative, i.e., I and II phases, chlamydial monoinfection-induced prostatitis patients do not look for a doctor's help because due to the irritation of interoreceptors caused by urogenital venous plexus and the prostate gland nerve ganglion inflammation, there may be even an extremely high libido and potency. Sick males subjectively perceive the hypersexual potency and sexual excess sensations as something positive and it, to their understanding, does not call for any treatment.

 

In etiopathogenetic therapy, when the prostatic edema and venous blood stasis decrease, the pathological irritation of interoreceptors decreases and pathological hypersexual sensations and potency are lost. Patients perceive the loss of this pathologic, hypersexual excess very negatively relating it to after-effects of maltreatment and doctors' incompetence. In such a case, after alternative and exudative inflammation phase is cured, and if signs of erectile dysfunction are observed, Viagra should be indicated.

In the prostate III-IV inflammation phase, which is characterized by proliferation of connective tissues, scarry deformation of tissues, calcinates in the parenchyma, paraprostatitis, inflammation of the urogenital venous plexus and degenerative dystrophic changes in the prostate nerve ganglia, one may experience suppressed libido in which case men do not perceive the fact of potency loss as a tragedy and do not seek a sexopathologist's help.

Long-lasting and repeated enzyme therapy with streptase, urokinase and tissue plasminogen activator (t-PA) provides reparative regeneration of prostatic tissues mainly at the expense of smooth musculature [19-20].

After the course of enzyme therapy, libido and potency are not always spontaneously restored, therefore, for the sake of rehabilitation of sexual potency, it is advisable to indicate Viagra 50-100 mg extra for at least a month not less than once a week or taking into consideration a sex partner's wishes.

We began to prescribe Viagra to chronic chlamydial prostatitis patients from November 1998. 43 patients with chronic chlamydial prostatitis and erectile dysfunction at the age of 25-76 years were prescribed Viagra 50-100 mg as a sigle trial dose before the enzyme therapy. We identified 3 different patient groups.

1 group. One hour after taking Viagra 50-100 mg, erectile dysfunction disappeared in 24 patients (55,8%). Coitus lasted for 1 hour with vigorous erection. On the second day patients felt very well. No side-effects were observed.

2 group. 5 patients (11,65) did not observe any essential changes in erectile dysfunction (±) after taking 100 mg Viagra pill.

3 group. Viagra did not help or even caused side-effects in 14 patients with chronic chlamydial prostatitis III-IV inflammation phase (32,6%).

The least effective or negative effect of Viagra before the enzyme therapy was seen in 19 (5+14) patients with chronic chlamydial prostatitis or in 44,2% cases.

After the enzyme therapy course with streptase, urokinase and tissue plasminogen activator (t-PA) in all patients, except one, erectile dysfunction regressed.

Example 1

Patient Z.S., 45 yrs.old, suffers from pain in the lower abdomen and sacrum for 2 years. He experiences suppressed libido and weak erection with an inability to perform penile introjection. He has applied to the family doctor and a sexopathologist. He was using Viagra 50-100 mg per day. Erectile dysfunction did not decrease. On the second day after taking Viagra, he experienced dull pain in the genitals, lower abdomen and sacrum. He was sent to the urologist.

Diagnosis was specified:

1. Urogenital chlamydiosis;
2. Chronic chlamydial prostatitis;
3. Paraprostatitis;
4. Inflammation of urogenital venous plexus;
5. Erectile dysfunction due to disorders of venous backflow retention.

When examining rectally, the prostate was found to be deformed, flat, with a levelled dorsal sulcus, poorly outlined, rigid, diffusely tender. Marked paraprostatitis with the inflammation of urogenital venous plexus and deformation of venous valves which make it impossible detain the venous backflow from the cavernous bodies.

Spontaneous fibrinolytic activity depression is diagnosed in venous blood - 4% (norm - 10-15%). Activation of fibrinolytic enzyme system by streptase and Actilyse was indicated.

The patient received the course of enzyme-antibiotic therapy for 28 days:

1. Streptase 5.000-500.000 e.u. i/v 1x a day, for 24 days, total dose 6.130.000 i/v;
2. Tissue plasminogen activator (t-PA) Actilyse 10-20 mg i/v 1x a day, for 6 days, total dose 100 mg i/v;
3. Heparin 5.000 u. 1x a day, for 26 days, total dose 120.000 u. i/v;
4. Antichlamydial antibiotics (doxocylin, erythromycin, surlid, claforan,etc.)

Starting with the 24th enzyme therapy day, after 500.000 e.u. streptase and 20 mg Actilyse i/v, one can observe a marked hypocoagulaemia in the infusion coagulogram: blood clot retraction o%, spontaneous fibrinolysis 100%, plasma euglobulin fraction fibrinolysis 10', proteolytic resistance 120 u.

Hypocoagulaemia is the necessary sanogenous reaction in the treatment of erectile dysfunction. The inflammation of organs ( prostate, venous plexus, paraprostatitis) in the small pelvis regressed. Erectile dysfunction disappeared. Viagra, which had been ineffective up to now, became effective.

Conclusion.
Venous type erectile dysfunction depends on corpora-cavernosa increased venous blood efflux.

Some urologists and sexopathologists are of the mind that the above-mentioned erectile dysfunction can be treated surgically. Surgery of genital organ venous system usually involves ligation or operation in which part of the veins which transport the blood from corpora-cavernosa are ligated thus making them remain saturated with blood and keep swollen. Physicians are refusing from these operations now, since the damage to health being observed, as well as decrease in the outcome. Fibrinolytic therapy, on the contrary, is the method of choice.

Operations on blood vessels are performed rarely, in the cases when there are congenital blood vessel pathologies or traumatic defects of arteries which supply corpora-cavernosa.

Arterial type erectile dysfunction depends on disorders of arterial blood afflux to corpora-cavernosa.

The reason for insufficiant arterial blood afflux is the trophic artery atherosclerosis of cavernous bodies, starting with the aortal bifurcation, a.iliaca and more to the peripheral.

The basis for erectile dysfunction is a specific pathology of arterial and venous blood vessels with the enzymatic defect of fibrinolytic enzyme system. In the chronic chlamydial prostatitis III-IV inflammation phase, the cause of disorders of corpora-cavernosa blood circulation is the translocation of infection and inflammation from the prostate to the surrounding tissues (paraprostatitis).

The most effective oral remedy for the treatment of erectile dysfunction and sexual rehabilitation of patients with chronic chlamydial prostatitis of III-IV inflammation phase is Viagra. Erectile dysfunction is not the primary disease but an after-effect of various diseases or a syndrome.Thus, concommitantly with erectile dysfunction, it is important to treat the primary disease as well. Prostatitis and erectile dysfunction is one of the most common urological diseases of men. Every third-fourth man who seeks urologist's help is a chronic prostatitis patient who needs Viagra for the treatment.

Viagra (sildenafil) is a new oral remedy for treating erectile dysfunctions, it restores the erectile function and natural response to sexual stimulation. Physiology of erection calls for the release of nitrous oxyde (NO) which occurs in the cavernous body during sexual stimulation. NO, in its turn, stimulates the activity of enzyme guanilate cyclasis which produces the rise of cyclic guanozine monophosphate (cGMP) level, causing slackening of smooth musculature of cavernous body and letting it swell with blood. Beneficial pharmacological effect of Viagra is achieved only in cases of sexual stimulation performed by a sex partner. Not only Viagra improves the erectile function but the orgasm, sexual satisfaction and general satisfaction [1;2] as well.

Sexual health is a very essential component of a human's general physical and emotional well-being [3]. However, erectile dysfunction is a rather wide-spread type of sexual disorder. In Latvia, men, starting with the age of 45-55 years, not less than in 50% of cases suffer from more or less evident erectile dysfunction, which is indirectly proved by a great rate of divorces.Most commonly the family life fails, if a wife due to a husband's erectile dysfunction, cannot achieve sexual satisfaction. Negative interpersonal relationship develops, which is quite commonly described as a " discord of characters",etc. To define the diagnosis of erectile dysfunction, the possible cause of the disorder and an adequate treatment, one needs to gather a very detailed case history and data of physical examination. Viagra's positive test (+) demonstrates that arterial blood afflux to cavernous bodies is adequate. The inflammation in the small pelvis is the reason to blame.

Sexual activity is related to the morphological and functional condition of the prostate and urogenital venous plexus. Therefore, before undertaking any therapy of erectile dysfunction, the physician has to assess the inflammation phase of the prostate, the presence of paraprostatitis, the functional state of veins and arteries in the penis.

A lot of men do not comprehend that prostatitis can affect their sexual behaviour and health, since in the I-II prostatic inflammation phase, many of the patients have increased libido and potency. However, in the III-IV prostatitis phase, erectile dysfunction is quite a common complication - permanent inability to achieve and preserve penile erection. Although earlier it was called "impotence", now it is more proper to define it as "erectile dysfunction", since the term "impotence" is associated with a negative implication to part of the people. Erectile dysfunction makes negative impact on a man's life, undermining his self-confidence. As a result, a man emocionally gets alienated from his family, friends, his spouse or a partner,thus making unnecessary tension on mutual relationship and greatly impairing the life quality [4].

Earlier the origin of erectile dysfunction was associated with psychological disturbances, but we know now that in the majority of cases the cause is due to organic changes [5].

Therefore, it is of great importance that men and their partners were informed about erectile dysfunction in order to know how to act when it develops.A surprisingly great number of men experience erectile dysfunction, yet only a few go to see a doctor. Thanks to the possibility to buy Viagra, erectile dysfunction is nothing to worry about. Erectile dysfunction in a majority of cases can be treated. But in case of penile artery sclerosis and obliteration, the enzyme therapy with t-Pa is the method to give some hope.

Erection is a result of a complex process where pelvic blood- vessels, prostatic nerve ganglia, interoreceptors and CNS are involved. The anatomical structure of the penis is specifically designed to respond to this process. The penis is composed of two corpora cavernosa which originate in the interior of the small pelvis and extend to the glans penis. These bodies contain a lot of blood-vessels. When a man experiences sexual excitement, the blood-vessels in the penis began to dilate. As a result, the penis becomes filled with blood. At the same time, the veins through which in ordinary conditions blood flows back from the penis, are compressed and the vein valves get closed. This restricts the backflow of blood from the penis.While arteries are getting more and more congested with blood but venous backflow being slower, the penis becomes enlarged and the erection results.

In cases of erectile dysfunction, the reactions which provide erection do not take the usual course, therefore the blood-vessels do not dilate sufficiently enough, venous backflow is greater than that of arterial afflux, as a result, the penis cannot get swelled with blood [6,7].

For men of 40-50 years of age, erectile dysfunction is not only a psychological disorder but also a sign of aging. Although the age really plays the role, erectile dysfunction, however, is not an inevitable sign for a man to be getting older [8].

In general, for a majority of middle-aged and elderly men, erectile dysfunction is connected with organic changes in the blood-vessels of the small pelvis which may result in a restricted blood afflux to the penis [9;10].

Diseases which may cause disorders of penile blood supply are: arterial atherosclerosis, inflammation of urogenital venous plexus, chronic chlamydial prostatitis in III-IV inflammation phase with the proliferation of connective tissues, scarry deformation of the prostate, calcinates in the parenchyma and paraprostatitis.

Polyarthritis, cardiac ischemia, diabetes mellitus, obliterating endarteritis may also be the most common organic causes of erectile dysfunction [11;12;13;14].


Example 2

Patient L, 56 yrs.old, had been hospitalized twice within a year - 32 and 45 beddays, in total - 77 beddays. On admission he complained of a burning sensation in the urethra and in the glans penis. Pains in the sacral and lumbar regions. Pains around the umblicus.Pains in the joints of arms and legs. Hot flashes.Sexual drive and potency had completely disappeared. Evident nervousness with signs of aggressiveness. Conjunctivitis. Chronic prostatitis for 8 years. During last 5 years there has been no sexual intercourse due to erectile dysfunction.

The patient has been treated in several Riga hospitals by different specialists. Due to antibiotic resistance, routine therapy and Viagra were ineffective.

Clinical diagnosis:

1. Chronic chlamydial prostatitis in III inflammation phase.
2. Paraprostatitis.
3. Male pathologic climacteric;
4. Reiter's syndrome - conjunctivitis, polyarthritis;
5. Impotence (5 years) due to disorders of penile arterial blood supply - arterial atherosclerosis.

In coagulogram control the patient got streptase i/v 1x a day for 77 days, in total - 23.210.000 e.u. and antichlamydial antibiotics.

Complaints, which were seen on admission, disappeared after the enzyme therapy. The inflammatory process in the prostate and paraprostatitis regressed, though sexual function was not restored spontaneously.

For the rehabilitation of sexual function, Viagra 50 mg 1x a day for 5-6 weeks was indicated. After the enzyme therapy with streptase, the patient and his wife gave a positive evaluation of Viagra. Libido and potency normalized, erectile dysfunction completely disappeared. In 1,5-2 months, normal coitus was achieved without any help of Viagra.

Conclusion.
Almost all men with chronic chlamydial prostatitis in III-IV inflammation phase, who have undertaken the enzyme therapy with streptase, urokinase and Actilyse must have extra treatment with Viagra 50-100 mg pills at least 1x a week.

Results of the late and now show that erectile dysfunction can be successfully treated. Since there are several methods of treatment available, the patient and the doctor have to decide which one is the best in the definite situation [15]. Fibrinolytic enzyme system activation with streptase, urokinase, Actilyse is the method of choice.

Since 1973, when treating chronic prostatitis, paraprostatitis, inflammation of the urogenital venous plexus with an aim to restore arterial and venous blood circulation, whatever the cause, we found out in the majority of cases that the erectile dysfunction regressed if proteolytic, fibrinolytic enzymes and their activators (tripsin, papain, terilitin, fibrinolyzin, streptase, urokinase, tissue plasminogen activators,etc.) had been used [16;17;18].

It is worth mentioning that when applying enzymes in the treatment, we have been the first to determine the morphologic structure of the prostate - reparative regeneration possibilities of smooth musculature in the treatment of the prostate atony and regression of erectile dysfunction [19;20].

Reparative regeneration of the prostate's morphologic structure may begin only after sanation of the inflammation caused by chlamydial or mixed infection, as well as after optimal activation of the fibrinolytic enzyme system. When starting the enzyme therapy with streptokinase, the time of treatment can be greatly shortened and the barrier of antibiotic resistance overcome [21;22;23]. In cases of allergy and anaphylactic shock to streptokinase, in order to achieve desensibilization and positive sanogenous response,urokinase should be simultaneously indicated [24;25;26;27;28;29;30;31;32]. Inflammatory processes being cured, Viagra could be prescribed for not less than 1x a week for the rehabilitation of sexual functions.

Nowadays, with a wide sprectre of treatment available, no man with erectile dysfunction should suffer from it in silence. Regression of degenerative dystrophic changes does not restore spontaneous erectile function, suppression of libido would persists. Viagra is a remedy which perfectly provides the way out of this vicious circle. Viagra has introduced a revolution in the treatment of andrologic patients and may promise positive treatment results even in men of 65-70 years of age.

In male pathologic climacteric one should first indicate the enzyme therapy with streptase, tissue plasminogen activator (t-PA) up to hypocoagulaemic effect and only then, Viagra should be added for the sake of sexual rehabilitation. [25;27].

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  17. P.Ivdra, "Sposob lecenija hroniceskogo prostatita"- Avtorskoje sviditelstvo SSSR N#486750, 05.10.1975.Bjul.N#37.

  18. P.Ivdra, "Sposob lecenija hroniceskogo prostatita proteoliceskimi fermentami i geparinom" - Zurnal " Urologija i Nefrologija", N#1b str.44-46, Medicina, Moskva, 1976 god.

  19. P.Ivdra, V.Kalinka, B.Solomjak, R.Ezerlicite, "Vozmoznostj reperativnoi regeneracii prostati pri fermentoterapii hronoceskogo intersticialno-perenhimatoznogo prostatita" - 2. Konferencija urologov Litovskoi SSR, Kaunas, 10-11 nojabrja 1977g., str.166-167.

  20. P.Ivdra, V.Kalinka, R.Ezerlicite, "Sposob ocenki fermento-geparinoterapii prostatita i polovih passtroistv" - Avtorskoje sviditelstvo SSSR N#607129, 15.05.1978.Bjul.N#18.

  21. V.Purmalis, P.Ivdra, I.Silins, "Sposob lecenia hroniceskogo prostatita streptokinazoi", Avtorskoje sviditelstvo SSSR N#1066604, 15.01.84.Bjul.N#2.

  22. P.Ivdra, E.Smiltens, V.Purmalis, "Fermentoterapija hroniceskogo prostatita streptokinazoi" - Materiali III Vsesojuznogo sjezda urologov, Minsk, 1984, str.251-252.

  23. Pavels Ivdra "Hroniska prostatita enzimoterapijas indikacijas un antibiotikreszistences regresijas iespejas" - "Latvijas Arsts", 1994.g., N#2, 120.-122.lpp.

  24. Pavels Ivdra "Urokinaze antibiotikrezistentas urogenitalas hlamidiozes arstesana"- "Latvijas Arsts", 1995.g., N#3, 30.-35.lpp.

  25. Pavels Ivdra, Edvins Platkajis "Audu plazminogena aktivatora lietosana viriesu patologiska klimakterija un prostatita arstesana" - "Latvijas Arsts", 1997.g., N#6, 351.-355.lpp.

  26. Pavels Ivdra "Indikacijas hlamidiju izraisita prostatita enzimterapijai" - "Latvijas Arstu Zurnals", 1998.g., N#6, 16.-20.lpp.

  27. Internet - Pavels Ivdra, Edvins Platkajis "Usage of tissue plasminogen activator in treatment of men pathological climacteric and prostatitis"-1998, http://www.expo.lv/gailes/climax.htm

  28. Internet - Pavels Ivdra, Edvins Platkajis, Ivars 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

  29. Internet - Edvins Platkajis, Pavels Ivdra, Alfreds Miltins, Ivars Geldners, Inara Ancupane "Clinical value of dynamics of streptokinase antibody level in antibiotic-resistant chlamydial prostatitis patients during enzyme therapy with streptokinase" - 01.14.1999, http://www.expo.lv/gailes/streptokinase.htm

  30. Pavels Ivdra, Alfreds Miltins, Ivars Geldners "Streptokinazes antivielu limena dinamikas kliniska nozime antibiotikrezistenta hlamidiju prostatita slimniekiem enzimoterapijas laika ar streptokinazi" - "Latvijas Arstu Zurnals", 1999.g., 15., 42.-46.lpp.

  31. Pavels Ivdra, Aija Zilevica, Alfreds Miltins, Inara Ancupane, Riga Clinical Hospital No.7, Head doctor: Edvins Platkajis, LSU Medical faculty, Latvian Association of Physicians-Chlamydiologists - "Role of tissue plasminogen activator (t-PA) in enzyme therapy of antibiotic-resistant chlamydial prostaitis" - 99.06.08, http://www.expo.lv/gailes/actilyse-prostatitis.htm

  32. Pavels Ivdra, Aija Zilevica, Alfreds Miltins, Inara Ancupane, Rigas 7.kliniska slimnica, galvenais arsts, docents E.Platkajis, LU Medicinas fakultate, Latvijas Arstu hlamidiologu asociacija - "Audu plazminogena aktivatora nozime antibiotikorezistenta chlamidiju prostatita enzimterapija" - "Latvijas Arstu Zurnāls", 1999.g., N#7, 40.-43.lpp.


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