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Acute and chronic prostatitis discussion. Arnon Krongrad, MD, moderator.

Since we have the manila protocol Dr here on this forum I think we should ask this question. Does prostate drainage offer symptom relief? I have read hundreds of story's saying no, Many from x manila patients. Yet there are a few out there who were helped or cured from massage. I wonder if the cured were the small percent of suffers with true bacterial prostatitis. Or does massaging actually help release the tense pelvic floor muscles when done, offering some relief? My doc tried the protocol with little results. And has stopped doing it for his patients. some say the anti inflammatory effects from antibiotics, combined with massage may also play a role in some patients getting short term relief..

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We can quote study's all day. I have been on prostatitis boards for about 4 years now. Seen hundreds of posts spoken to countless people who have tried drainage. Most find at most temp relief. The relief comes from draining the gland, the relief lasts until it refills with fluid. Antibiotics may play some anti inflammatory role, but the same effects can also be seen without using antibiotic. A friend of mine actually was at your fathers clinic, and drank beers with your father during treatment. Your father said the beer can help the antibiotics penetrate the prostate{.yea right} Of course 10 years later my friend still has prostatitis....

The fact is your business is drainage dr Feliciano. Its your family business. Your father started it and past it on to you. You have done quite well recruiting patients, but the word is now spread on every forum including international forums that drainage is at most a symptom reducer with temp effects. There are a few cures posted, but my guess is these people had true bacterial prostatitis. you also have to look at the pelvic floor muscles in relation to drainage. stressed muscles get massaged along with the prostate.

Surgery for prostatitis is your competition, If it is found to work. your clinic will slowly disappear into the sun set , as more uro perform the procedure

prostate drainage has been done since cave man times. poor results then, as it does now

with that said it should be tried before surgery.. get your local uro to do it, or purchase a massage.. take oral antibiotics fr a month and massage the gland drainning fluid 4 times a week. there thats it! see if it works

if not try direct prostate injections.

I have tried both with zipo results
This is from prostatitis doctor dr shokes at the cleveland clinic. He writes about Prostate drainage and Dr Feliciano cure rates

To be blunt, that is because much of what you have written in this newsgroup
and in your articles makes little or no sense to me or any other doctor whom
I have spoken to who has read them. I disagree with many of your statements
and disagree that much of the literature you quote actually supports your
views. None of that would matter if your techniques worked in our patients
but they don't, as the soon to be published paper by Nickel on the experience
of several North Amercian urologists with antibiotics and massage will show.
When I tried YOUR EXACT protocol in a number of patients I did not achieve a
single cure or even symptomatic improvement. I applaud and commend you for
setting it out in sufficient detail for others to try and test;
reproducibility by others is the cornerstone of scientific research. The fact
that it doesn't work means either that the technique is not what you posted
or that the patients are different. Your recent posts suggest that it is
because the patients are different. Fine, great explanation, time to move on
to other things for my patients.

> . I feel that we are treating the same disease that you are trying to
> treat, yet not achieving the same results as I have after more than 30
> years of research. However your 20 to 40% cure rate is far better than less
> than 20% without the massage therapy which is the beginning. I am glad that
> at least you are trying your own experiment based on a semblance of my
> method I was doing 10 years ago, which I have modified to the present
> protocol.

If I had known your protocol didn't work in North American patients with
chronic pelvic pain syndrome 3 years ago, it would have saved me a lot of
wasted clinical time and research. There were lots of clues, including the
complete lack of any reputable peer reviewed publications but I tried
nevertheless. So now we have had to start at square one and develop our own
protocols and approaches. We have been successful for a large number of very
difficult patients (roughly 67% cured or improved), but much more work needs
to be done. 99% of what I do clinically in Urology, Immunology and Organ
Transplantation is based on the published research and experience of others
whom I gladly quote and reference, but in the case of our research in
prostatitis and the protocols of the NIH study, your articles do not form
that basis.

>At least doctors are now
> attempting to standardize the diagnosis during the NIH meeting last
> November and remove the notorious "prostatodynia" from the classification.

Yes, it is now called chronic pelvic pain syndrome class IIIb.

I don't mean to be aggressive or argumentative in this public forum, but I
feel it is important to once clearly state my position.

Daniel Shoskes MD
YOu are refering to a different Dr. Feliciano and a different Protocol. I was with Drs Nickel and Shoskes last January in UK. We were invited to present our methodology. In the question and answer portion, I pointed out that they did not follow the procedure because they are unable to extract EPS.
Dr. Antonio E. Feliciano,Jr.MD.FPSV

Sorry to hear your sad story. Maybe you should try surgery. You may be an ideal candidate.

Dr. Polacheck doesn't follow the Manila Protocal? I thought that was exactly what he followed? His website certainly implies that he follows the Manila Protocal? Are you and Dr. Polacheck still in regular contact?
What exactly is the Manila Protocol? Are we on the same page? Is there a publication I can post here like I did the Chronic Prostatitis Symptom Index?
For Dr. Krongrad From AEF
Dr. Armon Krongrad asked: What exaxtly is the Manila Protocol Is there a publication I can post like I did the Prostatitis Index?

Yes there is a publication with the British Journal Of Urology. I could send to you the Publication via email if you wish. If permitted, I could post the protocol in this forum.
For Dell:
Dr Polacheck observed with me for a few weeks sometime 15 years ago. we have not comunicated for many years now.
This discussion is exactly why we need to develop common language. The NIH CPSI is a start in the direction of uniformity in symptom reporting. I'd love to help get us to one description of the Manila Protocol. Let's do it.

Dr Feliciano, anybody can add files. For example, where I am now typing if I click on "Upload Files" to my bottom left I can add a file. No problem and you can do the same.

Because the Manila Protocol will recur as a topic, just like the CPSI will recur, let's post something centrally so we don't have to dig through every discussion to find it. If you send me a file (Word, pdf ... anything) I will post it on the left column like I posted the CPSI so we can at least all be sure we're describing the same treatments. Then we can cut some of the confusion and compare apples to apples.

Thanks Mike and Dr. F. This is an important first step to clarity and progress.
Dr. Krongrad,
Thank you, I will send you the published study of the repetitive Porstatic Drainage in pdf. I could also write in this forum the revised or the improved version of the protocol.
I would like to know how one might standardize the Manila Protocol, be it the original or the revised. What is the technique exactly? How frequently is it applied? For how long? Is it done with or without antibiotics? If with, which ones and at which doses?

For now, I am less interested in the clinical outcomes with which it is associated than with what it is.
Hi again Dr. Krongrad
Please Read Through:

1) What is the protocol itself? How does one standardize the actual massage? Time? Technique? Frequency?
The protocol consist of repetitive prostatic drainage(RPD) monitored leukocyte count (MLC) and use of Target specific antimicrobials (TSA)The main objective of the protocol is to clear the impacted prostatic gland of inflammatory debri, release impacted organism for identification, and to allow selected antimicrobials to reach the pathogen and to monitor wbc count for diagnosis, treatment and to determine a test for cure.
The protocol has 2 phases:
1. Diagnostic: Consist of diagnostic repetitive prostatic drainage (RPD). This is done on a daily basis where the wbc of the expressed prostatic secretion (EPS) is monitored via wet mount. Usually the initial counts are within normal limits. On the average it will take 4-5 consecutive drainage until a peak of wbc count is appreciated. It can be presumed that the glands have been unclogged. This is the best time to collect EPS for comprehensive microbiologic examinations. An ideal specimen is about 10 drops or 0.5cc of EPS, placed in a microtube.
2. Therapeutic: Consist of RPD done every 2 days never less. This is needed to clear the impacted glands of debri and to release the organism so that the chosen antimicrobilials can reach the pathogen. This also permits us to an monitor the respond to treatment usually we will see an erratic but a downward trend in wbc counts. (wet mount is used each time)
On the average the treatment respond for a cure is as early as 12 days to as late of 32 days. Anything beyond this clinical horizon tells us that something is wrong with the protocol. (the clinical horizon may need more explanation)
Standardized drainage and technique. I can describe this in another time if required. In general it is not vigorous, not painful and between 4-10 drops even more of EPS is extracted each time. Wet mount is done and read each time. (Almost impossible to do if you do not have a microscope in your examination room)
Diagnostic: daily for 4-5 days
Therapeutic: 6-16 times done every other day never less otherwise the glands may obstruct, therefore antimicrobials will not reach the pathogen.
2) Is the protocol part massage and part antibiotics? That is what I understood from the paper.
RPD is done with the TSM to release the inflammatory debri, so that the TSM can reach the pathogen. This also permits us to monitor the wbc each time.
I did not mention about the history taking, physical examination specimen extraction and evaluation finally patient education and counseling. So the average time our team spends on a patient the first visit is around 110-180 minutes while the follow up takes 35-85 minutes. The team comprises of 3 physicians, 3 medical technologist 1 acting as a receptionist. I forgot to mention 1 runner.
The protocol was never duplicated, because I never supervised any clinic in the US to insure that the same protocol was used.
I hope I was able to make clear some points.
Thank you.
This forum is great. I am glad to see a forum where useful information is welcomed! Dr. Krongrad--Is there any chance that you would be willing to try the Manila Protocal exactly as Dr. AEF described it? It's too bad that Dr. Polacheck and Dr. AEF are not speaking any more, as I thought he was the answer to the problem of having to travel all the way to Manila to get proper treatment.



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