Systemic and local enzyme therapy used in combination with transurethral drainage of prostate in patients with obstructive forms of chronic prostatitis

Guskov A.R., Bogatcheva I.D., Iatsevitch G.B.

Research and Treatment Center of Non-Operative Urology and Andrology, Moscow

Urologia i nefrologia 1998, No. 6, pp. 37- 42

Russian and Czech version available here.

In our study, we focused on the complex treatment by a transurethral drainage and use of proteolytic enzymes, thus aiming to lyse the "plugs" and to diminish the viscosity of inflammatory products. This could, by our opinion, significantly accelerate restoration process of the affected organ.
Aim of the presented work - to study the effect of combined systemic (Wobenzym) and local (in situ electrophoresis of trypsin and chymotrypsin) enzyme therapy on the efficacy of transurethral prostate drainage (electrostimulator-aspirator "Intraton-4") in patients with chronic prostatitis and to investigate its mechanism.
530 patients with chronic prostatitis were observed. Examinations and treatment were done at the out-patient clinic. All patients underwent, besides general clinical examinations, analysis of urine in two portions, test on pathogenic microflora, gonococcus, trichomonad, chlamydia, mycoplasma, ureaplasma using direct and indirect fluorescence, and also diagnostics of urethral infections using PCR. Patients with clinical signs of acute urethritis received anti-inflammatory therapy with regard to the manifested pathogenic microflora.
All patients were subject to the ultrasound (US) examination of prostate using polypositional rectal apparatus "Pie Medical" (transurethral ultrasound examination) (8). Patients were US monitored during treatment. Patients with the presence of microabscesses and "pseudomicroabscesses" in the prostate were subject to the complex therapy including transurethral vacuum drainage of prostate ("Intraton-4") combined with in situ electrophoresis (urethral, rectal, or urethro-rectal) of trypsin and chymotrypsin and Wobenzym administration - 5 dragees 3 times a day.
A positive restoration dynamics in patients without Wobenzym reached 100% after 30 days of treatment, while in Wobenzym-treated patients the same result was obtained after 20 days.
A complete prostate drainage (disappearance of microcavities of irregular and drop-like form on US) after 20 days of treatment without systemic enzyme therapy was achieved in 52% of patients, while in Wobenzym-treated patients - in 88.2%. We show a case report of US data - patient X., aged 28 years.
The most important are comparison results of prostate drainage intensity in both groups of patients over the first 10 days of treatment. In the group without systemic enzyme therapy, a complete drainage of prostate was achieved in just 5% of patients, while in the Wobenzym-treated group - in 47.2 % of patients, i.e. nearly 10 fold.