Microsoft word - kirschfeldmucolytica.doc

This paper was submitted to :
World Journal of Urology
November 11, 2005
and not accepted
See Comment in Laborjournal, 3, 14- 18, 2007
Successful treatment of prostatitis syndrome with a
mucolyticum
Max-Planck- Institut für biologische Kybernetik Abstract No effective management of chronic, nonbacterial
prostatitits is as yet available. Here a case is reported in which a new therapy successfully has been applied: oral application of mucolytica, with the intention to reduce viscosity of fluids in prostatic tissue and ducts and hence facilitating their efflux. Tissue pressure may decrease and consequently painful sensations also. In the case documented acetylcystein was the mucolytical substance. Key words: prostatitis, mucolytica
Introduction
Diagnosis and management of benign prostatic hyperplasia and of prostate cancer saw great advances over the last decade. For the third group of prostate diseases, the prostatitis syndrome - except for the relatively rare acute or chronic bacterial prostatitis - no successful management is available as yet, in spite of the fact that prostatitis is a common urological diagnosis in men (1,3,4). Mortality and serious complications due to prostatitis are uncommon, but the impairment of life quality is considerable. Using the Sickness Impact Profile (SIP), it was found that the mean SIP total score of chronic prostatitis patients showed the range of scores reported in the literature by patients with myocardial infarction, angina, or Crohn's disease (1). Hence any kind of Therapeutic strategies to manage prostatitis comprise antibiotics, alpha blockers, muscle relaxants, antiphlogistics, analgetics, but phytotherapy, physical therapy, biofeedback, alternative therapies, and psychotherapy are also applied, and even surgical intervention Mucolytica, a new approach
Histological slides of the prostate often show so called corpora amylacea, coacervates of proteins, lipids and mucoids. Calcium salts may also be incorporated and form concrements. The latter tend to merge together and then show ramified structures. The prostatic ducts surrounding coacervates or concrements are often dilated, with atrophic epithelium (2) . This indicates that ducts have been occluded and the efflux of the prostate secretion was impeded. It has been dicussed that stagnation of fluids can be one reason for painful sensations in prostatitis. The finding that intraprostatic tissue pressure in patients with chronic nonbacterial prostatitis is increased (5) fits to this interpretation. An attempt to reduce the viscosity of prostatic secretion (and resolve coacervates and concrements) may lead to improved efflux of extracellular components from prostatic tissue with consequent shrinking of the organ. Mechanical strain being abolished, painful sensation might also disappear. In addition, with increased blood circulation antibiotics and other drugs will Secretolytics and mucolytics do have such an effect in general. In a first application in chronic prostatitis we used acetylcystein, commonly known for mucolytical properties. The sulfhydryl group of this molecule reduces disulfide bonds in glycoproteins, and thereby lowers their viscosity, an effect well known from applications in bronchopulmonal diseases, as well as in sinusitis and otitis. In addition, acetylcystein has an antioxidative effect and acts as an antiphlogistic, perhaps an other advantage of this compound in its application in prostatitis. Furthermore side effects of acetylcystein are rare and, if they occur, they are reversible. A case report
A patient, 68, had suffered for more than 4 years from prostatitis syndrome. The concentration of prostatitis specific antigen (PSA), which can indicate prostate cancer, was high for most of the time from October 2001 to January 2003 and unchanged under high dose antibiosis (table I). Twice a biopsy excluded malignancy. Transurethral resection was scheduled hoping to reduce pelvic pain by the intervention. Prior to surgical intervention, therapy with oral acetylcystein (ACC) was tried (6 hours after the last meal). Within two days the patient reported sensation of warmth in the pelvic floor area, and pain and voiding symptoms disappeared. Whenever feeble symptoms reappeared, they disappeared after reapplication of ACC. This was necessary every few weeks. One symptom of benign prostate hypertrophy persisted: increased frequency of urination at night. Controls of PSA in the following two years showed reduced levels corresponding to the actual Discussion
This positive outcome appears to be promising for a larger number of patients, malignancy being excluded. The excellent tolerance of ACC, its fast action and negligible side effects make it a candidate for many patients to ease or abolish their prostatic symptoms, reduce I thank Dr.med. Verena BaierRK for discussion. References
1. Brähler, E, Kupfer J, Ludwig M, Weidner W (2001) Untersuchungen zur Symptomatik der Prostatitis in Deutschland. 2. Hedinger C.E. and Dhom G: Pathologie des männlichen Genitale. Hoden,Prostata, Samenblasen Springer-Verlag ,1991. 3. Hochreiter W, Bader P (2001) Ätiopathogenese der Prostatitis. 4.Ludwig M, Weidner, W (2000) Diagnostik und Therapie des Prostatitissyndroms. Urologe (A) 39: 371-382 5. Mehik A, Hellström P, Lukkarinen O et al. (2000) Prostatic tissue pressure measurement as a possible diagnostic procedure in patients with chronic nonbacterial prostatitis / chronic pelvic pain syndrome.
Case history

Date
PSA
Antibiotic therapy
Remark
dd.mm.yyyy (ng/ml)
04.09.2001 18.2
biopsy 6x
not malign
biopsy 10x
not malign

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