A case for drainage, bacteria, Manila Protocol

[nickjr4]

First a brief history, then my assumptions.

10 years ago my semen became much thicker and with reduced volume.

5 years ago I had some pelvic pain and a bit of burning. Urologist did a prostate massage but no EPS would come out.

This year I have pelvic pain and some burning. Urologist did a prostate massage but again no EPS would come out. 4 glass test all negative for bacteria.

Now my deduction; There may be a longstanding infection in my prostate which has calcified and closed off the ejaculatory ducts sealing itself inside, which is why my semen got so thick 10 years ago, and which is why the prostate massage 5 yrs ago and this year produce no fluid, and why the cultures show no bacteria. Maybe if I can clear the infection out from behind the clogged ducts and out into the open where antibiotics can get at it the problem will go.

Can anyone shoot some holes in this theory for me?

The 'Manila Protocol' seems like a fairly reasonable approach for accomplishing this. Shoot some holes in that one too, please.

[webslave]

Please do some reading before asking such questions. Research negates your theory and the Manila Protocol.

[nickjr4]

Please do some reading before asking such questions. Research negates your theory and the Manila Protocol.

I have done a great deal of reading already. Still, I would still greatly appreciate comments on my post from other people who may be interested in having a discussion with me.

[akia]

Please do some reading before asking such questions. Research negates your theory and the Manila Protocol.

Ok forgive me if I'm out of line here but isn't this supposed to be a forum for open discussion? Since when are we limited to only discussing theories that are widely accepted by the frequent members? I don't personally believe in the Manila protocol but nor do I feel that the Dr. Wise protocol is the allgiving answer either. Does that mean I'm not free to still discuss it?

As a moderator you have to know that some people are going to come here with far less knowlege about their condition than you may possess. They are only as informed as the information they have been able to find or what their Uro has told them. Coming here might help to enlighten them that there is more to learn.

Comments like yours are not going to encourage anyone to help themselves. I don't think putting him down is a great idea.

And I would expect that as a moderator of this forum you have to allow people to have opinions of their own. Whether who is right and who is wrong will be decided when a cure or an answer is really found. Until then, there is a case for both sides of the fence.

Each and every sufferer has different combination of symptoms and sometimes very unique symptoms. Maybe this particular person does have a case for what he is describing. WE DON"T KNOW what is right and wrong for everyone.

Discussion should rule this website. I'm open to hearing it all.

Maybe I'm in a bad mood today or maybe that struck a cord I don't know. I just had to say it.

[james-d]

There is no "right" answer - just theories at the moment.

One school of thought is no infection; and the other is there may very well be one.

No one can really tell you for sure - hence your problem.

I benifit greatly from regular prostate massages done by my uro.

I have found them helpful with few side effects.

Others have found them to cause more problems.

Talk to your doctor - he very well may want to try it to see if it helps.

It is unlikely to do any serious long term damage - but it may hurt like hell for a while and not benifit you at all - or it just might.

So - there you go - a very long non-answer for you.

I have a different philosphy then many on this board - I beleive that until we have a valid scientific model that works for the majority - we must stay open minded about trying every reasonable protocol - just because the cost of not doing so can be unbearable to the sufferer.

Just my humble opinion - feel free to ignore - as most here will.

[nickjr4]

One school of thought is no infection; and the other is there may very well be one.

That's what I have read, although the theory which is the current darling seems to have moved away from infection.

But what I would like to hear feedback on is the specific hypothesis of a mechanical blockage sealing off an infection so that it is not visible in cultures and is inaccessible to antibiotics, such blockage also preventing release of prostatic fluid both during prostatic massage and during ejaculation. It just seems to me like an occams razor type conclusion to the available evidence.

Of course medicine seems to be one field where this type of logic is not always appropriate. This may be a more technical question that one of the urologists who post here could field.

[latte]

There are several ways to look at prostate massage. As we have discussed in past comments, simply the act of massaging the prostate may alleviate muscle tightness in the prostate or in the pelvic muscles. That may be beneficial to some sufferers. Whether there is an infection in long standing cases is pretty much been shown not to exist. Your doctor should culture the EPS and see if any bugs grow but the most recent papers have shown that most chronic prostatitis / chronic pelvic pain syndrome patients do not have an infection. The whole point of the current research is to show why there is inflammation with no infection. Cytokines are to blame but why is the big question.

[nickjr4]

Your doctor should culture the EPS and see if any bugs grow

There is no EPS. This is why I am speculating that it is sealed inside the prostate, perhaps alongside an infection.

[MastCells]

Urologist did a prostate massage but again no EPS would come out.

It is very common for uros not to obtain EPS during a prostatic massage, and it doesn't necessarily mean that you have calcifications.

4 glass test all negative for bacteria.

So basically the evidence points to your not having an infection.

The 'Manila Protocol' seems like a fairly reasonable approach for accomplishing this.

I have been reading internet prostatitis forums daily for years, and I can tell you the Manila protocol does not work. Many men have travelled long distances at great expense to pursue this treatment, and they returned uncured and miserable.

[MastCells]

I have done a great deal of reading already, but I guess that I am stupid and therefore a bad person, unworthy of explanations from the administrator.

Nobody said you are stupid or a bad person. Mark's just trying to save you time, money, and a lot of frustration.

I believe that you have done a great deal of reading, and that may be part of the problem. The internet has several websites that try to lure patients to questionable clinics that promise cures to prostate infections caused by occult bacteria.

If you read all of https://ucpps.men and many of the posts here, you'll get the other side of the story.

[nickjr4]

It is very common for uros not to obtain EPS during a prostatic massage, and it doesn't necessarily mean that you have calcifications.

But it doesn't mean that I don't, either, does it? I have read that for some patients several massages are required before fluid is obtained, but it does eventually come. Could this be because blockages are slowly being stressed by the massage and finally break open? And if I don't have calcifications, what is the reason my semen became so thick and with less volume 10 years ago? That condition has never changed. Is there some method of confirming or ruling out the calcification?

So basically the evidence points to your not having an infection.

Yes, except that the key piece of information, a bacterial test of fluid from inside the acini is missing, right? And if so, doesn't that suggest that the testing is as yet incomplete?

...the Manila protocol does not work. Many men....returned uncured and miserable.

Okay, but did they have true bacterial infections? I see some research showing that bacterial count is roughly the same in men with and without CPPS. But I also see posts sometimes talking about EPS with large clumps of bacteria and other junk - that certainly doesn't sound like something you would find in the patients without chronic prostatitis / chronic pelvic pain syndrome studied in the research, does it?

Don't get me wrong, I am not in denial (well not too much anyway). I can see the loads of evidence suggesting that even if there WAS a bacterial infection, and even if it WAS cleared up by antibiotics that would not neccessarily solve the problem. That is ostensibly the main critcism of the Manila Protocol - that their barometer for their 95% "cure" rate is the absence of bacteria.
But isn't it possible that in my case an infection is inside? And shouldn't I be looking for an answer to that question more substantial than just "well the vast majority of sufferers don't have infections but they still have pain, so therefore an infection should not be your problem either" ?. I am not dogmatic, but I do tend to hunt down every last loose end in almost everything I do.
Yes I could grill my doctor with these questions (have already to some extent) but I felt that with all the knowledge aquired by the group here some people would have read things that could either specifically refute or support what I am proposing, and that fellow sufferers would be more likely to engage in such a discussion than my doctor, who seems to not want to go near any subject to which the answer might be "I don't know". And I am not just running around looking for anyone who will agree with me. A solid refutation with a reasonable explanation is welcome.

[webslave]

Please do some reading before asking such questions. Research negates your theory and the Manila Protocol.

Ok forgive me if I'm out of line here but isn't this supposed to be a forum for open discussion?

Sure. But we have the right to ask forum newbies to read a little before posting questions asked and answered many times before.

[SickofCP]

Just to add my 2 cents:

Since Uro's are still giving antibiotics as the answer...Even if a "Newbie" reads this entire forum, he still may think that HIS problem has bacterial roots. Let's face it, the average person will believe his doctor over an internet forum.

There are also certain questions that are difficult to look up through the search, and some people are better at searches than others. Therefore, there should be no such thing as a stupid question on this forum. There really should be no prerequisite reading before posting. Many people are happy to find this website, and when they do, they are anxious to discuss questions that they have right away.

We have to be careful not to discourage people to post. Remember the mean teacher in school that made fun of student's questions, or would comment that they should already know the answer? Remember how student's would stop asking questions in those classes?

[webslave]

A while ago I posted a statement that I would not allow a stream of posts to this site asking about the Manila Protocol. That very thing is what ruined the Usenet prostatitis newsgroup. The fact that there are websites out there spreading this commercially-inspired misinformation does not mean we have to turn this site into a remedial center, trying to undo their malfeasance on a daily basis. There are enough posts here about the Manila Protocol and bacteria to make it crystal clear to visitors, at least those who are prepared to make even the most cursory examination of the existing posts, what our attitude to the infection theory is.

I will let this thread stand as a caution to future posters.

[TK]

Apologies to all for lengthy post. Webslave has carte blanch to edit this.

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Re Forum Issues

Maybe an "FAQ" section would be helpful.

Assembling this would place additional weight on those stalwart souls who are already carrying a substantial burden. But over time, it might eliminating repetitive questions.

Observations about openness in the forum are entirely appropriate, but as we offer these observations, we should think about what it means to commit to answering questions every day for months and years -- not just when we are so inclined. When we take up this burden, we may find that we commit occasional lapses.

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To nickjr4,

First and foremost, re your condition -- I can tell you with absolute certainty that my own prostatitis symptoms were caused by pelvic muscle spasm AND the symptoms included changes in COLORATION AND VISCOUSITY OF SEMEN. This can be a function of inflammation, which can and does occur in the absence of infection.

Like yourself and like many others, most of the information that I had review prior to finding this forum was focussed on the "infection theory".

SOME MORE OR LESS LEGITIMATE REASONS

1) A majority of urologists limited their treatment to antibiotics. (It is now understood that the antibiotics were in fact functioning as anti-inflammatory agents and this accounts for positive response of some patients.)

2) In the last decade, H. pylori -- a bacterial organism previously unknown -- was found to be responsible for stomach ulcers. This fueled the notion that "stealth" organisms might well be responsible for many conditions. There was also research into "biofilms" and other mechanisms that would explain how bacteria could remain sequestered.

3) For many patients, the experience of what was called "prostatitis" -- especially the urinary symptoms and the referred pain to the tip of the penis -- seemed consistent with a urinary tract infection.

(IMPORTANT: We now know with certainty that muscle spasms of the pelvic floor can cause prostatitis. Mhy own case is only one of many that demonstrates this)

INSTITUTIONAL REASONS -- CONVENIENCE OF DOCTORS
There was a lazy consensus among urologists that, beyond antibiotics, "chronic prostatitis" patients couldn't be helped and any additional effort was simply wasteful.

SOME JUST PLAIN EVIL REASONS:
The opportunists of this world recognized out that there was this large population of desperate men who had been treated dismissively by their urologists, and were therefore receptive to messages like: "Your urologist is an idiot who doesn't give a damn. We in Manila or Tuscon Ariz have this massage protocol that works 95% of the time. Or... it's all in the blocked acini. Come to my clinic in Europe and be cured by targetted injections. (Never mind the reports of disasterous results that have slowly come to light)

Some of these guys could clearly be recognized as scoundrels, but there was a time when I assumed, for example, that the Senior Dr. Feliciano was "on the level" -- a real humanitarian. Then I learned that, over the course of MANY controlled studies, it has been established that (something like) 5% of cases are truly bacterial. If this is true, it's flat out impossible for the Manila Clinic to have anything like the claimed cure rate. The only way for this to be true would be if the overwhelming proportion of patients were drawn from the infected 5%

When I first arrived at this forum (actually, it's predecessor), my own observations about my condition were beginning to persuade me that this was no infection. The "ups" and "downs" simply did not square with my experience of a growing population of organisms.

THE IDEOLOGY PROBLEM
But when I first put questions to the forum -- questions that were actually meant to help me take infection off the table entirely -- I was frustrated because I could not dismiss the possibility that I was receiving answers that were grounded in ideology. At the time, we were all aware of the sometimes fierce partisan battle that was raging between the "Inflammation/Cytokine" crowd and the infection theorists -- both of whom had respectable advocates in the research community.

I have since learned that the "webslave" is no idealogue.

If you read this forum in its entirety, you will find a number of cases where people who DID have some of the hallmarks of a bacterial infection were advised to pursue appropriate diagnosis and treatment. The problem is that vigilance is required to prevent the advocates of the "Manila Protocol" and their paid shills from continuing to poison the discourse. And we all know that vigilance is a tricky proposition.

We all must acknowledge that very few questions go unanswered here. Part of what drives this good work is a gut determination to fight substandard medicine and fraudulent information.

So if our stalwart leader gets pissed off because, for the 700th time, it seems that somebody is unwittingly resurrecting the Manila fraud, well, we all ought to understand this.

But reading your posts, nickjr, I suspect that you may actually be tryiing to "shoot down" the infection aspect so that you can feel free to concentrate on more probable avenues.

Pelvic Muscle Tension may not necessarily be the root of your problem (although, from what you describe, this may well be the case). But bear in mind that, in the absence of any other indications of bacterial infection, there are explanations and treatments that are far more likely than "sequestered bacteria."

Welcome to the forum!