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Prostate massage is a medical procedure used for diagnostic and sometimes therapeutic purposes. This manipulation was described at the end of the 1936th century, and introduced into medical practice in 90. Then the technique was abandoned, but since the mid-XNUMXs. of the last century, it was again put into practice in the treatment of chronic prostatitis in conjunction with the use of antibiotics and alpha-blockers.
Indications for use
To date, the main purpose of the manipulation is: • obtaining a prostatic secret for its subsequent analysis by the methods of cultural inoculation, microscopy, PCR; • conducting a pre- and post-massage test (bacteriological and microscopic urine tests are performed before and after massage, an increase in the number of leukocytes in the post-massage test indicates the presence of chronic prostatitis).
For preventive purposes, the procedure is not used. With regard to the therapeutic use of prostate massage, there are serious differences of opinion among doctors.
In the 90s of the last century, Filipino and American specialists proposed their own method for diagnosing and treating prostatitis, including taking antibiotics with repeated massage procedures. The technique was approved by the American Urological Association (Manila Protocol). In the Russian Federation, the procedure is officially recommended by the Ministry of Health for chronic prostatitis.
Massage is widespread in China, single European countries, countries of Southeast Asia. Also, some urologists in Canada and North America treat certain forms of inflammation of the prostate with a combination of antibiotic therapy with massage.
At the same time, a significant part of the medical community is categorically against the use of prostate massage, motivating their position with a high probability of injury to the tissues of the prostate when pressing on it. Those who consider the use of massage justified point out that it must be carried out by a qualified specialist and after a preliminary diagnosis, having received a conclusion that there is no acute inflammation or calcification in the prostate.
With all this disagreement of medical opinions, there is no adequate assessment of the effectiveness of manipulation. Available single studies contradict each other. So, Egyptian experts in 2006 published a study that reported no difference between the use of antibiotic therapy alone and its combination with massage. In the same year, American and Filipino researchers reported significant improvement in patients with the combination approach. Adherents of the procedure explain its effect by cleansing the prostatic ducts from dead cells and pus, as well as by increasing blood flow in the gland, which contributes to the penetration of antibacterial drugs into tissues and the activation of local defense forces.
Massage technique
Massage is performed by a trained specialist in a medical facility. The procedure is carried out after preliminary urination and hygiene procedures, and if indicated, and washing the urethra with saline. The latter is especially important if the massage is carried out for the purpose of further bacteriological examination of the prostatic secretion.
Since the prostate gland is tightly attached to the upper wide part of the rectum at the level of the sacrum (and is accessible for examination only in this way), the massage is performed through the anus. Optimal knee-elbow position of the patient. Manipulation is carried out first on one and then on the second lobe with finger light pressure along the excretory ducts in the direction of the central groove, without affecting the seminal vesicles. At the end of the procedure, the doctor presses on the zone of the central groove. The released secret is collected in clean laboratory glassware. If secretion is not observed, then the patient is recommended to take a vertical position. If, in this case, there is no discharge, then this indicates the reflux of the secret into the bladder. In such a situation, the bladder is washed and the wash fluid is analyzed.
The duration of the manipulation should not be longer than a minute. For therapeutic purposes, it is recommended to repeat the procedure two to three times a week.
Complications and contraindications
There are few reports of complications from the procedure: • a case of genital gangrene (described by Japanese doctors); • an episode of hemorrhage in the periprostatic region followed by the development of embolic pulmonary stroke (described by German specialists). Massage can lead to a temporary increase in the level of prostate-specific antigen (PSA) in the blood. Do not carry out the procedure for: • acute orchitis (inflammation of the testicles), prostatitis and urethritis; • adenoma, cancer, prostate tuberculosis; • prostatic calcifications; • exacerbation of hemorrhoids, proctitis, anal fissures, etc. If it is impossible to use massage for therapeutic purposes, some doctors recommend thermal physiotherapy (transrectal hyperthermia, ultrasound, infrared therapy, transurethral thermotherapy).
It should be noted once again that quite often massage does more harm than good precisely because of the negligent attitude of individual doctors to the preliminary diagnosis of the patient in order to identify contraindications to massage. The procedure itself has become quite firmly established in the practice of many doctors and they perform it for everyone indiscriminately. And there are cases when, after performing a massage or even a course of procedures, patients notice a deterioration in their condition and exacerbation of pain of prostatic origin. Of the contraindications described above, the most common is the presence of calcifications (concrements) in the prostate – solid deposits. In this case, pressure on the prostate in the area of the presence of calcifications causes injury to tissue areas, which in turn leads to the appearance of a focus of inflammation, and instead of a therapeutic effect, the opposite is achieved.
Based on the foregoing, once again it should be noted that performing a prostate massage should be justified by the expediency and lack of indications based on a preliminary diagnosis of the prostate condition.