Although prostatitis has been known for a long time, it is still a common disease that mainly affects young and middle-aged men, is a poorly understood disease and is difficult to treat.
If the causes, pathogenesis (mechanism of development) and therefore the treatment of acute prostatitis are quite clearly defined, then the treatment of chronic prostatitis in men in many cases causes significant difficulties and often contradictory opinions of leading specialists.
However, they all agree that:
- The earlier treatment is started, the more effective it is.
- Treatment should be comprehensive and take into account all research data, individual characteristics and the expected mechanism of development in each individual patient.
- There are no universal medications and treatment regimens – what helps one patient may harm another;
- Independent treatment, and especially treatment based solely on non-traditional methods, is unacceptable.
Treatment of acute bacterial prostatitis
The tactics and principles of treatment of acute prostatitis are determined by the severity of the clinical picture of the process. The patient's condition can be very serious, which is explained by poisoning.
The disease begins acutely and is manifested by high fever, chills, weakness, headache, nausea, vomiting, pain in the lower abdomen, lumbar region and perineum, painful and difficult urination or its absence with a full bladder, difficult and painful stools. The danger lies in the possibility of a staphylococcal infection, especially in the presence of chronic concomitant diseases (diabetes mellitus), the formation of a gland abscess, the occurrence of septicemia (massive entry of infectious pathogens into the blood) and septicopyemia (metastasis, transfer of purulent foci to othersOrgans).
If acute clinical signs of prostatitis appear in men, treatment should be carried out in a specialized urological or general surgical department (as a last resort) of a hospital.
Treatment tactics
The basic principles of treatment include:
- Bed rest.
- Antimicrobial drugs.
- Refusal to massage the prostate not only as a therapeutic method, but even to obtain secretions for laboratory studies, as this can lead to the spread of infection and sepsis.
- Agents for improving microcirculation and rheological properties of blood administered intravenously. They act at the capillary level and promote the outflow of lymph and venous blood from the area of inflammation, where toxic metabolic products and biologically active substances are formed.
- Nonsteroidal anti-inflammatory drugs in tablets and dragees, which also have a moderate analgesic effect.
- Relieving pain syndrome, which plays an important pathogenetic role in maintaining inflammatory processes. For this purpose, painkillers are used, which also have a moderate anti-inflammatory effect. The drugs in the previous group also have a pain-relieving effect. In addition, rectal suppositories are often used for phlebitis of hemorrhoids: they contain anti-inflammatory and analgesic agents. And also suppositories with propolis for prostatitis.
- Conducting infusion therapy for severe poisoning. It involves intravenous administration of electrolyte, detoxification and rheological solutions.
Purulent inflammation of the prostate (abscess) or inability to urinate are a direct indication for surgical treatment.
The most important link in the treatment of prostatitis in men is antibacterial therapy. In acute inflammatory processes, antimicrobial drugs are prescribed without waiting for the results of bacteriological urine cultures, which are carried out to determine the type of pathogen and its sensitivity to antibiotics.
Therefore, they immediately use drugs that have a wide spectrum of action against the most common pathogens of acute prostatitis - gram-negative bacilli and enterococci. Fluoroquinolone drugs are considered the most effective. Drugs in this series are also effective against anaerobic, gram-positive microorganisms and atypical pathogens. These drugs are involved in the protein metabolism of pathogenic microorganisms and destroy their core structures.
Some experts oppose their use until test results are available that rule out a tuberculous etiology of the prostate damage. The reason for this is that Mycobacterium tuberculosis (Koch's bacillus) does not die from treatment with fluoroquinolones alone, but rather becomes more resistant and transforms into new species and species of mycobacteria.
The World Health Organization recommends the use of fluoroquinolones not only for tuberculous prostatitis, but also for any form of tuberculosis. It is recommended to use them only in combination with anti-tuberculosis drugs, the treatment effect of which is thereby significantly increased even on drug-resistant mycobacteria.
Due to their specific physicochemical properties, fluoroquinolones penetrate well into the prostate and seminal vesicles and accumulate there in high concentrations, especially since the prostate has increased permeability during acute inflammation.
Fluoroquinolones are administered in appropriate doses intravenously or intramuscularly (depending on the activity of the inflammatory process). Side effects may occur in 3-17% of patients, particularly those with impaired liver and kidney function. The most typical are reactions of the central nervous system and dysfunction of the digestive organs. Less than 1% may experience cardiac arrhythmias, increased skin reaction to ultraviolet rays (photosensitivity), and decreased blood sugar levels.
After receiving (48-72 hours) laboratory data on the type of pathogen and its sensitivity to antibiotics, the lack of effectiveness of treatment in the first 1-2 days or in case of intolerance to fluoroquinolones, antibacterial therapy is corrected. For this purpose, second-line drugs are recommended - dihydrofolate reductase inhibitors, macrolides, tetracyclines, cephalosporins.
If the effectiveness is insufficient, correction is made 2 weeks after the start of therapy.
Authoritative European experts in the field of urology believe that the duration of antibacterial therapy should be at least 2 to 4 weeks. Subsequently, a repeated advanced examination is carried out, including an ultrasound scan of the prostate and a laboratory control of secretions with culture to identify the pathogen and determine its sensitivity to antibacterial drugs. With the growth of the microflora and its sensitivity to treatment, as well as an obvious improvement, therapy continues for another 2-4 weeks and should last (in total) 1-2 months. If there is no pronounced effect, tactics must be changed.
Patients in serious condition are treated in intensive care units of inpatient departments.
Therapy for chronic prostatitis
Chronic prostatitis is characterized by periods of remission and relapses (exacerbations). Drug treatment of prostatitis in men in the acute stage follows the same principles as for acute prostatitis.
The remission symptoms are characterized by:
- mild periodic pain;
- a feeling of heaviness, "pain" and discomfort in the perineum, genitals and lower back;
- Impairment of urination (sometimes) in the form of intermittent pain during urination, increase in the frequency of the urge to urinate with a small amount of urine excreted;
- psychoemotional disorders, depression and related sexual disorders.
Treating the disease outside of the exacerbation is associated with great difficulties. The main controversy lies in questions regarding the prescription of antibiotic therapy. Some doctors consider it necessary to carry out the course under any circumstances. They are based on the assumption that pathological microorganisms may not always enter the prostate secretion collected for laboratory culture during the remission phase.
However, most experts are sure that antibacterial drugs are necessary only for the bacterial form of chronic prostatitis. For abacterial forms and asymptomatic prostatitis, antibacterial drugs should not be prescribed (according to the principle "not all drugs are good").
The main tactics should be anti-inflammatory and pathogenetic in nature, for which the following is prescribed:
- Courses of non-steroidal anti-inflammatory drugs.
- Active ingredients that improve blood microcirculation and lymphatic drainage of the prostate.
- Immunomodulatory drugs. Products based on prostate extract are very popular: in addition to the immunomodulatory effect, they improve microcirculation by reducing thrombus formation and reducing the cross section of blood clots, reducing swelling and leukocyte infiltration of tissues. These drugs help reduce pain intensity by 3. 2 times and dysuric disorders by 3. 1 times in 97% of patients. The drugs are available in the form of rectal suppositories, which is very convenient for outpatient use. The duration of treatment is on average 3-4 weeks.
- Psychotherapeutic drugs (sedatives and antidepressants), especially for patients with erectile dysfunction.
- Physiotherapy complexes that help improve blood supply and strengthen the pelvic floor muscles, balneology and physiotherapy – UHF, local rectal electrophoresis, microcurrents, transrectal and transurethral microwave hyperthermia, infrared laser therapy, magnetic therapy, etc. These procedures are especially effective for pelvic floor pain syndrome.
Answers to some questions about treatment methods and complications of chronic prostatitis
Ask. Is it possible to use traditional medicine, especially medicinal plants?
Yes. An example would be well-studied extracts from medicinal plants such as goldenrod, echinacea, St. John's wort and licorice root. Each of these plants contains components that have a positive effect on various pathogenetic relationships of chronic asymptomatic and abacterial prostatitis. Suppositories consisting of extracts of these plants can be purchased in pharmacies.
Ask. Is treatment with rectal massage of the prostate necessary for chronic prostatitis in men?
In many foreign clinics, this physically and psychologically unpleasant procedure has been avoided due to the effectiveness of physiotherapeutic treatment. In addition, finger massage allows you to influence only the lower pole of the prostate. In some countries, massage is still considered effective and is used by most urologists.
Ask. Is it worth using non-traditional treatment methods – acupuncture, cauterization with medicinal herbs on energetically active points, hirudotherapy?
If you consider the theory of influence on energy points and fields, you should answer this in the affirmative. However, there is no convincing evidence of a positive effect. Only the possibility of short-term relief of unspoken pain and dysuria syndromes is reliable.
During hirudotherapy, the enzymes in the saliva of a medicinal leech help to improve microcirculation in the gland, reduce tissue swelling, increase the concentration of drugs in foci of inflammation, and normalize urination.
However, alternative treatment methods should be used in conjunction with officially recognized treatment and only in consultation with a specialist.
Ask. Can chronic prostatitis cause prostate cancer?
The reverse interdependence is absolutely correct. Complications of prostatitis include an abscess, sclerosis of the glandular tissue, and stricture (narrowing) of the urethra. There is currently no evidence of degeneration of gland cells (as a result of prostatitis) into cancer cells.
Patients with chronic prostatitis of any form should be constantly under urological supervision, undergo examinations and undergo preventive treatment.