Although prostatitis has been known for a long time, to this day it remains a common disease, affecting mainly young and middle-aged men, little researched and difficult to treat.
If the cause, pathogenesis (mechanism of development) and then the treatment of acute prostatitis are determined quite clearly, the treatment of chronic prostatitis in men in many cases causes serious problems. causing significant difficulties and often conflicting opinions from leading experts in the field.
However, they all agree that:
- The earlier treatment begins, the more effective it is;
- Treatment must be comprehensive, taking into account all research data, individual characteristics and the expected mechanism of development in each 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, the cause is 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 no full bladder, Defecation is difficult and painful. The danger lies in the possibility of staphylococcal infection, especially in the presence of concomitant chronic diseases (diabetes mellitus), the formation of glandular abscesses, the appearance of sepsis (massive penetration of infectious pathogensinto the blood) and septicemia (metastasis, transfer of pus foci to other organs).
If acute clinical signs of prostatitis occur in men, treatment should be carried out in the urology or general surgery (as a last resort) department of a hospital.
Treatment strategies
Basic treatment principles include:
- Bed rest.
- Antibacterial drugs.
- Refuse prostate massage not only as a treatment method but even taking secretions for laboratory research, as this can lead to the spread of infection and sepsis.
- Substances that improve the microcirculatory and rheological properties of blood, are administered intravenously. Acting at the capillary level, they promote the outflow of lymph and venous blood from the inflamed area, where toxic metabolic products and biologically active substances are formed.
- Nonsteroidal anti-inflammatory drugs, in the form of tablets and suppositories, also have a moderate analgesic effect.
- Reduces pain syndrome, which plays a significant pathogenic role in maintaining the inflammatory process. For this purpose, painkillers are used, which also have a moderate anti-inflammatory effect. Drugs from the previous group also have analgesic effects. In addition, rectal suppositories are widely used for hemorrhoidal phlebitis: they contain anti-inflammatory and analgesic substances. And also suppositories with propolis for prostatitis.
- Perform infusion therapy for severe intoxication. It includes intravenous injection of electrolyte, detoxification and rheological solutions.
Purulent prostatitis (abscess) or inability to urinate are direct indications for surgical treatment.
The leading link in the treatment of prostatitis in men is antibacterial therapy. In case of an acute inflammatory process, antibacterial drugs are prescribed without waiting for the results of bacterial urine culture, which is performed to determine the type of pathogen and its sensitivity to antibiotics.
Therefore, they immediately use drugs with a broad spectrum of action against the most common pathogens of acute prostatitis - gram-negative bacilli and enterococci. Fluoroquinolone drug is recognized as the most effective. Drugs of this group are also active against anaerobic, gram-positive microorganisms and atypical pathogens. These drugs participate in the protein metabolism of pathogenic microorganisms and disrupt their nuclear structure.
Some experts oppose their use until test results rule out a tuberculosis cause of prostate lesions. This is driven by the fact that tuberculosis Mycobacteria (Koch bacillus) do not die solely from treatment with fluoroquinolones but become more resistant and mutate into new types and species of mycobacteria.
The World Health Organization recommends the use of fluoroquinolones not only for prostatic tuberculosis but also for any form of tuberculosis. They are recommended to be used only in combination with anti-tuberculosis drugs, so the effectiveness of treatment will increase significantly even in cases of drug-resistant mycobacteria.
Having certain physicochemical properties, fluoroquinolones penetrate well into the prostate and seminal vesicles and accumulate in them in high concentrations, especially with acute inflammation, the prostate has increased permeability.
Fluoroquinolones are administered in appropriate doses intravenously or intramuscularly (depending on the activity of the inflammatory process). In 3-17% of patients, especially those with impaired liver and kidney function, adverse reactions may occur. The most typical are reactions of the central nervous system and dysfunction of the digestive organs. Less than 1% may experience heart arrhythmia, increased skin reaction to ultraviolet rays (photosensitivity), and decreased blood sugar levels.
After receiving (48-72 hours) data from the laboratory on the nature of the pathogen and its sensitivity to antibiotics, the lack of effectiveness of treatment in the first 1-2 days or in case of intoleranceloaded with fluoroquinolones, antibacterial therapy will be adjusted. For this purpose, second-line drugs are recommended - dihydrofolate reductase inhibitors, macrolides, tetracyclines, cephalosporins.
2 weeks after starting treatment, if the effect is insufficient, correction will be made.
Authoritative European experts in the field of urology believe that the duration of antibacterial treatment should last at least 2-4 weeks, followed by repeated prolonged examinations, including ultrastructural examinations. Prostate ultrasound and laboratory examination of secretions by culture to identify the pathogen and determine its sensitivity to antibacterial drugs. With the development of the microflora and its sensitivity to treatment, as well as the visible improvement, treatment will continue for another 2-4 weeks and will last (in total) 1-2 months. If there is no obvious effect, tactics must be changed.
Treatment of patients in serious condition is carried out in the intensive care units of the inpatient department.
Treatment of chronic prostatitis
Chronic prostatitis is characterized by periods of remission and relapse (exacerbation). Drug treatment of prostatitis in men in the acute stage is carried out according to the same principles as for acute prostatitis.
Symptoms of remission are characterized by:
- periodic mild pain;
- feeling of heaviness, "aching" and discomfort in the perineum, genitals and lower back;
- poor urination (sometimes) in the form of intermittent pain when urinating, increased frequency of urination with a small amount of urine excreted;
- Psychoemotional disorders, depression and related sexual disorders.
Treatment of the disease beyond the acute phase is difficult. The main controversy lies in the question of prescribing antibacterial therapy. Some doctors believe that this procedure should be performed in all cases. They are based on the assumption that pathological microorganisms during remission may not always penetrate into prostatic secretions taken for laboratory culture.
However, most experts are confident that antibacterial drugs are needed only for the chronic bacterial form of prostatitis. For bacterial forms and asymptomatic prostatitis, antibacterial drugs should not be prescribed (according to the principle "not all drugs are good").
The main tactics must have anti-inflammatory and pathogenic properties, which are prescribed as follows:
- Courses in non-steroidal anti-inflammatory drugs.
- The substance improves blood microcirculation and lymphatic drainage of the prostate.
- Immunomodulators. Products based on prostaglandin extract are quite popular: in addition to their immunomodulatory effect, they also improve microcirculation by reducing thrombus formation and reducing the cross-section of blood clots, reducing swelling. and leukocyte infiltration into tissues. These drugs help reduce pain intensity in 97% of patients by 3. 2 times, and dyspepsia disorders - by 3. 1 times. The drug is available in the form of a rectal suppository, which is very convenient for outpatient use. The average course of treatment is 3-4 weeks.
- Psychotherapeutic drugs (sedatives and antidepressants), especially for patients with erectile dysfunction.
- Physiotherapy complexes help improve blood supply and strengthen the pelvic floor muscles, thalassotherapy and physiotherapy - UHF, local rectal electrophoresis, microcurrent, microscopic hyperthermiatransrectal and transurethral waves, infrared laser therapy, magnetic therapy, etc. v. These procedures are especially highly effective for pelvic pain syndrome.
Answers to some questions about treatment methods and complications of chronic prostatitis
Question. Is it possible to use traditional medicine, especially medicinal plants?
Correct. An example is the well-researched extracts of 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 the various pathogenic links of asymptomatic and bacterial chronic prostatitis. Suppositories consisting of extracts of these plants can be purchased in pharmacies.
Question. If men have chronic prostatitis, do they need treatment with rectal prostatic massage?
In many foreign clinics, due to the effectiveness of physiotherapy treatment, they have abandoned this physically and psychologically unpleasant procedure. In addition, massage with your fingers allows you to affect only the lower pole of the prostate. In some countries, massage is still considered effective and is practiced by most urologists.
Question. Is it worth using non-traditional methods of treatment - acupuncture, burning with medicinal herbs at highly active points, hirudotherapy?
Considering the theory of the influence of points and energy fields, one should answer in the affirmative. But no convincing evidence of positive effects has been obtained. Only short-term relief of unexplained pain and dysuria is reliable.
As for hirudotherapy, enzymes in the saliva of medicinal leeches help improve microcirculation in the gland, reduce swelling of its tissues, increase the concentration of the drug in foci of inflammation and normalize urination.
However, alternative treatments should be used in conjunction with officially approved treatments and only in consultation with a specialist.
Question. Can chronic prostatitis cause prostate cancer?
The reverse interdependence is absolutely correct. Complications of prostatitis are abscesses, hardening of glandular tissue, and stricture (narrowing) of the urethra. There has been no evidence of degeneration of glandular cells (due to prostatitis) into cancer cells.
Patients with any form of chronic prostatitis must be regularly monitored by a urologist, undergo examinations, and undergo preventive treatment sessions.