Despite the fact that prostatitis has been known for a long time, it is still a common, poorly studied and difficult-to-treat disease affecting mainly young and middle-aged men.
If the causes, pathogenesis (mechanism of development) of acute prostatitis, as well as the treatment, are clearly defined, then the treatment of chronic prostatitis in men in many cases causes significant difficulties and the often polar opinions of leading specialists.
However, they all agree on this:
- the earlier the treatment starts, the more effective it is;
- treatment should be comprehensive, taking into account all research data, individual characteristics and the expected development mechanism of each patient;
- There are no universal drugs and regimens – what helps one patient may harm another;
- independent treatment, and especially treatment based 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, lower abdominal, lumbar and perineal pain, painful and difficult urination with a full bladder, and difficult and painful defecation. The danger lies in the possibility of staphylococcal infection, especially concurrent chronic diseases (diabetes mellitus), development of gland abscess, septicemia (massive entry of infectious pathogens into the blood) and septicopyemia (metastases, transfer of purulent foci to other organs).
If acute clinical symptoms of prostatitis appear in men, the treatment should be carried out in a special urology or general surgery department of the hospital (as a last resort).
Management tactics
The basic principles of treatment are as follows:
- Bed rest.
- Antimicrobial drugs.
- Refusal to massage the prostate not only as a therapeutic method, but also to obtain secretions for laboratory tests, as this can lead to the spread of infections and sepsis.
- Agents that improve blood microcirculation and rheological properties, which are administered intravenously. They act at the level of the capillaries, promoting the outflow of lymph and venous blood from the area of inflammation, where toxic metabolic products and biologically active substances are formed.
- Non-steroidal anti-inflammatory drugs in tablets and dragees, which also have a moderate pain-relieving effect.
- Alleviation of pain syndrome, which plays a significant pathogenetic role in the maintenance of inflammatory processes. Painkillers are used for this purpose, which also have a moderate anti-inflammatory effect. Medicines from the previous group also have an analgesic effect. In addition, rectal suppositories are widely used for phlebitis of hemorrhoidal veins: they contain anti-inflammatory and pain-relieving agents. And propolis suppositories for prostatitis.
- Implementation of infusion therapy in case of severe poisoning. This includes intravenous electrolytes, detoxification, and rheology solutions.
Purulent inflammation of the prostate (abscess) or the inability to urinate are direct indications for surgical treatment.
Antibacterial therapy is the leading link in the treatment of prostatitis in men. In the case of an acute inflammatory process, antimicrobial drugs are prescribed without waiting for the results of bacteriological urine cultures, which are performed to determine the type of pathogen and its sensitivity to antibiotics.
Therefore, they immediately use drugs that have a broad spectrum of action against the most common pathogens of acute prostatitis - gram-negative bacilli and enterococci. Fluoroquinolone drugs are recognized as the most effective. Medicines of this series are also effective 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 object to their use until they have test results that rule out a tuberculous etiology of prostate damage. This is due to the fact that Mycobacterium tuberculosis (Koch's bacillus) is not killed by treatment with fluoroquinolones, but becomes more resistant and transforms into new types and varieties of mycobacteria.
The World Health Organization recommends the use of fluoroquinolones not only for tuberculous prostatitis, but also for any form of tuberculosis. Their use is only recommended in combination with anti-tuberculosis drugs, as a result of which the number of medicinally drug-resistant mycobacteria increases significantly.
Fluoroquinolones with certain physicochemical properties penetrate well into the prostate gland and seminal vesicles and accumulate in them in high concentrations, especially since the permeability of the prostate is increased 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, especially those with impaired liver and kidney function. The most characteristic 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 laboratory data on the nature of the causative agent and its sensitivity to antibiotics (48-72 hours), the antibacterial therapy is corrected in case of treatment inefficiency in the first 1-2 days or intolerance to fluoroquinolones. For this purpose, second-line drugs - dihydrofolate reductase inhibitor, macrolides, tetracyclines, cephalosporins - are recommended.
2 weeks after the start of the therapy, if its effectiveness is not satisfactory, a correction is made.
Reputable European experts in urology believe that the duration of antibacterial therapy should be at least 2-4 weeks, after which a repeated extended examination should be carried out, including an ultrasound examination of the prostate and laboratory control of secretions with culture for identification. the pathogen and determines its sensitivity to antibacterial drugs. With the growth of the microflora and its sensitivity to treatment, as well as its obvious improvement, the therapy is continued for another 2-4 weeks and lasts (in total) 1-2 months. If there is no pronounced effect, tactics must be changed.
Patients with serious conditions are treated in the intensive care units of the inpatient wards.
Chronic prostatitis therapy
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.
Symptoms of remission are characterized by:
- mild intermittent pain;
- heaviness, "pain" and discomfort in the perineum, genitals and lower back;
- violation of urination (sometimes) in the form of periodic pain during urination, an increase in the frequency of the urge to urinate with a small amount of urine;
- psycho-emotional disorders, depression and related sexual disorders.
Treatment of the disease outside of exacerbation is very difficult. The main controversy lies in questions related to the prescription of antibacterial therapy. Some doctors consider it necessary to complete the course in all circumstances. They are based on the assumption that pathological microorganisms do not always enter the prostatic secretion taken for laboratory culture during the period of remission.
However, most experts are sure that antibacterial drugs are only necessary for the bacterial form of chronic prostatitis. In case of abacterial forms and asymptomatic prostatitis, antibacterial drugs should not be prescribed (according to the "not all drugs are good" principle).
The main tactics should be anti-inflammatory and pathogenetic, for which the following are prescribed:
- Courses of non-steroidal anti-inflammatory drugs.
- Agents that improve blood microcirculation and prostate lymphatic drainage.
- Immunomodulatory drugs. Products based on prostate extract are quite 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 the intensity of pain in 97% of patients by 3. 2 times, and dysuric disorders by 3. 1 times. Medicines are available in the form of rectal suppositories, which is very convenient on an outpatient basis. The duration of the treatment is on average 3-4 weeks.
- Psychotherapeutic agents (tranquilizers and antidepressants), especially for patients with erectile dysfunction.
- Physiotherapy complexes that help to improve blood supply and strengthen pelvic floor muscles, balneological and physiotherapy treatments - UHF, local rectal electrophoresis, microcurrents, transrectal and transurethral microwave hyperthermia, infrared laser therapy, magnetic therapy, etc. These procedures are particularly effective for patients with pelvic pain syndrome.
Answers to some questions related to the treatment methods and complications of chronic prostatitis
Question. Can traditional medicine, especially herbs, be used?
Yes. Examples include well-studied extracts of herbs such as goldenrod, echinacea, St. John's wort, and licorice. Each of these plants contains components that have a positive effect on the various pathogenetic relationships of chronic asymptomatic and abacterial prostatitis. Suppositories consisting of extracts of these plants can be purchased in pharmacies.
Question. If men have chronic prostatitis, is rectal massage of the prostate necessary?
In many foreign clinics, this physically and psychologically unpleasant procedure has been abandoned due to the effectiveness of the physiotherapy treatment. In addition, finger massage allows you to affect only the lower pole of the prostate. In some countries, massage is still considered effective and is used by most urologists.
Question. Is it worth using non-traditional treatment methods - acupuncture, cauterization with herbs on energetically active points, hirudotherapy?
Considering the theory of the effect on energy points and fields, the answer must be yes. But it was not possible to obtain convincing evidence of a positive effect. Only the possibility of short-term relief of unexpressed pain and dysuria syndromes is reliable.
As for hirudotherapy, the enzymes in the saliva of the medicinal leech improve the microcirculation of the gland, reduce tissue swelling, increase the concentration of drugs in the inflammatory foci and normalize urination.
However, alternative treatment methods should be used together with the officially accepted treatment and only in consultation with a specialist.
Question. Can chronic prostatitis cause prostate cancer?
Reverse interdependence is absolutely accurate. Complications of prostatitis are abscess, sclerosis of the glandular tissue, narrowing (narrowing) of the urethra. There is no evidence yet of the degeneration of glandular cells (as a result of prostatitis) into cancer cells.
Patients suffering from any form of chronic prostatitis should be under the constant supervision of a urologist, undergo examinations and undergo preventive treatments.