Although prostatitis has been known for a long time, to this day it remains a common disease, affecting mainly young and middle-aged men, a disease that is little studied and difficult to treat.
If the causes, pathogenesis (mechanism of development) and therefore the treatment of acute prostatitis are clearly defined, then the treatment of chronic prostatitis in men in many cases causes significant difficulties and often differing opinions of leading experts.
However, everyone agrees that:
- the sooner treatment is started, the more effective it will be;
- treatment must be comprehensive, taking into account all research data, individual characteristics and the expected development mechanism in each patient;
- There are no universal medications and treatment regimens - what helps one patient may harm another;
- independent treatment, and especially treatment based only 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 intoxication.
The disease begins acutely and is manifested by high fever, chills, weakness, headache, nausea, vomiting, pain in the lower abdomen, lower back and perineum, painful and difficult urination or its absence with a full bladder, difficult defecation and painful. The danger lies in the possibility of staphylococcal infection, especially in the presence of concomitant chronic diseases (diabetes mellitus), the formation of a glandular abscess, the occurrence of septicemia (massive entry of infectious pathogens into the blood) and septicopemia (metastasis, transfer of purulent foci to other organs ).
If acute clinical signs of prostatitis occur in men, treatment should be carried out in a specialist urology or general surgery department (as a last resort) of a hospital.
Treatment tactics
The basic principles of treatment include:
- Bed rest.
- Antimicrobial medications.
- Refusal to massage the prostate not only as a therapeutic method, but even to obtain secretions for laboratory research, as this can lead to the spread of infections and sepsis.
- Agents that improve microcirculation and rheological properties of blood, which are administered intravenously. Acting at the capillary level, they promote 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 pills, which also have a moderate analgesic effect.
- Relief of pain syndrome, which plays a significant pathogenetic role in maintaining inflammatory processes. For this purpose, analgesics are used, which also have a moderate anti-inflammatory effect. Medicines from the previous group also have an analgesic effect. Also, rectal suppositories are widely used for phlebitis of hemorrhoidal veins: they contain anti-inflammatory and analgesic agents. And also suppositories with propolis for prostatitis.
- Carrying out infusion therapy for severe poisoning. Includes intravenous administration of electrolytes, detoxification and rheological solutions.
Purulent inflammation of the prostate gland (abscess) or inability to urinate are direct indications for surgical treatment.
The main link in the treatment of prostatitis in men is antibacterial therapy. In cases of an acute inflammatory process, antimicrobials are prescribed without waiting for the results of bacteriological urine cultures, 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 recognized as the most effective. Medicines in this series 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 structures.
Some experts oppose its use until test results are obtained that exclude a tuberculous etiology of prostate damage. This is motivated by the fact that Mycobacterium tuberculosis (Koch's bacillus) not only dies with treatment with fluoroquinolones, but becomes more resistant and transforms into new types 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 that they be used only in combination with anti-tuberculosis drugs, the treatment effect of which is significantly increased, even in the case of drug-resistant mycobacteria.
Possessing certain physicochemical properties, fluoroquinolones penetrate well into the prostate and seminal vesicles and accumulate in them in high concentrations, especially since during acute inflammation the prostate gland increases permeability.
Fluoroquinolones are administered in appropriate dosages intravenously or intramuscularly (depending on the activity of the inflammatory process). In 3-17% of patients, especially those suffering from hepatic and renal insufficiency, adverse reactions may occur. The most typical are reactions of the central nervous system and dysfunctions of the digestive organs. Less than 1% may experience heart rhythm disturbances, increased skin reaction to ultraviolet rays (photosensitivity) and decreased blood sugar levels.
After receiving (48-72 hours) laboratory data 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 cases of intolerance to fluoroquinolones, antibiotic therapy is corrected. To this end, second-line medications are recommended - dihydrofolate reductase inhibitor, macrolides, tetracyclines, cephalosporins.
2 weeks after the start of therapy, if its effectiveness is insufficient, correction is carried out.
Renowned European experts in the field of urology believe that the duration of antibacterial therapy should be at least 2-4 weeks, after which a repeated and prolonged examination is carried out, including ultrasound examination of the prostate and 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 evident improvement, therapy continues for another 2 to 4 weeks and should last (in total) 1 to 2 months. If there is no pronounced effect, tactics must be changed.
Treatment of patients in serious condition is carried out in the intensive care wards of the 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 phase is carried out according to the same principles as for acute prostatitis.
Symptoms in remission are characterized by:
- mild and periodic pain;
- feeling of heaviness, "pain" and discomfort in the perineum, genitals and lower back;
- impaired urination (sometimes) in the form of intermittent pain when urinating, an increase in the frequency of the urge to urinate with a small volume of urine excreted;
- psycho-emotional disorders, depression and related sexual disorders.
Treatment of the disease outside of exacerbation is associated with great difficulties. The main controversy lies in questions about the prescription of antibiotic therapy. Some doctors consider it necessary to take its course under any circumstances. They are based on the assumption that pathological microorganisms during the period of remission cannot always get into the prostate secretion taken for laboratory culture.
However, most experts are confident that antibacterial drugs are only necessary for the bacterial form of chronic prostatitis. In 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 are prescribed:
- Courses of nonsteroidal anti-inflammatory drugs.
- Agents that improve blood microcirculation and lymphatic drainage of the prostate.
- Immunomodulatory medications. Products based on prostate extract are quite popular: in addition to their immunomodulatory effect, they improve microcirculation by reducing thrombus formation and reducing the cross-section of blood clots, reduce swelling and leukocyte infiltration in tissues. These drugs help to reduce the intensity of pain in 97% of patients by 3. 2 times, and in dysuric disorders - by 3. 1 times. Medicines are available in the form of rectal suppositories, which is very convenient for outpatient use. The course of treatment is on average 3-4 weeks.
- Psychotherapeutic medications (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. pain syndrome.
Answers to some questions about treatment methods and complications of chronic prostatitis
Question. Is it possible to use traditional medicine, particularly 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 different pathogenetic links of asymptomatic and abacterial chronic prostatitis. Suppositories made up of extracts from these plants can be purchased at pharmacies.
Question. If there is chronic prostatitis in men, is treatment with rectal prostate massage necessary?
In many foreign clinics, given the effectiveness of physiotherapeutic treatment, they abandoned this physically and psychologically unpleasant procedure. 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.
Question. Is it worth using non-traditional treatment methods - acupuncture, cauterization with medicinal herbs on energetically active points, hirudotherapy?
Considering the theory of influence on energy points and fields, one must answer affirmatively. But no convincing evidence of a positive effect has been obtained. Only the possibility of short-term relief from unexpressed pain and dysuria syndromes is reliable.
As for hirudotherapy, the enzymes in the saliva of a medicinal leech help to improve the microcirculation of the gland, reduce tissue swelling, increase the concentration of drugs in inflammatory foci and normalize urination.
However, alternative treatment methods should be used in conjunction with officially accepted treatment and only in consultation with a specialist.
Question. Can chronic prostatitis cause prostate cancer?
Inverse interdependence is absolutely accurate. Complications of prostatitis are abscess, sclerosis of the glandular tissue and stricture (narrowing) of the urethra. There is still no evidence of the degeneration of glandular cells (as a result of prostatitis) into cancerous cells.
Patients with any form of chronic prostatitis must be constantly under the supervision of a urologist, undergo examinations and undergo preventive treatments.