Despite the fact that prostatitis has been known for a long time, until today it remains a common disease, which affects mainly young and middle-aged men, little studied and difficult to treat disease.
If the cause, 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 polar opinions of leading experts.
However, they all agree that:
- the earlier treatment is started, the more effective;
- treatment should be comprehensive, taking into account all research data, individual characteristics and expected development mechanisms in each individual patient;
- There is no universal medicine and treatment regimen - 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 acute prostatitis treatment 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, lumbar area and perineum, painful and difficult urination or its absence with a full bladder, defecation thatdifficult and painful. The danger lies in the possibility of staphylococcal infection, especially in the presence of concomitant chronic diseases (diabetes mellitus), the formation of gland abscesses, the occurrence of septicemia (massive entry of infectious pathogens into the blood) and septicopyemia (metastasis, transfer of purulent focus to other organs).
If acute clinical signs of prostatitis occur in men, treatment should be carried out in the department of urology or general surgery (as a last resort) in a specialized hospital.
Treatment tactics
The basic principles of treatment include:
- Rest in bed.
- Antimicrobial drugs.
- Refusal to massage the prostate not only as a therapeutic method, but also to obtain secretions for laboratory research, because this can cause the spread of infection and sepsis.
- An agent that improves microcirculation and the rheological properties of blood, 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.
- Non-steroidal anti-inflammatory drugs in tablets and dragees, which also have a moderate analgesic effect.
- Relieves the pain syndrome, which plays an important pathogenetic role in maintaining the inflammatory process. For this purpose, painkillers are used, which also have a moderate anti-inflammatory effect. Medicines of 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 analgesic agents. And also suppositories with propolis for prostatitis.
- Conduct infusion therapy for severe motion sickness. It includes intravenous administration of electrolytes, detoxification and rheological solutions.
Purulent inflammation of the prostate (abscess) or inability to urinate is a direct indication for surgical treatment.
The main link in the treatment of prostatitis in men is antibacterial therapy. In the case of an acute inflammatory process, antimicrobial drugs are prescribed without waiting for the results of a bacteriological urine culture, carried out 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. Drugs of 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 structure.
Some experts object to its use until test results are obtained that exclude the tuberculosis etiology of prostate damage. This is motivated by the fact that Mycobacterium tuberculosis (Koch bacillus) does not die from treatment with fluoroquinolones alone, 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. They are recommended to be used only in combination with anti-tuberculosis drugs, the effect of which treatment results are significantly increased even in the case of drug-resistant mycobacteria.
Having certain physicochemical properties, fluoroquinolones penetrate well into the prostate gland and seminal vesicles and accumulate in them in high concentrations, mainly because during acute inflammation of 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 rhythm disturbances, increased skin response to ultraviolet radiation (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 treatment effectiveness in the first 1-2 days, or in the case of intolerance to fluoroquinolones, antibacterial therapy is corrected. For this purpose, second-line drugs are recommended - dihydrofolate reductase inhibitors, macrolides, tetracyclines, cephalosporins.
2 weeks after the start of therapy, if the effectiveness is insufficient, correction is carried out.
Authoritative European experts in the field of urology believe that the duration of antibacterial therapy should be at least 2-4 weeks, after which repeated advanced examinations are carried out, including ultrasound examination of the prostate gland and laboratory control of secretions with cultures to identify. pathogens and determine their sensitivity to antibacterial drugs. With the growth of microflora and its sensitivity to treatment, as well as clear improvement, therapy continues for another 2-4 weeks and should last (in total) 1-2 months. If there is no noticeable effect, tactics must be changed.
Treatment of patients in serious condition is carried out in the intensive care ward of the inpatient department.
Therapy for 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 acute prostatitis.
Symptoms in remission are characterized by:
- mild periodic pain;
- heaviness, "pain" and discomfort in the perineum, genitals, and lower back;
- impaired urination (sometimes) in the form of intermittent pain during urination, increased frequency of the urge to urinate with a small amount of urine released;
- psychoemotional disorders, depression and related sexual disorders.
Treatment of the disease beyond exacerbation is associated with great difficulty. The main controversy lies in the question regarding the prescription of antibacterial therapy. Some doctors consider it necessary to run a course in any case. They are based on the assumption that pathological microorganisms during the period of remission may not always enter the secretion of the prostate gland taken for laboratory culture.
However, most experts are convinced that antibacterial drugs are only necessary 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, of which the following are prescribed:
- A course of non-steroidal anti-inflammatory drugs.
- An agent that improves microcirculation of blood and lymphatic drainage of the prostate.
- Immunomodulatory drugs. Products based on prostate extract are quite popular: in addition to their immunomodulatory effect, they improve microcirculation by reducing the formation of thrombus 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 the disorder is screened - by 3. 1 times. Medicines are available in the form of rectal suppositories, which are 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.
- Complex of physical therapy that helps to increase blood supply and strengthen pelvic floor muscles, balneology and physiotherapy - UHF, local rectal electrophoresis, microcurrent, transrectal and transurethral microwave hyperthermia, infrared laser therapy, magnetic therapy, etc. This procedure is very effective for the pelvis. 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?
yes. Examples are well-studied medicinal plant extracts 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 prostatitis and chronic abacteremia. Suppositories consisting of this plant extract can be purchased at the pharmacy.
question. If there is chronic prostatitis in men, is treatment with rectal massage of the prostate gland necessary?
In many foreign clinics, given the effectiveness of physiotherapeutic treatment, they abandon this physically and psychologically unpleasant procedure. In addition, finger massage allows you to affect only the lower pole of the prostate. In some countries, massage is still considered effective and used by most urologists.
question. Is it worth using non-traditional methods of treatment - acupuncture, cauterization with medicinal herbs on energetic active points, hirudotherapy?
Considering the theory of influence on points and energy fields, one should answer in the affirmative. But no convincing evidence of a positive effect has been obtained. Only the possibility of short-term relief of unspecified pain and dysuria syndrome can be trusted.
As for hirudotherapy, enzymes in the saliva of medical leeches help improve microcirculation in the gland, reduce tissue swelling, increase drug concentration in the focus of inflammation, 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?
Reverse interdependence is exactly that. Complications of prostatitis are abscesses, sclerosis of glandular tissue, narrowing (narrowing) of the urethra. There is no evidence yet for the degeneration of glandular cells (as a result of prostatitis) into cancer cells.
Patients with any form of chronic prostatitis should always be under the supervision of a urologist, undergo examinations and undergo a course of preventive treatment.