Although prostatitis has been known for a long time, until today it remains a common disease that affects mainly young and middle-aged men, is little studied and difficult to treat.
If the causes, pathogenesis (mechanism of development) and, therefore, the treatment of acute prostatitis are clearly defined, the treatment of chronic prostatitis in men in many cases causes significant difficulties and often polar opinions of leading experts.
However, they all agree:
- the earlier the treatment starts, the more effective it is;
- treatment should be comprehensive, taking into account all research data, individual characteristics and expected development mechanism in each individual patient;
- There are no universal drugs 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, lumbar region and perineum, painful and difficult urination or its absence with a full bladder, difficult and painful defecation. The danger is in the possibility of staphylococcal infection, especially in accompanying chronic diseases (diabetes), the formation of gland abscess, 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 specialized urological or general surgical (as a last resort) department of the hospital.
Treatment tactics
The main principles of treatment include:
- Bed rest.
- Antimicrobial drugs.
- Prostate massage not only as a therapeutic method, but also to refuse to take secretions for laboratory studies, because this can lead to the spread of infection and sepsis.
- Agents that improve microcirculation and rheological properties of blood administered intravenously. Acting at the capillary level, it helps to remove 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 have a moderate analgesic effect.
- Elimination of pain syndrome, which plays an important pathogenetic role in maintaining inflammatory processes. Painkillers are used for this purpose, they also have a moderate anti-inflammatory effect. Drugs 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. Also candles with propolis for prostatitis.
- Administration of infusion therapy for severe intoxication. This includes intravenous administration of electrolyte, detoxification, and rheological solutions.
Purulent inflammation (abscess) of the prostate or inability to urinate is a direct indication for surgical treatment.
The leading link in the treatment of prostatitis in men is antibacterial therapy. During an acute inflammatory process, 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 with a wide spectrum of action against the most common pathogens of acute prostatitis - gram-negative bacilli and enterococci. Fluoroquinolone drugs are known to be the most effective. Medicines 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 structures.
Some experts object to their use until test results are available that exclude a tuberculous etiology of prostate lesions. This is due to the fact that Mycobacterium tuberculosis (Koch's bacillus) does not die from treatment with fluoroquinolones alone, it is more resistant and transforms into new species and types 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, as a result of which the treatment effect increases significantly even in the case of drug-resistant mycobacteria.
Fluoroquinolones with certain physicochemical properties penetrate well into the prostate gland and seminal vesicles and accumulate in them in high concentrations, especially during acute inflammation, the permeability of the prostate is increased.
Fluoroquinolones are injected in appropriate doses intravenously or intramuscularly (depending on the activity of the inflammatory process). Adverse reactions may occur in 3-17% of patients, especially in patients with impaired liver and kidney function. The most typical ones are reactions of the central nervous system and dysfunction of the digestive organs. Less than 1% may experience heart rhythm disturbances, increased skin reaction to ultraviolet rays (photosensitivity), and decreased blood sugar levels.
The nature of the pathogen and sensitivity to antibiotics are corrected after receiving laboratory data (48-72 hours) on antibacterial therapy in cases of lack of treatment effectiveness or intolerance to fluoroquinolones in the first 1-2 days. For this purpose, second-line drugs are recommended - dihydrofolate reductase inhibitor, macrolides, tetracyclines, cephalosporins.
2 weeks after the start of therapy, if the effectiveness is insufficient, correction is made.
Authoritative European specialists in the field of urology believe that the duration of antibacterial therapy should be at least 2-4 weeks, after which a comprehensive examination is carried out, including ultrasound examination of the prostate gland and laboratory control of secretions with culture. determine the pathogen and its sensitivity to antibacterial drugs. With the growth of microflora and sensitivity to treatment, as well as obvious improvement, therapy continues for another 2-4 weeks and should last (in total) 1-2 months. If there is no clear effect, the tactic should be changed.
Patients in serious condition are treated in intensive care units of inpatient departments.
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 acute prostatitis.
Symptoms during remission are characterized by:
- mild periodic pain;
- a feeling of heaviness, "pain" and discomfort in the perineum, genitals and lower back;
- impaired urination in the form of intermittent pain during urination (sometimes), increased frequency of urination with a small amount of urine;
- psychoemotional disorders, depression and related sexual disorders.
Treatment of the disease outside of exacerbation is associated with great difficulties. The main controversy is questions about the appointment of antibacterial therapy. Some doctors consider it necessary to carry out its course under any circumstances. They are based on the assumption that pathological microorganisms cannot always enter the secretion of the prostate gland taken for laboratory culture during remission.
However, most experts are convinced that antibacterial drugs are necessary only for the bacterial form of chronic prostatitis. Antibacterial drugs should not be prescribed for bacterial forms and asymptomatic prostatitis (according to the principle "all drugs are not good").
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 lymphatic drainage of the prostate.
- Immunomodulatory drugs. Products made on the basis of prostate extract are quite popular: in addition to the immunomodulatory effect, they improve microcirculation by reducing the formation of thrombus and the crossing of blood clots, reducing tissue swelling and leukocyte infiltration. These drugs help reduce pain intensity by 3. 2 times and dysuric disorders by 3. 1 times in 97% of patients. Medicines are available in the form of rectal suppositories, which are very convenient for use in outpatient settings. The course of treatment is on average 3-4 weeks.
- Psychotherapeutic drugs (sedatives and antidepressants), especially for patients with erectile dysfunction.
- Physiotherapy complexes that help to improve blood supply and strengthen pelvic floor muscles, balneological and physiotherapy - UHF, local rectal electrophoresis, microcurrents, transrectal and transurethral microwave hyperthermia, infrared laser therapy, magnetic therapy, etc. These procedures are especially highly 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 include well-studied extracts of medicinal plants such as yarrow, 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 bacterial prostatitis. Suppositories containing extracts of these plants can be purchased from pharmacies.
Question. If men have chronic prostatitis, is it necessary to treat with rectal massage of the prostate gland?
Considering the effectiveness of physiotherapeutic treatment in many foreign clinics, they refused 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 is used by most urologists.
Question. Is it worth using non-traditional methods of treatment - acupuncture, cauterization with medicinal plants on energetically active points, hirudotherapy?
If we consider the theory of influence on energy points and fields, it is necessary to answer positively. However, no convincing evidence of a positive effect has been obtained. Only the possibility of short-term relief of unexpressed pain and dysuria syndromes is reliable.
As for hirudotherapy, the enzymes contained in the leech's saliva help to improve microcirculation in the gland, reduce the swelling of its tissue, increase the concentration of drugs in the inflammatory sites, and normalize urine output.
However, alternative treatment methods should be used in conjunction with officially accepted treatment and only in consultation with a specialist.
Question. Can chronic prostatitis lead to prostate cancer?
Inverse interdependence is absolutely certain. Complications of prostatitis are abscess, sclerosis of the glandular tissue, narrowing (narrowing) of the urethra. There is still no evidence that glandular cells (as a result of prostatitis) can become cancer cells.
Patients with any form of chronic prostatitis should be constantly monitored by a urologist, undergo examinations and undergo preventive treatment courses.