Despite the fact that prostatitis has been known since ancient times, it remains a common disease that affects mostly young and middle-aged men, a poorly studied and difficult to treat disease.
If the causes, pathogenesis (mechanism of development), and therefore the treatment of acute prostatitis are quite clearly defined, then the treatment of chronic prostatitis in men in a large number of cases causes significant difficulties and often polar opinions of leading experts.
However, everyone agrees that:
- 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 mechanism of development in each individual patient;
- There are no universal drugs and treatment regimens – what helps one patient may harm another;
- Independent treatment, and especially treatment only with 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 region and perineum, painful and difficult urination or its absence with a full bladder, difficult and painful defecation. The danger lies in the possibility of staphylococcal infection, especially in the presence of concomitant chronic diseases (diabetes mellitus), the occurrence of gland abscesses, 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 appear in men, treatment should be carried out in a specialized urology or general surgery (as a last resort) department of the hospital.
Treatment tactics
The basic principles of treatment include:
- Bed rest.
- Antimicrobial drugs.
- Rejection of prostate massage not only as a therapeutic method, but even to obtain secretions for laboratory research, as this can lead to the spread of infection and sepsis.
- Means that improve microcirculation and rheological properties of blood, which are administered intravenously. Acting at the capillary level, they stimulate the outflow of lymph and venous blood from the area of inflammation, where toxic metabolic products and biologically active substances are created.
- Non-steroidal anti-inflammatory drugs in tablets and dragees, which also have a moderate analgesic effect.
- Alleviation of pain syndrome, which has a significant pathogenetic role in maintaining inflammatory processes. 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 propolis suppositories for prostatitis.
- Implementation of infusion therapy in case of severe intoxication. It includes intravenous administration of electrolytes, detoxification and rheological solutions.
Purulent inflammation of the prostate (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 cases of an acute inflammatory process, antimicrobial drugs are prescribed without waiting for the results of a bacteriological urine culture, which is 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 causes of acute prostatitis - gram-negative bacilli and enterococci. Fluoroquinolone drugs are recognized as 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 oppose their use until the results of tests that exclude a tuberculous etiology of prostate damage are obtained. This is motivated by the fact that Mycobacterium tuberculosis (Koch bacillus) does not just die from fluoroquinolone treatment, 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, whose treatment effect is significantly increased even in the case of drug-resistant mycobacteria.
Possessing certain physical and chemical properties, fluoroquinolones penetrate well into the prostate gland and seminal vesicles and accumulate in them in high concentrations, especially since the prostate has increased permeability during acute inflammation.
Fluoroquinolones are administered in appropriate doses intravenously or intramuscularly (depending on the activity of the inflammatory process). In 3-17% of patients, especially those suffering from 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 have heart rhythm disturbances, increased skin reaction to ultraviolet rays (photosensitivity), and reduced blood sugar levels.
After receiving (48-72 hours) laboratory data on the nature of the pathogen and its sensitivity to antibiotics, the ineffectiveness of treatment in the first 1-2 days, or in cases 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 the therapy, if its effectiveness is insufficient, a correction is made.
Authoritative European experts in the field of urology believe that antibacterial therapy should last at least 2-4 weeks, after which a repeated prolonged examination is performed, including an ultrasound examination of the prostate and laboratory control of secretions with a culture for identification. pathogen and determine its sensitivity to antibacterial drugs. With the increase of microflora and its sensitivity to treatment, as well as obvious improvement, the therapy is continued for another 2-4 weeks and should last (in total) 1-2 months. If there is no pronounced effect, the tactics must be changed.
Treatment of patients in serious condition is carried out in intensive care units of inpatients.
Therapy of chronic prostatitis
Chronic prostatitis is characterized by periods of remission and relapse (exacerbation). 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 periodic pain;
- feeling of heaviness, "pain" and discomfort in the perineum, genitals and lower back;
- difficulty urinating (sometimes) in the form of occasional pain when urinating, increasing the frequency of the urge to urinate with a small amount of excreted urine;
- psychoemotional disorders, depression and related sexual disorders.
Treatment of the disease beyond exacerbation is associated with great difficulties. The main controversy lies in questions about prescribing antibacterial therapy. Some doctors believe that it is necessary to carry out its course under any circumstances. They are based on the assumption that pathological microorganisms in the period of remission cannot always enter the prostate secretion taken for laboratory culture.
However, most experts are convinced that antibacterial drugs are needed only for the bacterial form of chronic prostatitis. Antibacterial drugs should not be prescribed for abacterial forms and asymptomatic prostatitis (according to the principle "not all drugs are good").
The main tactics should be of an anti-inflammatory and pathogenetic nature, for which the following is prescribed:
- Courses of non-steroidal anti-inflammatory drugs.
- Means that improve blood microcirculation and lymphatic drainage of the prostate.
- Immunomodulatory drugs. Products based on prostate extract are quite popular: in addition to immunomodulatory effects, they improve microcirculation by reducing the formation of thrombus and reducing the cross-section of blood clots, reducing swelling and infiltration of tissue leukocytes. These drugs help reduce pain intensity 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 are very suitable for outpatient use. The course of treatment is on average 3-4 weeks.
- Psychotherapeutic drugs (sedatives and antidepressants), especially for patients with erectile dysfunction.
- Physical therapy 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, magnetotherapy, etc. These procedures are particularly effective for pelvic pain syndrome.
Answers to some questions about treatment methods and complications of chronic prostatitis
A question. Is it possible to use traditional medicine, especially medicinal plants?
Yes. An example would be the well-studied 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 various pathogenetic links of chronic asymptomatic and abacterial prostatitis. Suppositories consisting of extracts of these plants can be purchased in pharmacies.
A question. If there is chronic prostatitis in men, is treatment with rectal massage of the prostate necessary?
In many foreign clinics, given the effectiveness of physiotherapy treatment, they have abandoned 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.
A question. Is it worth using non-traditional methods of treatment - acupuncture, cauterization with herbs on energetically active points, hirudotherapy?
Considering the theory of influence on energy points and fields, the answer should be affirmative. But no convincing evidence of a positive effect was obtained. Only the possibility of short-term relief of unexpressed pain and dysuria syndrome is reliable.
As for hirudotherapy, the enzymes in the saliva of medical leeches help improve microcirculation in the gland, reduce the swelling of its tissue, increase the concentration of drugs in the foci of inflammation and normalize urination.
However, alternative methods of treatment should be used together with officially accepted treatment and only in consultation with a specialist.
A question. Can chronic prostatitis cause prostate cancer?
The reverse interdependence is absolutely true. Complications of prostatitis are abscess, sclerosis of the tissue of the gland, stricture (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 be under the constant supervision of a urologist, undergo examinations and preventive treatment.