Despite the fact that prostatitis has been known for a long time, until today 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 quite clearly defined, then the treatment of chronic prostatitis in men in many cases causes significant difficulties and often polar opinions of leading specialists.
However, everyone agrees that:
- the earlier the treatment is started, the more effective it is;
- treatment must 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 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 and perineum, painful and difficult urination or its absence with a bladderfull, difficult and painful defecation. The risk lies in the possibility of a staphylococcal infection, especially in the presence of accompanying chronic diseases (diabetes mellitus), the formation of a gland abscess, the occurrence of septicemia (massive entry of infectious pathogens into the blood) and septicopemia (metastasis; transfer of purulent foci toother organs).
If acute clinical signs of prostatitis appear in men, treatment should be carried out in a specialized urological or general surgical department (as a last resort) of a hospital.
Treatment tactics
The basic principles of treatment include:
- Bed rest.
- Antimicrobial drugs.
- Refusal to massage the prostate not only as a therapeutic method, but also to take secretions for laboratory research, as this can lead to the spread of infection and sepsis.
- Agents that improve microcirculation and blood rheological properties, which are administered intravenously. Acting at the capillary level, they promote the outflow of lymphatic 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 analgesic effect.
- Relief of the pain syndrome, which plays an important pathogenetic role in the maintenance of inflammatory processes. For this purpose, tranquilizers 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.
- Carrying out infusion therapy for severe intoxication. It includes intravenous electrolyte administration, 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 cases of acute inflammatory process, antimicrobial drugs are prescribed without waiting for the results of bacteriological urocultures, 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 known to be more 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 destroy their nuclear structures.
Some experts oppose their use until test results are obtained that exclude tuberculous etiology of prostate damage. This is motivated by the fact that Mycobacterium tuberculosis (Koch bacillus) does not die only from treatment with fluoroquinolones, but becomes more resistant and transforms into new types 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 be used only in combination with anti-tuberculosis drugs, the curative effect of which as a result increases significantly 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, especially since during acute inflammation 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 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 disorders, increased skin reaction to ultraviolet rays (photosensitivity), and decreased blood sugar levels.
After obtaining (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, antibacterial therapy is corrected. For this purpose, second-line drugs are recommended - dihydrofolate reductase inhibitor, macrolides, tetracyclines, cephalosporins.
2 weeks after the start of therapy, if its effectiveness is insufficient, correction is made.
Authoritative European experts in the field of urology believe that the duration of antibacterial therapy should be at least 2-4 weeks, after which a prolonged repeated examination is carried out, including ultrasound examination of the prostate gland and laboratory control of secretions with cultureto identify. pathogen and determine its sensitivity to antibacterial drugs. With the growth of the microflora and its sensitivity to the treatment, as well as the obvious improvement, the therapy continues for another 2-4 weeks and should last (in total) 1-2 months. If there is no pronounced effect, tactics should be changed.
Treatment of patients in serious condition is carried out in intensive care units of hospital wards.
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:
- periodic mild pain;
- a heavy feeling, "pain" and discomfort in the perineum, genitals and lower back;
- impaired urination (sometimes) in the form of interrupted pain during urination, an increase in the frequency of the desire to urinate with a small volume of excreted urine;
- psychoemotional disorders, depression and related sexual disorders.
Treatment of the disease outside the irritation is accompanied by great difficulties. The main controversy lies in questions about prescribing antibacterial therapy. Some doctors consider it necessary to carry out its course under any circumstances. They are based on the assumption that pathological microorganisms during the period of remission cannot always enter the secretion of the prostate gland taken for laboratory culture.
However, most experts are convinced that antibacterial drugs are necessary only for the bacterial form of chronic prostatitis. For bacterial forms and asymptomatic prostatitis, antibacterial drugs should not be prescribed (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 are described:
- Courses of non-steroidal anti-inflammatory drugs.
- Agents that improve blood microcirculation and lymphatic drainage of the prostate.
- Immunomodulating drugs. Products based on prostate extract are well known: in addition to the immunomodulating effect, they improve microcirculation by reducing thrombus formation and reducing the cross-section of blood clots, reduce swelling and tissue leukocyte infiltration. 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 is very convenient for use on an outpatient basis. The course of treatment is on average 3-4 weeks.
- Psychotherapeutic medications (sedatives and antidepressants), especially for patients with erectile dysfunction.
- Physical therapy complexes that help improve blood supply and strengthen pelvic muscles, balneological and physiotherapy - UHF, local rectal electrophoresis, microcurrent, transrectal and transurethral microwave hyperthermia, infrared laser therapy, magnetic therapy, etc. These procedures are especially very effective for pelvic 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. 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 pathogenic links of chronic asymptomatic and abacterial prostatitis. Suppositories composed of extracts of these plants 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 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.
Question. Is it worth using non-traditional methods of treatment - acupuncture, cauterization with medicinal herbs on energetically active points, hirudotherapy?
Considering the theory of impact on energy points and fields, we must answer positively. But no convincing evidence of a positive effect has been obtained. Only the possibility of short-term relief of inexpressible pain and dysuria syndromes is reliable.
As for hirudotherapy, enzymes in the saliva of a medicinal leech help improve microcirculation in the gland, reduce the swelling of its tissues, increase the concentration of drugs in inflammatory foci and normalize urination.
However, alternative treatment methods should be used together with officially accepted treatment and only in consultation with a specialist.
Question. Can chronic prostatitis cause prostate cancer?
The opposite interdependence is absolutely correct. Complications of prostatitis are abscess, sclerosis of the tissue of the gland, narrowing (narrowing) of the urethra. There is still no evidence of the degeneration of glandular cells (as a result of prostatitis) into cancer cells.
Patients with any form of chronic prostatitis should be constantly under the supervision of a urologist, undergo examinations and undergo preventive treatment courses.