Although prostatitis has been known for a long time, to this day it remains a common disease, mainly affecting young and middle-aged men, a disease that is poorly studied and difficult to treat.
If the causes, pathogenesis (development mechanism) and therefore treatment of acute prostatitis are quite clearly defined, then the treatment of chronic prostatitis in men in many cases leads to significant difficulties and often polar opinions of thefrom eminent specialists.
However, they all agree that:
- the earlier treatment is started, 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 patient;
- There are no universal medications or treatment regimens: what helps one patient may harm another;
- independent treatment, and especially treatment based solely 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 poisoning.
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 urination anddifficult 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 formation of glandular abscesses, the occurrence of sepsis (mass entry of infectious pathogens into the blood) and septicopyemia(metastases, transfer of purulent foci to other organs).
If acute clinical signs of prostatitis appear in men, treatment should be carried out in a specialized department of urology or general surgery (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 even to obtain secretions for laboratory research, as this can lead to the spread of infections and sepsis.
- Agents improving microcirculation and rheological properties of blood, administered intravenously. Acting at the capillary level, they promote the flow of lymph and venous blood from the area of inflammation, where toxic metabolic products and biologically active substances are formed.
- Nonsteroidal anti-inflammatory drugs in the form of tablets and dragees, which also have a moderate analgesic effect.
- Relief of pain syndrome, which plays an important pathogenetic role in maintaining inflammatory processes. For this purpose, pain relievers are used, which also have a moderate anti-inflammatory effect. Medicines from 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.
- Carrying out infusion treatment in case of serious poisoning. 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 case of an acute inflammatory process, antimicrobial drugs 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-based 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 test results excluding tuberculous etiology of prostate lesions are obtained. This is motivated by the fact that Mycobacterium tuberculosis (Koch's bacillus) does not die only due to 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 to use them only in combination with anti-tuberculosis drugs, the therapeutic 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 there 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 to 17% of patients, especially those with hepatic and renal impairment, 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 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, lack of effectiveness of treatment in the first 1-2 days, or in case of intolerance to fluoroquinolones, antibiotic therapy is corrected. For this purpose, second-line drugs are recommended - dihydrofolate reductase inhibitor, macrolides, tetracyclines, cephalosporins.
2 weeks after the start of treatment, if its effectiveness is insufficient, a correction is carried out.
Authoritative European experts in the field of urology believe that the duration of antibacterial treatment should be at least 2-4 weeks, after which a repeated thorough examination is carried out, including ultrasound of the prostate and control insecretions laboratory 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 obvious improvement, treatment continues for another 2-4 weeks and is expected to last (in total) 1-2 months. If there is no pronounced effect, the tactics should be changed.
Treatment of patients in serious condition is carried out in the intensive care units of inpatient 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 stage is carried out according to the same principles as for acute prostatitis.
Symptoms in remission are characterized by:
- slight periodic pain;
- a feeling of heaviness, "pain" and discomfort in the perineum, genitals and lower back;
- impaired urination (sometimes) in the form of intermittent pain when urinating, increased frequency of urge to urinate with a small volume of urine excreted;
- psychoemotional disorders, depression and associated sexual disorders.
Treatment of the disease outside of exacerbations is associated with great difficulties. The main controversy lies in issues related to the prescription of antibacterial treatment. Some doctors believe that it is necessary to carry out its treatment in all circumstances. They are based on the assumption that pathological microorganisms during the period of remission may not always penetrate the prostate secretion 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 of an anti-inflammatory and pathogenetic nature, for which the following are prescribed:
- Course of non-steroidal anti-inflammatory drugs.
- Agents that improve blood microcirculation and lymphatic drainage of the prostate.
- Immunomodulatory drugs. Products based on prostate extract are very popular: in addition to their immunomodulatory effect, they improve microcirculation by reducing the formation of thrombus and reducing the cross section of blood clots, reduce swelling and leukocyte infiltration of tissues. These drugs help to reduce the intensity of pain by 3. 2 times in 97% of patients and dysuric disorders by 3. 1 times. The drugs are available in the form of rectal suppositories, which is very convenient for outpatient use. The duration of treatment lasts on average 3 to 4 weeks.
- Psychotherapeutic medications (sedatives and antidepressants), especially for patients suffering from erectile dysfunction.
- Physiotherapy complexes that help improve blood supply and strengthen the muscles of the pelvic floor, 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, especially medicinal plants?
Yes. An example would be 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 different pathogenetic links of chronic asymptomatic and abacterial prostatitis. Suppositories made from extracts of these plants can be purchased at pharmacies.
Question. In cases of chronic prostatitis in men, is treatment with rectal prostate massage necessary?
In many foreign clinics, taking into account the effectiveness of physiotherapeutic treatment, this physically and psychologically unpleasant procedure has been abandoned. 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 methods of treatment - acupuncture, cauterization with medicinal herbs at energetically active points, hirudotherapy?
Taking into account the theory of influence on energy points and fields, one must answer in the affirmative. But no convincing evidence of a positive effect has been obtained. Only the possibility of short-term relief from unexpressed pain syndromes and dysuria is reliable.
As for hirudotherapy, the enzymes contained in the saliva of a medicinal leech help to improve microcirculation in the gland, reduce swelling of its tissues, 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?
The opposite interdependence is absolutely correct. Complications of prostatitis are abscess, sclerosis of glandular tissue, stricture (narrowing) of the urethra. There is no evidence that gland cells (as a result of prostatitis) degenerate 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.