Despite the fact that prostatitis has been known for a long time, to this day it remains a common disease affecting mainly young and middle-aged men, a little 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 many cases causes significant difficulties and often polar opinions of leading specialists.
However, they all agree that:
- the earlier treatment begins, 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 schemes - 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 severe, 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 formation of a gland abscess, the occurrence of septicemia (massive entry of infectious pathogens into the blood) and septicopemia (metastases, transfer of purulent foci to otherorgans).
If acute clinical signs of prostatitis appear in men, treatment should be carried out in a specialized urological or general surgical (as a last resort) department of a hospital.
Tactics of treatment
The main 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 tests, 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 promote the outflow 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 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. Painkillers are used for this purpose, 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 suppositories with propolis for prostatitis.
- Administration of infusion therapy in case of severe intoxication. Includes intravenous administration of electrolyte, 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 the case of an acute inflammatory process, antimicrobial drugs are prescribed without waiting for the results of bacteriological urine cultures conducted to determine the type of pathogen and its sensitivity to antibiotics.
That is why 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 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 destroy their nuclear structures.
Some experts object to their use until test results are obtained that exclude a tuberculous etiology of prostate damage. This is motivated by the fact that Mycobacterium tuberculosis (Koch's bacillus) does not just die from fluoroquinolone treatment, but becomes 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. They are recommended to be used only in combination with antituberculosis drugs, the therapeutic effect of which as a result is 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, 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). Adverse reactions may occur in 3-17% of patients, especially those with impaired liver and kidney function. The most characteristic are the reactions of the central nervous system and the dysfunction of the digestive organs. Less than 1% may have 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, the lack of effectiveness of treatment in the first 1-2 days or in cases of intolerance to fluoroquinolones, antibacterial therapy is adjusted. For this purpose, second-line preparations are recommended - dihydrofolate reductase inhibitor, macrolides, tetracyclines, cephalosporins.
2 weeks after the start of therapy, if its effectiveness is insufficient, a 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 repeated extended examination is carried out, including an ultrasound examination of the prostate gland and laboratory control of secretions with a culture to identify the pathogen anddetermining its sensitivity to antibacterial drugs. With an increase in the microflora and its sensitivity to the treatment, as well as an obvious improvement, the therapy continues for another 2-4 weeks and should last (in total) 1-2 months. If there is no pronounced effect, the tactics should be changed.
Treatment of patients in a serious condition is carried out in the intensive care units of the hospital wards.
Treatment of 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:
- mild intermittent pain;
- a feeling of heaviness, "pain" and discomfort in the perineum, genitals and lower back;
- impaired urination (sometimes) in the form of periodic pain during urination, an increase in the frequency of the desire to urinate with a small volume of urine output;
- psychoemotional disorders, depression and related sexual disorders.
Treatment of the disease outside the exacerbation is associated with great difficulties. The main controversy lies in questions about the prescription of antibacterial therapy. Some doctors believe that it is necessary to conduct its course under any circumstances. They are based on the assumption that pathological microorganisms during the period of remission cannot always penetrate 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. In 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, for which they are prescribed:
- Courses of nonsteroidal 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 the immunomodulatory effect, they improve microcirculation by reducing the formation of thrombus and reducing the cross-section of blood clots, reduce edema and leukocyte infiltration of tissues. These drugs help reduce the intensity of pain 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 outpatient use. The course of treatment is on average 3-4 weeks.
- Psychotherapeutic drugs (sedatives and antidepressants), especially in patients with erectile dysfunction.
- Physiotherapy complexes that help 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 the pelvic organs. pain syndrome.
Answers to some questions about treatment methods and complications of chronic prostatitis
A question. Is it possible to use traditional medicine, in particular medicinal plants?
An example of this is well-studied extracts from 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 from these plants can be purchased in pharmacies.
A 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 physiotherapy 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.
A question. Is it worth using non-traditional methods of treatment - acupuncture, burning with medicinal herbs on energetically active points, hirudotherapy?
Considering 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 of unexpressed pain and dysuria syndromes is reliable.
As for hirudotherapy, enzymes in the saliva of a medical leech help to improve microcirculation in the gland, reduce the swelling of its tissue, 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 after consultation with a specialist.
A question. Can chronic prostatitis cause prostate cancer?
The inverse interdependence is absolutely correct. Complications of prostatitis are abscess, sclerosis of the tissue of the gland, stricture (narrowing) of the urethra. There is still no evidence of 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 courses of treatment.