Although prostatitis has been known for a long time, to this day it remains a common disease, affecting mainly young and middle-aged men, a disease little studied and difficult to treat.
If the causes, pathogenesis (development mechanism) and therefore the treatment of acute prostatitis are clearly defined, then the treatment of chronic prostatitis in men in many cases causes significant difficulties and often polarized opinions. of the main specialists.
However, everyone agrees that:
- The sooner treatment is started, the more effective it will be;
- treatment should be comprehensive, taking into account all research data, individual characteristics and the expected development mechanism in each individual 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 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 glandular abscess, the appearance of septicemia (massive entry of infectious pathogens into the blood) and septicopemia (metastasis, transfer from purulent foci to other organs).
If acute clinical signs of prostatitis occur in men, treatment should be carried out in a specialized urology or general surgery department (as a last resort) of a hospital.
Treatment tactics
The basic principles of treatment include:
- Bed rest.
- Antimicrobial medications.
- Refuse 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 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.
- Non-steroidal anti-inflammatories in tablets and dragees, which also have a moderate analgesic effect.
- Relief of pain syndrome, which plays an important pathogenic role in the maintenance of inflammatory processes. For this, analgesics are used, which also have a moderate anti-inflammatory effect. Drugs from the previous group also have an analgesic effect. Also, 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 in case of severe poisoning. 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 antibiotic therapy. In cases of an acute inflammatory process, antimicrobial medications 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, drugs that have a wide spectrum of action against the most common pathogens of acute prostatitis - gram-negative bacilli and enterococci are immediately used. Fluoroquinolone medications are recognized as the most effective. The drugs of this series are also active against anaerobic, gram-positive and atypical pathogenic microorganisms. These drugs participate in the protein metabolism of pathogenic microorganisms and alter their nuclear structures.
Some experts oppose its use until test results are obtained that exclude tuberculous etiology of damage to the prostate. This is motivated by the fact that Mycobacterium tuberculosis (Koch's bacillus) does not die only with fluoroquinolone treatment, but rather 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. Its use is recommended only in combination with anti-tuberculosis drugs, the therapeutic 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 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 liver and kidney failure, 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 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, therapy is corrected with antibiotics. For this, second-line medications are recommended: dihydrofolate reductase inhibitor, macrolides, tetracyclines and 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 repeated extensive examination is performed, including ultrasound examination of the prostate and control of Laboratory of secretions with culture to identify. the pathogen and determine its sensitivity to antibacterial medications. With the growth of microflora and its sensitivity to treatment, as well as obvious improvement, therapy continues for another 2 to 4 weeks and should last (in total) 1 to 2 months. If there is no pronounced effect, it is necessary to change tactics.
Treatment of patients in serious condition is carried out in the intensive care wards of inpatient departments.
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:
- mild periodic pain;
- 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 the urge to urinate with a small volume of urine excreted;
- Psychoemotional disorders, depression and related sexual disorders.
Treatment of the disease outside of exacerbation entails great difficulties. The main controversy lies in the issues regarding the prescription of antibacterial therapy. Some doctors consider it necessary to carry out their course under any circumstances. They are based on the assumption that pathological microorganisms during the period of remission may not always enter the secretion of the prostate gland taken for laboratory culture.
However, most experts are confident that antibacterial medications 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 anti-inflammatory and pathogenic in nature, 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 based on prostate extract are quite popular: in addition to the immunomodulatory effect, they improve microcirculation by reducing the formation of thrombi and reducing the cross section of blood clots, reduce swelling and infiltration of leukocytes into tissues. These drugs help reduce the intensity of pain in 97% of patients by 3. 2 times and dysuric disorders by 3. 1 times. The drugs are available in the form of rectal suppositories, which is very convenient for use on an outpatient basis. The course of treatment averages 3-4 weeks.
- Psychotherapeutic drugs (sedatives and antidepressants), especially for patients with erectile dysfunction.
- Physiotherapy complexes that help improve blood flow 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. These procedures are especially effective for the pelvis. pain syndrome.
Answers to some questions about treatment methods and complications of chronic prostatitis.
Ask. Is it possible to use traditional medicine, in particular 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 pathogenic links of asymptomatic and abacterial chronic prostatitis. Suppositories composed of extracts of these plants can be purchased in pharmacies.
Ask. If there is chronic prostatitis in men, is treatment with rectal prostate massage 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 influence only the lower pole of the prostate. In some countries, massage is still considered effective and is used by most urologists.
Ask. Is it worth using non-traditional treatment methods: acupuncture, cauterization with medicinal herbs on energetically active points, hirudotherapy?
Considering the theory of influence on energy points and fields, the answer must be 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 from the saliva of a medicinal leech help to improve microcirculation in the gland, reduce inflammation 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 after consultation with a specialist.
Ask. Can chronic prostatitis cause prostate cancer?
Inverse interdependence is absolutely accurate. Complications of prostatitis are an abscess, sclerosis of the glandular tissue, and stricture (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 constantly be under the supervision of a urologist, undergo examinations and undergo preventive treatment.