Difficulties in treating prostatitis in men

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 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 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 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 a 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 septicopyemia (metastasis, transfer of purulent foci to other organs).

If acute clinical signs of prostatitis occur in men, treatment should be carried out in a specialized urological or general surgical (as a last resort) department of a hospital.

Treatment tactics

Serious condition of a man with acute prostatitis

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 infection 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-inflammatory drugs in tablets and dragees, which also have a moderate analgesic effect.
  • Relief of pain syndrome, which plays a significant pathogenetic role in maintaining inflammation processes. For this purpose, painkillers are used, which also have a moderate anti-inflammatory effect. The drugs 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 administration of electrolyte, detoxification and rheological solutions.

Purulent inflammation of the prostate (abscess) or the inability to urinate are a direct indication for surgical treatment.

The leading 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 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 drugs are recognized as the most effective. Drugs of this series are also active against anaerobic, gram-positive microorganisms and atypical pathogens. These drugs take part in the protein metabolism of pathogenic microorganisms and disrupt their nuclear structures.

Some experts object to 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 from treatment with fluoroquinolones alone, 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. They are recommended to be used only in combination with anti-tuberculosis drugs, the treatment 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 dosages 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 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 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 carried out.

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 ultrasound examination of the prostate gland and laboratory control of secretions with culture to identify the pathogen and determine its sensitivity to antibacterial drugs. With the growth of microflora and its sensitivity to treatment, as well as obvious improvement, therapy continues 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 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 stage is carried out according to the same principles as for acute prostatitis.

Symptoms in remission are characterized by:

  • mild periodic pain;
  • a feeling of heaviness, "ache" and discomfort in the perineum, genitals, and lower back;
  • impaired urination (sometimes) in the form of intermittent pain when urinating, an increase in the 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 is associated with great difficulties. The main controversy lies in questions about the prescription of 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 may not always enter the secretion of the prostate gland taken for laboratory culture.

However, most experts are confident that antibacterial drugs are necessary only 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 pathogenetic 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 thrombus formation and reducing the cross-section of blood clots, reduce swelling 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. 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.
  • Physical therapy complexes that help improve blood supply and strengthen the pelvic floor muscles, balneological and physiotherapy - UHF, local rectal electrophoresis, microcurrents, transrectal and transurethral microwave hyperthermia, infrared laser therapy, magnetic therapy, etc. These procedures are especially highly 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, 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 pathogenetic links of chronic asymptomatic and abacterial prostatitis. Suppositories consisting of extracts of these plants can be purchased in pharmacies.

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 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?

Considering the theory of influence on energy points and fields, one should 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, the enzymes in the saliva of a medicinal leech help improve microcirculation in the gland, reduce swelling of its tissue, 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 reverse interdependence is absolutely accurate. Complications of prostatitis are an abscess, sclerosis of the gland tissue, stricture (narrowing) of the urethra. There is no evidence yet for the degeneration of gland 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.