Difficulties in treating male prostatitis

Although prostatitis has long been known, to date it remains a common disease that mainly affects young and middle-aged men, is poorly studied, and is difficult to treat.While the etiology, pathogenesis (mechanism of development) and treatment of acute prostatitis are well defined, the treatment of chronic prostatitis in men causes significant difficulties in many cases and often polarizes the opinions of leading experts.However, they all agree:

• The earlier treatment is started, the better the results;
• Treatment should be comprehensive, taking into account all research data, individual characteristics, and expected developmental mechanisms of each patient;
• There are no universal medications and treatments—what helps one patient may harm another;
• Independent treatment, especially treatment based solely on non-traditional methods, is not acceptable.

Treatment of acute bacterial prostatitis

The strategies and principles of treatment of acute prostatitis depend on the severity of the clinical manifestations of the process. The patient's condition may be so severe that it may be explained by intoxication.The disease has an acute onset and is characterized by high fever, chills, weakness, headache, nausea, vomiting, pain in the lower abdomen, waist and perineum, difficulty or difficulty urinating, full bladder, and difficulty or pain during defecation. The danger lies in the possibility of staphylococcal infection, especially in conjunction with chronic disease (diabetes), the formation of glandular abscesses, the development of sepsis (massive entry of infectious pathogens into the blood) and sepsis (metastasis, the transfer of foci of suppuration to other organs).

If a man develops acute clinical symptoms of prostatitis, he should be treated in a hospital's specialized urology department or general surgery department (as a last resort).

treatment strategies

Basic principles of treatment include:

• rest on bed.
• Antibacterial drugs.
• Refusal to massage the prostate not only as a treatment, but even to obtain secretions for laboratory studies, as this may lead to the spread of infection and sepsis.
• Drugs that improve microcirculation and blood rheology are administered intravenously. They act at the capillary level, promoting the outflow of lymphatic and venous blood from the inflamed area, forming toxic metabolites and bioactive substances.
• Nonsteroidal anti-inflammatory drugs, available in tablets and dragees, also have moderate analgesic effects.
• Relieve pain syndrome and play an important role in the pathogenesis of maintaining inflammation. For this purpose, painkillers are used, which also have a certain anti-inflammatory effect. Drugs from the former group also have analgesic properties. In addition, rectal suppositories are widely used in the treatment of hemorrhoidal vein phlebitis: they contain anti-inflammatory and analgesic agents. There are also propolis suppositories for treating prostatitis.
• Severe poisoning is treated with infusion. It includes intravenous administration of electrolytes, detoxification, and rheological solutions.

Purulent inflammation of the prostate (abscess) or the inability to urinate are direct indications for surgical treatment.The leading link in the treatment of male prostatitis is antibacterial treatment. In the case of acute inflammatory processes, antimicrobial drugs can be prescribed without waiting for the results of bacteriological urine cultures to determine the type of pathogen and its susceptibility to antibiotics.Therefore, they immediately use drugs with broad action against the most common pathogens of acute prostatitis - Gram-negative bacilli and enterococci. Fluoroquinolones are considered the most effective. This family of drugs also has activity against anaerobic bacteria, Gram-positive microorganisms and atypical pathogens. These drugs participate in the protein metabolism of pathogenic microorganisms and damage their nuclear structure.Some experts advise against their use until test results are available that exclude TB as a cause of prostate damage. This is because Mycobacterium tuberculosis (Koch's bacterium) does not die from treatment with fluoroquinolones alone, but instead becomes more resistant and transforms into new types and species of mycobacteria.The World Health Organization recommends the use of fluoroquinolones not only to treat tuberculous prostatitis but also to treat any form of tuberculosis. It is recommended to be used only in combination with anti-tuberculosis drugs, the therapeutic effect of which is significantly increased even in the case of drug-resistant mycobacteria.Fluoroquinolones have certain physicochemical properties that allow them to penetrate well into the prostate and seminal vesicles, where they accumulate at high concentrations, especially since the permeability of the prostate increases during acute inflammation.Fluoroquinolones are injected intravenously or intramuscularly in appropriate doses (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 typical are central nervous system reactions and digestive organ dysfunction. Less than 1% of people may experience irregular heartbeats, increased skin reaction to ultraviolet light (photosensitivity), and decreased blood sugar levels.Antimicrobial treatment after lack of effectiveness of treatment within the first 1-2 days after receipt (48-72 hours) of laboratory data on the nature of the pathogen and its susceptibility to antibiotics, or in case of intolerance to fluoroquinolonesbe corrected. For this reason, second-line drugs are recommended - dihydrofolate reductase inhibitors, macrolides, tetracyclines, cephalosporins. 2 weeks after the start of treatment, if the effect is insufficient, correction is made.

Leading experts in the field of European urology believe that the duration of antimicrobial therapy should be at least 2-4 weeks, followed by repeated extended examinations, including ultrasound of the prostate and laboratory control of secretions with culture to identify the pathogen andDetermine their susceptibility to antimicrobial drugs. Treatment will continue for 2-4 weeks and should continue (in total) for 1-2 months as the microbiota grows and becomes more sensitive to treatment and improves significantly. If the effect is not obvious, the strategy must be changed.

Treatment of seriously ill patients takes place in the intensive care unit of the inpatient unit.

Treatment of chronic prostatitis

Chronic prostatitis is characterized by periods of remission and relapse (exacerbation). Medical treatment of acute prostatitis in men follows the same principles as acute prostatitis.Symptoms during remission are characterized by:

• mild periodic pain;
• Feelings of heaviness, "pain" and discomfort in the perineum, genitals, and lower back;
• Urinary disturbances (sometimes) characterized by intermittent pain during urination, increased frequency of urination, and small amounts of urine produced;
• Psycho-emotional disorders, depression and related sexual disorders.

Treatment beyond exacerbation of the disease presents significant difficulties. The main controversy is over the prescription of antimicrobial treatments. Some doctors believe that treatment is necessary in any case. They are based on the hypothesis that pathological microorganisms during remission may not always enter the prostate secretions used for laboratory culture.However, most experts believe that only bacterial chronic prostatitis requires antibacterial drugs. For non-bacterial forms and asymptomatic prostatitis, antimicrobial drugs should not be prescribed (according to the "not all drugs are good" principle).The main strategy should be anti-inflammatory and pathogenic, for which the following is prescribed:

• NSAID course.
• Drugs that improve blood microcirculation and lymphatic drainage from the prostate.
• Immunomodulatory drugs. Products based on prostate extracts are quite popular: in addition to their immunomodulatory effect, they improve microcirculation, reduce swelling of tissues and infiltration of leukocytes by reducing thrombosis and reducing the cross-section of blood clots. These drugs helped reduce pain intensity by 3. 2 times and dysuria symptoms by 3. 1 times in 97% of patients. These medications are available as rectal suppositories, which are very convenient for outpatient use. The average treatment course is 3-4 weeks.
• Psychotherapeutic drugs (sedatives and antidepressants), especially in patients with erectile dysfunction.
• Comprehensive physical therapy, balneotherapy and physiotherapy to help improve blood supply and strengthen pelvic floor muscles - UHF, local rectal electrophoresis, microcurrent, transrectal and transurethral microwave thermotherapy, infrared laser therapy, magnetic therapy and more. These procedures are particularly effective for pelvic pain syndrome.

Answers to several questions about the treatment methods and complications of chronic prostatitis

question. Is it possible to use traditional medicine, especially medicinal plants?

Yes. One example is the well-studied medicinal plant extracts such as goldenrod, echinacea, St. John's wort, and licorice root. Each of these plants contains components that exert a positive effect on the different pathogenesis of chronic asymptomatic and nonbacterial prostatitis. Suppositories composed of extracts from these plants can be purchased in pharmacies.

question. If men suffer from chronic prostatitis, do they need prostate and rectal massage treatment?

In many clinics abroad, due to the effectiveness of physiotherapy treatment, they have abandoned this physically and mentally unpleasant surgery. Additionally, finger massage can 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 treatments - acupuncture, cautery with herbs at energy activity points, leech therapy?

Considering the theory of influence of energy points and fields, the answer should be yes. But convincing evidence of a positive effect has not yet been obtained. Only the possibility of short-term relief of unexpressed pain and dysuria syndrome is reliable.As for leech therapy, the enzymes in the saliva of medicinal leeches help to improve the microcirculation of the glands, reduce the swelling of their tissues, increase the concentration of drugs in inflammatory foci and normalize urination.

However, alternative treatment methods should be used in conjunction with officially accepted treatments and only after consultation with a specialist.

question. Can chronic prostatitis cause prostate cancer?

Reverse interdependence is absolutely accurate. Complications of prostatitis include abscesses, hardening of glandular tissue, and urethral stricture. There is currently no evidence that glandular cells degenerate into cancer cells (due to prostatitis).Patients with any form of chronic prostatitis should always be examined and receive preventive treatment under the supervision of a urologist.