The complexity of the treatment of prostatitis in men

Update: December 2018

Read also on the topic: Symptoms of prostatitis in men

Despite the fact that prostatitis has been known for a long time, to the present
time it remains common, affecting mostly men
young and middle age, poorly understood and difficult to
treatment of the disease.

If causes, pathogenesis (developmental mechanism), and hence the treatment
acute prostatitis quite clearly delineated, then the treatment
chronic prostatitis у мужчин во многих случаях вызывает
significant difficulties and often polar judgments leading
specialists.

Nevertheless, they all agree that:

  • the earlier treatment is started, the more effective it is;
  • treatment should be comprehensive with all the data
    research, individual characteristics and intended
    the mechanism of development of each individual patient;
  • There are no universal drugs and treatment regimens – what
    helped one patient, then another can harm;
  • self-treatment, and especially treatment on the basis of only
    unconventional techniques are unacceptable.

Treatment of acute bacterial prostatitis

Tactics and principles of treatment of acute prostatitis due to
severity of the clinical picture of the process. Patient status
can be very difficult due to intoxication.

The disease begins acutely and is manifested by high fever,
chills, weakness, headache, nausea, vomiting, pain in
lower abdomen, lumbar region and perineum,
painful and difficult urination or lack of it when
full bladder, obstructed and painful defecation.
The danger lies in the possibility of joining staphylococcal
infections, especially in the presence of concomitant chronic
diseases (diabetes mellitus), glandular abscess formation,
the occurrence of septicemia (mass ingestion of infectious
pathogens into the blood) and septicopyemia (metastasis, transfer
purulent foci to other organs).

If you have acute clinical signs of prostatitis
men treatment should be carried out in a specialized
urological or general surgical (in extreme cases) department
hospital

Treatment tactics

The basic principles of treatment include: Лечение простатита у мужчин

  • Bed rest
  • Antimicrobial drugs.
  • Failure to massage the prostate is not only a therapeutic method, but
    even to get a secret for laboratory research, so
    how it can lead to the spread of infection and sepsis.
  • Means improving microcirculation and rheological properties
    of blood (trental, detralex, cavinton, pentoxifylline), which
    are administered intravenously. By acting on the capillary level, they
    contribute to the outflow of lymph and venous blood from the area of ​​inflammation,
    where toxic metabolic products are formed and biologically
    active substances.
  • Nonsteroidal anti-inflammatory drugs in pills and pills
    (indomethacin, piroxicam, ibuprofen, ketoprofen, see NSAIDs list in
    the article pain shots), possessing and moderate painkillers
    action.
  • Removal of pain playing a lot of pathogenetic
    role in maintaining the processes of inflammation. For this purpose are used
    painkillers: tempalgin, nimesil, nise, ketanov,
    also having a moderate anti-inflammatory effect.
    Anesthetic effect and drugs have the previous group.
    In addition, rectal suppositories are widely used.
    phlebitis of hemorrhoidal veins: they consist of the listed
    anti-inflammatory and pain relievers (see treatment
    external hemorrhoids). And also candles with propolis from prostatitis.
  • Conducting infusion therapy with severe intoxication. She is
    includes the intravenous administration of electrolyte (solution
    Ringer, lactosol, disol, trisol, solution of potassium chloride with
    glucose), detoxification and rheological solutions
    (neocompensation, gemodez).

Purulent inflammation of the prostate (abscess) or impossibility
urination is a direct indication for operative
treatment.

The leading link in the treatment of prostatitis in men is
antibacterial therapy. In cases of acute course
antimicrobial anti-inflammatory drug process
prescribed, without waiting for the results of bacteriological crops
urine, conducted to determine the type of pathogen and its
antibiotic sensitivity.

Therefore, immediately use drugs with a wide range of
action against the most common causative agents of acute
prostatitis – gram-negative bacilli and enterococci. Most
effective recognized drugs fluoroquinolone series –
levofloxacin, ciprofloxacin (cyprobay), ofloxacin. Drugs
This series is also active against anaerobic, gram-positive
microorganisms and atypical pathogens. These drugs take
participation in the protein metabolism of pathogenic microorganisms and violate them
nuclear structures. Read more in the article Antibiotics for
prostate

Some experts object to their use before
obtaining test results excluding tuberculosis etiology
damage prostate gland. This is motivated by the fact that
Mycobacterium tuberculosis (Koch’s wand) do not die from treatment
only fluoroquinolones alone, and become more resilient and
are transformed into new types and types of mycobacteria.

World Health Organization recommended appointment
fluoroquinolones not only with tuberculous prostatitis, but also with
any forms of tuberculosis. They are recommended to be used only in
combination with anti-TB drugs, the effect of treatment
which as a result of this significantly increased even
drug resistance of mycobacteria.

Possessing certain physicochemical properties,
fluoroquinolones penetrate well into the prostate gland and seminal
bubbles and accumulate in them in high concentrations, especially
that in acute inflammation the prostate has an 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 a violation
liver and kidney function; adverse reactions may occur. Most
typical are central nervous system reactions and impairment
functions of the digestive system. Less than 1% may be impaired
heart rate, increased skin reaction to ultraviolet
rays (photosensitization), lowering blood sugar levels.

After receiving (after 48 – 72 hours) laboratory data
Studies on the nature of the pathogen and its sensitivity to
antibiotics, lack of effectiveness of treatment in the first 1 to 2 days
or in cases of intolerance to fluoroquinolones antibacterial
therapy corrected. For this purpose, preparations of the second are recommended.
lines – trimethoprim, macrolides (sumamed, azithromycin), doxycycline,
cephalosporins (cefazolin, kefzol, cefotaxime, cefpirome,
cefepime).

2 weeks after the start of therapy with insufficient
efficiency is a correction.

Authoritative European and Russian experts in the field
urologists believe that the duration of antibiotic therapy should
be at least 2 – 4 weeks, after which it is held
re-extended examinations, including ultrasound
prostate gland and laboratory control of secretions
with seeding to identify the pathogen and determine it
sensitivity to antibacterial drugs. With growth
microflora and its sensitivity to treatment, as well as a clear improvement
therapy continues for another 2 to 4 weeks and should be (in total
difficulty) 1 – 2 months. In the absence of a pronounced effect
tactics need to be changed.

The treatment of patients in serious condition is carried out
in the wards of intensive care inpatient units.

Therapy of chronic prostatitis

Chronic prostatitis is characterized by periods of remission and
relapse (exacerbations). Drug treatment of prostatitis in men
in the acute stage is carried out according to the same principles as in
acute prostatitis.

Symptoms in remission are characterized by:

  • mild recurrent pain;
  • feeling of heaviness, “aches” and discomfort in the crotch area,
    genitals, lower back;
  • impaired urination (sometimes) in the form of non-permanent cuts
    during urination, increase the frequency of urge to urinate
    with a small amount of urine excreted;
  • psycho-emotional disorders, depression and related
    sexual disorders.

It is more convenient to buy drugs to increase potency.
online pharmacies (like here), because it is anonymous and prices are more
low.

Treatment of the disease without exacerbation is associated with large
the complexities. The main controversy lies in questions about
the appointment of antibiotic therapy. Some doctors believe
necessary to conduct her course in any circumstances. They
based on the assumption that it is not always pathological
microorganisms in remission may fall into the secret
prostate gland taken for laboratory seeding.

However, most experts believe that
antibacterial drugs are needed only when bacterial
form of chronic prostatitis. With abacterial forms and
asymptomatic prostatitis antibacterial drugs
should not be appointed (according to the principle “not all means are good”).

The main tactic should have anti-inflammatory and
pathogenetic character, for which are assigned:

  • Courses nonsteroidal anti-inflammatory drugs.
  • Means improving blood and lymphatic circulation
    prostate drainage.
  • Immunomodulatory drugs (T-activin, timolin, prostatilen,
    vitaprost, thymosin). Prostatilen and Vitaprost enjoy considerable
    popular: in addition to the immunomodulatory effect, it improves
    microcirculation by reducing blood clots and reducing
    cross section of blood clots, reduce puffiness and
    leukocyte tissue infiltration. These drugs are 3.2 times (by
    research data prof. Tkachuka V.N.) contribute to the reduction
    intensity of pain in 97% of patients, and dysuric disorders – in
    3.1 times. The drugs are available in the form of rectal suppositories, which is very
    convenient for outpatient use. A course of treatment
    averages 3-4 weeks.
  • Psychotherapeutic drugs (sedatives and
    antidepressants), especially in patients with erectile dysfunction.
  • The complex of physical therapy, contributing to the improvement
    blood supply and strengthen the muscles of the pelvic floor, balneological and
    physiotherapy – UHF, local rectal electrophoresis,
    microcurrent, transrectal and transurethral microwave
    hyperthermia, infrared laser therapy, magnetic therapy, etc.
    These procedures are especially highly effective in pelvic syndrome.
    the pains.

Answers to some questions about treatments and complications
chronic prostatitis

Question. Is it possible to use traditional medicine in
particular medicinal plants?

Yes. An example would be well-studied extracts of such
medicinal plants like goldenrod, echinacea, St. John’s wort, root
licorice. Each of these plants contains components that positively
affecting various pathogenetic links of chronic
asymptomatic and abacterial prostatitis. Candles composed
from extracts of these plants, can be purchased at pharmacies.

Question. If there is chronic prostatitis in men,
Is treatment of rectal prostate massage necessary?
glands?

In many foreign clinics, given the effectiveness
physiotherapy treatment, abandoned this physically and
psychologically unpleasant procedure. In addition, finger massage
allows you to work only on the lower pole of the prostate. In Russia
massage is still considered effective, it is used by most
urologists.

Question. Should I use non-traditional methods of treatment –
acupuncture, cauterization of medicinal herbs in
energetically active points, hirudotherapy?

Considering the theory of the impact on energy points and fields,
should be answered in the affirmative. But convincing evidence
positive effect is not received. Only authentic is
the possibility of short-term relief of unexpressed pain and
dysuric syndromes.

As for hirudotherapy, according to V.A Savinov, M.I.
Kuznetsova and other saliva enzymes of the medicinal leech contribute to
improvement of microcirculation in the gland, reduction of edema of its tissue,
increasing the concentration in the inflammatory foci of medicinal
means, normalization of urination.

However, non-traditional treatment methods should be applied in
complex with officially accepted treatment and only by agreement
with a specialist.

Question. Could chronic prostatitis cause cancer
prostate?

Inverse interdependence is completely accurate.
Complications of prostatitis – abscess, hardening of the gland tissue,
stricture (narrowing) of the urethra. Evidence in favor of rebirth
gland cells (as a result of prostatitis) in cancer until
exists.

Больные любыми формами chronic prostatitis должны постоянно
be under the supervision of a urologist, undergo examinations and
conduct preventive treatment courses.

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