Post Date December, 03 2023
What are the treatment methods for prostatitis? Prostatitis is a common disease in urology, ranking first among male patients under 50 years of age in urology. In 1995, NIH developed a new classification method for prostatitis. Type I: equivalent to acute bacterial prostatitis in the traditional classification method, Type II: equivalent to chronic bacterial prostatitis in the traditional classification method, Type III: chronic prostatitis/chronic pelvic pain syndrome, and Type IV: asymptomatic prostatitis. Non bacterial prostatitis is far more common than bacterial prostatitis. What are the treatment methods for prostatitis?
1. Antibacterial treatment
The detection of pathogenic pathogens in prostate fluid culture is the basis for selecting antimicrobial drugs for treatment. If patients with non bacterial prostatitis have signs of bacterial infection that are not effective after general treatment, they may also be treated with appropriate antibacterial drugs. In the selection of antibacterial drugs, attention should be paid to the existence of a prostate blood barrier composed of lipid membranes between the prostatic acini and microcirculation, which hinders the passage of water-soluble antibiotics and greatly reduces the therapeutic effect. When prostate stones are present, they can become a shelter for bacteria. The above factors constitute difficulties in the treatment of chronic bacterial prostatitis, which requires a longer course of treatment and is prone to relapse.
Currently, there are many advocates for quinolones such as ofloxacin or levofloxacin. If it fails, continue to use it for 8 weeks. If the recurrence occurs and the bacterial strain remains unchanged, use a prophylactic dose to reduce acute episodes and reduce symptoms. If long-term use of antibiotics induces serious side effects, such as pseudomembranous enteritis, diarrhea, and the growth of intestinal drug resistant strains, it is necessary to change the treatment plan. Whether antibacterial drugs are suitable for the treatment of non bacterial prostatitis is still controversial in clinical practice. Patients with "sterile" prostatitis can also use drugs that are effective against bacteria and mycoplasma, such as quinolones, SMZ-TMP, or TMP alone, in combination with or at intervals with tetracycline and quinolones. If antibiotic treatment is ineffective and confirmed as sterile prostatitis, antibiotic treatment should be discontinued. In addition, using a double balloon catheter to seal the prostate urethra and inject antibiotic solution from the urethral cavity into the prostate tube can also achieve therapeutic purposes.
Type I mainly includes broad-spectrum antibiotics, symptomatic treatment, and supportive treatment. For type II, oral antibiotics are recommended as the main treatment, and sensitive drugs are selected. The course of treatment is 4-6 weeks. During this period, the efficacy of patients should be evaluated periodically. Type III can be treated with oral antibiotics for 2-4 weeks before evaluating the efficacy. It is also supplemented with non steroidal anti-inflammatory drugs, α- Receptor antagonists, M-receptor antagonists, etc. improve urination symptoms and pain. Type IV requires no treatment.
2. Anti inflammatory and analgesic drugs
Non steroidal anti inflammatory drugs can improve symptoms. Generally, indomethacin is taken orally or suppositories are used, while traditional Chinese medicines such as anti-inflammatory, antipyretic, detoxifying, and softening drugs have also received certain effects. Allopurinol can reduce the concentration of uric acid in the whole body and prostate fluid. In theory, it acts as a free radical scavenger, and can also remove active oxygen species, alleviate inflammation, and relieve pain. It can be regarded as an optional auxiliary treatment method.
3. Physical therapy
Prostate massage can empty the concentrated secretion in the prostate tube and drain the infected areas in the obstructive area of the gland. Therefore, for stubborn cases, prostate massage can be performed every 3 to 7 days while using antibiotics. A variety of physical factors are used as prostate physiotherapy, such as microwave, radio frequency, ultrashort wave, medium wave, and hot water sitz baths, which have certain benefits for relaxing the prostate, posterior urethral smooth muscle, and pelvic floor muscles, enhancing antibacterial efficacy, and alleviating pain symptoms.
4. M-receptor antagonists
M-receptor antagonists can be used to treat prostatitis patients with overactive bladder function, such as urgency, frequent urination, and increased nocturia, but without urinary tract obstruction.
5. α- Receptor antagonist
In patients with prostate pain, bacterial or non bacterial prostatitis, the tension of the smooth muscle of the prostate, bladder neck, and urethra increases. During urination, the increased internal pressure of the posterior urethra causes urine to flow back into the prostate canal, which is an important cause of prostate pain, prostate stones, and bacterial prostatitis α Receptor antagonists can effectively improve prostate pain and urination symptoms, and are important for preventing recurrence of infection. α Receptor antagonists should be used for a longer period of time to allow sufficient time to adjust smooth muscle function and consolidate the therapeutic effect.
6. Prostate massage and hyperthermia
Prostate massage is one of the traditional treatment methods. Research shows that appropriate prostate massage can promote the emptying of the prostate tube, increase local drug concentration, and alleviate the clinical symptoms of chronic prostatitis. Hyperthermia mainly utilizes the thermal effects generated by various physical means to increase blood circulation in prostate tissue, accelerate metabolism, facilitate the effect and elimination of tissue edema, alleviate pelvic floor muscle spasms, and so on.
7. Surgical treatment
Surgical treatment can be used for recurrent chronic bacterial prostatitis. Prostatectomy can achieve the goal of healing, but it should be used with caution. Due to the fact that prostatitis usually involves the peripheral zone of the gland, it is difficult to achieve the treatment goal of prostate resection. TURP can remove prostate stones and bacterial infection lesions near the prostate duct, which is beneficial for reducing the reinfection of peripheral zone lesions. Chronic bacterial prostatitis can lead to recurrent urinary tract infections and infertility.
8. Other treatments
It includes biofeedback therapy, transperineal extracorporeal shock wave therapy, psychotherapy, and traditional Chinese medicine treatment.
