Chronic Prostatitis Treatment

Treatment of chronic prostatitis, like any chronic disease, should be carried out in compliance with the principles of consistency and an integrated approach. First of all, it is necessary to change the patient's lifestyle, his thinking and psychology. Eliminating the influence of many harmful factors, such as physical inactivity, alcohol, chronic hypothermia and others. Thus, we not only stop the further progression of the disease, but also contribute to recovery. This, as well as the normalization of sexual activity, diet and much more, is a preparatory stage in treatment. This is followed by the main, basic course, involving the use of various drugs. Such a stepwise approach to the treatment of the disease allows you to control its effectiveness at each stage, making the necessary changes, and also to fight the disease according to the same principle by which it developed. from predisposing factors to producing ones.

Medication for chronic prostatitis

It is necessary to simultaneously use several medicinal preparations and methods that act on different links of pathogenesis in order to eliminate the infectious factor, normalize blood circulation in the pelvic organs, (including improving microcirculation in the prostate), adequate drainage of the prostatic acini, especially in the peripheral zones, normalization of the level of basic hormones and immune responses. Based on this, antibacterial and anticholinergic drugs, immunomodulators, NSAIDs, angioprotectors and vasodilators, as well as prostate massage can be recommended for use in chronic prostatitis. In recent years, chronic prostatitis has been treated with drugs that were not previously used for this purpose: alpha1-blockers (terazosin), 5-a-reductase inhibitors (finasteride), cytokine inhibitors, immunosuppressants (cyclosporin), drugs that affect urate metabolism ( allopurinol) and citrates.

The mainstay of treatment for chronic prostatitis due to infectious agents. in the antibacterial treatment of chronic prostatitis, carried out taking into account the sensitivity of a particular pathogen to a particular drug. The effectiveness of antibiotic therapy has not been proven for all types of prostatitis. In chronic bacterial prostatitis, antibacterial treatment of chronic prostatitis is effective and leads to the elimination of the pathogen in 90% of cases, provided that drugs are selected taking into account the sensitivity of microorganisms to them, as well as the properties of the drugs themselves. It is necessary to correctly choose their daily dose, frequency of priming and duration of treatment.

In chronic abacterial prostatitis and inflammatory syndrome of chronic pelvic pain (in the case when, as a result of the use of microscopic, bacteriological and immune diagnostic methods, the pathogen has not been identified), empirical antibacterial treatment of chronic prostatitis can be carried out in a short course and, with its clinical efficacy, continued. The effectiveness of empirical antimicrobial therapy in both patients with bacterial prostatitis and abacterial prostatitis is about 40%. This indicates the undetectability of the bacterial flora or the positive role of other microbial agents (chlamydia, mycoplasma, ureaplasma, fungal flora, Trichomonas, viruses) in the development of an infectious inflammatory process, which is currently not confirmed. The flora, which is not determined by standard microscopic or bacteriological examination of prostate secretion, in some cases can be detected by histological examination of prostate biopsies or other subtle methods.

In non-inflammatory chronic pelvic pain syndrome and asymptomatic chronic prostatitis, the need for antibiotic therapy is controversial. The duration of antibiotic therapy should be no more than 2-4 weeks, after which, with positive results, it lasts up to 4-6 weeks. If there is no effect, it is possible to cancel antibiotics and prescribe drugs of other groups (for example, alpha1-blockers, plant extracts of Serenoa repens).

Antibacterial drugs are also recommended to be prescribed in order to prevent recurrence of bacterial prostatitis.

Given the important role of intraprostatic reflux in the pathogenesis of chronic abacterial prostatitis, while the obstructive and irritative symptoms of the disease persist after antibiotic therapy (and sometimes together with it), α-blockers are shown. Their use is due to the fact that in humans up to 50% of intraurethral pressure is maintained due to the stimulation of a1-adrenergic receptors. The contractile function of the prostate is also under the control of a1-adrenergic receptors, which are localized mainly in the stromal elements of the gland. Alpha-blockers reduce increased intraurethral pressure and relax the bladder neck and prostate smooth muscles, and reduce detrusor tone.A positive effect occurs in 48-80% of cases, regardless of the use of a specific drug from the group of a-blockers.

Pain and irritative symptoms are an indication for the appointment of NPS, which are used both in complex therapy, as well as as an alpha-blocker alone if antibiotic therapy is ineffective (diclofenac at a dose of 50-100 mg / day).

Some studies demonstrate the effectiveness of herbal medicine, but this information is not supported by multicenter, placebo-controlled trials.

In our country, the most widespread drugs are based on Serenoa repens (Sabal palm). According to modern data, the effectiveness of these drugs is ensured by the presence of phytosterols in their composition, which have a complex anti-inflammatory effect on the inflammatory process in the prostate. This action of Serenoa repens is due to the ability of the extract to suppress the synthesis of inflammatory mediators (prostaglandins and leukotrienes) by inhibiting phospholipase A2, which is actively involved in the conversion of membrane phospholipids into arachidonic acid, as well as inhibiting cyclooxygenase (responsible for the formation of prostaglandins) and lipoxygenase (responsible for the formation of leukotrienes). In addition, Serenoa repens preparations have a pronounced anti-edema effect. The recommended duration of therapy for chronic prostatitis with drugs based on Serenoa repens extract is at least 3 months.

If the clinical symptoms of the disease (pain, dysuria) persist after the use of antibiotics, a-blockers and NSAIDs, subsequent treatment should be aimed either at relieving pain, or at solving problems with urination, or at correcting both of the above symptoms.

If dysuria predominates in the clinical picture of the disease, UDI (UVM) should be performed before starting drug therapy, if possible in a urodynamic study. Further treatment is prescribed depending on the results obtained. In case of hypersensitivity (hyperactivity) of the bladder neck, treatment is carried out as in interstitial cystitis. With detrusor hyperreflexia, anticholinesterase drugs are prescribed. With hypertonicity of the external sphincter of the urinary bladder, benzodiazepines are prescribed, and if drug therapy is ineffective, physiotherapy (relieving spasm), neuromodulation (for example, sacral stimulation) is prescribed.

Based on the neuromuscular theory of the etiopathogenesis of chronic abacterial prostatitis, antispasmodics and muscle relaxants can be prescribed.