Consultations on the treatment of chronic prostatitis

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Prostatitis is a disease of the prostate gland, which is inflammatory in nature. In men, this is the most common problem of the genitourinary system. The course of the disease can be acute or chronic.

According to statistics, a third of the male population of the planet faces prostatitis. This pathology of the prostate is in third place after cancer and hyperplasia. Studies show that prostatitis occupies a fourth of the disorders of the male sexual and reproductive system.

Causes of prostatitis

The main causes of prostatitis are infections that enter the genitourinary system.

• hormonal changes;
• immune failure;
• growth of blood vessels inside the prostate;
• changes in the nervous apparatus of the prostate.

Prostatitis symptoms

You need to pay more attention to your health and consult a doctor if you have the following symptoms:

• Disorder of urination. Thus, prostatitis is manifested. Patients experience the urge to urinate more often than usual, during which pain is disturbed, and after going to the toilet there is a feeling of incomplete emptying.
• Sexual disorders. With Chronic prostatitis, more than 35% of men experience accelerated ejaculation and a decrease in the sensation of orgasm.
• Stress and psychological disorders. The development of prostate pathology is often preceded by psychological disorders and emotional outbursts. The degree of these violations is in no way connected with the level of the inflammatory process of the prostate. It depends on the psychological stability of the patient. Psycho-emotional problems often manifest themselves in the absence of the effect of chronic prostatitis treatment.
• Infertility. Prostatitis is the cause of infertility in about 30% of cases. This is due to a decrease in sperm motility, which is characteristic of this disease.

The development of Acute prostatitis is evidenced by a distinct clinical picture, as well as morphological changes.

There are three stages of the disease:

Diagnosis of pathology

Acute or chronic prostatitis is diagnosed in the presence of a characteristic clinical picture.

To clarify or confirm the diagnosis, studies are carried out:

• rectal collection of prostate secretion;
• prostate secretion culture;
• bacterial culture of urine.

In order to differentiate prostatitis from other pathologies of the prostate gland and to identify the presence of an adenoma, cyst or tumor, the patient needs to undergo an ultrasound of the prostate. The results of the spermogram allow you to diagnose or exclude infertility.

Prostatitis treatment

The urological clinics of the capital have the most modern equipment for therapy. Modern clinical and laboratory studies make it possible to establish an accurate diagnosis and determine a set of therapeutic measures.

Antibacterial therapy is prescribed in most cases, although in individual cases non-drug treatment is dispensed with.

The doctor selects the medicines taking into account the degree of pathology and the individual characteristics of the patient. Uncomplicated forms of acute prostatitis are treated on an outpatient basis under the supervision of a urologist or andrologist. treatment of chronic prostatitis in a hospital is mandatory in the presence of purulent processes and severe intoxication of the body.

One of the modern methods of treating prostatitis is antihomotoxic drugs. Made using homeopathic technologies, they do not cause intoxication of the body and are absolutely safe. The drugs have a comprehensive effect on the mechanisms of development and course of the disease.

The use of antihomotoxic drugs in complex therapy gives the following results:

• the remission phase occurs in a short time;
• it is possible to quickly relieve the patient from pain;
• inflammation goes away;
• drugs are non-addictive and well tolerated;
• No side effects.

Complex therapy of chronic prostatitis, in addition to treatment with antibacterial drugs, includes physiotherapy.

With the help of a low-energy helium-neon laser, they achieve:

• stimulation of phagocytosis and hematopoiesis processes;
• reduce pain;
• tissue regeneration;
• increasing the body's immune abilities.

Ultraphonophoresis is a procedure for the local treatment of prostatitis.

Having an antibacterial effect, ultrasound has the following effect on the prostate:

• stimulates tissue activity;
• increases the activity of leukocytes;
• improves the immune capacity of the body;
• normalizes metabolic processes;
• increases the permeability of tissues, due to which drugs are better absorbed into the blood.

Another treatment method is to use the possibilities of the electromagnetic field.

With the help of such a physiotherapy, they achieve:

For the treatment and prevention of prostatitis, men are advised to lead a healthy lifestyle. This means that you need to review your diet and diet, adjust your wakefulness and sleep patterns, and monitor physical activity.

Course of treatment of chronic prostatitis

Prostatitis usually bothers for a long time and is characterized by frequent resumptions after breaks. Therefore, complex treatment is aimed at all factors of the disease.

The course of therapy can last from one to three months. The goal is to achieve long-term remission. The treatment is considered successful if it passed without complications, and the patient's quality of life was restored. The complex of therapeutic measures consists of antimicrobial therapy prescribed based on the results of bacterial culture and sensitivity tests, anti-inflammatory therapy, physiotherapy and prostate massage.

With the help of massage, the inflammatory secretion is achieved from the prostate gland into the ducts and urethra with further removal from the body. At the same time, blood circulation is improved, which allows drugs to better penetrate the tissues.

If, despite conservative treatment, frequent relapses are still observed, then surgical methods such as transurethral resection of the prostate or prostatectomy are used. Chronic prostatitis is dangerous with complications in the form of urinary tract infections, as well as infertility.

Don't forget about simple prevention methods. The most important thing after treatment is to see a urologist for control!

Specialized clinics have modern equipment. Patients are treated and treated by qualified urologists. The cost of treating chronic prostatitis depends on the stage of the disease and the procedures prescribed.

Effective treatment regimen for prostatitis

Statistical studies show that a considerable number of men suffer from prostatitis. And the fact that the disease is rapidly getting younger. Now you can already meet 20-year-old men suffering from prostatitis. But now medicine is capable of much. Including cure this disease. The only thing that is required from the patient is that the prostatitis treatment regimen is maintained to the last point. Otherwise, the consequences can be very bad.

Treatment measures

Today, doctors use the following treatment therapy, which necessarily includes the following requirements:

Balancing the mode of life, allocating time for work and rest in it; Start eating right. This is an important factor in the healing process; Normalization of intimate life. By this is meant its regularity, but only with one partner. Promiscuous sex life, albeit regular, is not included in this concept; The patient must take special antibacterial agents that will fight the causative agent of the disease; Reception of multivitamin complexes in order to increase immunity; Elimination of pain syndrome; Use of local anesthetics; And taking antidepressants. Pills for depression

The course of treatment of prostatitis is impossible without taking medications. Doctors often prescribe strong antibiotics. But the problem is that patients refuse to take them, explaining that they are afraid of the negative impact of antibiotics on their intestinal microflora. Their fears are well founded. But without antibiotics, a complete cure is impossible, because only they can cope with the causative agents of the disease. Therefore, fears are fears, and men's health is more expensive. In addition, at the same time as prescribing these drugs, the doctor also prescribes probiotics, which will reduce the negative effects of antibiotics. So if they can do at least some harm, then the most minimal.

The course of treatment for prostatitis includes massaging the prostate. Again, there is one thing, but many men perceive it as some kind of humiliating procedure that affects their honor. If a man is embarrassed to undergo a procedure in a hospital with staff or other patients, then you can perform it at home. Either on your own or with the help of relatives.

Doctors recommend purchasing a special device for prostate massage, but if this is not possible, then you can get by with improvised means.

Vibrating prostate massager

The best and most familiar way to massage the prostate gland. This is due to contractions of the muscles of the anus. Therefore, men do not believe the rumors that during prostatitis it is necessary to refrain from intimate relationships. If you are sick, you need to do this regularly.

Have sex every day

Changing partners is not recommended, no meaningful delay or interruption of the process.Ideally, you need to have sex with only one partner, a permanent one. Sexologists advise a man, if she is not there, you need to engage in self-satisfaction.

Peculiarities in the treatment of acute and chronic types of prostatitis

The symptoms of these forms of the disease are the same, but the treatment regimens for chronic and acute prostatitis are different.

Firstly, the acute form is much easier to cure, since the body of a man is still able to cope with infection and inflammation on his own. Enough to help him with this.

Acute prostatitis is treated with antibiotic therapy

While the fight against neglected problems will require a lot of effort and time from both the patient and his doctor. Because the body is weakened. Decreased immunity. The body of a man ceases to fight the infection. Instead, he begins to adapt to such a state, learns to live with the disease. And it will be very difficult to make him live in the old way, without illness.

The treatment regimen for acute prostatitis in men requires the use of antibiotic therapy. This will help the male body to successfully fight pathogenic bacteria that caused inflammation of the prostate.

With an exacerbation of the disease state, the patient's pain increases, in this case, the patient is prescribed adrenoblockers. This is done to reduce inflammation and swelling of the prostate. Along with the activities, massage and physiotherapy are recommended.

The best non-selective adrenoblocker

Schematically, the treatment of the acute form can be represented as follows:

• Antibiotic therapy;
• Sulfanilamide preparations;
• In the presence of pain, anti-inflammatory drugs are prescribed;
• Medications to strengthen and support immunity;
• Edema is removed with alpha-blockers;
• Physiotherapy.

Chronic prostatitis treatment plan

With incompetent treatment or late treatment of a patient with an acute form for medical help, there is a risk of complications with the transition of the disease to a chronic form. In addition, the following features must be taken into account during treatment:

It is necessary to diagnose the hormonal balance. If there are problems, then special drugs are prescribed to eliminate them; Preparations for treatment

• To strengthen the immune system, it is necessary to organize proper nutrition and take vitamin complexes;
• It is necessary to restore a regular sexual life. Excessively active sexual intercourse doctors recognized as unacceptable;
• Prescribing anti-inflammatory drugs;
• Prescribing drugs that improve blood circulation (such as heparin and the like);
• The patient is advised to completely refrain from drinking alcohol and smoking tobacco;
• It is highly recommended that all existing infectious diseases be cured. This will avoid re-infection of the prostate;
• Prescribing antibiotics of various groups. Moreover, it is recommended to change these groups among themselves during treatment - this will help to avoid the pathogen becoming addicted to the drug;
• The course of treatment of chronic prostatitis includes physiotherapy. It is especially worth paying attention to prostate massage, which will free the iron ducts from the secret.

In the treatment of chronic prostatitis, it is important to strengthen the entire body!

It is important to strengthen the whole body, improve the general condition of the patient while blocking the inflammatory process. Treatment of the chronic form takes a long time and there is no guarantee of a complete recovery of the patient. It is important to prevent serious consequences in the form of damage to other organs. It is desirable to establish a long period of remission. Otherwise, serious problems are possible in the organs responsible for reproduction, up to infertility and sexual impotence (impotence).

Effective drugs in the treatment of prostatitis

With prostatitis, the course of treatment is not complete without prescribing antibiotics. The following is a list of the most commonly used groups of antibiotics.

Penicillin is an antibacterial drug

• Penicillin and its derivatives. Despite its "age" it remains a broad-spectrum drug. Most doctors prescribe it as an alternative remedy until final lab results are available. The most common of this group of drugs at the moment are tablets Amoxiclav, Amoxicillin. Their effectiveness has been proven, and the price is affordable for anyone;
• Macrolides - the advantage of this group is their non-toxicity. Therefore, there is no negative effect on the intestinal microflora. Sumamed, Rulid, Klacid;
• The next group is Cephalosparins. Used only permanently.Administered intravenously;
• Another group used only in stationary conditions - Ceftriaxone;
• If all the above drugs do not work, then doctors usually prescribe Fluoroquinols.

When taking antibiotics, patients are not recommended to reduce the dosage and treatment time on their own. The full course is at least two weeks. People prone to allergies should inform their doctor. Then he will establish constant monitoring to exclude the occurrence of an allergic reaction to the drug.

If there are diseases of the kidneys, liver, then you must immediately warn the doctors about this. Then they will choose a different treatment regimen.

Prostatitis is an inflammation of the prostate gland. Criteria for the diagnosis of prostatitis are: the presence of symptoms of prostatitis and / or the corresponding results of microscopy and culture of a three-glass urine sample and prostate secretion. Prostatitis is the most common urological disease among men of reproductive age. According to various authors, from 8 to 35% of men aged 20 to 40 suffer from chronic prostatitis.

Types of prostatitis

At present, the clinical classification of prostatitis by categories, developed in 1995 by the National Institutes of Health (NIH) USA, is generally recognized in the world:

• Category I acute bacterial prostatitis.
• Category II chronic bacterial prostatitis.
• Category III chronic abacterial prostatitis: a chronic inflammatory pelvic pain syndrome;
• b Non-inflammatory chronic pelvic pain syndrome (prostatodynia).

Criteria for classifying prostatitis by category

According to generalized literature data, the frequency of acute and chronic bacterial prostatitis is 5-10%, and chronic abacterial prostatitis is about 90%.

Causes of prostatitis

Bacterial prostatitis (acute and chronic), in most cases, is caused by bacteria of the Enterobacteriaceae family, in particular Escherichia coli (E. Coli). The main causative agents of prostatitis are presented in Table. 9.2. The role of the so-called atypical microorganisms (chlamydia, ureaplasmas, mycoplasmas) in the development of prostatitis today cannot be considered proven. In patients with human immunodeficiency virus (HIV), yeast fungi (Candida spp.) and Mycobacterium tuberculosis can also be etiological pathogens. Before the advent of antibiotics, gonococci (Neisseria gonorrhoeae) played an important role in the occurrence of bacterial prostatitis, and especially its abscessing form.

The most frequently detected pathogens of prostatitis

The etiology of abacterial prostatitis is not fully understood. There are a number of pathogenetic factors that play a role in the development of abacterial prostatitis, the main of which are: intraprostatic urinary reflux, autoimmune aseptic inflammation and circulatory disorders of the prostate and pelvic organs.

Prostatitis symptoms

When acute prostatitis occurs (category I prostatitis), there is an increase in body temperature to high numbers (above 38 C) with chills, sweating, weakness, arthralgia and severe pain in the lower abdomen, in the perineum and / or in the genitals. Urination disorders are characteristic: frequent, painful, difficult, sometimes acute urinary retention.

The symptoms of chronic prostatitis (categories II and III prostatitis) include dull aching pain in the lower abdomen, in the perineum with irradiation to the vulva and in the sacrum. Also, patients are often concerned about painful and frequent urination, especially at night, imperative urges, deterioration of erection and / or shortening of the duration of sexual intercourse, a decrease in the severity of orgasm. These symptoms can be observed all together or in various combinations. In a number of patients suffering from chronic prostatitis, there is a decrease in fertility (oligospermia, asthenozoospermia).

Diagnosis of prostatitis

In acute prostatitis (category I prostatitis), digital rectal examination should be carried out delicately, since, firstly, palpation of the prostate gland is extremely painful, and secondly, the risk of septic complications is high. On digital rectal examination, the prostate gland of a patient with acute prostatitis is enlarged, edematous ("tense"), sharply painful. In case of complications of acute prostatitis with an abscess of the prostate gland, foci of fluctuation may be detected.

Laboratory confirmation of the presence of an infectious process in acute prostatitis is an increase in the number of leukocytes and the detection of pathogenic microorganisms (usually E. coli) in the course of a microscopic and bacteriological analysis of urine of a medium portion, respectively.Of all patients with prostatitis, only patients with acute prostatitis are not tested for prostate secretion, since prostate massage, during which a secret for research is obtained, is contraindicated for them. A patient with acute prostatitis can significantly (several times) increase the level of prostate-specific antigen in the blood serum.

In chronic prostatitis, digital rectal examination allows you to detect changes in the shape, general and focal consistency, to assess the degree of pain in the prostate gland.

Classifying chronic prostatitis into categories allows the clinical picture and the so-called three-glass urine sample with the study of prostate secretion. Various portions of urine and the secret of the prostate gland are subjected to microscopic and bacteriological studies, as a result of which it is possible to establish the presence of signs of an inflammatory process, determine its localization and, in some cases, identify the causative agent of the disease.

Laboratory signs of prostatitis on microscopy are: an increase in the number of leukocytes (more than 10-15 per p / o), a decrease in the number of lecithin grains and the presence of macrophages containing fat (oval fat bodies) in the secretion of the prostate gland or in the 3rd portion of urine . Identification during bacteriological cultural studies in the prostate secretion or in the 3rd portion of urine of pathogens pathogenic for the prostate gland indicates the bacterial nature of the disease. If urethritis is suspected, it is advisable to take smears from the urethra before performing a three-glass test.

Transrectal ultrasound in chronic prostatitis allows to detect focal changes in the prostate gland: heterogeneity of the echogenicity of the gland, its decrease (due to edema) and increase (due to fibrosis), the presence of calculi and cysts, expansion of the seminal vesicles. Color Doppler examination of the prostate and surrounding tissues reveals circulatory disorders, which are one of the pathogenetic factors of this disease.

The diagnosis of asymptomatic inflammatory prostatitis (category IV) is established in the absence of complaints in the patient and the detection of inflammatory infiltration during the histological examination of prostate tissue (usually biopsy specimens) or an increased number of leukocytes during microscopy of prostate secretion or the 3rd portion of urine.< /p>

Prostatitis treatment

The main role in the treatment of bacterial prostatitis belongs to antibacterial drugs. The penetration of antibiotics into the prostate gland is extremely difficult. In this regard, antibiotic therapy for prostatitis is usually carried out for a long time (4-12 weeks) and high doses of drugs. According to pharmacological studies, of the currently available antibiotics, preparations of the fluoroquinolone group are best penetrated into the prostate tissue.

In acute bacterial prostatitis (category I), parenteral empiric antibiotic therapy is indicated in high dosages until the general manifestations of infection subside (primarily, the disappearance of high fever). The drugs of choice for parenteral treatment are fluoroquinolones (ciprofloxacin, norfloxacin, ofloxacin) and third-generation cephalosporins (ceftriaxone, ceftazidime). After receiving the culture results, if necessary, antibiotic therapy is adjusted depending on the sensitivity of the microorganism. Oral therapy (usually high doses of fluoroquinolones) is given after the general symptoms subside and continues for at least 30 days from the start of treatment.

In case of complications of acute prostatitis by the development of acute urinary retention, puncture cystostomy is indicated.

When an abscess of the prostate gland is formed, its perineal drainage is performed against the background of ongoing antibiotic therapy.

For chronic bacterial prostatitis (category II) and chronic inflammatory pelvic pain syndrome (abacterial chronic prostatitis category IIIa), high-dose oral antibiotic therapy is indicated. Fluoroquinolones are the drugs of choice. After 2 weeks from the moment of initiation of treatment, it is necessary to re-evaluate the patient's condition and, if the result of the initial culture was positive or there is a decrease in the clinical manifestations of the disease, therapy should be continued until the full 4-6-week course has been completed.

It is advisable to combine antibiotic therapy with the appointment of a1-blockers (doxazosin, tamsulosin, terazosin), which reduce irritative symptoms and contribute to a more rapid improvement in the condition of patients.

Treatment of patients with non-inflammatory chronic pelvic pain syndrome (abacterial chronic prostatitis category IIIb, prostatodynia) is mainly symptomatic. To reduce the severity of urination disorders, it is advisable to prescribe a1-adrenergic blockers.In order to reduce pain manifestations, non-steroidal anti-inflammatory drugs (for example, diclofenac sodium in suppositories) are used.

For prostatitis categories II, IIIa and IIIb, physiotherapeutic methods of treatment are often used: prostate massage, microwave hyperthermia and thermotherapy, electrical stimulation with modulated currents with skin or rectal electrodes, etc. The effectiveness and safety of these methods of treatment are still under study.

Asymptomatic inflammatory prostatitis (category IV) does not require treatment, except in situations where the patient is scheduled for intervention on the prostate gland. In this case, the patient is given a prophylactic course of antibiotic therapy.