Prostatitis should be treated with a combination of
Type I: The main treatment is broad-spectrum antibiotics, symptomatic treatment and supportive therapy. Those with urinary retention should apply suprapubic cystostomy to drain urine, and those with prostate abscesses can be surgically drained. Type II: Treatment is based on antibiotics, choosing sensitive drugs, and treatment is maintained for at least 4-6 weeks, during which the patient should be evaluated for stage efficacy. If the efficacy is unsatisfactory, other sensitive antibiotics can be used instead. Alpha-blockers can be used to improve urinary symptoms and pain. Botanical preparations, NSAIDs and M-blockers can also improve the associated symptoms.
Type IIIA: Oral antibiotics can be given for 2 to 4 weeks, and then the decision to continue antibiotic therapy is based on their efficacy feedback. Alpha-blockers are recommended to improve urinary symptoms and pain, and NSAIDs, botanicals and M-blockers are also available.
Type IIIB: Treatment with alpha-blockers, NSAIDs, botanicals and M-blockers are available.
Type IV: No treatment is generally required.
The clinical progressiveness of chronic prostatitis is not clear enough to threaten the life and vital organ function of patients, and not all patients require treatment. The goal of treatment for chronic prostatitis is mainly to relieve pain, improve urinary symptoms and improve quality of life, and efficacy evaluation should be based on symptom improvement.
Treatment Type I.
Antibiotic therapy for type I prostatitis is necessary and urgent. Antibiotics should be applied as soon as a clinical diagnosis or blood or urine culture results are obtained. In the beginning, antibiotics can be applied intravenously, such as: broad-spectrum penicillin, third-generation cephalosporins, aminoglycosides or fluoroquinolones. When the patient’s fever and other symptoms improve, switch to oral medications (e.g., fluoroquinolones) for a minimum of 4 weeks. Patients with milder symptoms should also take oral antibiotics for 2 to 4 weeks.
For acute bacterial prostatitis with urinary retention, avoid transurethral catheterization for drainage and apply suprapubic cystostomy for drainage of urine. Those with abscess formation can be drained by transrectal ultrasound-guided fine needle aspiration, transurethral resection of prostatic abscesses or perineal aspiration.
Types II and III.
(i) General treatment Health education, psychological and behavioral counseling have positive effects. Patients should abstain from alcohol, avoid spicy and stimulating foods; avoid holding urine, sitting for a long time, pay attention to keeping warm and strengthen physical exercise. Hot water baths can help relieve painful symptoms.
(B) Drug treatment The three most commonly used drugs are antibiotics, alpha-blockers and non-steroidal anti-inflammatory analgesics, and other drugs also have different degrees of efficacy in relieving symptoms.
1, antibiotics Currently, the most commonly used first-line drugs in clinical practice for the treatment of prostatitis are antibiotics, but only about 5% of patients with chronic prostatitis have a definite bacterial infection.
Type II: Antibiotics are selected based on bacterial culture results and the ability of the drug to penetrate the prostate envelope. The ability of the drug to penetrate the prostate envelope depends on its degree of ionization, lipid solubility, protein binding rate, relative molecular mass and molecular structure. The commonly used antibiotics are fluoroquinolones such as ciprofloxacin, levofloxacin and lomefloxacin. After the diagnosis of prostatitis, antibiotic treatment is maintained for at least 4-6 weeks, during which the patient should be evaluated for stage efficacy. If the efficacy is not satisfactory, other sensitive antibiotics can be changed. Intraprostatic injection of antibiotics is not a recommended treatment.
Type IIIA: Antibiotic therapy is mostly empirical and is based on the theory that certain pathogens that are routinely culture-negative are presumed to cause this type of inflammation. Therefore, oral antibiotics such as fluoroquinolones are recommended for 2 to 4 weeks, followed by a decision to continue antibiotic therapy based on efficacy feedback. Continuation of antibiotics is recommended only if the patient does experience a reduction in clinical symptoms. The recommended total course of treatment is 4 ~ 6 weeks. Some patients with this type may have intracellular pathogenic infections such as Chlamydia trachomatis, Ureaplasma lysis or Mycoplasma humanum, which can be treated with oral antibiotics such as macrolides.
Type IIIB: Antibiotic treatment is not recommended.
2. alpha-blockers alpha-blockers can relax the smooth muscles of the prostate and bladder and improve lower urinary tract symptoms and pain, thus becoming the basic drug for the treatment of type II/III prostatitis.
Different alpha-blockers can be selected according to the individual patient. The main recommended alpha-blockers are: alfuzosin, doxazosin, naphazidil, tamsulosin and terazosin, etc. The results of controlled studies have shown that the above drugs have different degrees of improvement on patients’ urinary symptoms, pain and quality of life index. Adverse effects such as vertigo and postural hypotension caused by this class of drugs should be noted during treatment.
The course of alpha-blockers should be at least 12 weeks. alpha-blockers can be used in combination with antibiotics for the treatment of type IIIA prostatitis, and the combined course of treatment should be at least 6 weeks.
The NSAIDs are empirical medications used to treat the symptoms associated with type III prostatitis. Their primary purpose is to relieve pain and discomfort. To date, only a few randomized, placebo-controlled studies have evaluated the efficacy of such drugs. Controlled clinical studies have confirmed the effectiveness of celecoxib in improving pain and other symptoms in patients with type IIIA prostatitis.
4. Phytochemicals The therapeutic role of phytochemicals in type II and III prostatitis is gaining attention as an optional treatment. The plant preparations mainly refer to pollen-based preparations and plant extracts, which have a wide range of pharmacological effects, such as non-specific anti-inflammatory, anti-edema, promoting bladder contraction and urethral smooth muscle relaxation and other effects.
Commonly used botanical preparations include: Pulcitol, quercetin, sabal palm and its infusion, etc.. Due to the large number of varieties, their dosage depends on the specific condition of the patient, and the course of treatment is usually measured in months. Adverse effects are minor.
The results of a recently completed multicenter controlled study showed that the combination of Pulsatilla and levofloxacin was significantly more effective than levofloxacin monotherapy in the treatment of type III prostatitis. Another randomized, double-blind, placebo-controlled study showed that prolonged (6 months) treatment with Pulsatilla significantly reduced pain and urinary symptoms in patients with type III prostatitis compared to placebo.
5. M-blockers can be used to treat prostatitis patients with overactive bladder (OAB) manifestations such as urinary urgency, frequency and nocturia but without urinary obstruction.
6, antidepressants and anxiolytics For patients with chronic prostatitis who are combined with depression and anxiety, according to their condition, they can choose to use antidepressants and anxiolytics while treating prostatitis. These drugs can significantly improve both the symptoms of the patient’s mood disorder and also the physical discomfort and pain. Clinical application must pay attention to the prescription regulations for these drugs? and adverse drug reactions. The main antidepressants and anxiolytics available are tricyclic antidepressants, selective 5-hydroxytryptamine reuptake inhibitors and benzodiazepines.
7, Allopurinol Allopurinol is an optional drug for the treatment of type IIIA prostatitis. A small randomized controlled clinical trial confirmed the efficacy of allopurinol on type IIIA prostatitis.
According to the patient’s diagnosis and classification, choose the soup or Chinese medicine, such as Weng Li Tong, prostate security suppository, Zegui retention capsule, Longjin Tonglin capsule or acupuncture treatment, etc.
The combination of other treatments can be effective in shortening the duration of the disease. The recommended course of treatment is 4 to 6 weeks, 2 to 3 times a week. type I prostatitis patients are prohibited.
Biofeedback therapy requires the patient to actively participate in the treatment through the biofeedback instrument. It is a non-invasive and optional treatment.
3. Heat therapy mainly uses the thermal effects generated by a variety of physical means to increase blood circulation in the prostate tissue and accelerate metabolism, which is conducive to anti-inflammation and elimination of tissue edema and relief of pelvic floor muscle spasm. There are reports of heat therapy using microwave, radiofrequency, laser and other physical means via urethral, transrectal and perineal routes. Although it has a certain effect on symptom relief in the short term, long-term follow-up data are lacking. It is not recommended for unmarried and infertile patients.
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