Treatment of prostatitis

  Prostatitis is one of the common diseases in adult men. Although it is not a direct life-threatening disease, it seriously affects the quality of life of patients and is more common in urology and male outpatient clinics. According to the classification developed by the National Institutes of Health in 1995, prostatitis is divided into four types, each with different treatment options.  Type I generally refers to acute bacterial prostatitis, where pathogenic infection is the primary causative factor. Antibiotic treatment is necessary and urgent. Antibiotics should be applied as soon as a clinical diagnosis or blood or urine culture results are obtained. It is recommended to apply antibiotics via intravenous at the beginning, and after the patient’s fever and other symptoms improve, oral medication is recommended for a minimum of 4 weeks. Acute bacterial prostatitis with urinary retention can be treated with suprapubic cystostomy for drainage of urine or fine catheterization, but the catheter should not be left in place for more than 12 hours. Those with abscess formation can be drained by transrectal ultrasound-guided fine needle aspiration, transurethral resection of the prostate abscess, or transperineal aspiration.  Types II and III, equivalent to chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome. The goals of treatment for chronic prostatitis are primarily to relieve pain, improve urinary symptoms and improve quality of life, and efficacy evaluation should be based on symptom improvement. General treatment health education, psychological and behavioral counseling has a positive effect. Patients should abstain from alcohol, avoid spicy and stimulating foods; avoid holding urine, sedentary, pay attention to warmth, and strengthen physical exercise. Medication is the most commonly used drugs are antibiotics, alpha-blockers, phytochemicals and non-steroidal anti-inflammatory analgesics, other drugs also have varying degrees of efficacy in relieving symptoms. Currently, in clinical practice for the treatment of prostatitis, the most commonly used first-line drugs are antibiotics, but only about 5% of patients with chronic prostatitis have a definite bacterial infection.  Type IV refers to asymptomatic prostatitis that generally does not require treatment. If the patient has a combination of elevated serum PSA or infertility, the differential diagnosis should be noted and treated accordingly.  So, prostatitis patients should choose the right treatment according to their type.