Principles of treatment
Prostatitis should be treated in a comprehensive manner.
Type I: The main treatment is broad-spectrum antibiotics, symptomatic treatment and supportive treatment. Those with urinary retention can be treated with fine tube catheterization or suprapubic cystocentesis to drain urine, and those with prostate abscess can be treated with surgical drainage.
Type II: Treatment is based on oral antibiotics, choosing sensitive drugs for a course of 4 to 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. Phytochemicals, NSAIDs and M-blockers are also available to improve urinary symptoms and pain.
Type IIIB: Treatment with alpha-blockers, botanical agents, NSAIDs and M-blockers is recommended.
Type IV: No treatment is generally required.
Treatment
Type I
Antibiotic treatment of 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. It is recommended to start with antibiotics via intravenous application, 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 prostatic abscess, or transperineal aspiration.
Types II and III
The goal of treatment for chronic prostatitis is mainly to relieve pain, improve urinary symptoms and improve quality of life, and the evaluation of efficacy should be based on symptom improvement.
1, general treatment Health education, psychological and behavioral counseling have a positive effect. Patients should abstain from alcohol, avoid spicy and stimulating food; avoid holding urine, sedentary, pay attention to warmth, and strengthen physical exercise.
2.Medication The most commonly used drugs are antibiotics, alpha-blockers, plant preparations 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. After the diagnosis of prostatitis is confirmed, the course of antibiotic therapy is 4 to 6 weeks, during which the patient should be evaluated for stage efficacy. 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 when there is a definite reduction in clinical symptoms. The recommended total course of treatment is 4 to 6 weeks.
Type IIIB: antibiotic treatment is not recommended.
(2) Alpha-blockers: Alpha-blockers can relax smooth muscle in the prostate and bladder and improve lower urinary tract symptoms and pain, making them the basic treatment for type II/III prostatitis.
Different alpha-blockers can be chosen depending on the patient’s condition. The main recommended alpha-blockers are: doxazosin, naftopidil, 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.
(3) Botanical preparations: The therapeutic role of botanical preparations in type II and type III prostatitis is gaining attention as the recommended therapeutic drugs. Botanical 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, and promoting bladder contraction and urethral smooth muscle relaxation. The recommended botanical preparations are: Pulsatilla, 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 reactions are small.
(4) Non-steroidal anti-inflammatory analgesics: Non-steroidal anti-inflammatory analgesics are empirical drugs used to treat symptoms associated with type III prostatitis. Their main purpose is to relieve pain and discomfort.
(5) M-blockers: M-blockers (such as tolterodine) can be used to treat patients with prostatitis who exhibit symptoms such as urinary urgency, frequency and nocturia but no urinary tract obstruction.
(6) Antidepressants and anxiolytics: For patients with chronic prostatitis who have a combination of depression, anxiety and other mood disorders, you can choose to use antidepressants and anxiolytics to treat the prostatitis at the same time. These drugs can improve the patient’s mood disorder symptoms as well as relieve physical symptoms such as abnormal urination and pain. It is important to be aware of the prescription regulations and adverse drug reactions to these drugs when applying them. The main antidepressants and anxiolytics available are selective 5-hydroxytryptamine reuptake inhibitors, tricyclic antidepressants and other drugs.
(7) Traditional Chinese medicine: It is recommended that the treatment of prostatitis with traditional Chinese medicine be carried out in accordance with the relevant norms of the Society of Traditional Chinese Medicine or the Society of Integrative Chinese and Western Medicine
3.Other treatments
1. prostate massage Prostate massage is one of the traditional treatment methods, research shows that appropriate prostate massage can promote the emptying of the prostate ducts and increase the local concentration of drugs, and thus relieve the symptoms of patients with chronic prostatitis, so it is recommended as an adjuvant therapy for type III prostatitis. It is prohibited for patients with type I prostatitis.
The actual heat therapy mainly makes use of the heat effect produced by a variety of physical means to increase the blood circulation of the prostate tissue and accelerate metabolism, which helps to reduce inflammation and eliminate tissue edema and relieve pelvic floor muscle spasm. It has a short-term effect on relieving symptoms, but the long-term effect is unclear. It is not recommended for unmarried and infertile people.
4. prostate injection therapy / transurethral prostate irrigation therapy The efficacy and safety of the treatment have been confirmed.