Patient's question:
Hello doctor, I have acute prostatitis. I've heard of chronic prostatitis, but I haven't heard of acute prostatitis. What treatment methods are available now? What should I pay more attention to in daily life?Doctor's answer:
Currently, the treatment outcomes for most chronic prostatitis patients worldwide are unsatisfactory. Chronic prostatitis has a wide range of treatment methods, which is a unique phenomenon compared to other diseases. Common treatments include antibiotic therapy, physical therapy, α-adrenergic blockers, repeated prostate massage, muscle relaxants, and herbal medicines.1. Traditional Treatment Methods: Due to the tough outer capsule of the prostate, especially where blockages or calcifications have formed, blood circulation is poor. Oral or intravenous medications, including Western medicine, antibiotics, and herbal preparations, cannot penetrate the lipid membrane and barriers, leaving the root cause unaddressed. The pathogens within the root cause can repeatedly flare up, leading to chronic, untreatable conditions.
2. Systemic Antibiotic Therapy: Systemic antibiotic therapy can be effective for early-stage prostatitis without blockages. However, for patients with blocked or calcified prostatitis, the drugs cannot reach the prostate, rendering the treatment ineffective. Moreover, long-term use can lead to drug resistance, liver, kidney, and gastrointestinal damage, as well as dysbiosis, increasing the risk of endogenous infections.
3. Old Prostatic Intralesional Injection Method: This method may help some stubborn prostatitis patients, but it requires high technical skill, is cumbersome to perform, causes significant discomfort to the patient, and risks damaging the prostate. It also does not address inflammation in the seminal vesicles, vas deferens, or epididymis.
4. Urethral Catheter Medication Technique: This technique can be effective for patients without blockages. If the prostatic ducts and their openings into the posterior urethra are blocked, the medication cannot reach the glands, and it does not address inflammation in the seminal vesicles, vas deferens, or epididymis.
5. Repeated Prostate Massage: This helps prevent duct blockages but has limited effect on patients with significant purulent plugs or calcifications. Since it cannot eliminate pathogens, it is only used as an adjunctive treatment.
Antibiotic therapy is a common treatment for prostatitis. Antibiotic drugs diffuse from the plasma into prostatic fluid, and most are effective against Gram-positive bacteria that cause urinary tract infections. However, because they cannot penetrate the lipid membrane of the prostate epithelium to reach the alveoli for therapeutic effect, the outcomes are often unsatisfactory. Therefore, when selecting antibiotics for prostatitis treatment, the following principles should be followed:
(1) The drug should have high sensitivity to bacteria.
(2) The chosen drug should have high lipophilicity, high permeability, low binding to plasma proteins, and high dissociation.
(3) Combine two or more drugs with synergistic effects.
(4) Use high doses and extended durations (4–12 weeks) to achieve effective concentrations in the prostate stroma and prevent urethral infections.
Note: Rest in bed for 3–4 days, drink plenty of water, avoid alcohol and spicy foods. Warm sitz baths or perineal heat applications can be helpful, and bowel movements should be kept regular. Abstinence from sexual activity is recommended.
1) If the patient has obvious systemic symptoms, high fever, and significantly elevated white blood cell counts, intravenous administration should be used for the first week, followed by oral medication for up to a month.
2) Select a broad-spectrum intravenous antibiotic that can rapidly diffuse into the prostate to quickly control symptoms and prevent chronic prostatitis. Switch to a sensitive antibiotic once bacterial culture results are available.
Three essential conditions for prostatitis medications:
Improve immunity and enhance/tonify the body's gonadal function.
Contain potent antibacterial and anti-inflammatory ingredients targeting the gonadal region.
Strengthen blood circulation to help medication reach the prostate, promote efficacy, and effectively alleviate symptoms.
1) If high fever occurs, symptomatic antipyretics should be given, such as half a dose of indomethacin suppository (PRN), rectally; or one tablet of ibuprofen (PRN).
2) If bladder irritation is severe, options include: Droxylate 0.2g, oral, three times daily; Harle 0.2mg, oral, once daily.
3) If urination difficulties or retention occur, temporary suprapubic bladder puncture drainage or soft silicone catheter insertion may be necessary.
Recently, some scholars have classified antibiotics based on their ability to diffuse into the prostate. High levels include trimethoprim, clindamycin, and erythromycin; medium levels include chloramphenicol and lincomycin; and low levels include ampicillin,I,IV, doxycycline, kanamycin, nitrofurantoin, oxytetracycline, penicillin G, polymyxin B, rifampin, and most sulfonamides. Patients should consult their doctor to select drug types, dosages, and administration methods.
Surgical Treatment: If acute prostatitis has developed into a prostatic abscess, drainage surgery via the rectum or perineum should be performed. If the abscess is confined to the prostate, a urethral scope can be used for prostatic puncture and pus drainage, followed by the injection of broad-spectrum antibiotics.