Patient's question:
Detailed medical condition and consultation purpose: Diagnosed with prostatitis, but injections and medications have not shown improvement. What should I do?Duration and persistence of the current illness: One year
Medical history: Had two cases of urethritis, possibly not fully cured.
Doctor's answer:
Hello:1. General Treatment: Boost confidence, eliminate mental concerns, and moderate sexual desires, but avoid forced abstinence. Avoid alcohol and stimulating foods. Take warm sitz baths once daily, undergo local physical therapy, and modify obvious lifestyle triggers, such as avoiding prolonged cycling.
2. Prostate Massage: Regular prostate massage can promote the discharge of prostatic inflammatory secretions. Perform once weekly, and simultaneously conduct routine prostatic fluid tests to evaluate treatment effectiveness.
3. Drug Infusion: Insert a specially designed balloon catheter through the urethra, inject sterile physiological saline into the prostatic urethra, and aspirate several times to remove purulent secretions. Then, inject antibiotics. Perform once weekly.
4. Urethral Dilation: For patients with urethral stricture or obstruction, regular dilation facilitates excretion. Additionally, as the probe passes through the urethra, it can stretch the prostate opening, promoting better glandular drainage.
5. Prostatic Perineural Block: Gentamicin 80,000 units plus 1% novocaine 1–2 mL, administered once daily, with 7–10 sessions constituting one course. Alternatively, penicillin 800,000 units, streptomycin 0.5 g, plus 1% novocaine 2–4 mL, administered 1–2 times weekly.
6. Antibacterial Drugs: General antibacterial drugs are difficult to penetrate prostate tissue, which is one reason for the challenges in clinical treatment. An ideal antibacterial drug should meet three criteria: ① Lipophilic alkaline drugs; ② Low binding to plasma proteins; ③ High dissociation. Currently, commonly used drugs include:
- Co-trimoxazole 1.0 g, twice daily
- Doxycycline 0.1 g, twice daily
- TMP 0.1 g, twice daily
- Norfloxacin 0.2 g, three times daily
- Urological tablets 0.2 g, three times daily
- Ciprofloxacin 0.5 g, twice daily
- Erythromycin 0.25 g, four times daily
- Nitrofurantoin 0.1 g, four times daily
- Rifampicin 300 mg + TMP 80 mg, prepared as tablets, taken at bedtime (2 tablets for 15 days, then reduced to 1 tablet for 90 days). It is reported that this regimen has a high cure rate but may cause some damage to hearing and kidney function.
These drugs can be used in combination (2–3 types) or selected based on bacterial culture results of prostatic fluid and drug sensitivity tests.