Patient's question:
Detailed medical condition and consultation purpose: Diagnosed with prostatitis, but injections and medication have not shown improvement. What should I do?Duration of 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 worries, moderate sexual desire, but avoid forced abstinence. Avoid alcohol and stimulating foods. Hot Sitz baths once daily, local 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 concurrently conduct routine prostatic fluid tests to evaluate treatment effectiveness.
3. Drug irrigation: 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 urethral stricture or obstruction, regular dilation facilitates excretion. Additionally, as the probe passes through the urethra, it can stretch the prostatic orifice, promoting glandular drainage.
5. Prostatic perineural block: Gentamicin 80,000 units plus 1% procaine 1–2 mL daily, for 7–10 sessions per course. Alternatively, penicillin 800,000 units, streptomycin 0.5 g, plus 1% procaine 2–4 mL, once or twice weekly.
6. Antibacterial drugs: General antibacterial drugs are difficult to penetrate prostate tissue, which is one reason for the clinical challenges in 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
- Ofloxacin 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 tablets, taken at bedtime (2 tablets for 15 days, then reduced to 1 tablet for 90 days). It is reported to have a high cure rate but may cause some damage to hearing and kidney function.
The above drugs can be used in combination (2–3 types) or selected based on bacterial culture and drug sensitivity tests of prostatic fluid.