Patient's question:
Doctor, hello, I would like to consult about whether there are any good hospitals for treating acute prostatitis. I have taken a lot of medicine, but it hasn't been very effective. I would like to ask what the main treatment methods are now.Doctor's answer:
Currently, the majority of chronic prostatitis patients worldwide are dissatisfied with treatment outcomes. Chronic prostatitis has many treatment methods, which is a unique phenomenon compared to other diseases. Common methods include antibiotic treatment, physical therapy, α-receptor blockers, repeated prostatic massage, muscle relaxants, and herbal Chinese medicine.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 Chinese medicine preparations, cannot penetrate the lipid membrane and barriers. The root cause cannot be eliminated, and pathogens within the root cause repeatedly flare up, leading to chronic, untreatable conditions.
2. Systemic Antibiotic Treatment: Systemic antibiotic treatment has a certain effect on early-stage prostatitis without blockages. However, for patients with blocked or calcified prostatitis, the drugs cannot enter the prostate and are ineffective. Moreover, long-term use can lead to drug resistance, damage to the liver, kidneys, gastrointestinal function, and dysbiosis, increasing the risk of endogenous infections.
3. Old Prostatic Intraurethral Injection Method: This method has some effect on stubborn prostatitis patients but requires high technical skill, is cumbersome to operate, causes significant discomfort to patients, and may damage the prostate. It also does not target inflammation in the seminal vesicles, vas deferens, or epididymis.
4. Urethral Catheter Medication Technique: This technique has a certain effect on prostatitis without blockages. If the prostatic ducts and excretory openings into the posterior urethra are blocked, the medication cannot reach the glandular tissue and does not target inflammation in the seminal vesicles, vas deferens, or epididymis.
5. Repeated Prostatic Massage: Repeated massage helps prevent duct blockages but has limited effect on patients with obvious purulent plugs or calcifications. Since it cannot eliminate pathogens, it is only used as adjuvant therapy.
Antibiotic treatment is a common method for treating prostatitis. Antibiotic drugs diffuse from the plasma into prostatic fluid, and most are effective against Gram-positive bacteria causing urinary tract infections. However, due to their inability to 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) Combination therapy using two or more drugs with synergistic effects.
(4) To achieve effective concentrations in the prostate stroma and prevent urethral infections, high-dose and prolonged (4–12 weeks) medication should be recommended.
Note: Rest in bed for 3–4 days, drink plenty of water, avoid alcohol and irritating foods. Hot baths or perineal heat applications can be performed, 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) A broad-spectrum, rapidly effective intravenous antibiotic capable of diffusing into the prostate should be chosen to quickly control symptoms and prevent chronic prostatitis. After obtaining bacterial culture results, a sensitive antibiotic should be selected.
Three essential conditions for prostatitis medications:
Improve human immunity and enhance/tonify the function of the gonads.
Contain potent anti-inflammatory ingredients targeting the gonadal region.
Strengthen blood circulation in the body, facilitating drug entry into the prostate, promoting efficacy, and effectively alleviating prostatitis symptoms.
1) If high fever occurs, symptomatic antipyretics should be given, such as half a dose of indomethacin suppository (rectal), PRN; 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 urinary difficulties or retention occur, temporary suprapubic bladder puncture drainage or soft silicone catheter insertion may be performed.
Recently, some scholars have classified antibiotics based on their ability to diffuse into the prostate, categorizing them as high, medium, or low levels. High-level examples include trimethoprim, clindamycin, and erythromycin; medium-level examples include chloramphenicol and lincomycin; low-level examples include ampicillin,I,IV, doxycycline, kanamycin, nitrofurantoin, oxytetracycline, penicillinG, polymyxinB, rifampin, and most sulfonamides. Patients should consult their doctors to select drug types, dosages, and 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 localized within the prostate, a urethral scope can be used for prostatic puncture and pus drainage, followed by the injection of broad-spectrum antibiotics.