Patient's question:
Doctor, hello, I have acute prostatitis. I've heard of chronic prostatitis, but have never 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 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 therapy, physical therapy, α-receptor antagonists, repeated prostatic massage, muscle relaxants, and herbal Chinese medicine.1. Traditional Treatment Methods: Due to the tough fibrous capsule covering the prostate, especially where blockages or calcifications have formed, blood circulation is poor. General 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 Therapy: Systemic antibiotic therapy has a certain effect on early-stage chronic prostatitis patients without blockages. However, for patients with blocked or calcified prostates, as the drugs cannot enter the prostate, the treatment is ineffective. Additionally, long-term use can lead to drug resistance, damage to the liver, kidneys, gastrointestinal function, and disrupt the microbiome, increasing the risk of endogenous infections.
3. Old Prostatic Intralesional Injection Method: The old prostatic intralesional injection method has some effect on stubborn chronic prostatitis patients. However, it requires high technical skill, is cumbersome to perform, causes significant discomfort to patients, and may damage the prostate. It also does not affect inflammation in the seminal vesicles, vas deferens, or epididymis.
4. Urethral Catheter Medication Technique: The urethral catheter medication technique has a certain effect on patients without blockages. If the prostatic ducts and excretory orifices opening into the posterior urethra are blocked, the medication cannot reach the glandular tissue. It also does not affect inflammation in the seminal vesicles, vas deferens, or epididymis.
5. Repeated Prostatic Massage: Repeated prostatic massage is highly beneficial in preventing duct blockages but has little effect on patients with significant purulent thrombus blockages or calcifications. Since it cannot eliminate pathogens, it is only suitable for adjuvant therapy.
Antibiotic therapy is a common method for treating chronic prostatitis. Antibiotic drugs diffuse from the plasma into the prostatic fluid, and most are effective against Gram-positive bacteria causing urinary tract infections. However, as they cannot penetrate the lipid membrane of the prostate epithelium to reach the glandular alveoli for therapeutic effect, the outcomes are often unsatisfactory. Therefore, when selecting antibiotics for chronic 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 irritating foods. Hot Sitz 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) Select a broad-spectrum intravenous antibiotic that can rapidly diffuse into the prostate and control symptoms to prevent chronic progression. Switch to a sensitive antibiotic after obtaining bacterial culture results.
Three essential conditions for chronic prostatitis medications:
Enhance immunity and nourish the human sex glands.
Contain potent anti-inflammatory ingredients targeting the sex gland area.
Improve blood circulation to facilitate drug entry into the prostate, enhance efficacy, and effectively alleviate symptoms.
1) If high fever occurs, symptomatic antipyretics should be administered, such as half a dose of indomethacin suppository (PRN), rectally; or one tablet of ibuprofen (PRN).
2) If bladder irritation is severe, options include: 0.2g D, oral, three times daily; or 0.2mg , oral, once daily.
3) If urinary retention or difficulty urinating occurs, 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, categorizing them as high, medium, or low levels. High levels include trimethoprim, clindamycin, and erythromycin; medium levels include chloramphenicol and lincomycin; and low levels include ampicillin, cefalexin, ceftriaxone, doxycycline, kanamycin, nitrofurantoin, oxytetracycline, penicillin G, polymyxin B, rifampicin, and most sulfonamides. Patients should consult their doctors 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 abscess drainage, followed by the injection of broad-spectrum antibiotics.