The treatment goal of chronic prostatitis is mainly to relieve pain, improve urination symptoms and improve quality of life, and the evaluation of curative effect should focus on symptom improvement.
1. Comprehensive therapy plays an active role in health education, psychological and behavioral counseling. Patients should abstain from alcohol and avoid spicy food; Avoid holding your urine for a long time, keep warm and strengthen physical exercise.
2. The most commonly used drugs in drug therapy are antibiotics, α-blockers, plant preparations and non-steroidal anti-inflammatory and analgesic drugs, and other drugs have different degrees of efficacy in relieving symptoms.
(1) Antibiotics: At present, antibiotics are the most commonly used first-line drugs in the treatment of prostatitis, but only about 5% of patients with chronic prostatitis have definite bacterial infection.
Chronic bacterial prostatitis: Choose antibiotics according to the results of bacterial culture and the ability of drugs to penetrate the prostate. After the diagnosis of prostatitis, the course of antibiotic treatment is 4 ~ 6 weeks, during which the patients should be evaluated by stages. Injecting antibiotics into the prostate is not recommended.
Chronic nonbacterial prostatitis: Antibiotic treatment is mostly empirical treatment, and the theoretical basis is that some pathogens with negative conventional culture have caused this type of inflammation. Therefore, it is recommended to take fluoroquinolones and other antibiotics orally for 2 ~ 4 weeks, and then decide whether to continue antibiotic treatment according to the feedback of curative effect. Only when the clinical symptoms are truly relieved, it is recommended to continue to use antibiotics. It is suggested that the total course of treatment is 4 ~ 6 weeks.
(2)α-blockers: α-blockers can relax the smooth muscle of prostate and bladder and improve the symptoms and pain of lower urinary tract, so they become the basic drugs for the treatment of type II/III prostatitis.
Different α -blockers can be selected according to the patient's condition. The recommended alpha blockers are doxazosin, naftopidil, tamsulosin and terazosin. The results of comparative study show that these drugs can improve the micturition symptoms, pain and quality of life index of patients to varying degrees.
(3) Plant preparation: The therapeutic effect of plant preparation on type II and type III prostatitis has been paid more and more attention, and it is a recommended therapeutic drug. Plant preparations mainly refer to pollen preparations and plant extracts, which have a wide range of pharmacological effects, such as nonspecific anti-inflammatory, anti-edema, promoting detrusor contraction and urethral smooth muscle relaxation. Recommended plant preparations are: Pervaside, Sabah palm and their extracts. Because there are many varieties, its usage and dosage depend on the specific situation of patients, and usually the course of treatment is in months. The adverse reaction is small.
(4) Non-steroidal anti-inflammatory and analgesic drugs: Non-steroidal anti-inflammatory and analgesic drugs are empirical drugs for treating symptoms related to type III prostatitis. Its main purpose is to relieve pain and discomfort.
(5)M receptor blockers: For prostatitis patients without urinary tract obstruction, such as urgency, frequent micturition and nocturia, M receptor blockers (such as tolterodine) can be used for treatment.
(6) Antidepressants and antianxiety drugs: For patients with chronic prostatitis complicated with depression, anxiety and other emotional disorders, antidepressants and antianxiety drugs can be selected to treat prostatitis. These drugs can not only improve patients' emotional disorders, but also relieve physical symptoms such as abnormal urination and pain. Attention must be paid to the prescription of these drugs and the adverse drug reactions during use. Selective serotonin reuptake inhibitors and tricyclic antidepressants are the main antidepressants that can be selected.
(7) Traditional Chinese Medicine: It is suggested to treat prostatitis with traditional Chinese medicine according to the relevant norms of the Chinese Society of Traditional Chinese Medicine or the Society of Integrated Traditional Chinese and Western Medicine.
3. Other treatments
1. Prostate massage is one of the traditional treatment methods. Studies have shown that proper prostate massage can promote the emptying of prostate and increase the local drug concentration, thus alleviating the symptoms of patients with chronic prostatitis, so it is recommended as an auxiliary treatment for type ⅲ prostatitis. Patients with type I prostatitis are prohibited.
2. Biofeedback therapy research shows that patients with chronic prostatitis have pelvic floor muscle coordination disorder or external urethral sphincter tension. Biofeedback combined with electrical stimulation can relax pelvic floor muscles, make them tend to be coordinated and relax external sphincter, thus alleviating perineal discomfort and urination symptoms of chronic prostatitis.
3. Hyperthermia mainly uses the thermal effect produced by various physical means to increase the blood circulation of prostate tissue, accelerate metabolism, help diminish inflammation, eliminate tissue edema and relieve pelvic floor muscle spasm. Symptoms can be relieved in the short term, but the long-term effect is not clear. It is not recommended for unmarried childless people.
4. The efficacy and safety of prostate injection/transurethral prostate perfusion have been confirmed.