prostatitis treatments

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prostatitis treatments



Anyone who knows anything about advance abacterial prostatitis treatment anywhere in the word?

Any information about research on advance abacterial prostatitis treatment or the best doctor(urology) in the world will be very much appreciated.
Thank you very much for your time and help guys.

Medical Care:

nonbacterial prostatitis may be bacterial, originating from infection with a fastidious organism. Therefore, a 2-week trial of an antibiotic such as trimethoprim-sulfamethoxazole (160 mg/800 mg), levofloxacin (250 mg qd), or ciprofloxacin (500 mg) twice daily for 2 weeks may help lead to the diagnosis. If the patient improves, continue therapy with a full 4- to 6-week course of treatment.

Bladder neck dysfunction may be treated with alpha-blockers such as terazosin (2-15 mg) or doxazosin (2-8 mg) given in a dose titration. Flomax (0.4-0.8 mg), a more selective alpha-blocker with fewer adverse effects, may also be tried. Alpha-blocker therapy should be continued for a minimum of 6 months or symptoms may recur.

Saw palmetto, an herbal supplement for BPH, has been used with some success. It is hypothesized to work similar to 5-alpha-reductase inhibitors.

Finasteride, a 5-alpha-reductase inhibitor, has been shown to be effective in reducing symptoms.

Cernilton, a pollen extract product, is thought to have anti-inflammatory activity. Cernilton can be taken 3 times daily for 6 months for symptom improvement. Reports of successful treatment are anecdotal.

Quercetin, a flavonoid found in green tea, oranges, and onions has also been shown to reduce symptoms, hypothesized to be through its antioxidant and anti-inflammatory activities.

Painful symptoms may be treated with ibuprofen (600-800 mg tid).
Irritative voiding symptoms of urgency and frequency may be treated with anticholinergics such as oxybutynin (5 mg bid/tid) or tolterodine (1-2 mg bid). Dysuria may be treated short term with Pyridium for 1-2 weeks (100-200 mg tid).
Patients with significant pelvic floor tension may benefit from diazepam (5 mg tid), methocarbamol (1500 mg tid) or cyclobenzaprine (10 mg tid). Sitz baths may be helpful. Manual self-massage of the perianal area may also provide some relief from pelvic floor tension. Biofeedback has also shown to provide some relief from these symptoms, although reports are anecdotal.
In an effort to include all possible therapies, note that some evidence suggests that symptoms may improve with the use of allopurinol; however, further studies are needed.
Consider interstitial cystitis, which can be treated with a combination of anticholinergics and behavioral therapy, if a patient is refractory to other therapies. In addition, hydrodistension, dimethyl sulfoxide (DMSO) cocktail instillation (DMSO at 50 mL, heparin at 5000 U, Solu-Medrol at 40 mg, gentamicin at 80 mg) or initiation of Elmiron oral therapy may be required. Refer to Interstitial Cystitis for more information.
For a treatment algorithm, see Image 3 and Special Concerns.
Surgical Care:

If no other diagnosis is felt to be the cause of the patient’s symptoms, perform videourodynamics, voiding cystourethrogram, and/or a cystoscopic evaluation to help determine if bladder neck dysfunction or urethral stricture is the cause.
A stricture should be treated with either an open surgical repair or via direct visual internal urethrotomy.
If no other cause for symptoms can be found, some patients have had improvement of prostatitis symptoms after transurethral microwave thermotherapy (TUMT). TUMT has been successful in 70% of patients in one study. Some possible reasons for its success are that it may speed up the body’s response to inflammation in the gland and promote fibrosis or it may damage the afferent nerve fibers that transmit pain. In addition, patients with tension floor myalgia have been shown to improve after rectal heat therapy. Therefore, the application of heat therapies to the prostate may transmit sufficient energy to also help treat pelvic floor tension.
Other ablative procedures that destroy or remove prostate tissue can accomplish the same results for prostatic sources of pain, but these have not been studied in controlled trials. These include interstitial laser, radiofrequency ablation, and transurethral resection of the prostate.
Treat carcinoma of the bladder using standard measures after tissue diagnosis has been made.
In addition to the other previously mentioned therapies, patients with suspected tension floor myalgia may benefit from biofeedback therapy to help relax the pelvic floor muscles.
Consultations:

Patients who appear to be under significant job or family stress may benefit from consultation with a mental health provider.
A PM&R specialist can help with the diagnosis of pelvic floor tension myalgia and potential therapies.
Diet:

Some foods thought to be irritants to the urinary tract include alcohol, cranberry juice/cranberries, lemon juice, carbonated drinks (especially colas), spicy foods (eg, hot chilies), coffee, acidic foods, and chocolate.
Patients should be made aware of these potential irritants and told to limit them one at a time to see if their symptoms improve.
The reported success of this is anecdotal, and it will not work for everyone. After being instructed to take note of their reactions to certain foods, some patients can identify the foods that cause more irritation to their urinary system.
Activity:

Avoiding specific activities will not improve symptoms. This author tells patients that relatively frequent ejaculation (ie, every 3 d) may help improve their symptoms. The rationale for this is that it allows for the natural drainage of secretions from the prostate. Some physicians have advocated frequent prostatic massage to promote prostatic drainage and improve symptoms. Frequent ejaculation allows the same drainage without repeated invasive and uncomfortable prostatic massages.
Perianal self-massage may also offer some relief in conjunction with frequent ejaculation because this may relieve tension in the pelvic floor. The reported success is also anecdotal, but it is worth mentioning to patients with persistent symptoms.

Filed under: Prostate

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