ProstatitisIt is a urological disease accompanied by inflammation of the tissues of the prostate gland. Damage to the prostate can be caused by an infection transmitted through blood, lymph, or unprotected contact. The development of prostatitis in men is facilitated by injuries and disruption of blood supply to the pelvic organs, constant hypothermia, low physical activity, hormonal imbalance and other factors. Prostatitis may be accompanied by vesiculitis, urethritis and other infectious and inflammatory diseases of the reproductive and urinary organs.
Disease statistics
Prostatitis is one of the most common diseases of the male genitourinary system in the world. According to various sources, sex is observed in 60-80% of adult men. According to official medical statistics, more than 30% of young people of reproductive age suffer from chronic prostatitis. It occurs in about a third of the time, in men over 20 and under 40. According to the WHO, urologists diagnose chronic prostatitis in every tenth patient.
Causes of prostatitis
Infections.Pathogens and opportunistic bacteria enter the prostate through the lymph and blood vessels. Secondary prostate infection is often a complication of inflammatory diseases of the rectum and urethra.
Types of infection:
- increasing- microbes rise from the cavity of the external urethra;
- down- Germs enter the prostate along with the flow of infected urine.
Conditionally pathogenic microorganisms that cause the disease (according to the Research Institute of Urology 1997-1999)
| Microorganisms | Number of studies | |
|---|---|---|
| % | USA | |
| Staphylococcus epidermidis | 42. 3 | 55 |
| S. saprophyticus | 17. 6 | 23 |
| S. aureus | 4. 6 | 6 |
| S. hemoliticus | 3. 1 | four |
| S. hominis | 0. 8 | a |
| S. Warneri | 1. 5 | 2 |
| Staphylococcus spp. | 3. 1 | four |
| Enterococcus faecalis | 11. 6 | fifteen |
| Streptococcus spp. | 3. 1 | four |
| Total (gr. +) | 87. 6 | 114 |
| P. aeruginosa | 3. 7 | five |
| E. coli | 4. 7 | 6 |
| Enterobacter spp. | 2, 3 | 3 |
| Proteus spp. | 1. 5 | 2 |
| Total (gr. -) | 12. 3 | sixteen |
Weakening of immunity.One of the causes of prostatitis is the weakening of the body's immune system. This can often be helped by stress, an unbalanced diet, overwork, smoking, and alcohol. With reduced immunity, the body is most susceptible to infections that cause the development of prostate disease.
Blood supply diseases.The development of chronic prostatitis can be the result of a sedentary, sedentary lifestyle. Lack of regular physical activity impairs the functioning of the endocrine, cardiovascular and nervous systems, as well as blood circulation in the pelvic organs. The result is oxygen starvation of the prostate tissue.
Irregular sexual activity. Both prolonged sexual abstinence and excessive sexual activity can lead to prostatitis. Many sexually active men have nervous exhaustion, hormonal imbalances, impaired secretion in the sex glands, and a gradual decrease in strength. Loss of family ties has a negative impact on the health of the prostate gland.
Chronic prostate injury. . . Chronic prostatitis can develop as a result of frequent trauma to the soft tissues of the prostate gland. This is often observed in patients whose professional activities are related to driving. In this case, the cause of prostatitis is constant shaking, tremors and excessive stress on the perineum muscles.
The main syndromes of prostatitis
Pain.In men, prostatitis is aching and cutting pains in the lower abdomen and lower back, pain throughout the body. This symptom may worsen with ejaculation, especially during sexual intercourse after prolonged abstinence.
Dysuria.Typical symptoms of prostatitis in men are frequent urination, burning and stinging when emptying the bladder, and pain in the perineum after urination. Another symptom of prostatitis is difficulty urinating. Acute urinary retention can occur if the disease is not treated.
Sexual disorders.Accelerated ejaculation with uncomplicated prostatitis, erosion of organic sensations, pain during ejaculation, partial or complete decrease in libido. Prolonged erection at night is also a sign of chronic prostatitis.
External manifestations.In some patients with prostatitis, the most common morning discharge is purulent or clear discharge from the urethra. Patients may also experience symptoms such as the presence of white fibers or filaments in the urine.
Types of prostatitis
Acute bacterial.Acute prostatitis develops as a result of infection of the prostate gland with Staphylococcus aureus, Escherichia coli, enterococci and other pathogenic bacteria. If left untreated, the disease can cause blood poisoning. In this case, the man needs to be hospitalized urgently.
Symptoms of this type of prostatitis:
- chills and fever (38 ° C and above);
- acute or traction pain in the groin, back and perineum;
- desire to urinate frequently;
- painful urination;
- difficulty urinating and acute urinary retention;
- white or colorless discharge from the urethra.
Chronic bacterial.The recurrent form of the disease occurs as a result of the infection penetrating the gland. Chronic hypothermia, prolonged sexual abstinence and premature urination contribute to the development of prostatitis. Chronic prostatitis can cause cystitis if left untreated, because inflammation in the prostate is a storehouse of bacteria that affects the genitourinary system.
Symptoms of chronic prostatitis:
- pain in the scrotum, lower abdomen, perineum;
- dysuria;
- power violations.
Not chronic bacterial.Causes of the disease include the entry of viruses or bacteria into the prostate (tuberculosis bacilli, Trichomonas, chlamydia), autoimmune processes, penetration into the urinary tract. Chronic prostatitis accounts for up to 95% of all prostatitis.
The symptoms of prostatitis are:
- chronic pain in the pelvic region (disturbs the man for at least 3 months);
- recurrent groin pain;
- absence of signs of inflammation in urine, semen and prostate secretions.
Chronic asymptomatic. Asymptomatic chronic prostatitis is not associated with bacterial infection and symptomatic prostate syndrome. It is hypothesized that this disease is an age-related physiological feature.
Symptoms of this type of chronic prostatitis:
- absence of the main syndromes of the disease;
- increased content of leukocytes and bacteria in the urine.
The main symptom of the disease - the presence of an infection in the gland - can be detected only by biopsy or during surgery in the treatment of various pathologies of the prostate (adenoma, cancer).
Stagnant.Prostatitis does not develop only against the background of anatomical and physiological changes in the venous and other body systems. The main cause of the disease is irregular sex life.
Symptoms of prostatitis:
- aching pain in the perineum, spreading to the sacrum;
- increased urination in the morning;
- a small difficulty in urine flow (symptom is observed in the chronic form of the disease);
- weakening of the erection;
- decreased libido;
- "Paleness" of orgasmic sensations during ejaculation.
Diagnosis of acute and chronic prostatitis
To choose the right method of treatment, the doctor prescribes a comprehensive diagnosis of the condition of the genitourinary system, including the following methods.
Digital rectal examination.If you suspect a prostatitis, the urologist will perform a digital examination. The posterior surface of the prostate is adjacent to the rectum, so when a finger enters the anus, the doctor can determine the condition of the gland. During the examination, its size, consistency and shape, surface condition, pain are determined.
Symptoms of prostatitis in men include:
- soft, inelastic consistency of the prostate;
- pain on palpation;
- enlarged gland;
- inactivity of the rectal mucosa over the prostate.
Ultrasound procedure.Ultrasound examination of the prostate is prescribed to identify / exclude glandular abscess before starting treatment of acute prostatitis and to determine the degree of prostate cysts and stones, as well as in the chronic course of the disease. compression of the urethra. The most effective method is rectal ultrasound.
Uroflowmetry.This method of diagnosing prostatitis is used to study the indicators of the process of urinary excretion: the duration of this physiological movement and the speed of urine flow. If the velocity is 15 ml / s or more, this indicates normal urethral permeability. A sign of prostatitis is a drop in this value below 10 ml / s. This speed is the result of poor urinary passage.
Interpretation of uroflowmetry results
| Urine flow rate | Interpretation |
|---|---|
| >15ml / sec | Urinary tract obstruction is unlikely |
| <10ml / sec | Significant narrowing of the urethra or detrusor weakness is likely |
| 10-15ml / sec | Indefinite result |
Cystoscopy.An endoscopic imaging system is placed in the bladder for examination. For the diagnosis of acute and chronic prostatitis, this method is used when diseases such as cancer, cystitis or bladder trauma are suspected.
Laboratory research.Urine and prostate secretions are examined when there are signs of chronic prostatitis or acute inflammation to diagnose and diagnose the disease-causing microorganism. An indication of the presence of pathogenic microflora is an increase in the number of leukocytes in the biological material. To develop an effective course of treatment, the type of bacteria is determined by inoculation into PCR, RIF and nutrient medium.
Interpretation of laboratory results
| Prostate secretion | Third urine sample (after prostate massage) | |||
|---|---|---|---|---|
| HP uniform | Leukocyte count, uv. x 400 | Sowing results | Leukocyte count, uv. x 400 | Sowing results |
| Bacterial | >10 | + | The difference between the number of leukocytes in the third part of the urine and the second part of the urine is ≥10 | + |
| Chronic pelvic pain inflammatory syndrome | >10 | - | The difference between the number of leukocytes in the third part of the urine and the second part of the urine is ≥10 | - |
| Non-inflammatory chronic pelvic pain syndrome | <10 | - | - | - |
Prevention of prostatitis
Physical activity.To prevent and treat prostate disease, a man should avoid physical inactivity. Recommendation:
- walking (4 km or more per day);
- sports (squats, jumps, bends);
- training of the perineum and hip muscles (10 tension and relaxation).
Proper nutrition.To prevent acute and chronic prostatitis, men should include foods high in zinc and vitamin B in their diet: Eating is recommended:
- seafood (oysters, seaweed);
- meat;
- pumpkin seeds;
- walnut;
- bran;
- kefir;
- Rye bread.
Regular sex life. When preventing and treating a disease, a person needs:
- lead a rhythmic sex life;
- avoid interrupted sex;
- Avoid casual relationships.
Treatment of acute and chronic prostatitis
Prostatitis is treated in the following ways.
Antibacterial therapy.If the prostatitis is bacterial, antibiotics are needed to treat it. The doctor selects a group of drugs according to the type of microbes that cause the disease, the sensitivity of the pathogen to various drugs and the presence of contraindications in the patient.
Properties of drugs
| Medication | Benefits | disadvantages |
|---|---|---|
| Fluoroquinolones |
|
|
| Macrolides |
|
It is not active enough against gram-negative bacteria |
| Tetracyclines | Active against atypical pathogens |
|
Hormone therapy.Hormone therapy is needed to restore the normal hormonal balance between androgens and estrogens. Drugs with antiandrogen activity reduce inflammation of the glandular tissues and prevent the disease from progressing to more severe stages.
Prostate massage.This treatment for chronic prostatitis can only be used outside of inflammation. A man should take a prone position, place his palms on a throne or table, and spread his legs shoulder-width apart. The treating physician wears sterile gloves, applies an ointment or gel (in some cases an anesthetic) to the index finger of the right hand, and injects it from the anus into the rectum. The massage is performed by applying a light pressure until the secretions of the prostate are separated by opening the urethra. The treatment includes at least 10 massage sessions.
Physiotherapy.Methods are used to normalize and increase blood circulation in the pelvic region to treat the symptoms of prostatitis. This allows you to rule out stagnation and increase the effectiveness of drug treatment. The treatment is carried out by exposing the gland to ultrasound waves, electromagnetic vibrations, as well as high temperatures (microclusters with hot water).
Surgical intervention.Surgery for prostate disease is rarely used. Such treatment is mandatory for complications of acute or chronic prostatitis.
Tips for prostate surgery:
- acute urinary retention as a result of acute narrowing of the urethra;
- abscess (appearance of pus on the surface of the gland);
- pancreatic sclerosis;
- adenoma that does not respond to conservative treatment.
Complications of prostatitis
Vesiculitis.Untreated prostatitis can cause inflammation in the seminal vesicles. Symptoms of the disease include pain in the depths of the pelvis, radiating to the sacrum, aggravated by erection and ejaculation, frequent urination, blood and / or pus in the semen and urine.
Colliculitis and urethritis.Because of its proximity to the secretory currents of the prostate, seminal tubercle often becomes inflamed as a result of infection by an infected gland. When left untreated, the symptoms of prostatitis are complemented by the characteristic symptom of urethritis - burning or tingling in the urethra when urinating. Convulsive narrowing of the urethra also causes pain during ejaculation.
Prostate abscess.The appearance of purulent cavities on the surface of the gland is due to pathogenic bacteria that cause prostatitis. A characteristic symptom of the disease is general weakness, poor consciousness, delirium, a sharp rise in temperature, increased sweating, chills. Prostate abscess is a serious septic disease that needs to be treated in a hospital setting.
Prostate sclerosis.Prostate sclerosis develops as a result of non-compliance with the treatment prescribed by a urologist against the background of regular exacerbations of chronic prostatitis. The disease can occur over several years, but if the hormonal balance in a man's body is disturbed, rapid development is possible. With prostate sclerosis, intermediate and slow urine flow is observed during bladder emptying.
Formation of cysts and stones. . . The appearance of cysts in the gland is one of the possible options for the development of chronic prostatitis. Infection with neoplasms can cause abscesses and make treatment much more difficult. Single and multiple stones can also form in the prostate. In addition to the usual symptoms of chronic prostatitis in this disease there is a violation of urine flow, frequent urination, pain in the perineum.
Infertility.In chronic prostatitis, sperm production and motor function are impaired. When left untreated, the disease also affects the vas deferens and seminal vesicles, making them impermeable to sperm, so they are not thrown into the urethra during ejaculation. As a result, men with chronic prostatitis often suffer from infertility.