Prostatitis is an inflammation of the prostate gland that is a common problem in 40% of middle-aged and elderly men.Without directly threatening life, this disease significantly reduces the quality of life, affects the intimate sphere, restricts freedom, and causes daily difficulties and psychological disorders.
Prostatitis occurs in acute or chronic form and can be infectious or non-infectious in origin.
Causes of prostatitis
The causes of prostatitis are various: the acute form, the increased route during urological and venereal diseases of an infectious nature, in 90% of chronic prostatitis, chronic prostatitis is not associated with infections.Stagnation of prostate secretion is formed as a result of both infectious inflammation of the walls of the ducts and systemic diseases.
Causes of acute prostatitis
Acute bacterial prostatitis is caused by Enterobacteria, gram-negative and gram-positive cocci, chlamydia, mycoplasma and viruses.Risk factors for prostate infection are sexually transmitted diseases and invasive urological interventions (catheterization, urethra, urocystoscopy).
The provocateurs for the development of infectious inflammation are usually hypothermia, prolonged constipation or diarrhea, sedentary work, excessive sexual activity, chronic sexual and urological diseases, lack of sleep, lack of abrasions, excessive, chronic stress.With the deterioration of the blood supply to the pelvic organs, these factors themselves contribute to aseptic inflammation and facilitate the application of the pathogen to the prostate tissue.
Acute bacterial inflammation can resolve without results, but in some cases the following complications develop:
- acute urinary retention;
- chronic prostatitis (chronic inflammatory pelvic pain syndrome);
- epididymitis;
- prostate abscess;
- fibrosis of prostate tissue;
- infinity.
Causes of chronic prostatitis
In 10% of cases, chronic prostatitis develops as an exacerbation of acute inflammation of the prostate gland, as well as urethritis, chlamydia, human papillomavirus and other chronic infections.About 90% are due to uncomplicated chronic prostatitis or chronic pelvic pain syndrome (CPP).This form of the disease is not associated with infections, but for many reasons, primarily stagnant processes in the pelvis.Urinary stasis, urethritis, bladder neck, urethritis of serious and autoimmune inflammation of the urethra, neurogenic narrowing, causing inflammation.Blood supply to the pelvic organs worsens, which is explained by systemic cardiovascular diseases (IHD, atherosclerosis).It determines the connection of chronic prostatitis with the common venous system of the small pelvis, anal fissures, hemorrhoids, proctitis and fistulas.
Chronic pelvic pain in men is associated with:
- low physical activity;
- low level of testosterone in the blood;
- changes in the microbial environment of the body;
- genetic and phenotypic predisposition.
Symptoms of prostatitis
- Fever (acute prostatitis for chronic prostatitis and 38-39 degrees Celsius for low-grade fever).
- Urinary dysfunction: Frequent urge to urinate, especially at night, urinary frequency or increased frequency of urination.The flow of urine is depleted and there is always a residual amount in the bladder.
- Prostate damage: spermatocytes and spermatocytes and blood pain during urological examination.
- Fibromyalgia.
- Prostatorrhea is a small discharge from the urethra.
- Pain in the pelvis, perineum, testicles, above the pubis, penis, sacrum, bladder, scrotum.
- Painful urination and ejaculation.
- Convulsive muscle spasms.
- Stones in the prostate gland.
- Chronic fatigue, feeling of hopelessness, disaster, psychological stress against the background of chronic pain syndrome.
- Performance (asthenia) decreased, mood decreased, nervous).
- Sexual dysfunction - erectile dysfunction, premature ejaculation, lack of orgasm.
- Irritable bowel syndrome and proctitis may occur.
In the chronic course of the disease, the symptoms of prostatitis are blurred (less pronounced), but they are accompanied by general, neurological and mental symptoms.
Diagnosis of prostatitis
The key to successful and timely treatment of prostatitis is an accurate and comprehensive diagnosis.The low rate of infectious prostatitis is explained by the fact that the pathogen is not detected in most cases.Chronic sexually transmitted infections can be asymptomatic, their pathogens can penetrate the prostate tissue and cause inflammation.Therefore, laboratory research methods play a leading role in the diagnostic process.
To determine the sensitivity of bacteria to antibiotics, biological fluids are inoculated: urine, semen, prostate secretions.This method allows you to choose a drug that is most effective for a certain strain of the pathogen, which can penetrate directly into the site of inflammation.
The "classic" method of laboratory diagnosis of prostatitis is cultural (urine culture, discharge, composition of urogenital smears).The method is very accurate, but it takes time.To detect bacteria, a smear is smeared with a mixed stain, but in this way it is unlikely to detect viruses, mycoplasma and ureaplasma.To increase the accuracy of the research, mass spectrometry and PCR (polymerase chain reaction) are used.Mass spectrometry is the ion analysis of the structure of a substance and the determination of its components.Polymerase chain reaction allows detection of fragments of DNA or RNA that are the cause of an infectious disease, including viruses and plasma.
Currently, a special comprehensive pcl study of the microflora of the geninourinary tract is used for special examination of urological patients.The result of the study is ready in a day and reflects the complete picture of the microbial ratio in the subject's body.
Tests for prostatitis include collection of urine and ejaculate and urological smears.
The European Urological Association recommends the following laboratory tests:
- general urine;
- bacterial culture of urine, semen and discharge;
- PCR diagnostics.
A general urine test reveals signs of inflammation (the number of colony-forming units of microorganisms, the number of leukocytes, the number of red blood cells, urine clarity) and calcifications (the presence of prostate stones).General analysis is included in the methodology of several urological (vial or section) samples.
Bottle or portion samples consist of a serial collection of urine or other biological fluids.In this way, the localization of the infectious process is determined.Prostatitis is indicated by the detection of infectious agents, blood cells (leukocytes and erythrocytes) in the last part of the urine during a three-bottle sample or urological massage of the prostate.
Two-bottle test - conducting the middle part of the urine stream before and after urological prostate massage.
Three bottle samples - initial, middle and final portions of urine are taken during the same urination.
Four-bottle test - culture and general analysis of prostate secretions after urological prostate massage and prostate secretions that are part of the urine after this procedure.
Also cultural culture or PCR diagnosis and PCR diagnosis of urogenital smear material.
To diagnose prostatitis, blood tests are also required.A general capillary blood test allows you to confirm or deny the presence of inflammation, as well as exclude other diagnoses that cause the same symptoms.
The diagnosis of non-inflammatory chronic pelvic pain syndrome is even more difficult because it is based on the clinical picture and indirect laboratory indicators (including general analysis of urine and blood).The intensity of the pain syndrome is determined using a visual analog pain scale, and the severity of psychological changes is determined using scales to assess anxiety and depression.At the same time, research is required to search for an infectious agent, because the range of pathogens can be very wide.Instrumental studies, residual urine volume of the prostate gland and transrectal ultrasound (TRUS) transrectal ultrasound (TRUS).
Asymptomatic prostatitis is detected by histological examination of a prostate biopsy sample prescribed for suspected cancer.A blood test for prostate-specific antigen (PSA) is performed first.Blood serum PSA, prostatic hypertrophy and inflammation, and age appear to be within normal criteria.This study also helps to rule out suspicions of a malignant prostate tumor.
Treatment and prevention of prostatitis
Acute prostatitis is treated with antibiotics (fluoroquinolines and cephalosporins, macrolides), alpha-blockers, non-steroidal anti-inflammatory drugs, neuromodulators.Few antibiotics can penetrate the prostate gland;Pathogens are immune to some drugs, so bacterial culture is necessary.
Conservative urological treatment may include acupuncture, herbal medicine, remote shock wave therapy, thermal physiotherapeutic procedures (after acute inflammation), massage.
Prevention of prostatitis includes both medical procedures and the formation of healthy habits:
- use of barrier contraceptives;
- regular sexual activity in conditions of minimizing the risk of infection;
- physical activity;
- Elimination of deficiency conditions - hypo and avitaminosis, mineral deficiency;
- compliance with aseptic conditions and careful technique for performing invasive urological interventions;
- regular preventive examinations using laboratory tests.