Prostatitis is an inflammation of the prostate gland, one of the common problems in 40% of middle-aged and older men.Without directly threatening life, this disease leads to a significant decrease in its quality, which affects performance, the intimate sphere, limits freedom and causes everyday difficulties and psychological disorders.
Prostatitis occurs in acute or chronic form and can be of infectious or non-infectious origin.
Causes of prostatitis
The causes of prostatitis vary: the acute form is associated with bacterial infection that enters the prostate gland through the ascending route during urological and genital diseases of an infectious nature, chronic prostatitis in 90% of cases is not associated with infection.Symptoms of prostatic secretion are formed as a result of infectious inflammation of the duct wall 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, instillation and diversion of the urethra, urocystoscopy).
Provocateurs for the development of infectious inflammation are usually hypothermia, prolonged constipation or diarrhea, inactive work, excessive sexual activity or sexual abstinence, sexual diseases and chronic urological diseases, suppressed immune response, lack of sleep, coping with chronic stress.By worsening the blood supply to the pelvic organs, these factors themselves contribute to aseptic inflammation and also facilitate the introduction of pathogens into the prostate tissue.
Acute bacterial inflammation can resolve without consequences, but in some cases the following complications develop:
- acute urinary retention;
- chronic prostatitis (chronic inflammatory pelvic pain syndrome);
- Epididymitis;
- prostate abscess;
- Prostate tissue fibrosis;
- infertility.
Causes of chronic prostatitis
In 10% of cases, chronic prostatitis develops as a complication of acute inflammation of the prostate gland, as well as urethritis, chlamydia, human papillomavirus and other chronic infections.About 90% are caused by chronic non-osteal prostatitis or chronic pelvic pain syndrome (CPPS).This form of the disease is not associated with infection, but is caused by many reasons, especially unstable processes in the pelvis.The movement of urine, causing inflammation, is formed against the background of urethritis, neurogenic narrowing of the bladder neck, urethral stricture, and autoimmune inflammation.Blood supply to the pelvic organs is impaired, which is explained by systemic cardiovascular disease (IHD, atherosclerosis).The common venous system of the small pelvis determines the connection of chronic prostatitis with anal fissures, hemorrhoids, proctitis, and fistulas.
Chronic pelvic pain in men is associated with:
- low physical activity;
- low levels of testosterone in the blood;
- changes in the body's microbial environment;
- Genetic and phenotypic predisposition.
Symptoms of prostatitis
- Fever (from 38-39 degrees Celsius for acute prostatitis and low fever for chronic prostatitis).
- Urinary dysfunction: Frequent urge to urinate, not always effective, difficulty or increased frequency of urination, especially at night.The flow of urine is exhausted, and there is always a residual amount in the bladder.
- Prostate damage: leukocytes and blood in semen, 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.
- Abandonment and painful ejaculation.
- Convulsive muscle spasms.
- Stones in the prostate gland.
- Chronic fatigue, feelings of hopelessness, catastrophe, psychological stress against the background of chronic pain syndrome.
- Decreased performance (asthenia), decreased mood, irritability).
- Sexual dysfunction - erectile dysfunction, premature ejaculation, lack of orgasm.
- Intestinal syndrome and proctitis may occur.
In the chronic course of this disease, the signs of prostatitis are vague (less clear), 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 in most cases by the fact that the pathogen is not detected.Chronic sexual infections can be asymptomatic, while their pathogens can penetrate prostate tissue and cause inflammation.Therefore, laboratory research methods play a major role in the diagnostic process.
To determine the sensitivity of bacteria to antibiotics, biological fluids are injected: urine, semen, prostate secretions.This method allows you to choose the most effective drug for a particular pathogen strain, which is able to penetrate directly to the site of inflammation.
The "classic" method of laboratory diagnosis of prostatitis is culture (urine culture, ejaculate, urogenital smear content).This method is very accurate, but takes time.To detect bacteria, the smear is stained with gram stain, but in this way it is not possible to detect viruses, mycoplasma and ureaplasma.To increase the accuracy of research, mass spectrometry and PCR (polymerase chain reaction) are used.Mass spectrometry is the analysis of the ion structure of a substance and the determination of each of its components.Polymerase chain reaction allows you to detect DNA or RNA fragments of infectious agents, including viruses and plasma.
Currently, for the special examination of urological patients, a special comprehensive PCR study of the microflora of the genitourinary tract is used.The results of the study are ready in a day and reflect a complete picture of the ratio of microbes in the subject's body.
Tests for prostatitis include collection of urine and ejaculate and urological smear.
The European Society of Urology recommends the following set of laboratory tests:
- general urinalysis;
- bacterial culture of urine, semen and ejaculate;
- PCR diagnostics.
A general urine test allows you to determine signs of inflammation (the number of microorganism colony-forming units, the number of leukocytes, red blood cells, urine clarity) and the presence of calcification (prostate stones).General analysis is included in the methodology of several urological samples (glass or sections).
Glass samples or sections consist of sequential collection of urine or other biological fluids into different containers.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-glass sample or after a prostate urological massage
Two-glass test - inoculation of the middle part of the urine stream before and after urological prostate massage.
Three glass samples - the first, middle and last portions of urine are taken during the same urination.
Four-glass test - Culture and general analysis of the early and middle part of the urine stream, prostate secretions after urological prostate massage and part of the urine after this procedure.
They also perform culture culture or diagnostic PCR of ejaculate and urogenital material.
To make a diagnosis of prostatitis, a blood test is 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 similar symptoms.
Diagnosis of chronic non-inflammatory pelvic pain syndrome is more difficult, as it is based on clinical picture and indirect laboratory indications (including general analysis of urine and blood).The intensity of the pain syndrome was determined using a visual analog pain scale, and the severity of psychological changes was determined using a scale to assess anxiety and depression.At the same time, research is needed to find infectious agents, because the variety of pathogens can be very wide.Instrumental studies include urofluometry with determination of residual urine volume and transrectal ultrasound (TRUS) examination of the prostate gland.
Asymptomatic prostatitis is detected by histological examination of prostate biopsy specimens, which are prescribed for suspected cancer.A blood test for prostate specific antigen (PSA) is done first.PSA in blood serum appears with prostate hypertrophy and inflammation, and the normal criteria change with age.This study also helps exclude the suspicion of a malignant prostate tumor.
Treatment and prevention of prostatitis
Treatment of acute prostatitis is carried out with antibiotics (fluoroquinolins and cephalosporins, macrolides), alpha blockers, non-steroidal anti-inflammatory drugs, neuromodulators.Some antibiotics can penetrate the prostate gland;The pathogen is resistant to some drugs, so a bacterial culture is required.
Conservative urological treatment can also include acupuncture, herbal medicine, remote shock wave therapy, thermal physiotherapy procedures (after acute inflammation), massage.
Prevention of prostatitis includes medical procedures and the formation of healthy habits:
- use of barrier contraceptives;
- frequent sexual activity in conditions of minimized 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;
- Periodic preventive examinations using laboratory tests.