Prostatitis is an inflammation of the prostate gland, one of the most common problems in 40% of middle -aged and older men. Without directly threatening life, the disease leads to a significant decrease in its quality, affects work capacity, intimate sphere, limits freedom and provokes daily difficulties and psychological disorders.
Prostatitis occurs in acute or chronic form, it can be of infectious and non -infectious origin.
Causes of prostatitis
The causes of prostatitis are varied: the acute form is associated with bacterial infection that enters the ascending prostate gland in urological and genital diseases of an infectious nature, chronic prostatitis in 90% of cases is not associated with infection. Stagnation of prostate secretion is formed as a result of infectious inflammation of the duct walls and systemic diseases.
Causes of Acute Prostatitis
Acute bacterial prostatitis is caused by enterobacteria, Gram-negative and Gram-positive cocci, chlamydia, mycoplasma, viruses. Risk factors for prostate infection are venereal disease and invasive urological interventions (catheterization, instillation and bougienage of the urethra, urocystoscopy).
Provocateurs of the development of infectious inflammation are usually hypothermia, prolonged constipation or diarrhea, sedentary work, excessive sexual activity or sexual abstinence, chronic course of venereal and urological diseases, suppression of immune responses, lack of sleep, too much exercise, chronic stress. . Poor blood supply to the pelvic organs, these factors themselves contribute to aseptic inflammation, and also facilitate the introduction of pathogens into the tissues of the prostate gland.
Acute bacterial inflammation can be cured without consequences, but in some cases the following complications form:
- acute urinary retention;
- chronic prostatitis (chronic pelvic inflammatory 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 abacterial chronic prostatitis or chronic pelvic pain syndrome (CPPS). This form of the disease is not associated with infection, but is due to many reasons, especially the process of stagnation in the small pelvis. Stagnation of urine, causing inflammation, is formed on the background of urethritis, neurogenic narrowing of the bladder neck, narrowing of the urethra, autoimmune inflammation. Blood supply to the pelvic organs is impaired, which is explained by systemic cardiovascular disease (coronary artery disease, atherosclerosis). The general venous system of the small pelvis determines the connection of chronic prostatitis with cracks in the anus, hemorrhoids, proctitis, fistulas.
Chronic pelvic pain in men is associated with:
- low physical activity;
- low levels of testosterone in the blood;
- changes in the microbial environment of the body;
- genetic predisposition and phenotype.
Symptoms of prostatitis
- Fever (from 38-39 degrees Celsius in acute prostatitis and subfebrile conditions in chronic).
- Urinary dysfunction: frequent urge to urinate, not always effective, difficulty or increased urination, especially at night. The flow of urine is reduced, and over time there is a certain amount of urine left in the bladder.
- Damage to the prostate: leukocytes and blood in semen, pain during urological examination.
- Fibromyalgia.
- Prostatorrhea is a small discharge from the urethra.
- Pain in the small pelvis, perineum, testicles, above the pubis, in the penis, sacrum, bladder, scrotum.
- Pain in urination and ejaculation.
- Seizure muscle spasms.
- Stones in the prostate gland.
- Chronic fatigue, feelings of hopelessness, disaster, psychological stress against the background of chronic pain syndrome.
- Decreased performance (asthenia), decreased mood, irritability).
- Sexual dysfunction - erectile dysfunction, premature ejaculation, lack of orgasm.
- Irritable bowel syndrome, proctitis can be combined.
In the chronic course of the disease, the signs of prostatitis are vague (less obvious), 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 proportion of infectious prostatitis is explained in most cases by the fact that the pathogen is not detected. Chronic sexually transmitted infections can be asymptomatic, while the pathogen can invade prostate gland tissue and cause inflammation. Therefore, laboratory research methods play a key role in the diagnostic process.
To determine the sensitivity of bacteria to antibiotics, inoculation of biological fluids is performed: urine, semen, and prostate secretions. This method allows you to select the most effective drug for a particular strain of the pathogen, which is able to penetrate directly into the focus of inflammation.
The "classic" method of laboratory diagnostics of prostatitis is considered to be culture (urine culture, ejaculation, urogenital smear content). The method is very precise, but takes time. To detect bacteria, Gram smears are produced, but in this way it is not possible to detect viruses, mycoplasma and ureaplasma. To improve the accuracy of the research, mass spectrometry and PCR (polymerase chain reaction) were used. Mass spectrometry is the ionic analysis of the structure of a material and the determination of each of its components. The polymerase chain reaction allows the detection of DNA or RNA fragments of infectious disease -causing agents, including viruses and plasma.
Currently, for the special examination of urological patients, a special comprehensive study by PCR method of urogenital tract microflora is used. The test results are completed in a day and describe a full picture of the microbial ratio in the subject’s body.
Tests for prostatitis include collection of urine and ejaculation and urological smears.
The European Urological Association recommends the following set of laboratory tests:
- general urine analysis;
- bacterial cultures of urine, semen and ejaculation;
- diagnostic PCR.
General analysis of urine allows you to determine the signs of inflammation (number of colony-forming units of microorganisms, number of leukocytes, erythrocytes, transparency of urine) and the presence of calcification (prostate stones). General analysis is included in the method of several urological samples (glasses or parts).
A glass sample or section consists of a sequential collection of urine or other biological fluids in different containers. Therefore, the localization of the infectious process is determined. Prostatitis is evidenced by the detection of infectious agents, blood cells (leukocytes and erythrocytes) in the final portion of the urine during a three -glass test or after a prostate urological massage.
Two -glass test - sowing the middle part of the urine stream before and after prostate urological massage.
Three -glass samples - the initial, middle and final portions of urine were taken at the same time of urination.
Four -glass sample - culture and general analysis of the early and middle parts of the urine flow, prostate secretions after prostate urological massage and part of the urine after this procedure.
Culture inoculation or PCR diagnostics for ejaculation and urogenital swabs were also performed.
Blood tests are also needed to make a diagnosis of prostatitis. General analysis of capillary blood allows you to confirm or deny the presence of inflammation, as well as exclude other diagnoses that cause similar symptoms.
The diagnosis of non -inflammatory chronic pelvic pain syndrome is more difficult, as it is based on the clinical picture and indirect laboratory parameters (including general analysis of urine and blood). The intensity of pain syndrome was determined by a visual analog scale of pain, and the severity of psychological changes was determined by a scale for assessing anxiety and depression. At the same time, research must be conducted to find infectious agents, as the spectrum of pathogens can be very wide. From instrumental studies, urofluometry was established with the establishment of total urine waste and transrectal ultrasound (TRUS) of the prostate gland.
Asymptomatic prostatitis is detected by histological examination of prostate biopsy, which is prescribed for suspected cancer. Blood tests for Prostate Specific Antigen (PSA) are performed first. Serum PSA appears with hypertrophy and inflammation of the prostate, and the criteria for norm change with age. The study also helped to rule out the suspicion of malignant prostate tumors.
Treatment and prevention of prostatitis
Treatment of acute prostatitis is carried out with antibiotics (fluoroquinoline and cephalosporins, macrolides), alpha blockers, non-steroidal anti-inflammatory drugs, neuromodulators. Some antibiotics can penetrate the prostate gland, pathogens are resistant to some drugs, therefore, bacterial inoculation is required.
Conservative urological treatment may also include acupuncture, phytotherapy, external shock wave therapy, thermal physiotherapy (after acute inflammation), massage.
Prevention of prostatitis includes both medical manipulation and the formation of healthy habits:
- use of barrier contraceptives;
- frequent sexual activity in a state of minimized risk of infection;
- physical activity;
- elimination of deficient conditions - hypo- and avitaminosis, mineral deficiency;
- compliance with aseptic conditions and careful techniques for performing invasive urological interventions;
- routine preventive examination using laboratory tests.