Prostatitis is an inflammation of the prostate gland, one of the most common problems in 40% of middle-aged and elderly men.Without immediate threat to life, this disease causes a significant decrease in its quality, affects performance, intimate sphere, limits freedom and causes daily difficulties and psychological disorders.
Prostatitis develops in acute or chronic form and can be of infectious or non-infectious origin.
Causes of prostatitis
The causes of prostatitis are diverse: the acute form is associated with bacterial infection, which enters the prostate gland in an ascending way during infectious urological and venereal diseases, chronic prostatitis is not associated with infections in 90% of cases.Stagnation of prostate secretion is formed both as a result of infectious inflammation of duct walls 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 (urethral catheterization, instillation and coiling, urocystoscopy).
As a rule, provocateurs for the development of infectious inflammation are hypothermia, prolonged constipation or diarrhea, sedentary work, excessive sexual activity or sexual abstinence, chronic sexually transmitted and urological diseases, suppressed immune response, lack of sleep, excessive exercise, chronic stress.By worsening the blood supply to the pelvic organs, these factors themselves contribute to aseptic inflammation and also contribute to the introduction of the pathogen into the prostate tissue.
Acute bacterial inflammation can disappear without consequences, but in some cases the following complications develop:
- acute retention of urine;
- Chronic prostatitis (chronic inflammatory pelvic pain syndrome);
- epididymitis;
- prostate abscess;
- fibrosis of prostate tissue;
- childlessness.
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 due to non-bacterial chronic prostatitis or chronic pelvic pain syndrome (CPPS).This form of the disease is not related to infections, but is due to many reasons, primarily the processes taking place in the pelvic cavity.Urinary stagnation, which causes inflammation, is formed against the background of urethritis, neurogenic narrowing of the bladder neck, urethral stricture, and autoimmune inflammation.The blood supply to the pelvic organs deteriorates, which is explained by systemic cardiovascular diseases (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 level of testosterone in the blood;
- changes in the microbial environment of the body;
- Genetic and phenotypic predisposition.
Symptoms of prostatitis
- Fever (38-39 degrees Celsius in acute prostatitis and low-grade chronic prostatitis).
- Urinary dysfunction: frequent urge to urinate, not always effective, difficulty or 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.
- Painful urination and ejaculation.
- Convulsive muscle spasm.
- Stones in the prostate gland.
- Chronic fatigue, feeling 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 and proctitis may develop.
In the chronic course of the disease, the signs of prostatitis are vague (less pronounced), but 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 share of infectious prostatitis in most cases is explained by the fact that the cause was not identified.Chronic sexually transmitted infections can be asymptomatic, and 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 secretion.This method allows you to choose the drug that is most effective for a particular 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, ejaculate, urogenital smear content).The method is very accurate, but it takes time.Gram stain is used to detect bacteria, but it is less likely to detect viruses, mycoplasma and ureaplasma in this way.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 each of its components.Polymerase chain reaction allows you to detect DNA or RNA fragments of the causative agent of an infectious disease, including viruses and plasma.
Currently, a special comprehensive PCR study of the microflora of the urinary tract is used for special examination of urological patients.The result of the study is ready in one day and shows a complete picture of the microbial ratio in the subject's body.
Tests for prostatitis include urine and ejaculate collection and a urological smear.
The European Association of Urologists recommends the following set of laboratory tests:
- general urine analysis;
- bacterial culture of urine, sperm and ejaculate;
- PCR diagnostics.
A general urine test allows you to determine signs of inflammation (the number of colony-forming units of microorganisms, the number of leukocytes, the number of red blood cells, the purity of urine) and the presence of calcification (prostate stones).General analysis is included in the methodology of several urological (glass or portion) samples.
Glass or part samples consist of successive collections of urine or other biological fluids in 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 urine during a three-cup sample or after urological massage of the prostate.
Two-glass test - inoculation of the middle part of urine before and after prostate urological massage.
Three cup samples - initial, middle and last part of urine are taken during the same urination.
Four glass tests - culture and general analysis of the initial and middle parts of the urine flow, prostate secretion after urological massage of the prostate and part of the urine after this procedure.
They also perform culture or PCR diagnosis of ejaculate and urogenital smear material.
A blood test is also required to diagnose prostatitis.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 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 the visual analog pain scale, and the severity of psychological changes is determined using the anxiety and depression rating scales.At the same time, it is necessary to investigate to find the infectious agent, because the range of pathogens can be very wide.Instrumental studies include uroflowmetry with determination of residual urine volume and transrectal ultrasound examination of the prostate gland (TRUS).
Asymptomatic prostatitis is detected by histological examination of a prostate biopsy specimen, which is prescribed for suspected cancer.First, a blood test for prostate-specific antigen (PSA) is performed.PSA in blood serum appears with prostatic hypertrophy and inflammation, and normal criteria change with age.This study also helps to rule out suspicions of prostate cancer.
Treatment and prevention of prostatitis
Acute prostatitis is treated with antibiotics (fluoroquinolines and cephalosporins, macrolides), alpha-blockers, nonsteroidal anti-inflammatory drugs, and neuromodulators.Several antibiotics can penetrate the prostate gland;Pathogens are immune to some drugs, so bacterial culture is necessary.
Conservative urological treatment can also include acupuncture, herbal medicine, remote shock wave therapy, thermophysiotherapy 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 under minimal risk of infection;
- physical activity;
- Elimination of deficient conditions - hypo- and avitaminosis, mineral deficiency;
- maintaining aseptic conditions and careful technique of performing invasive urological interventions;
- Regular preventive examinations using laboratory tests.