Prostatitis is an inflammation of the prostate, one of the common problems in 40% of middle-aged and elderly men.Without a direct threat to life, this disease leads to a significant reduction in quality, affects performance, the intimate sphere, limits freedom and causes daily difficulties and psychological disorders.
Prostatitis occurs in an acute or chronic form and can be of infectious or non-infectious origin.
Causes of prostatitis
The causes of prostatitis are different: the acute form is associated with a bacterial infection that enters the prostate via the ascending route during urological and venereal diseases of an infectious nature, chronic prostatitis in 90% of cases is not associated with infections.Stagnation of prostate secretions occurs 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 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 inflammations are usually hypothermia, long-term constipation or diarrhea, sedentary work, excessive sexual activity or sexual abstinence, chronic sexually transmitted and urological diseases, suppressed immune response, lack of sleep, overtraining, chronic stress.By worsening the blood supply to the pelvic organs, these factors themselves contribute to aseptic inflammation and 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 retention of urine;
- chronic prostatitis (chronic inflammatory pelvic pain syndrome);
- epididymitis;
- prostate abscess;
- fibrosis of prostate tissue;
- infertility.
Causes of chronic prostatitis
In 10% of cases, chronic prostatitis occurs as a complication of acute inflammation of the prostate, as well as urethritis, chlamydia, human papillomavirus and other chronic infections.About 90% are caused by non-bacterial chronic prostatitis or chronic pelvic pain syndrome (CPPS).This form of the disease is not related to infections, but is caused by many reasons, primarily stagnant processes in the pelvis.Stagnation of urine, which causes inflammation, occurs 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 (IBS, 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 (from 38-39 degrees Celsius for acute prostatitis and low temperature 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 some 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 spasms.
- Stones in the prostate.
- Chronic fatigue, feeling of hopelessness, disaster, psychological stress on 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 occur.
In the chronic course of the disease, the signs of prostatitis are blurred (less pronounced), but are accompanied by general, neurological and psychological 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 in most cases is explained by the fact that the pathogen has not been detected.Chronic sexually transmitted infections can be asymptomatic, while their pathogens can penetrate the prostate tissue and cause inflammation.Therefore, laboratory research methods play a leading role in the diagnostic process.
In order to determine the sensitivity of bacteria to antibiotics, biological fluids are inoculated: urine, semen, prostate secretions.This method allows you to choose the drug that is most effective for a particular strain of the pathogen, which can penetrate directly to the site of inflammation.
The "classic" method of laboratory diagnosis of prostatitis is considered culture (culture of urine, ejaculate, content of urogenital smear).The method is very precise, but it takes time.To detect bacteria, the smear is stained with Gram stain, but this way it is unlikely that viruses, mycoplasma and ureaplasma will be detected.To increase the accuracy of 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 genitourinary tract is used for a special examination of urological patients.The result of the study is ready in one day and reflects a complete picture of the microbial ratio in the subject's body.
Tests for prostatitis include collection of urine and ejaculate and urological smear.
The European Urological Association 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 colonies of microorganisms, the number of leukocytes, red blood cells, urine clarity) and the presence of calcifications (prostate stones).General analysis is included in the methodology of several urological (glass or portion) samples.
Glass or portion samples consist of successive collection 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 final portion of urine during a three-cup sample or after urological massage of the prostate.
Two glass test - inoculation of the middle part of the urine before and after urological massage of the prostate.
A sample of three glasses - initial, middle and final portions of urine are taken during the same urination.
Four-glass test - culture and general analysis of the initial and middle part of the urinary stream, prostate secretions after urological prostate massage and part of the urine after this procedure.
They also perform cultural or PCR diagnostics of ejaculate and urogenital smear.
Blood tests are also required to establish a diagnosis of 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 syndrome of chronic pelvic pain is more difficult, because it is based on the clinical picture and indirect laboratory indicators (including a general analysis of urine and blood).The intensity of the pain syndrome is determined by the visual analog scale of pain, and the severity of psychological changes by scales for assessing anxiety and depression.At the same time, research is needed to search for an 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 (TRUS) of the prostate.
Asymptomatic prostatitis is detected by histological examination of a prostate biopsy sample, prescribed for suspected cancer.First, a blood test for prostate-specific antigen (PSA) is done.PSA in the blood serum occurs with hypertrophy and inflammation of the prostate, and the normal criteria change with age.This study also helps rule out the suspicion of a malignant prostate tumor.
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;pathogens are immune to some drugs, so a bacterial culture is necessary.
Conservative urological treatment can also include acupuncture, herbal medicine, remote shock wave therapy, thermal physiotherapeutic procedures (after acute inflammation), massage.
Prevention of prostatitis includes medical procedures and the creation of healthy habits:
- use of protective contraception;
- regular sexual activity in conditions of minimized risk of infection;
- physical activity;
- elimination of deficiency conditions - hypo- and avitaminosis, lack of minerals;
- compliance with aseptic conditions and careful technique of performing invasive urological interventions;
- regular preventive examinations with laboratory tests.