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, affecting work capacity, the intimate sphere, limiting freedom and causing daily difficulties and psychological disorders.
Prostatitis occurs in an 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 a bacterial infection that enters the ascending prostate gland in urological and venereal diseases of an infectious nature, chronic prostatitis in 90% of cases is not associated with infections. Stagnation of secretion from the prostate is formed as a result of infectious inflammation of the walls of the duct 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 sexually transmitted diseases and invasive urological interventions (catheterization, instillation and spark plug of the urethra, urocystoscopy).
The 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 the immune response, lack of sleep, overtraining, chronic stress. . Poor blood supply to the pelvic organs, these factors in themselves contribute to aseptic inflammation, and also facilitate the introduction of the pathogen into the tissue of the prostate gland.
Acute bacterial inflammation can resolve without consequences, but in some cases the following complications are formed:
- acute urinary retention;
- chronic prostatitis (chronic pelvic inflammatory syndrome);
- epididymitis;
- prostate abscess;
- fibrosis of prostate tissue;
- sterility.
The 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% is due to chronic bacterial prostatitis or chronic pelvic pain syndrome (CPPS). This form of the disease is not associated with infections, but is due to many reasons, mainly stagnant processes in the small pelvis. Stagnation of urine, causing inflammation, is formed against the background of urethritis, neurogenic narrowing of the bladder neck, urethral stricture, autoimmune inflammation. The blood supply to the pelvic organs deteriorates, which is explained by systemic cardiovascular diseases (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 and phenotypic predisposition.
Symptoms of prostatitis.
- Fever (38 to 39 degrees Celsius in acute prostatitis and subfebrile condition in chronic).
- Urinary dysfunction: frequent need to urinate, not always effective, difficulty or increased urination, especially at night. The stream of urine is exhausted and a residual amount remains in the bladder all the time.
- 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.
- 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.
- Decreased performance (asthenia), decreased mood, irritability).
- Sexual dysfunction: erectile dysfunction, premature ejaculation, lack of orgasm.
- Irritable bowel syndrome, can join proctitis.
In the chronic course of the disease, the signs of prostatitis are blurred (less pronounced), but they are joined by general, neurological and mental symptoms.
Prostatitis diagnosis
The key to the timely and successful treatment of prostatitis is an accurate and complete diagnosis. The low proportion of infectious prostatitis is explained in most cases by the fact that the pathogen was not detected. Chronic sexually transmitted infections can be asymptomatic, while their pathogens can invade the tissue of the prostate gland and cause inflammation. Therefore, laboratory research methods play a fundamental role in the diagnostic process.
To determine the sensitivity of bacteria to antibiotics, biological fluids are inoculated: urine, semen, and prostate secretions. This method allows you to select a drug that is most effective for a specific strain of the pathogen, capable of directly penetrating the focus of inflammation.
The "classical" method of laboratory diagnosis of prostatitis is considered culturological (urine culture, ejaculation, contents of urogenital smears). The method is very accurate, but it takes time. A Gram smear is produced to detect bacteria, but viruses, mycoplasma, and ureaplasma are unlikely to be detected in this manner. To improve the precision of the investigation, mass spectrometry and PCR (polymerase chain reaction) are used. Mass spectrometry is an ionic analysis of the structure of a substance and the determination of each of its components. The polymerase chain reaction allows the detection of DNA or RNA fragments of the causative agent of an infectious disease, including viruses and plasma.
Currently, for a special examination of urological patients, a special comprehensive study by the PCR method of the microflora of the urogenital tract is used. The test result is ready in one day and reflects the complete picture of the microbial ratio in the subject's body.
Tests for prostatitis include urine and ejaculation collection and urologic smears.
The European Urological Association recommends the following set of laboratory tests:
- general urinalysis;
- bacterial culture of urine, semen and ejaculate;
- PCR diagnosis.
A general analysis of the urine allows you to determine the signs of inflammation (the number of colony-forming units of microorganisms, the number of leukocytes, erythrocytes, transparency of the urine) and the presence of calcifications (prostate stones). The general analysis is included in the method of several urological samples (in glass or in portions).
Glass or portion samples consist of the sequential collection of urine or other biological fluids in different containers. Therefore, the location 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-vessel test or after urologic massage of the prostate.
Two-vessel test: seeding the middle part of the urine stream before and after urological prostate massage.
Three-glass sample: the initial, middle and final portions of urine are taken with the same urination.
Four-vessel sample: culture and general analysis of the initial and middle parts of the urine stream, prostatic discharge after urological massage of the prostate, and a portion of urine after this procedure.
Culturological seeding diagnoses or PCR of ejaculate and urogenital smear material are also performed.
Blood tests are also required to make a diagnosis of prostatitis. A general capillary blood test can confirm or deny the presence of inflammation, as well as exclude other diagnoses that cause the same symptoms.
The diagnosis of chronic non-inflammatory pelvic pain syndrome is more difficult, as it is based on the clinical picture and indirect laboratory parameters (including general urine and blood analysis). The intensity of the pain syndrome is determined by the visual analog scale of pain, and the severity of psychological changes is determined by the scales for assessing anxiety and depression. At the same time, research is necessarily carried out to find an infectious agent, since the spectrum of pathogens can be very wide. From instrumental studies, urofluometry is prescribed with the establishment of the residual urine volume and transrectal ultrasound (TRUS) of the prostate gland.
Asymptomatic prostatitis is detected with a histological examination of a prostate biopsy, prescribed for suspected cancer. A blood test for prostate specific antigen (PSA) is done beforehand. Serum PSA appears with hypertrophy and inflammation of the prostate, and the criteria for the norm change with age. This study also helps to rule out suspicions of a malignant prostate tumor.
Treatment and prevention of prostatitis.
Treatment of acute prostatitis is carried out 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 of the drugs, therefore bacterial inoculation is necessary.
Conservative urological treatment can also include acupuncture, herbal medicine, external shock wave therapy, thermal physiotherapy (after acute inflammation), massage.
Prevention of prostatitis includes both medical manipulations and the formation of healthy habits:
- the use of barrier contraception;
- regular sexual activity under conditions of minimal risk of infection;
- physical activity;
- elimination of deficiency states: hypo and vitamin deficiency, mineral deficiency;
- compliance with aseptic conditions and careful technique to perform invasive urological interventions;
- periodic preventive examinations through laboratory tests.