ProstatitisIt is a urological disease accompanied by inflammation of the tissues of the prostate gland. Damage to the prostate can be caused by an infection transmitted through the blood, lymph or through unprotected intercourse. The development of prostatitis in men is facilitated by injuries and impaired blood supply to the pelvic organs, constant hypothermia, low physical activity, hormonal imbalance and other factors. Prostatitis can be accompanied by vesiculitis, urethritis and other infectious and inflammatory diseases of the reproductive and urinary organs.
Incidence statistics
Prostatitis is one of the most common diseases of the male genitourinary system in the world. According to various sources, it is observed in 60-80% of sexually mature men. According to official medical statistics, over 30% of young people of reproductive age suffer from chronic prostatitis. In about one third of cases, it occurs in men over 20 and under 40. According to the WHO, urologists diagnose chronic prostatitis in every tenth patient.
Causes of prostatitis
Infections.Pathogenic and opportunistic bacteria enter the prostate through the lymphatic and blood vessels. Secondary infection of the prostate is often a complication of inflammatory diseases of the rectum and urethra.
Types of Infection:
- ascending- microbes rise to the gland from the external urethral opening;
- downward- microbes enter the prostate together with the infected urine stream.
Conditionally pathogenic microorganisms that cause disease (according to the Research Institute of Urology 1997-1999)
| Microorganisms | Number of studies | |
|---|---|---|
| % | abdominals | |
| Staphylococcus epidermidis | 42. 3 | 55 |
| S. saprophyticus | 17. 6 | 23 |
| S. aureus | 4. 6 | 6 |
| S. haemolyticus | 3. 1 | four |
| S. hominis | 0, 8 | one |
| S. warneri | 1. 5 | 2 |
| Staphylococcus spp. | 3. 1 | four |
| Enterococcus faecalis | 11. 6 | fifteen |
| Streptococcus spp. | 3. 1 | four |
| TOTAL (gr. +) | 87. 6 | 114 |
| P. aeruginosa | 3. 7 | five |
| E. coli | 4. 7 | 6 |
| Enterobacter spp. | 2, 3 | 3 |
| Proteus spp. | 1. 5 | 2 |
| TOTAL (gr. -) | 12. 3 | sixteen |
Weakening of immunity.One of the causes of inflammation of the prostate is the weakening of the body's immune defenses. This can be facilitated by frequent stress, unbalanced diet, overwork, smoking, alcohol consumption. With reduced immunity, the body is more vulnerable to infections that lead to the development of prostate diseases.
Blood flow disturbances.The development of chronic prostatitis can be the result of a sedentary and sedentary lifestyle. With a constant lack of physical activity, the work of the endocrine, cardiovascular and nervous systems, as well as blood circulation in the pelvic organs, is disrupted. The result is the oxygen deficiency of the prostate tissue.
Irregular sexual activity.Both prolonged sexual abstinence and excessive sexual activity can contribute to the onset of prostatitis. Many sexually active men have nervous breakdowns, hormonal imbalance, reduced secretion of the sex glands and a gradual decrease in potency. Interrupted intercourse has a negative impact on the health of the prostate gland.
Chronic prostate injury. . . Chronic prostatitis can develop as a result of frequent trauma to the soft tissues of the prostate gland. Most often this is observed in patients whose professional activities are related to driving. The cause of prostatitis in this case is constant shaking, vibration and excessive stress on the muscles of the perineum.
The main syndromes of prostatitis
Ache.With prostatitis in men, there are aching and cutting pains in the lower abdomen and lower back, as well as pains throughout the body. This symptom can worsen with ejaculation, especially during intercourse after prolonged abstinence.
Dysuria.Typical signs of prostatitis in men are the frequent need to urinate, burning and stinging when emptying the bladder, pain after urination in the perineum. Another symptom of prostate inflammation is difficulty urinating. In the absence of treatment for the disease, acute urinary retention may occur.
Sexual dysfunctions.With uncomplicated prostatitis, accelerated ejaculation occurs, wear of orgastic sensations, pain during ejaculation, partial or complete decrease in libido. Prolonged erection during the night is also a symptom of chronic prostatitis.
External manifestations.With prostatitis, some patients have purulent or clear discharge from the urethra, which is more abundant in the morning. Patients may also notice a symptom such as the presence of white flakes or filaments in the urine.
Types of prostatitis
Acute bacterial.Acute prostatitis develops as a result of infection of the prostate gland with Staphylococcus aureus, Escherichia coli, enterococcus and other pathogenic bacteria. If left untreated, this disease can lead to blood poisoning. In this case, the man must be urgently hospitalized.
Symptoms seen with this type of prostatitis:
- chills and fever (38 ° C and above);
- sharp or pulling pains in the groin, lower back, and perineum;
- frequent need to urinate;
- painful urination;
- difficulty urinating and acute urinary retention;
- white or colorless discharge from the urethra.
Chronic bacterial.The recurrent form of the disease occurs due to the penetration of the infection into the gland. Chronic hypothermia, prolonged sexual abstinence and premature urination contribute to the development of prostatitis. Chronic prostatitis, if left untreated, can lead to cystitis, as inflammation of the prostate is a reservoir of bacteria that affect the genitourinary tract.
Symptoms of chronic prostatitis:
- pain in the scrotum, lower abdomen, perineum;
- dysuria;
- violations of potency.
Chronic non-bacterial.Causes of the disease include the entry of viruses or bacteria into the prostate (tubercle bacillus, Trichomonas, chlamydia), autoimmune processes, urine penetration into the gland. Chronic prostatitis accounts for up to 95% of all types of prostate inflammation.
The signs of prostatitis are:
- chronic pain in the pelvic area (discomfort to the man for at least 3 months);
- recurrent groin pain;
- absence of symptoms of inflammation in the secretions of urine, semen and prostate.
Chronic asymptomatic.Chronic asymptomatic prostatitis is not associated with bacterial infection and symptomatic prostate syndromes. This disease is assumed to be an age-related physiological feature.
Symptoms of this type of chronic prostatitis:
- absence of major syndromes of the disease;
- an increase in the content of leukocytes and bacteria in the urine.
The main symptom of the disease - the presence of an infection in the gland - can be detected only with a biopsy or during surgical operations in the treatment of various pathologies of the prostate (adenoma, cancer).
Stagnant.Prostatitis develops not only against the background of anatomical and physiological changes in the venous and other body systems. The main cause of the disease is irregular sex life.
Signs of prostatitis:
- aching pain in the perineum, radiating to the sacrum;
- increased urination in the morning;
- slight difficulty in the outflow of urine (the symptom is observed in the chronic form of the disease);
- weakening of the erection;
- decreased libido;
- "Pallor" of orgasmic sensations during ejaculation.
Diagnosis of acute and chronic prostatitis
To select the correct method of treatment, the doctor prescribes a complete diagnosis of the state of the genitourinary system, including the following methods.
Digital rectal exam.If you suspect a disease of prostatitis, the urologist performs a digital examination. The posterior surface of the prostate is adjacent to the rectum, so when a finger is inserted through the anus, the doctor can determine the condition of the gland. In the course of the study, its size, texture and shape, surface condition, soreness are established.
Signs of prostatitis in men include:
- soft and inelastic consistency of the prostate;
- pain on palpation;
- enlarged gland;
- immobility of the rectal mucosa on the prostate.
Ultrasound procedure.Ultrasound of the prostate is prescribed before the start of treatment for acute prostatitis in order to identify / exclude an abscess of the gland and in the chronic course of the disease - to identify cysts and stones of the prostate, as well as the degree of compression of the urethra. The most effective method is rectal ultrasound.
Uroflowmetry.This method of diagnosing prostatitis is used to study the indicators of the process of urination: the duration of this physiological act and the rate of outflow of urine. If the rate is 15 ml / s or more, this indicates a normal patency of the urethra. A sign of prostatitis is a decrease in this value of less than 10 ml / s. This speed is a consequence of the poor patency of the urinary tract.
Interpretation of the results of uroflowmetry
| Urinary flow | Interpretation |
|---|---|
| >15 ml / sec | Urinary tract obstruction is unlikely |
| <10ml / sec | Significant narrowing of the urethra or weakness of the detrusor is likely |
| 10-15 ml / sec | Indeterminate result |
Cystoscopy.For examination, an endoscopic imaging system is inserted into the bladder. This method of diagnosing acute and chronic prostatitis is used when diseases such as cancer, cystitis or bladder trauma are suspected.
Laboratory research. To diagnose and determine the microorganism that caused the disease, in the presence of symptoms of chronic prostatitis or acute inflammation, urine and prostate secretions are examined. A sign of the presence of pathogenic microflora is an increase in the number of leukocytes in the biological material. To compose an effective treatment cycle, the type of bacteria is determined by PCR, RIF and inoculation on a nutrient medium.
Interpretation of laboratory results
| Secret of the prostate | Third urine sample (after prostate massage) | |||
|---|---|---|---|---|
| HP module | The number of leukocytes, uv. x 400 | Sowing results | The number of leukocytes, uv. x 400 | Sowing results |
| Bacterial | >10 | + | The difference between the number of leukocytes in the third portion of urine and the second portion of urine is ≥10 | + |
| Chronic pelvic inflammatory pain syndrome | >10 | - | The difference between the number of leukocytes in the third portion of urine and the second portion of urine is ≥10 | - |
| Chronic non-inflammatory pelvic pain syndrome | <10 | - | - | - |
Prevention of prostatitis
Physical activity.For the prevention and treatment of prostate disease, a man must avoid physical inactivity. Recommended:
- walking (4 km per day or more);
- exercise (squats, jumps, turns);
- training of the muscles of the perineum and buttocks (10 tensions and relaxations).
Proper nutrition.For the prevention of acute and chronic prostatitis, men must include foods rich in zinc and vitamin B. It is recommended to eat:
- seafood (oysters, seaweed);
- meat;
- pumpkin seeds;
- Walnuts;
- bran;
- kefir;
- Rye bread.
Regular sex life.When a disease is prevented and treated, a man needs:
- lead a rhythmic sex life;
- avoid interrupted sexual intercourse;
- avoid casual relationships.
Treatment of acute and chronic prostatitis
Inflammation of the prostate is treated using the following methods.
Antibacterial therapy.If prostatitis is bacterial, antibiotics are needed to treat it. The doctor selects a group of drugs based on the type of microbes that caused the disease, the sensitivity of the pathogen to various drugs and the presence of contraindications in the patient.
Characteristics of drugs
| A drug | Benefits | disadvantages |
|---|---|---|
| Fluoroquinolones |
|
|
| Macrolides |
|
Insufficiently active against gram-negative bacteria |
| Tetracyclines | Active against atypical pathogens |
|
Hormone therapy.Hormone treatment is necessary to restore the normal hormonal balance between androgens and estrogens. Drugs with antiandrogenic activity reduce inflammation of the tissues of the gland and prevent the passage of the disease to more severe stages.
Prostate massage.This method of treatment of chronic prostatitis can be used only outside of exacerbations. A man needs to take an inclined position, rest his palms on a sofa or table, spread his legs shoulder-width apart. The doctor performing the treatment puts on sterile gloves on the hands, applies an ointment or gel (in some cases, a drug with an anesthetic component) to the index finger of the right hand, and injects it through the anus into the rectum. The massage is performed by applying gentle pressure until secretions from the prostate are separated through the opening of the urethra. The treatment includes at least 10 massage sessions.
Physiotherapy.To treat the symptoms of prostatitis, methods are used to normalize and increase blood circulation in the pelvic area. This allows you to exclude stagnation and increase the effectiveness of drug therapy. The treatment is performed by exposing the gland to ultrasonic waves, electromagnetic vibrations and high temperatures (microcliters with hot water).
Surgical intervention.Surgery for prostate disease is rarely used. Such treatment is mandatory for the development of complications of acute or chronic prostatitis.
Indications for prostate surgery:
- acute urinary retention due to severe narrowing of the urethra;
- abscess (appearance of suppuration on the surface of the gland);
- sclerosis of the gland;
- adenoma that does not respond to conservative treatment.
Complications of prostatitis
Vesiculitis.Untreated prostatitis can cause inflammation of the seminal vesicles. Symptoms of the disease are deep pains in the pelvis, radiating to the sacrum, aggravated by erection and ejaculation, frequent urination, the appearance of blood and / or pus in the semen and urine.
Colliculitis and urethritis.Due to its proximity to the excretory streams of the prostate, the seminal tubercle is often inflamed due to the infection of the infected gland. If left untreated, the symptoms of prostatitis are complemented by the characteristic symptom of urethritis: burning or tickling in the urethra when urinating. There is also pain during ejaculation due to the convulsive contraction of the urethra.
Prostate abscess.The appearance of purulent cavities on the surface of the gland is due to the pathogenic bacteria that caused prostatitis. A characteristic symptom of the disease is general weakness, impaired consciousness, delirium, a sharp rise in temperature, increased sweating, chills. Prostate abscess is a serious septic disease that must be treated in a hospital setting.
Prostate sclerosis.Prostate sclerosis develops against the background of regular exacerbations of chronic prostatitis due to non-compliance with the treatment prescribed by the urologist. This disease can form over the course of several years, however, if the hormonal balance in a man's body is disturbed, rapid development is possible. With sclerosis of the prostate, pain is observed when emptying the bladder, an intermittent and slow flow of urine.
Formation of cysts and stones. . . The appearance of cysts in the gland is one of the likely options for the progression of chronic prostatitis. Cancer infection can cause an abscess and greatly complicate the treatment of the disease. Single and multiple stones can also form in the prostate. In this disease, in addition to the usual symptoms of chronic prostatitis, there are violations of the outflow of urine, frequent urination, pain in the perineum.
Infertility.In chronic prostatitis, sperm production and motor function are impaired. If left untreated, the disease also affects the vas deferens and seminal vesicles, making them impractical for sperm, so they are not thrown into the urethra during ejaculation. As a result, men who have chronic prostatitis often suffer from infertility.