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, this disease leads to a significant decrease in its quality, affecting performance, the intimate sphere, limiting freedom and causing daily difficulties and psychological disorders.
Prostatitis occurs in acute or chronic form and can be of infectious or non-infectious origin.
Causes of prostatitis
The causes of prostatitis are various: the acute form is associated with a bacterial infection that enters the prostate via ascending during urological and venereal diseases of an infectious nature, chronic prostatitis in 90% of cases is not associated with infections.Stagnation of prostatic secretion is formed both due to infectious inflammation of the walls of the ducts 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).
Provocators for the development of infectious inflammation are usually 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, overtraining, chronic stress.These same factors, worsening the blood supply to the pelvic organs, contribute to aseptic inflammation and also facilitate the introduction of the pathogen into the prostate tissue.
Acute bacterial inflammation can resolve without consequences, but in some cases the following complications develop:
- acute urinary retention;
- chronic prostatitis (chronic inflammatory pelvic pain syndrome);
- epididymitis;
- prostate abscess;
- fibrosis of the prostatic tissue;
- 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.Approximately 90% are due to chronic non-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 pelvis.Stagnation of urine, causing 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:
- poor 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 (38-39 degrees Celsius for acute prostatitis and mild fever for chronic prostatitis).
- Urinary dysfunction: frequent need to urinate, not always effective, difficulty or increased frequency of urination, especially at night.The flow of urine is exhausted and there is always a certain residual amount left 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 gland.
- Chronic fatigue, feeling of hopelessness, catastrophe, 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 occur.
In the chronic course of the disease, the signs of prostatitis are faded (less pronounced), but are accompanied by general, neurological and mental symptoms.
Diagnosis of prostatitis
The key to effective and timely treatment of prostatitis is an accurate and complete diagnosis.The low percentage 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 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, sperm, prostatic secretions.This method allows you to select a more effective drug for a specific strain of pathogen, capable of penetrating directly to the site of inflammation.
The “classic” method of laboratory diagnosis of prostatitis is considered cultural (culture of urine, ejaculate, contents of urogenital smears).The method is very accurate, but takes time.To detect bacteria, a smear is stained with a Gram stain, but this is unlikely to detect viruses, mycoplasma, and ureaplasma.To increase the precision 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.The polymerase chain reaction allows you to detect 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 PCR study of the microflora of the genitourinary tract is used.The result of the study is ready in a day and reflects the complete picture of the microbial relationship in the subject's body.
Tests for prostatitis include collection of urine and ejaculate and urological smears.
The European Urological Association recommends the following series of laboratory tests:
- general urinalysis;
- bacterial culture of urine, semen and ejaculate;
- PCR diagnostics.
A general urinalysis allows you to determine signs of inflammation (number of colony-forming units of microorganisms, number of leukocytes, red blood cells, clarity of urine) and the presence of calcifications (prostatic stones).General analysis is included in the methodology of several urological samples (glass or portion).
Glass or portion samples consist of sequential collection of urine or other biological fluids into 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-glass sampling or after urological massage of the prostate
Two-glass test: inoculation of the central part of the urine stream before and after urological prostate massage.
Sample in three glasses: during the same urination, the initial, middle and final portions of the urine are taken.
Four-glass test: culture and general analysis of the initial and middle parts of the urine stream, prostatic secretion after urological massage of the prostate and a portion of urine after this procedure.
They also perform culture culture or PCR diagnostics of ejaculate and urogenital smear material.
Blood tests are also necessary to make 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 chronic non-inflammatory pelvic pain syndrome is more difficult, since 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 a visual analog pain scale, and the severity of psychological changes is determined using scales to assess anxiety and depression.At the same time, research is needed to detect an infectious agent, since the range of pathogens can be very broad.Instrumental studies include uroflowmetry with determination of residual urinary volume and transrectal ultrasound examination (TRUS) of the prostate gland.
Asymptomatic prostatitis is detected by histological examination of a prostate biopsy specimen, prescribed for suspected cancer.First, a blood test for prostate specific antigen (PSA) is done.PSA in blood serum appears with hypertrophy and inflammation of the prostate, and normal criteria change with age.This study also helps to exclude the suspicion of a malignant tumor in the prostate.
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 drugs, so bacterial culture is necessary.
Conservative urological treatment may also include acupuncture, phytotherapy, remote shock wave therapy, thermal physiotherapeutic 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 in conditions of minimal risk of infection;
- physical activity;
- elimination of deficiency conditions - hypo- and avitaminosis, mineral deficiency;
- compliance with aseptic conditions and careful technique for performing invasive urological interventions;
- regular preventive examinations using laboratory tests.