Prostatitis is an inflammation of the prostate, one of the common problems in 40% of middle-aged and older men. Without directly endangering life, this disease leads to a significant reduction in quality, affects the ability to work, the intimate sphere, restricts freedom and causes daily difficulties and mental disorders.
Prostatitis occurs in acute or chronic form, can be of infectious and 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 ascending in urological and venereal diseases of infectious nature, chronic prostatitis in 90% of cases is not associated with infections. Stagnation of prostate secretion occurs as a result of infectious inflammation of the canal walls 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 tubing, urocystoscopy).
Provokers of infectious inflammation are usually hypothermia, prolonged constipation or diarrhea, sedentary work, excessive sexual activity or sexual abstinence, chronic venereal and urological diseases, suppression of immune response, lack of sleep, overtraining, chronic stress. . Poor blood supply to the pelvic organs, these factors alone contribute to aseptic inflammation, and also facilitate the introduction of pathogens into prostate tissue.
Acute bacterial inflammation can be withdrawn without sequelae, but in some cases the following complications occur:
- acute urinary retention;
- chronic prostatitis (chronic pelvic inflammatory disease syndrome);
- epididymitis;
- prostate abscess;
- prostate tissue fibrosis;
- infertility.
Causes of chronic prostatitis
In 10% of cases, chronic prostatitis occurs as a complication of acute prostate inflammation, as well as urethritis, chlamydia, human papilloma virus and other chronic infections. About 90% are caused by abacterial chronic prostatitis or chronic pelvic pain syndrome (CPPS). This form of the disease is not associated with infections, but is caused by many reasons, primarily stagnant processes in the small pelvis. Stagnation of urine, which causes inflammation, occurs in the background of urethritis, neurogenic narrowing of the bladder neck, strictures of the urethra, autoimmune inflammation. The blood supply to the pelvic organs worsens, 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 blood testosterone;
- changes in the microbial environment of the body;
- genetic and phenotypic predisposition.
Symptoms of prostatitis
- Fever (from 38-39 degrees Celsius in acute prostatitis and subfebrile condition in chronic).
- Urinary dysfunction: frequent urge to urinate, not always effective, difficulty or increased urination, especially at night. The urine stream is depleted, and there is some residual amount of urine in the bladder all the time.
- Prostate damage: leukocytes and blood in semen, pain during urological examination.
- fibromyalgia.
- Prostatory 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 cramps.
- Prostate stones.
- Chronic fatigue, feelings 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.
- May be accompanied by irritable bowel syndrome, proctitis.
In the chronic course of the disease, the signs of prostatitis are blurred (less pronounced), but they 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 attack 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, inoculation of biological fluids is performed: urine, semen and prostate secretions. This method allows you to choose the drug that is most effective for a particular strain of pathogen, which can penetrate directly into the focus of inflammation.
The "classic" method of laboratory diagnosis of prostatitis is considered cultural (urine, ejaculate, urogenital smear culture). The method is very precise, but time consuming. viruses, mycoplasma and ureaplasma will be detected. To improve the accuracy of the research, mass spectrometry and PCR (polymerase chain reaction) are used. Mass spectrometry is an ionic analysis of the structure of a substance and determination of each of its components. infectious agents, including viruses and plasma.
Currently, a special comprehensive PCR study of the urogenital tract microflora is used for the special examination of urological patients. The test result is ready in one day and reflects the complete picture of the microbial ratio in the subject's body.
Prostatitis tests include urine and ejaculate collection and urological swabs.
The European Urological Association recommends the following set of laboratory tests:
- general urine analysis;
- bacterial culture of urine, semen and ejaculate;
- PCR diagnostics.
General urine analysis allows you to determine the signs of inflammation (number of colonies of microorganisms, number of leukocytes, erythrocytes, urine transparency) and the presence of calcifications (prostate stones). General analysis is included in the method of several urological (glass or portioned) samples.
Glass or portioned samples consist of successive collection of urine or other biological fluids in different containers. This is how the localization of the infectious process is determined. Prostatitis is proven by detecting infectious agents, blood cells (leukocytes and erythrocytes) in the final portion of urine during the three-cup test or after urological prostate massage.
Two-glass test - sowing the middle part of the urine before and after the urological prostate massage.
A sample of three glasses - initial, middle and final portion of urine is taken during the same urination.
Sample of four glasses - culture and general analysis of the initial and middle part of the urinary flow, prostate secretion after urological prostate massage and portion of urine after this procedure.
Cultural seeding or PCR diagnostics of ejaculate and urogenital smear material is also performed.
Blood tests are also needed to diagnose prostatitis. A general capillary blood test allows you to confirm or deny the presence of inflammation, as well as to rule out 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 parameters (including general urine and blood analysis). The intensity of the pain syndrome is determined by a visually analogous scale of pain, and the severity of psychological changes by scales for assessing anxiety and depression. At the same time, research is necessarily being conducted to find an infectious agent, as the spectrum of pathogens can be very wide. From instrumental studies, urofluometry is prescribed with the determination of residual urine volume and transrectal ultrasound (TRUS) of the prostate.
Asymptomatic prostatitis is detected by histological examination of the prostate biopsy, prescribed for suspected cancer. A blood test for prostate-specific antigen (PSA) is performed beforehand. Serum PSA occurs in hypertrophy and inflammation of the prostate, and the criteria for the norm change with age. This study also helps rule out the suspicion 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, nonsteroidal anti-inflammatory drugs, neuromodulators. Several antibiotics can penetrate the prostate, pathogens are immune to some of the drugs, so inoculation with bacteria is necessary.
Conservative urological treatment may include acupuncture, phytotherapy, external shock wave therapy, thermal physiotherapy (after acute inflammation), and massage.
Prevention of prostatitis includes medical manipulations 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 states - hypo- and avitaminosis, mineral deficiency;
- respect for aseptic conditions and careful technique of performing invasive urological interventions;
- regular preventive examinations by laboratory tests.