Prostatitis is an inflammation of the prostate gland, one of the common problems in 40% of middle-aged and elderly men.Without directly threatening life, this disease leads to a significant reduction in its quality, affecting performance, the intimate sphere, limiting freedom and causing daily difficulties and psychological disturbances.
Prostatitis occurs in acute or chronic form and can be of infectious or non-infectious origin.
Causes of prostatitis
The causes of prostatitis vary: the acute form is associated with a bacterial infection that enters the prostate gland through the ascending tract during urological and venereal diseases of an infectious nature, chronic prostatitis in 90% of cases is not associated with infections.Stagnation of prostate secretion is formed both as a result of infectious inflammation of the walls of the ducts and as a result of 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).
Triggers 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, immune suppression, lack of sleep, excessive training, chronic stress.By worsening the blood supply to the pelvic organs, these same factors contribute to aseptic inflammation and also facilitate the introduction of the pathogen into the prostate tissue.
Acute bacterial inflammation can subside 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 prostate 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.About 90% are due to non-bacterial chronic 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.Urinary stasis, which causes inflammation, is formed in the context 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:
- low physical activity;
- low levels of testosterone in the blood.
- changes in the body's microbial environment.
- genetic and phenotypic predisposition.
Symptoms of prostatitis
- Fever (from 38-39 degrees Celsius for acute prostatitis and low fever 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 pelvis, perineum, testicles, over pubis, penis, sacrum, bladder, scrotum.
- Painful urination and ejaculation.
- Spastic muscle spasms.
- Stones in the prostate gland.
- Chronic fatigue, feeling of hopelessness, destruction, psychological stress in the context of chronic pain syndrome.
- Decreased performance (illness), 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 intense), but accompanied by general, neurological and mental symptoms.
Diagnosis of prostatitis
The key to successful and timely treatment of prostatitis is accurate and comprehensive diagnosis.The low rate 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, semen, prostate secretions.This method allows you to choose a drug that is more effective for a specific pathogen strain, able to penetrate directly to the site of inflammation.
The "classic" method of laboratory diagnosis of prostatitis is considered cultural (urine culture, ejaculation, content of urogenital smears).The method is very accurate, but it takes time.To detect bacteria, a smear is stained with Gram stain, but in this way viruses, mycoplasma and ureaplasma are unlikely to be detected.To increase the accuracy 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 system is used.The result of the study is ready in one day and reflects the complete picture of the microbial ratio in the examinee's body.
Tests for prostatitis include urine and ejaculate collection and urological swabs.
The European Society of Urology recommends the following series of laboratory tests:
- general urinalysis;
- bacterial culture of urine, semen and ejaculation.
- PCR diagnosis.
A general urinalysis allows you to determine signs of inflammation (number of units of colony-forming microorganisms, number of leukocytes, red blood cells, clarity of urine) and the presence of calcifications (prostate stones).General analysis is included in the methodology of many urological specimens (glass or aliquot).
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 part of the urine during a three-glass sample or after urological massage of the prostate
Two-pane test - inoculation of the middle part of the urinary stream before and after urological massage of the prostate.
Three-cup sample - the initial, middle and final portions of urine are taken during the same voiding.
Four-slide test - culture and general analysis of the initial and middle parts of the urine stream, prostate secretion after urological prostate massage and a portion of urine after this procedure.
They also perform culture culture or PCR diagnosis of ejaculate material and urogenital swab.
Blood tests are also required to diagnose prostatitis.A general capillary blood test allows you to confirm or refute the presence of inflammation, as well as exclude other diagnoses that cause the same symptoms.
The diagnosis of non-inflammatory chronic pelvic pain syndrome is more difficult, as 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 for the assessment of anxiety and depression.At the same time, research is needed to look for an infectious agent, since the range of pathogens can be very wide.Instrumental studies include urofluorometry with determination of residual urine volume and transrectal ultrasonography (TRUS) of the prostate gland.
Asymptomatic prostatitis is detected by histological examination of a prostate biopsy sample, which is prescribed for suspected cancer.A blood test for Prostate Specific Antigen (PSA) is first performed.Serum PSA occurs with prostatic hypertrophy and inflammation, and the normal criteria change with age.This study also helps 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 are able to penetrate the prostate gland.Pathogens are immune to some drugs, so bacterial culture is necessary.
Conservative urological treatment may also include acupuncture, herbal therapy, remote shock wave therapy, thermal physiotherapy 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 minimized risk of infection.
- physical activity;
- elimination of deficiency conditions - hypo- and vitamin deficiency, mineral deficiency.
- adherence to aseptic conditions and careful technique for performing invasive urological procedures.
- regular preventive examinations using laboratory tests.