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Prostatitis

symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the prostate gland (prostate) in men, which has a negative impact on both sexual function and the process of urinating. Pain in the perineum, groin, lumbar and pelvic area, urodynamic disturbances (urine output) may indicate the presence of prostatitis. Untreated prostatitis in time can cause male infertility and prostate cancer.

This is one of the most common male ailments, which requires careful attention and competent systemic treatment. It is this approach to solving the problem of prostatitis that you will find in the urology department of a professional clinic. Highly qualified urologists-andrologists have been successfully treating acute and chronic prostatitis for many years. Complex therapy, attentive attitude and individual approach to each case inevitably lead patients to recovery and long-term stable remission.

Predominance

Prostatitis ranks fifth among the top 20 urologic diagnoses. It is believed that at the age of 30, 30% of the male population suffers from prostatitis, at 40 - 40%, and after 50, almost all men in one way or another bear the burden of this sickness. And if until the age of 35 predominantly infectious prostatitis is recorded, then at a more mature age the non-infectious form prevails, and in general it is diagnosed several times more often than bacterial inflammation of the prostate.

Anatomy and physiology of the prostate.

The prostate gland (prostate) is located in the lower front part of the small pelvis below the bladder. It consists of glandular and smooth muscle tissue, surrounded by a fibrous capsule. The urethra passes through the body of the prostate from the bladder, into which the ejaculatory ducts open.

The prostate is a hormone dependent organ. It is formed and works under the influence of male hormones - androgens. Testosterone plays a key role in this process.

The prostate gland is associated with the seminal tubercle, which acts as a valve for the ejaculatory duct. As part of the male reproductive system, the prostate affects erection, ejaculation, and orgasm. The nerves responsible for the erection pass through the gland. In the chronic course of the disease, they are involved in the inflammatory process, and erectile dysfunction develops.

The prostate produces a secret that is part of the semen. Creates favorable conditions for the activity of sperm. Therefore, with chronic dysfunction of the gland, male infertility can be observed.

pathogenesis

There are two main reasons for the development of prostatitis:

  • stagnation of prostate secretion against the background of circulatory disorders and outflow of lymph in the gland and neighboring organs;
  • pathogenic and conditionally pathogenic microflora.

Acute prostatitis is usually associated with an infection of the prostate tissue. But, as a rule, both factors are interrelated and together they create a vicious circle that makes it difficult to treat prostatitis.

The swollen prostate becomes painful. Pain can be felt in the perineum, groin, pelvis, lower back. It increases sharply on palpation during digital rectal examination or defecation.

The prostate enlarges, constricting the urethra. Therefore, the outflow of urine from the bladder becomes difficult. The urine stream becomes weak. The patient has to tense the abdominal muscles for the act of urination to occur. In acute cases, there may be obstruction of the urinary tract and acute urinary retention.

Inflammation leads to a violation of the outflow of prostate juice and its stagnation. The resulting edema disrupts the processes of cell metabolism and respiration in the gland. This creates the conditions for the chronization of the process. With prolonged prostatitis, neighboring organs can also become inflamed: the seminal tubercle, Cooper's glands, seminal vesicles. The chronic form of the disease is associated with the risk of developing male infertility, adenoma and prostate cancer.

In recent years, it has been found that in 70-80% of cases, prostatitis occurs due to stagnant processes in the gland. Venous disorders are less frequent, but they can also cause prostatitis, especially if they are accompanied by hemorrhoids and varicocele on the left side (expansion of the testicular vein).

Classification

The US National Institutes of Health identify 4 categories of prostatitis:

  • Acute prostatitis (Category I)
  • Chronic bacterial prostatitis (Category II)
  • Chronic Prostatitis / Chronic Pelvic Pain Syndrome (Category III)
  • Asymptomatic chronic prostatitis (Category IV)

Due to the appearance of prostatitis is divided into two types:

  • non-infectious
  • Infectious

The inflammatory process can develop rapidly, accompanied by vivid symptoms (acute stage), or slowly with the gradual disappearance of symptoms.

non-infectious prostatitisin most cases, it is associated with stagnation of the secretion of the prostate gland and impaired blood circulation and lymph flow in the gland itself and in nearby organs.

infectious prostatitisdevelops due to the penetration of pathogenic or conditionally pathogenic microflora into the tissues of the prostate gland: bacteria, viruses, fungi. There are different ways for the infection to enter the prostate:

  • Urinogenic (ascending): the entrance door is the urethra. It should be noted that the infection can also develop downstream, for example, with purulent pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphogenic: Infection of neighboring pelvic organs can enter the prostate through lymph due to inflammation of the rectum (proctitis) or bladder (cystitis), as well as infected hemorrhoidal veins.
  • Hematogenous (through the blood): due to the presence in the body of foci of chronic infection (tonsillitis, carious teeth) or complications of acute infections (flu, acute respiratory infections, tonsillitis, etc. ).

The most common causative agents of prostatitis are:

  • bacteria: E. coli, Proteus, gardnerella (gram-negative); staphylococci, streptococci (gram positive);
  • viruses (influenza, herpes, cytomegalovirus, ARVI pathogens);
  • mycoplasma;
  • chlamydia;
  • specific flora (gonococcus, Trichomonas, Mycobacterium tuberculosis).

By the nature of the course, prostatitis occurs:

  • Spicy
  • Chronic

acute prostatitisit usually occurs under the influence of pathogenic (conditionally pathogenic) microflora in the presence of predisposing factors. It has a rapid course and pronounced symptoms. If it is not cured in time, a purulent process can develop, leading to the fusion of the tissues of the prostate gland. With improper treatment, acute prostatitis often becomes chronic.

chronic prostatitishas a milder course, symptoms erased. However, it can be aggravated from time to time, and then the symptoms will correspond to an acute process. At the same time, complete remission does not always occur between exacerbations, and the patient may constantly feel discomfort. Chronic prostatitis can cause impotence, male infertility, adenoma or prostate cancer.

There is a chronic asymptomatic form of the disease, when the patient has no complaints, but there is an increased number of purulent elements (leukocytes) in the prostatic secretion.

complications

Without proper therapy, the inflammatory process can lead to a purulent melting of the prostate tissues. Also, inflammation can spread to nearby organs: the seminal tubercle, Cooper's glands, seminal vesicles, urethra. Consequently, the following complications may occur:

  • prostatic abscess
  • Sclerosis/fibrosis of the prostate (the functional tissue of the gland is replaced by connective tissue)
  • prostate cysts
  • prostate stones
  • Vesiculitis (inflammation of the seminal vesicles)
  • Colliculitis (inflammation of the seminal tubercle)
  • Epididymorchitis (inflammation of the testicles and their appendages)
  • posterior urethritis
  • erectile dysfunction / impotence
  • ejaculation disorder
  • Sterility
  • prostate adenomas
  • prostate cancer

Symptoms

Different forms of prostatitis have their own characteristics of the course and severity of symptoms. In general, prostatitis is characterized by the following manifestations:

  • Pain in the groin, lower back, perineum (may radiate along the spermatic cord).
  • The pain increases with defecation, digital rectal examination.
  • Violation of urodynamics (frequent urination, urinary retention, difficulty urinating, weak flow, incomplete emptying of the bladder).
  • Prostatorrhoea (involuntary secretion of prostate juice, especially in the morning and during bowel movements).
  • Sexual function disorders (decreased libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • Temperature rise to 39-40 degrees
  • acute urinary retention
  • generalized intoxication
  • Leukocyturia, protein and mucus in the urine
  • Blood in urine and semen
  • Leukocytosis in prostatic secretion
  • Hypoechogenicity and enlargement of the gland, increased blood flow according to ultrasound

Symptoms of chronic prostatitis

  • Body temperature is usually not higher than 37C
  • Pain sensations are attenuated and softened
  • Discharge from the urethra during bowel movements.
  • micturition disorders
  • decreased libido
  • erectile dysfunction
  • Ejaculation disorders (premature or delayed ejaculation)

The reasons

The key reasons for the development of prostatitis are infections and stagnation of secretion from the prostate. The following factors contribute to the appearance of prostatitis:

  • Infections and opportunistic flora with weakened immunity
  • hypodynamia
  • "Sedentary work
  • prolonged sexual abstinence
  • Coitus interruptus (with delayed ejaculation)
  • Excessive sexual activity leading to exhaustion of the glands
  • Alcohol abuse
  • Decreased local immunity (hypothermia, use of immunosuppressants, immunodeficiency, autoimmune diseases)
  • Pelvic organ injuries
  • Manipulations on the prostate and nearby organs (prostate biopsy, surgery, catheterization, cystoscopy, etc. )
  • Chronic diarrhea or constipation

Diagnosis

To detect prostatitis, many methods are used, which can be divided into 3 groups: digital rectal examination, laboratory tests and instrumental methods.

digital rectal examperformed by a urologist-andrologist after a conversation with the patient. This method allows you to assess the size, shape and some features of the structure of the prostate. If the size of the prostate increases, and the procedure itself is painful for the patient, the doctor can preliminarily diagnose prostatitis.

If the case is not acute, the doctor may perform prostate massage during the examination to obtain prostatic secretion, the study of which is an important link in the diagnosis of prostatitis. If there is a suspicion of acute bacterial prostatitis, prostate massage is contraindicated: such manipulation can lead to the spread of the pathogen and blood poisoning.

To clarify the diagnosis, the patient will be asked to undergoinstrumental research, What:

  • transrectal ultrasound examination of the prostate and pelvic organs (reveals structural features, the presence of inflammation and purulent foci, stones, cysts and other neoplasms);
  • dopplerography (characteristics of blood flow in the gland);
  • uroflowmetry (determination of the speed and time of the act of urination);
  • MRI of pelvic organs (a very informative and safe study that allows differential diagnosis with other diseases).

If necessary, diagnostics of nearby organs of the genitourinary system are performed: ureteroscopy, urethrography and urethrocystography.

laboratory researchare a necessary component of the diagnosis of prostatitis:

  • Urinalysis (before and after prostate massage)
  • General blood tests
  • Blood tests for proteins of the acute phase of inflammation (C-reactive protein, etc. )
  • Microscopic examination of prostatic discharge after finger massage
  • Microscopic examination of a scraping from the urethra
  • Spermogram (cytology and biochemistry of sperm)
  • Culture of urine, prostatic secretion and semen
  • Determination of prostate specific antigen (PSA)
  • Punch biopsy of the prostate and histological examination of the glandular tissues.

The last two studies are necessary to rule out prostate cancer or adenoma.

The modern has an excellent highly informative diagnostic base. Urologists have extensive experience in the successful diagnosis and treatment of various forms of prostatitis, and the status of a multidisciplinary clinic allows you to use the services of related specialists. The medical center has developed research packages that include all types of diagnostics needed at a very attractive price.

Treatment

Treatment of prostatitis is not an easy task. It requires a thoughtful and integrated approach. The treatment protocol for this disease includes pharmacotherapy and physiotherapy, in some cases surgery is required.

medical therapy

It involves the use of the following drugs:

  • Antibiotics (after determining sensitivity to them)
  • Antiseptics (locally)
  • Vascular preparations (improvement of microcirculation in the prostate)
  • Non-steroidal anti-inflammatory drugs
  • Alpha-1-adrenergic blockers (in violation of urination)
  • Enzyme preparations (thin the secret of the prostate, stimulate the immune system, relieve inflammation)
  • Immunomodulators
  • antidepressants

physiotherapy treatment

  • Electrical stimulation of the prostate (electrophoresis, galvanization, pulse exposure)
  • vibromassage
  • Rectal sensor laser therapy (for chronic prostatitis)

In chronic prostatitis, prostate massage can be used as a treatment procedure. In the acute stage of the disease, this manipulation is not carried out in order to avoid the spread of infection and sepsis.

surgical treatment

Surgery is rarely used for prostatitis. Such a need arises in case of severe suppuration of prostate tissues, the absence of positive dynamics for drug treatment, and pathological enlargement of the prostate that blocks the urethra.

Forecast

With early diagnosis and proper treatment, acute prostatitis can be overcome. However, very often the chronization of the process occurs even with correct and timely therapy.

With improper treatment and non-compliance with the terms of treatment (this is several months), the disease, as a rule, takes a chronic course. Chronic prostatitis greatly affects the quality of life of a man, because not only urinary function suffers, but also sexual. Erectile dysfunction, loss of orgasmic acuity, ejaculation problems and infertility are observed in 30% of cases. It is completely impossible to cure chronic prostatitis, but with the right approach, you can achieve a stable remission.

Benefits of going to a professional clinic

  • Successful treatment of various forms of prostatitis.
  • Experienced urologists-andrologists of the highest qualification
  • Multidisciplinary, allowing the involvement of specialists in related areas in the treatment
  • Modern high-precision diagnostic and treatment equipment.
  • European-class clinical diagnostic laboratory
  • Comfortable and high-tech hospitals
  • A package of urological diagnostic services at an attractive price

Prevention of prostatitis

  • Choose safe sex to avoid sexually transmitted infections (STIs)
  • Support the immune system (vitamins, healthy nutrition, prevention of dysbacteriosis, reasonable antibiotic therapy, etc. )
  • avoid hypothermia
  • Lead an active lifestyle
  • Have sex regularly, if possible, with only one partner (to avoid prostate engorgement and STIs)
  • Avoid coitus interruptus (this will eliminate sperm stasis)
  • See a urologist once a year for preventive purposes and 2 times a year if you are over 50 or have a history of prostate disease.

Frequent questions

How informative is the PSA test in the diagnosis of prostatitis?

Prostate-specific antigen (PSA) is a marker for prostate cancer. It is known that in some cases prostate cancer has a clinical picture similar to the manifestations of prostatitis. Therefore, the PSA test is used for the differential diagnosis between these two diseases. However, do not bet on PSA. This antigen is also increased with prostate adenoma, a benign growth of glandular tissue. With prostatitis, PSA levels can also rise during periods of active inflammation. In the remission phase, it decreases. Therefore, PSA cannot be used as unconditional evidence of prostate cancer or prostatitis.

Why is prostatitis difficult to treat?

Prostatic capillaries have a special structure that creates a hematoprostatic barrier. This makes it difficult for some types of antibiotics to penetrate the gland tissues. In addition, microorganisms tend to form biofilms that reliably protect them from the action of antibacterial agents. Therefore, modern protocols for the treatment of prostatitis necessarily include proteolytic enzymes that can destroy biofilms. The bacteria become vulnerable and the antibiotics work more effectively. The most stubbornly treated chronic prostatitis, the key feature of which is a wide variety of microflora in culture. In about 50% of cases, Enterococcus faecalis, resistant to all aminoglycosides and cephalosporins, is sown. This reduces the list of effective antimicrobial agents, which also complicates treatment.