Prostatitis is an inflammatory disease of the prostate gland (prostate gland) in men, which negatively affects both sexual function and urination. Pain in the perineum, groin, back and pelvis, urodynamic disorders (urine flow) may indicate the presence of prostatitis. Untreated prostatitis can lead to male infertility and prostate cancer.
It is one of the most common male diseases that requires careful attention and competent systemic treatment. To solve the problem of prostatitis, you can find this approach in the urology department of a professional clinic. Highly qualified urologists and 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 stable long-term remission.
Don't spread
Prostatitis ranks 5th among 20 main urological diagnoses. It is estimated that at the age of 30, 30% of the male population suffers from prostatitis, at the age of 40 - 40%, and after 50 years, almost all men bear the burden of this disease in one way or another. If mainly infectious prostatitis is recorded up to 35 years of age, the non-infectious form predominates in older age and is generally diagnosed several times more often than bacterial inflammation of the prostate.
Anatomy and physiology of the prostate gland
The prostate gland (prostate) is located in the front lower part of the 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, where the ejaculatory ducts open.
The prostate is a hormone-dependent organ. It is formed and functions 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 erection pass through the gland. In the chronic course of the disease, they participate in the inflammatory process and develop erectile dysfunction.
The prostate produces a secret that is part of the sperm. Creates favorable conditions for the activity of spermatozoa. Therefore, male infertility can be observed with chronic dysfunction of the gland.
Pathogenesis
There are two main reasons for the development of prostatitis:
- stagnation of prostate secretion against the background of impaired blood circulation and lymph flow in the gland itself and neighboring organs;
- pathogenic and conditionally pathogenic microflora.
Acute prostatitis is usually associated with an infection of the prostate tissue. However, as a rule, both factors are related to each other and together they create a vicious circle that complicates the treatment of prostatitis.
An inflamed prostate is painful. Pain can be felt in the perineum, groin, pelvis, lower back. It increases sharply during rectal digital examination or palpation during defecation.
The size of the prostate increases, compressing the urethra. Thus, it becomes difficult to pass urine from the bladder. The flow of urine weakens. In order for urination to occur, the patient must tense the abdominal muscles. In acute cases, urinary tract obstruction and acute urinary retention sometimes occur.
Inflammation causes a violation of the flow of prostate juice and its stagnation. As a result, cell metabolism and respiratory processes are disrupted in the gland. This allows the process to be synchronized. With prolonged prostatitis, neighboring organs can also be inflamed: 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 become known that in 70-80% of cases, prostatitis occurs as a result of the stagnation of processes in the gland. Venous disorders are less common, but they also cause prostatitis, especially if accompanied by hemorrhoids and varicocele on the left (enlargement of the testicular vein).
Classification
The American National Institutes of Health defines 4 categories of prostatitis:
- Acute prostatitis (category I)
- Chronic bacterial prostatitis (category II)
- Chronic Prostatitis / Chronic Pelvic Pain Syndrome (Category III)
- Symptomatic chronic prostatitis (category IV)
According to the occurrence of prostatitis, it is divided into two types:
- non-infectious
- Infectious
The inflammatory process can develop rapidly, be accompanied by bright symptoms (acute phase) or the gradually increasing symptoms disappear.
Non-infectious prostatitisin most cases, it is associated with stagnation of prostate gland secretion and disruption of blood circulation and lymph flow in the gland itself and 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 that the infection can enter the prostate:
- Urinogenic (high): portal of entry is the urethra. It should be noted that the infection can go downstream, for example, with purulent pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
- Lymphogenic: infection from neighboring pelvic organs can enter the prostate through lymph due to inflammation of the rectum (proctitis) or bladder (cystitis), as well as infected hemorrhoidal vessels.
- Hematogenous (through the blood): due to the presence of chronic infection foci (tonsillitis, rotten teeth) or complications of acute infections (flu, acute respiratory infections, tonsillitis, etc. ) in the body.
The most common causes 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).
According to the nature of the course, prostatitis occurs:
- spicy
- Chronic
Acute prostatitisusually occurs under the influence of pathogenic (conditionally pathogenic) microflora in the presence of predisposing factors. It has a rapid course and clear symptoms. If not treated in time, a purulent process can develop, which causes the tissues of the prostate gland to dissolve. With incorrect treatment, acute prostatitis often becomes chronic.
Chronic prostatitishas a milder course, the symptoms disappear. However, it may worsen 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 feel constant discomfort. Chronic prostatitis can lead to impotence, male infertility, adenoma or prostate cancer.
The patient has a chronic asymptomatic form of the disease without any complaints, but with an increase in the amount of purulent elements (leukocytes) in the prostate secretion.
Complications
Without appropriate therapy, the inflammatory process can lead to purulent union of prostate tissues. Moreover, inflammation can spread to nearby organs: seminal tubercle, Cooper's glands, seminal vesicles, urethra. Accordingly, the following complications may occur:
- prostate abscess
- Sclerosis / fibrosis of the prostate (functional tissue of the gland is replaced by connective tissue)
- prostate cysts
- prostate stones
- Vesiculitis (inflammation of the seminal vesicles)
- Colliculitis (inflammation of the tubercle of the sperm)
- Epididymorchitis (inflammation of the testes and their appendages)
- Posterior urethritis
- Erectile dysfunction / impotence
- Ejaculation disorder
- Infinity
- Prostate adenoma
- 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 (can spread along the spermatic cord).
- Pain increases with defecation, digital rectal examination.
- Violation of urodynamics (frequent urination, urinary retention, difficulty urinating, weak flow, incomplete emptying of the bladder).
- Prostatorrhea (involuntary discharge of prostate juice, especially in the morning and during bowel movements).
- Sexual dysfunction (decrease in libido, erectile dysfunction, infertility).
Symptoms of acute prostatitis
- Temperature rise to 39-40 degrees
- Urinary incontinence
- General intoxication
- Leukocyturia, protein and mucus in the urine
- Blood in urine and semen
- Leukocytosis in prostate 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 dulled and smoothed
- Urethral discharge during bowel movements
- Disturbance of urination
- Decreased libido
- erectile dysfunction
- Ejaculation disorders (early or delayed ejaculation)
The reasons
The main reasons for the development of prostatitis are infections and stagnation of prostate secretion. 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 leads to exhaustion of the glands
- Alcohol abuse
- Reduction of local immunity (hypothermia, use of immunosuppressants, immunodeficiency, autoimmune diseases)
- Damage to the pelvic organs
- Manipulations to the prostate gland and nearby organs (biopsy of the prostate gland, surgery, catheterization, cystoscopy, etc. )
- Chronic diarrhea or constipation
Diagnostics
Many methods are used to detect prostatitis, which can be divided into 3 groups: digital rectal examination, laboratory tests and instrumental methods.
Digital rectal examinationit is conducted by a urologist-andrologist after a conversation with the patient. This method allows to evaluate the size, shape and some features of the structure of the prostate gland. If the size of the prostate has increased and the procedure itself is painful for the patient, the doctor can initially diagnose prostatitis.
If the condition is not acute, during the examination, the doctor can massage the prostate to obtain prostate secretions, the study of which is an important link in the diagnosis of prostatitis. If acute bacterial prostatitis is suspected, prostate massage is contraindicated: such manipulation can lead to the spread of the pathogen and blood poisoning.
Examination of the patient will be required to clarify the diagnosisinstrumental research, whom:
- 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 bladder);
- uroflowmetry (determining the speed and time of urination);
- magnetic resonance imaging of the pelvic organs (a highly informative and safe study that allows differential diagnosis with other diseases).
If necessary, diagnostics of nearby organs of the genitourinary system are carried out: ureteroscopy, urethrography and urethrocystography.
Laboratory researchis a necessary component of the diagnosis of prostatitis:
- Urinalysis (before and after prostate massage)
- General blood analysis
- Blood test for proteins of the acute phase of inflammation (C-reactive protein, etc. )
- Microscopic examination of prostate secretion after finger massage
- Microscopic examination of a scrap from the urethra
- Spermogram (cytology and biochemistry of sperm)
- Urine, prostatic secretion and sperm culture
- Determination of prostate specific antigen (PSA).
- Prostate puncture biopsy and histological examination of gland tissues
The last two studies are necessary to rule out prostate cancer or adenoma.
It has a modern excellent highly informative diagnostic database. Urologists have extensive experience in diagnosing and successfully treating 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 necessary types of diagnostics at a very attractive price.
Treatment
Treatment of prostatitis is not an easy task. This requires a thoughtful, integrated approach. The treatment protocol for this disease includes drug therapy and physiotherapy, in some cases surgical intervention is required.
Medical therapy
This involves the use of the following drugs:
- Antibiotics (after determining sensitivity to them)
- Antiseptics (local)
- Vascular preparations (improving microcirculation in the prostate)
- Non-steroidal anti-inflammatory drugs
- Alpha-1-adrenergic blockers (with urinary disorders)
- Enzyme preparations (thins the secret of the prostate, stimulates the immune system, eliminates inflammation)
- Immunomodulators
- Antidepressants
Physiotherapy treatment
- Electrical stimulation of the prostate (electrophoresis, galvanization, pulse exposure)
- Vibro massage
- Rectal sensor laser therapy (for chronic prostatitis)
Prostate massage can be used as a treatment procedure in chronic prostatitis. In the acute stage of the disease, this manipulation is not carried out to prevent the spread of infection and sepsis.
Surgical treatment
Surgery is rarely used for prostatitis. Such a need arises in the case of severe suppuration of prostate tissue, lack of positive dynamics for drug treatment, and pathological enlargement of the prostate gland blocking the urethra.
Forecast
Acute prostatitis can be overcome with early diagnosis and adequate treatment. But often the chronization of the process occurs even with correct and timely therapy.
With improper treatment and non-compliance with treatment conditions (this is several months), the disease, as a rule, takes a chronic course. Chronic prostatitis greatly affects a person's quality of life, because not only urine, but also sexual function suffers. In 30% of cases, erectile dysfunction, rapid orgasm, ejaculation problems, infertility are observed. Chronic prostatitis cannot be completely cured, but with the right approach, you can achieve stable remission.
Benefits of going to a professional clinic
- Successful treatment of various forms of prostatitis
- The most highly qualified experienced urologists and andrologists
- Multidisciplinary, allows to involve specialists in relevant fields in treatment
- High-precision modern diagnostic and treatment equipment
- Own clinical diagnostic laboratory of European class
- Comfortable and high-tech hospitals
- A package of urological diagnostic services at an affordable 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
- Live an active lifestyle
- If possible, have regular sex with a partner (to avoid prostate congestion)
- Avoid having sex (this will get rid of sperm stasis)
- For preventive purposes, see a urologist once a year, if you are over 50 years old or if you have a history of prostate disease, 2 times a year.
Frequently asked 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 differential diagnosis between these two diseases. Don't bet on PSA, though. This antigen also rises with prostate adenoma - a good growth of glandular tissue. With prostatitis, PSA levels can also rise during periods of active inflammation. It decreases during the remission phase. Therefore, PSA cannot be used as absolute proof of prostate cancer or prostatitis.
Why is prostatitis difficult to treat?
Prostate capillaries have a special structure that creates a hematoprostatic barrier. This makes it difficult for some types of antibiotics to penetrate the tissues of the gland. In addition, microorganisms form biofilms that reliably protect them from the effects of antibacterial agents. Therefore, modern protocols for the treatment of prostatitis necessarily include proteolytic enzymes that can destroy biofilms. Bacteria become sensitive and antibiotics work more effectively. The most stubbornly treated chronic prostatitis, the main feature of which is the presence of different microflora in the product. Enterococcus faecalis is cultivated in about 50% of cases, it is resistant to all aminoglycosides and cephalosporins. This narrows the list of effective antimicrobial agents, which complicates treatment.