Prostatitis is an inflammation of the prostate gland, one of the problems found in 40% of middle-aged and older men. Without a direct threat to life, the disease significantly reduces the quality, affects the ability to work, the intimate sphere, restricts freedom and causes daily difficulties and psychological disorders.
Prostatitis can be acute or chronic, and can be infectious or non-infectious.
Causes of prostatitis
The causes of prostatitis are different: the acute form is associated with bacterial infection of the prostate gland in infectious urological and venereal diseases, chronic prostatitis is not associated with infections in 90% of cases. Stagnation of prostate secretion is caused by infectious inflammation of the duct 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 include sexually transmitted diseases and invasive urological interventions (urinary catheterization, instillation and bougienage, urocystoscopy).
Provocateurs of the development of infectious inflammation are usually hypothermia, prolonged constipation or diarrhea, sedentary work, excessive sexual activity or sexual abstinence, chronic course of venereal and urological diseases, suppression of the immune response, lack of sleep, excessive exercise, chronic stress. . Poor blood supply to the pelvic organs, these factors themselves contribute to aseptic inflammation, as well as facilitate the entry of the pathogen into the tissue of the prostate gland.
Acute bacterial inflammation can pass without any results, but in some cases the following complications occur:
- acute urinary retention;
- chronic prostatitis (chronic pelvic inflammatory syndrome);
- epididymitis;
- prostate abscess;
- prostate fibrosis;
- 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% of abacterial infections are associated with chronic prostatitis or chronic pelvic pain syndrome (CPPS). This form of the disease is not associated with infections, but for many reasons, primarily stagnant processes in the small pelvis. Inflammatory urinary stagnation is formed against the background of urethritis, neurogenic narrowing of the bladder neck, narrowing of the urethra, autoimmune inflammation. Blood supply to the pelvic organs deteriorates, which is explained by systemic cardiovascular diseases (coronary artery disease, atherosclerosis). The general venous system of the small pelvis determines the relationship of chronic prostatitis with cracks in the anus, hemorrhoids, proctitis, fistulas.
Chronic pelvic pain in men is associated with:
- low 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 in acute prostatitis and chronic subfebrile condition).
- Urinary incontinence: frequent urination, not always effective, difficulty urinating or increased urination, especially at night. Urine flow is depleted and there is always a certain amount of residue left in the bladder.
- Prostate damage: blood in leukocytes and sperm, pain during urological examination.
- Fibromyalgia.
- The prostate is a small discharge from the urethra.
- Pain in the small pelvis, perineum, testicles, pubis, penis, sacrum, bladder, testicles.
- Painful urination and discharge.
- Convulsive muscle spasms.
- Prostate stones.
- Against the background of chronic pain syndrome, chronic fatigue, feelings of hopelessness, disaster, psychological stress.
- Decreased performance (asthenia), decreased mood, nervousness).
- Sexual dysfunction - erectile dysfunction, premature ejaculation, lack of orgasm.
- Irritable bowel syndrome, proctitis may be associated.
In the chronic course of the disease, the symptoms of prostatitis become blurred (less pronounced), but they are accompanied by general, neurological and mental symptoms.
Diagnosis of prostatitis
The key to successful and timely treatment of prostatitis is an accurate and comprehensive diagnosis. The low rate of infectious prostatitis is often explained by the absence of the pathogen. Chronic sexually transmitted infections can be asymptomatic, their pathogens can penetrate the tissue of the prostate gland 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, biological fluids are inoculated: urine, sperm and prostate secretions. This method allows you to choose a drug that is most effective for a particular strain of the pathogen and can penetrate directly into the center of inflammation.
The "classic" method of laboratory diagnosis of prostatitis is considered culturological (composition of urine, ejaculate, urogenital swab). The method is very accurate, but it takes time. A Gram smear is prepared to detect bacteria, but it is not possible to detect viruses, mycoplasmas and ureaplasma in this way. Mass spectrometry and PCR (polymerase chain reaction) are used to increase the accuracy of the study. Mass spectrometry is the ionic analysis of the structure of a substance and the determination of each of its components. The polymerase chain reaction allows the detection of DNA or RNA fragments of an infectious disease agent, including viruses and plasma.
Currently, for the special examination of urological patients, a special comprehensive study of the microflora of the genitourinary system by PCR is used. The test result is ready in a day and provides a complete picture of the microbial ratio in the subject's body.
Tests for prostatitis include urine and discharge collection and urological smears.
The European Urological Association recommends the following laboratory tests:
- general urinalysis;
- bacterial culture of urine, semen and discharge;
- PCR diagnostics.
General analysis of urine allows to determine the signs of inflammation (number of colony-forming units of microorganisms, number of leukocytes, erythrocytes, transparency of urine) and the presence of calcifications (prostate stones). The general analysis includes the method of several urological (glass or fragmented) samples.
Samples divided into bottles or sections consist of a sequential collection of urine or other biological fluids in different containers. Thus, the localization of the infectious process is determined. Prostatitis is evidenced by the detection of infectious agents, blood cells (leukocytes and erythrocytes) in the last part of the urine during a three-vial test or after urological massage of the prostate.
Two-glass test - culture of the middle part of the urine flow before and after urological massage of the prostate.
Three-glass sample - the initial, middle and last parts of the urine are taken during the same urination.
Four-glass sample - culture and general analysis of the primary and middle parts of the urine flow, prostate secretion after urological massage of the prostate, and part of the urine after this procedure.
Diagnosis of ejaculation and urogenital smear material by culture or PCR is also performed.
Blood tests are also required to diagnose prostatitis. A general analysis of capillary blood allows you to confirm or deny the presence of inflammation, as well as 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 analysis of urine and blood). The intensity of pain syndrome is determined by a visual analog scale of pain, and the severity of psychological changes is determined by a scale to assess anxiety and depression. At the same time, the spectrum of pathogens can be very wide, so research is needed to find an infectious agent. From instrumental studies, urofluometry is determined by the establishment of residual urine volume and transrectal ultrasound of the prostate gland (TRUS).
Asymptomatic prostatitis is detected by histological examination of the prostate biopsy, which is prescribed for suspected cancer. A blood test for Prostate Specific Antigen (PSA) is performed in advance. Serum PSA occurs with hypertrophy and inflammation of the prostate, and the criteria for the norm change with age. This study also helps rule out suspicions of prostate cancer.
Treatment and prevention of prostatitis
Acute prostatitis is treated with antibiotics (fluoroquinolones and cephalosporins, macrolides), alpha-blockers, non-steroidal anti-inflammatory drugs, neuromodulators. A small number of antibiotics can penetrate the prostate gland, pathogens are immune to some drugs, so bacterial vaccination is necessary.
Conservative urological treatment may also include acupuncture, phytotherapy, external shock wave therapy, thermal physiotherapy (after acute inflammation), and massage.
Prevention of prostatitis includes both medical manipulations and the formation of healthy habits:
- use of barrier contraception;
- regular sexual activity to minimize the risk of infection;
- physical activity;
- elimination of deficiencies - hypo- and avitaminosis, mineral deficiency;
- compliance with aseptic conditions and careful techniques for invasive urological interventions;
- regular preventive examinations using laboratory tests.