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prostatitis

symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the prostate (prostate) in men, which has a negative impact on both sexual function and the urination process. Pain in the perineum, groin, lower back and pelvic region, urodynamic disturbances (urine flow) may indicate the presence of prostatitis. Prostatitis not treated in a timely manner can cause male infertility and prostate cancer.

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

prevalence

Prostatitis ranks 5th among the top 20 urological diagnoses. It is believed that by the age of 30, 30% of the male population suffers from prostatitis, by the age of 40 - 40%, and after 50 years, almost all men in one way or another bear the burden of this disease. And if up to 35 years predominantly infectious prostatitis is recorded, at a more mature age the non-infectious form prevails and, in general, is diagnosed several times more often than bacterial inflammation of the prostate.

Anatomy and physiology of the prostate

The prostate (prostate) is located in the lower front part of the small pelvis under the bladder. It consists of glandular tissue and smooth muscle, surrounded by a fibrous capsule. The urethra passes through the body of the prostate gland to 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 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 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 sperm activity. Therefore, with chronic gland dysfunction, 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 lymphatic flow in the gland itself and neighboring organs;
  • pathogenic and conditionally pathogenic microflora.

Acute prostatitis is usually associated with 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 inflamed prostate becomes painful. Pain can be felt in the perineum, groin, pelvis, lower back. It increases markedly on palpation during digital rectal examination or defecation.

The prostate increases in size, compressing the urethra. Thus, the output of urine from the bladder becomes difficult. Urine flow becomes weak. The patient has to stretch the abdominal muscles for urination to take place. In acute cases, there is sometimes urinary tract obstruction and acute urinary retention.

Inflammation leads to a violation of the output of juice from the prostate and its stagnation. The resulting edema interrupts the processes of cellular 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 diseases are less common but also cause prostatitis, particularly if accompanied by hemorrhoids and a left varicocele (expansion of the testicular vein).

Classification

The American National Institutes of Health identifies 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 occurrence of prostatitis is divided into two types:

  • non-infectious
  • Infectious

The inflammatory process may develop rapidly, accompanied by vivid symptoms (acute phase), or slowly, with gradually fading symptoms.

non-infectious prostatitisin most cases, it is associated with stagnation of prostate secretion 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 prostate tissues: bacteria, viruses, fungi. There are different ways for the infection to enter the prostate:

  • Urinogenic (ascending): the gateway is the urethra. It should be noted that the infection can also be 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 the 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, dental caries) 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 happens:

  • Spicy
  • chronicle

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

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

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

complications

Without adequate therapy, the inflammatory process can lead to purulent fusion of prostate tissues. In addition, the inflammation can spread to nearby organs: the seminal tubercle, Cooper's glands, seminal vesicles, urethra. Thus, the following complications can occur:

  • prostate abscess
  • Prostate sclerosis/fibrosis (functional gland tissue is replaced by connective tissue)
  • prostate cysts
  • prostate stones
  • Vesiculitis (inflammation of the seminal vesicles)
  • Colliculitis (inflammation of the seminal tubercle)
  • Epididymoorchitis (inflammation of the testicles and their appendages)
  • posterior urethritis
  • Erectile Dysfunction / Impotence
  • Ejaculation Disorder
  • Infertility
  • 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 groin, lower back, perineum (may radiate along the spermatic cord).
  • Pain increases with defecation, rectal examination.
  • Violation of urodynamics (frequent urination, urinary retention, difficulty urinating, weak stream, incomplete emptying of the bladder).
  • Prostatorrhea (involuntary secretion of juice from the prostate, especially in the morning and during bowel movements).
  • Disorders of sexual function (decreased libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

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

Symptoms of chronic prostatitis

  • Body temperature is usually no higher than 37C
  • Pain sensations are dulled and soothed
  • Discharge from the urethra during bowel movements
  • Urination disorders
  • Decreased libido
  • erectile dysfunction
  • Ejaculation disorders (early or late 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 leading to gland depletion
  • alcohol abuse
  • Decreased local immunity (hypothermia, use of immunosuppressants, immunodeficiencies, 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 makes it possible to evaluate the size, shape and some characteristics of the structure of the prostate. If the size of the prostate is enlarged and the procedure itself is painful for the patient, the doctor can make a preliminary diagnosis of prostatitis.

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

To clarify the diagnosis, the patient will beinstrumental research, as:

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

If necessary, the diagnosis of organs close to the genitourinary system is carried out: ureteroscopy, urethrography and cystourethrography.

laboratory researchare a necessary component of diagnosing prostatitis:

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

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

The modern has an excellent, highly informative diagnostic base. Urologists have extensive experience in successfully diagnosing and 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 types of necessary diagnoses at a very attractive price.

Treatment

Treating prostatitis is not an easy task. It requires a thoughtful and integrated approach. The treatment protocol for this disease includes drug therapy and physical therapy, in some cases surgery is required.

medical therapy

It involves the use of the following medications:

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

physiotherapy treatment

  • Electrical stimulation of the prostate (electrophoresis, electroplating, 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 phase of the disease, this manipulation is not performed to prevent the spread of infection and sepsis.

Surgical treatment

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

Prediction

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

With improper treatment and non-compliance with the terms of treatment (this is several months), the disease, as a rule, follows a chronic course. Chronic prostatitis greatly affects a man's quality of life, because not only urinary but also sexual function suffers. In 30% of cases erectile dysfunction, loss of orgasmic acuity, ejaculation problems and infertility are observed. 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 specialists in related areas to be involved in the treatment
  • Modern high-precision diagnostic and treatment equipment
  • Own European-class clinical diagnostic laboratory
  • Comfortable, 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)
  • Supporting the immune system (vitamins, healthy nutrition, preventing dysbacteriosis, reasonable antibiotic therapy, etc. )
  • avoid hypothermia
  • Lead an active lifestyle
  • Have sex regularly, if possible, with a partner (to avoid prostate congestion and STIs)
  • Avoid withdrawal (this will eliminate sperm stasis)
  • Visit a urologist once a year for preventive purposes and twice a year if you are over 50 or have a history of prostate disease.

Common questions

How informative is the PSA test in diagnosing prostatitis?

Prostate specific antigen (PSA) is a marker of prostate cancer. It is known that in some cases prostate cancer presents 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 the PSA. This antigen also increases with prostate adenoma - a benign growth of glandular tissue. With prostatitis, PSA levels can also increase 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?

Prostate capillaries have a special structure that creates a blood-prostatic barrier. This makes it difficult for some types of antibiotics to penetrate the tissues of the gland. 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. Bacteria become vulnerable and antibiotics work more effectively. The most stubbornly treated chronic prostatitis, the main feature of which is a wide variety of microflora in the culture. In about 50% of the cases, Enterococcus faecalis is sown, resistant to all aminoglycosides and cephalosporins. This narrows the list of effective antimicrobial agents, which also complicates treatment.