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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 urination process. Pain in the perineum, groin, lower back and pelvic area, urodynamic disturbances (urine output) may indicate the presence of prostatitis. Untreated prostatitis can lead to male infertility and prostate cancer.

This is one of the most common male diseases, which requires careful attention and competent systematic treatment. It is this approach to solving the problem of prostatitis that you will find in the urology department of a professional clinic. For many years, qualified urologists-andrologists have been successfully treating acute and chronic prostatitis. Complex therapy, attentive attitude and individual 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 at the age of 30, 30% of the male population suffers from prostatitis, at 40 years - 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 of age mainly infectious prostatitis is recorded, then at a more mature age the non-infectious form prevails 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 under 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 functions under the influence of male hormones - androgens. Testosterone plays a key role in this process.

The prostate gland is connected to 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 secretion that is part of the sperm. It creates favorable conditions for sperm activity. 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 disorders of blood circulation and lymph 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 interconnected and together create a vicious circle that makes the treatment of prostatitis difficult.

An inflamed prostate becomes painful. Pain can be felt in the perineum, groin, pelvis, lower back. It increases significantly with palpation during digital rectal examination or defecation.

The prostate increases in size, squeezing the urethra. Thus, the exit of urine from the bladder becomes difficult. The flow of urine becomes weak. The patient must strain the abdominal muscles in order to carry out the act of urination. In acute cases, sometimes there is an obstruction of the urinary tract, and acute retention of urine.

Inflammation leads to a violation of the flow of prostate fluid and its stagnation. The resulting edema disrupts the processes of cellular metabolism and respiration in the gland. This creates the conditions for the chronology of the process. 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 been established that in 70-80% of cases, prostatitis appears due to stagnant 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).

Distribution

The US 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 appearance of prostatitis, it is divided into two types:

  • not infectious
  • Infectious

The inflammatory process can develop rapidly, accompanied by vivid symptoms (acute phase) or slowly with gradually increasing erased symptoms.

Non-infectious prostatitisin most cases, it is accompanied by stagnation of the secretion of the prostate gland and disorder of blood circulation and lymphatic 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 for the infection to enter the prostate:

  • Urinogenic (ascending): the portal of entry is the urethra. It should be noted that the infection can also get 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 from infected hemorrhoidal veins.
  • Hematogenous (through the blood): due to the presence in the body of foci of chronic infection (tonsillitis, tooth decay) 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 prostatitisusually occurs under the influence of pathogenic microflora (conditionally pathogenic) 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 prostatitisprogress is easier, symptoms are gone. However, it can worsen 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 feel 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 increased amount of purulent elements (leukocytes) in the secretion of the prostate.

Complications

Without proper therapy, the inflammatory process can lead to purulent melting of the prostate tissue. In addition, inflammation can spread to nearby organs: seminal tuberculosis, Cooper's glands, seminal vesicles, urethra. Therefore, 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)
  • Coliculitis (inflammation of the seminal tubercle)
  • Epididymoorchitis (inflammation of the testicles and their appendages)
  • Posterior urethritis
  • Erectile dysfunction / impotence
  • Ejaculation disorder
  • Infertility
  • Adenoma of the prostate
  • Prostate cancer

Symptoms

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

  • Pain in the groin, in the lower back, in the perineum (may radiate along the spermatic cord).
  • Pain increases with defecation, digital rectal examination.
  • Violation of urodynamics (frequent urination, urinary retention, difficulty urinating, weak stream, incomplete emptying of the bladder).
  • Prostatorrhea (involuntary discharge of prostate fluid, especially in the morning and during bowel movements).
  • Disorders of sexual function (decrease in libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • Increase in temperature to 39-40 degrees
  • Acute retention of urine
  • General intoxication
  • Leukocytosis, protein and mucus in the urine
  • Blood in urine and semen
  • Leukocytosis in prostate secretion
  • Hypoechogenicity and enlargement of the gland, increased blood circulation according to ultrasound

Symptoms of chronic prostatitis

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

reason

The main reasons for the development of prostatitis are infections and stagnation of prostate secretion. The following factors contribute to the occurrence 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 depletion of the glands
  • Alcohol abuse
  • Reduction of local immunity (hypothermia, use of immunosuppressants, lack of immunity, autoimmune diseases)
  • Pelvic organ injuries
  • Manipulations in the prostate and nearby organs (biopsy of the prostate, surgery, catheterization, cystoscopy, etc. )
  • Chronic diarrhea or constipation

Diagnosing

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

Digital rectal examinationperformed by a urologist-andrologist after a conversation with the patient. This method allows you to evaluate the size, shape and some features of the structure of the prostate gland. If the size of the prostate is enlarged and the procedure itself is painful for the patient, the doctor can pre-diagnose prostatitis.

If the case is not acute, the doctor can massage the prostate during the examination to obtain the secretion of the prostate, 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.

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

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

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

Laboratory researchare a necessary component of the diagnosis of prostatitis:

  • Urine analysis (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 her finger massage
  • Microscopic examination of an itch from the urethra
  • Spermogram (cytology and biochemistry of sperm)
  • Culture of urine, prostate secretion and sperm
  • Determination of prostate specific antigen (PSA)
  • Puncture biopsy of the prostate and histological examination of the tissue of the gland

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

The modern one has an excellent diagnostic base very informative. Urologists have extensive experience in the diagnosis and successful 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 necessary types of diagnostics 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 physiotherapy, in some cases surgery is required.

Medical therapy

It includes the use of the following drugs:

  • Antibiotics (after determining sensitivity to them)
  • Antiseptics (on site)
  • Vascular preparations (improving microcirculation in the prostate)
  • Non-steroidal anti-inflammatory drugs
  • Alpha-1-adrenergic blockers (in violation of urination)
  • Enzymatic preparations (dilute prostate secretion, stimulate the immune system, relieve inflammation)
  • Immunomodulators
  • Antidepressants

Physiotherapy treatment

  • Electrical stimulation of the prostate (electrophoresis, galvanization, pulse exposure)
  • Vibro massage
  • 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 performed to avoid the spread of infection and sepsis.

Surgical treatment

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

prediction

With early diagnosis and adequate treatment, acute prostatitis can be overcome. However, quite 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 man's quality of life, because not only urinary function suffers, but also sexual function. In 30% of cases, erectile dysfunction, loss of orgasmic sharpness, problems with ejaculation and infertility are observed. It is completely impossible to cure chronic prostatitis, but with the right approach, you can achieve a lasting remission.

The benefits of going to a professional clinic

  • Successful treatment of various forms of prostatitis
  • Urologists-andrologists with the highest qualification experience
  • Multidisciplinary, allowing the involvement of specialists in similar fields in the treatment
  • Modern diagnostic equipment and high-precision treatment
  • Own clinical diagnostic laboratory of European class
  • 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)
  • Supports the immune system (vitamins, healthy food, prevention of dysbacteriosis, reasonable antibiotic therapy, etc. )
  • Avoid hypothermia
  • Lead an active lifestyle
  • Have sex regularly, if possible, with a partner (to avoid prostate blockage and STIs)
  • Avoid interrupting coitus (this will get rid of 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.

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 the differential diagnosis between these two diseases. Don't bet on PSA, though. This antigen is also raised 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 absolute evidence 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 tissue of the gland. In addition, microorganisms tend to form biofilms that reliably protect them from the action of antibacterial agents. Therefore, modern prostatitis treatment protocols necessarily include proteolytic enzymes that can destroy biofilms. Bacteria become vulnerable and antibiotics work more effectively. The most stubbornly treated chronic prostatitis, a main feature of which is a wide variety of microflora in the crop. In about 50% of cases, Enterococcus faecalis is grown, resistant to all aminoglycosides and cephalosporins. This narrows the list of effective antimicrobial agents, which also complicates treatment.