ProstatitisIs a urological disease accompanied by inflammation of the tissues of the prostate. Damage to the prostate can be caused by infection transmitted through blood, lymph, or unprotected sex. The development of prostatitis in men is facilitated by injuries and impaired blood supply to the pelvic organs, constant hypothermia, low physical activity, hormonal imbalance and other factors. Prostatitis can be accompanied by vesiculitis, urethritis and other infectious and inflammatory diseases of the reproductive and urinary organs.
Incidence statistics
Prostatitis is one of the most common diseases of the male genitourinary system in the world. According to various sources, it is observed in 60-80% of sexually mature men. According to official medical statistics, more than 30% of young people of childbearing age suffer from chronic prostatitis. In about a third of cases, it occurs in men over 20 and under 40. According to the WHO, urologists diagnose chronic prostatitis in one in ten patients.
Causes of prostatitis
Infections.Pathogenic and opportunistic bacteria enter the prostate through lymphatic and blood vessels. Secondary infection of the prostate is often a complication of inflammatory diseases of the rectum and urethra.
Types of infection:
- Ascending- microbes ascend to the gland from the external urethral opening;
- down- the microbes enter the prostate with the current of infected urine.
Conditionally pathogenic microorganisms that cause disease (according to the Urology Research Institute 1997-1999)
| Microorganisms | Number of studies | |
|---|---|---|
| % | abs | |
| Staphylococcus epidermidis | 42, 3 | 55 |
| S. saprophyticus | 17, 6 | 23 |
| S. aureus | 4. 6 | 6 |
| S. haemolyticus | 3, 1 | four |
| S. hominis | 0, 8 | a |
| S. warneri | 1, 5 | 2 |
| Staphylococcus spp. | 3, 1 | four |
| Enterococcus faecalis | 11, 6 | fifteen |
| Streptococcus spp. | 3, 1 | four |
| TOTAL (gr. +) | 87, 6 | 114 |
| P. aeruginosa | 3, 7 | five |
| E. coli | 4. 7 | 6 |
| Enterobacter spp. | 2, 3 | 3 |
| Proteus spp. | 1, 5 | 2 |
| TOTAL (gr. -) | 12, 3 | sixteen |
Weakened immunity.One of the causes of inflammation of the prostate is the weakening of the body's immune defenses. It can be facilitated by frequent stress, unbalanced diet, overwork, smoking, alcohol consumption. With reduced immunity, the body is most vulnerable to infections leading to the development of prostate disease.
Disorders of the blood supply.The development of chronic prostatitis can be the result of a sedentary and sedentary lifestyle. With a constant lack of physical activity, the work of the endocrine, cardiovascular and nervous systems, as well as blood circulation in the pelvic organs, are disturbed. The result is oxygen deprivation of the prostate tissue.
Irregular sexual activity.Prolonged sexual abstinence and excessive sexual activity can contribute to the development of prostatitis. Many sexually active men experience nervous exhaustion, hormonal imbalance, impaired secretion of the sex glands, and a gradual decrease in potency. Interrupted sex has a negative impact on the health of the prostate.
Chronic prostate injury. . . Chronic prostatitis can develop as a result of frequent trauma to the soft tissues of the prostate. Most often, this is observed in patients whose professional activities are related to driving. The cause of prostatitis in this case is constant shaking, vibration and excessive stress on the muscles of the perineum.
The main syndromes of prostatitis
Pain.With prostatitis in men there are aching, cutting pains in the lower abdomen and lower back, as well as pain throughout the body. This symptom may worsen with ejaculation, especially during sex after prolonged abstinence.
Dysuria.Typical signs of prostatitis in men are frequent urge to urinate, burning and tingling when emptying the bladder, pulling pain after urination in the perineum. Another symptom of an inflamed prostate is difficulty in passing urine. In the absence of treatment for the disease, acute urinary retention can occur.
Sexual dysfunctions.With uncomplicated prostatitis, there is accelerated ejaculation, wear and tear of orgastic sensations, pain during ejaculation, partial or complete decrease in libido. A prolonged erection at night is also a symptom of chronic prostatitis.
External events.With prostatitis, some patients have a purulent or clear discharge from the urethra, which is most abundant in the morning. Patients may also notice a symptom such as the presence of white flocs or filaments in the urine.
Types of prostatitis
Acute bacterial.Acute prostatitis develops as a result of infection of the prostate with Staphylococcus aureus, Escherichia coli, enterococcus and other pathogenic bacteria. If left untreated, this disease can cause blood poisoning. In this case, the man must be hospitalized urgently.
Symptoms seen with this type of prostatitis:
- chills and fever (38 ° C and above);
- sharp or drawing pains in the groin, lower back and perineum;
- frequent urge to urinate;
- painful urination;
- difficulty urinating and acute urinary retention;
- white or colorless discharge from the urethra.
Chronic bacterial.The recurrent form of the disease occurs as a result of the penetration of the infection into the gland. Chronic hypothermia, prolonged sexual abstinence and unwanted urination contribute to the development of prostatitis. Chronic prostatitis, if left untreated, can cause cystitis because the inflamed prostate is a reservoir of bacteria that affects the genitourinary tract.
Symptoms of chronic prostatitis:
- pain in the scrotum, lower abdomen, perineum;
- dysuria;
- potency violations.
Chronic non-bacterial.The causes of the disease include the penetration of viruses or bacteria into the prostate (tubercle bacillus, Trichomonas, chlamydia), autoimmune processes, the penetration of urine into the gland. Chronic prostatitis accounts for up to 95% of all types of prostate inflammation.
The signs of prostatitis are:
- chronic pain in the pelvic area (bothers the man for at least 3 months);
- recurrent groin pain;
- absence of symptoms of inflammation in urine, semen and prostate secretions.
Asymptomatic chronic.Chronic asymptomatic prostatitis is not associated with bacterial infection and symptomatic prostatic syndromes. It is assumed that this disease is a physiological characteristic associated with age.
Symptoms of this type of chronic prostatitis:
- absence of major syndromes of the disease;
- an increased content of leukocytes and bacteria in the urine.
The main symptom of the disease - the presence of infection in the gland - can be detected only by a biopsy or during surgical operations in the treatment of various pathologies of the prostate (adenoma, cancer).
Stagnant.Prostatitis develops not only against the background of anatomical and physiological changes in the venous and other systems of the body. The main cause of the disease is irregular sex life.
Signs of prostatitis:
- aching pain in the perineum, radiating to the sacrum;
- increased urination in the morning;
- slight difficulty in the outflow of urine (the symptom is observed in the chronic form of the disease);
- weakened erection;
- decreased libido;
- "Pallor" of orgasmic sensations during ejaculation.
Diagnosis of acute and chronic prostatitis
To select the right method of treatment, the doctor prescribes a comprehensive diagnosis of the condition of the genitourinary system, including the following methods.
Digital rectal exam.If you suspect a disease of prostatitis, the urologist conducts a digital examination. The posterior surface of the prostate is adjacent to the rectum, so that when a finger is inserted into the anus, the doctor can determine the condition of the gland. During the study, its size, consistency and shape, surface condition, pain are established.
Signs of prostatitis in men include:
- soft and inelastic consistency of the prostate;
- pain on palpation;
- enlarged gland;
- immobility of the rectal mucosa on the prostate.
Ultrasound procedure.Ultrasound of the prostate is prescribed before the start of treatment for acute prostatitis in order to identify / exclude an abscess of the gland, and in the chronic course of the disease - to identify cysts and stones of the prostate, as well as the degree of compression of the urethra. The most effective method is rectal ultrasound.
Uroflowmetry.This method of diagnosing prostatitis is used to study the indicators of the urination process: the duration of this physiological act and the rate of urine flow. If the speed is 15 ml / s or more, this indicates normal patency of the urethra. A sign of prostatitis is a decrease in this value below 10 ml / s. This speed is a consequence of poor permeability of the urinary tract.
Interpretation of urine flow measurement results
| Urinary flow | Interpretation |
|---|---|
| >15 ml / sec | Urinary tract obstruction is unlikely |
| <10 ml / s | Severe urethral stricture or detrusor weakness is likely |
| 10 to 15 ml / sec | Undetermined outcome |
Cystoscopy.For the examination, an endoscopic imaging system is inserted into the bladder. This method of diagnosing acute and chronic prostatitis is used when diseases such as cancer, cystitis, or trauma to the bladder are suspected.
Laboratory research.To diagnose and determine the microorganism that caused the disease, in the presence of symptoms of chronic prostatitis or acute inflammation, urine and prostate secretions are examined. A sign of the presence of pathogenic microflora is an increased number of leukocytes in biological material. In order to compose an effective treatment, the type of bacteria is determined by PCR, RIF and inoculation on nutrient medium.
Interpretation of laboratory results
| Secret of the prostate | Third urine sample (after prostate massage) | |||
|---|---|---|---|---|
| HP Form | The number of leukocytes, uv. x 400 | Seeding results | The number of leukocytes, uv. x 400 | Seeding results |
| Bacterial | >10 | + | The difference between the number of leukocytes in the third portion of urine and the second portion of urine is ≥10 | + |
| Chronic pelvic pain inflammatory syndrome | >10 | - | The difference between the number of leukocytes in the third portion of urine and the second portion of urine is ≥10 | - |
| Chronic non-inflammatory pelvic pain syndrome | <10 | - | - | - |
Prevention of prostatitis
Physical activity.For the prevention and treatment of prostate disease, a man should avoid physical inactivity. Recommended:
- walking (4 km per day or more);
- exercise (squats, jumps, turns);
- training of the muscles of the perineum and buttocks (10 tensions and relaxations).
Adequate nutrition.For the prevention of acute and chronic prostatitis, men should include in their diet foods rich in zinc and vitamin B. It is recommended to eat:
- seafood (oysters, seaweed);
- Meat;
- pumpkin seeds;
- nuts;
- fiber;
- kefir;
- Rye bread.
Regular sex life.To prevent and treat disease, a man needs:
- lead a rhythmic sex life;
- avoid interrupted sex;
- avoid casual relationships.
Treatment of acute and chronic prostatitis
Inflammation of the prostate is treated using the following methods.
Antibacterial therapy.If the prostatitis is bacterial, antibiotics are needed to treat it. The doctor selects a group of drugs depending on the type of microbes that caused the disease, the sensitivity of the pathogen to various drugs and the presence of contraindications in the patient.
Drug characteristics
| A drug | Benefits | disadvantages |
|---|---|---|
| Fluoroquinolones |
|
|
| Macrolides |
|
Insufficiently active against Gram-negative bacteria |
| Tetracyclines | Active against atypical pathogens |
|
Hormonal therapy.Hormonal therapy is necessary to restore the normal hormonal balance between androgens and estrogen. Drugs with antiandrogenic activity reduce inflammation of the tissues of the gland and prevent the progression of the disease to more severe stages.
Prostate massage.This method of treating chronic prostatitis can be used only outside of exacerbations. A man should take a reclined position, rest his palms on a sofa or table, spread his legs shoulder-width apart. The doctor performing the treatment puts sterile gloves on his hands, applies an ointment or gel (in some cases a medicine with an anesthetic component) to the index finger of his right hand, and injects it through the anus into therectum. The massage is performed by applying gentle pressure until the secretions from the prostate are separated by the opening of the urethra. The treatment includes at least 10 massage sessions.
Physiotherapy.To treat the symptoms of prostatitis, methods are used to normalize and increase blood circulation in the pelvic area. This allows you to exclude stagnation and increase the effectiveness of drug therapy. The treatment is carried out by exposing the gland to ultrasonic waves, electromagnetic vibrations, as well as high temperatures (microclysters with hot water).
Surgical intervention.Surgical interventions for diseases of the prostate are rarely used. Such treatment is mandatory to develop complications of acute or chronic prostatitis.
Indications for prostate surgery:
- acute urinary retention as a result of severe urethral stricture;
- abscess (the appearance of suppuration on the surface of the gland);
- sclerosis of the gland;
- adenoma that does not respond to conservative treatment.
Complications of prostatitis
Vesiculitis.Untreated prostatitis can cause inflammation of the seminal vesicles. Symptoms of the disease are pain deep in the pelvis, radiating to the sacrum, aggravated by erection and ejaculation, frequent urination, the appearance of blood and / or pus in semen and urine.
Colliculitis and urethritis.Due to its proximity to the excretory currents of the prostate, the seminal tubercle is often inflamed as a result of infection with the infected gland. If left untreated, the symptoms of prostatitis are supplemented by the characteristic symptom of urethritis - burning or tickling in the urethra during urination. There is also pain during ejaculation due to the convulsive contraction of the urethra.
Prostate abscess.The appearance of purulent cavities on the surface of the gland is due to the pathogenic bacteria that cause prostatitis. A characteristic symptom of the disease is general weakness, impaired consciousness, delirium, a sharp rise in temperature, increased sweating, chills. Prostate abscess is a serious septic disease that must be treated in a hospital setting.
Sclerosis of the prostate.Sclerosis of the prostate develops against the background of regular exacerbations of chronic prostatitis due to non-compliance with the treatment prescribed by the urologist. This disease can form over several years, however, if the hormonal balance in a man's body is disturbed, rapid development is possible. With sclerosis of the prostate, pain is observed when emptying the bladder, intermittent, slow flow of urine.
Formation of cysts and stones. . . One of the likely options for the progression of chronic prostatitis is the appearance of cysts in the gland. Infection with neoplasms can cause an abscess and significantly complicate the treatment of the disease. Single and multiple stones can also form in the prostate. In this disease, in addition to the usual symptoms of chronic prostatitis, there are violations of the outflow of urine, frequent urination, pain in the perineum.
Infertility.In chronic prostatitis, sperm production and motor function are impaired. If left untreated, the disease also affects the vas deferens and seminal vesicles, making them impassable for semen so that they are not thrown into the urethra during ejaculation. As a result, men with chronic prostatitis often suffer from infertility.