Prostatitis is an inflammation of the prostate gland, one of the common problems in 40% of middle-aged and older men.Without directly threatening life, this disease leads to a significant decrease in its quality, affecting performance, the intimate sphere, limiting freedom and causing daily difficulties and psychological disorders.
Prostatitis presents in acute or chronic form and can be of infectious or non-infectious origin.
Causes of prostatitis
The causes of prostatitis are varied: the acute form is associated with a bacterial infection that enters the prostate ascending during urological and venereal diseases of an infectious nature, chronic prostatitis in 90% of cases is not associated with infections.Stagnation of prostate secretion results from both 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 and viruses.Risk factors for prostate infection are sexually transmitted diseases and invasive urological procedures (catheterization, urethral instillation and diversion, urocystoscopy).
The provocateurs of the development of infectious inflammation are usually hypothermia, prolonged constipation or diarrhea, sedentary work, excessive sexual activity or sexual abstinence, chronic sexually transmitted and urological diseases, suppressed immune response, lack of sleep, overtraining and chronic stress.By worsening the blood supply to the pelvic organs, these factors themselves contribute to aseptic inflammation, and also facilitate the introduction of the pathogen into the prostate tissue.
Acute bacterial inflammation can disappear without consequences, but in some cases the following complications develop:
- acute urinary retention;
- chronic prostatitis (chronic inflammatory pelvic pain syndrome);
- epididymitis;
- prostate abscess;
- fibrosis of prostate tissue;
- 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 papilloma virus and other chronic infections.About 90% are due to chronic nonbacterial prostatitis or chronic pelvic pain syndrome (CPPS).This form of the disease is not associated with infections, but is caused by many reasons, primarily stagnant processes in the pelvis.Stagnation of urine, causing inflammation, is formed against the background of urethritis, neurogenic narrowing of the bladder neck, narrowing of the urethra and autoimmune inflammation.The blood supply to the pelvic organs deteriorates, which is explained by systemic cardiovascular diseases (IHD, atherosclerosis).The common venous system of the small pelvis determines the connection between chronic prostatitis and anal fissures, hemorrhoids, proctitis and 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 to 39 degrees Celsius for acute prostatitis and mild fever for chronic prostatitis).
- Urinary dysfunction: frequent urges to urinate, not always effective, difficulty or increased frequency of urination, especially at night.The stream of urine is exhausted and there is always a certain residual quantity left in the bladder.
- Prostate damage: leukocytes and blood in semen, pain during urological examination.
- Fibromyalgia.
- Prostatorrhea is a small discharge from the urethra.
- Pain in the pelvis, perineum, testicles, above the pubis, penis, sacrum, bladder, scrotum.
- Painful urination and ejaculation.
- Convulsive muscle spasms.
- Stones in the prostate.
- Chronic fatigue, feeling of hopelessness, catastrophe, psychological stress against the background of chronic pain syndrome.
- Decreased performance (asthenia), decreased mood, irritability).
- Sexual dysfunction – erectile dysfunction, premature ejaculation, lack of orgasm.
- Irritable bowel syndrome and proctitis may occur.
During the chronic course of the disease, the signs of prostatitis are vague (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 accurate and complete diagnosis.The low proportion of infectious prostatitis is explained in most cases by the fact that the pathogen has not been detected.Chronic sexually transmitted infections can be asymptomatic, while their pathogens can penetrate prostate tissue and cause inflammation.Therefore, laboratory research methods play a leading role in the diagnostic process.
To determine the sensitivity of bacteria to antibiotics, biological fluids are inoculated: urine, semen, prostate secretions.This method allows you to select the most effective drug for a specific strain of the pathogen, capable of penetrating directly to the site of inflammation.
The “classic” method of laboratory diagnosis of prostatitis is considered cultural (urine culture, ejaculate, contents of urogenital smears).The method is very precise, but takes time.To detect bacteria, a smear is stained with a Gram stain, but in this way it is unlikely to detect viruses, mycoplasma and ureaplasma.To increase the accuracy of the research, mass spectrometry and PCR (polymerase chain reaction) are used.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 you to detect fragments of DNA or RNA of the causative agent of an infectious disease, including viruses and plasma.
Currently, for a special examination of urological patients, a special comprehensive PCR study of the microflora of the genitourinary tract is used.The result of the study is ready within a day and reflects the complete picture of the microbial ratio in the subject's body.
Tests for prostatitis include urine and ejaculate collection and urological smears.
The European Association of Urology recommends the following set of laboratory tests:
- general urine analysis;
- bacterial culture of urine, semen, and ejaculate;
- PCR diagnosis.
A general urine test helps to determine signs of inflammation (the number of colony-forming units of microorganisms, the number of leukocytes, red blood cells, urine clarity) and the presence of calcifications (prostatic stones).General analysis is included in the methodology of several urological samples (glass or portion).
Glass or portion samples consist of sequential collection of urine or other biological fluids in different containers.In this way, the location of the infectious process is determined.Prostatitis is indicated by the detection of infectious agents, blood cells (leukocytes and erythrocytes) in the last part of urine when taking a sample from three glasses or after urological massage of the prostate.
Two-glass test - inoculation of the middle part of the urinary stream before and after urological prostate massage.
Three-glass sample - the initial, middle and final portions of urine are collected during the same urination.
Four-glass test - culture and general analysis of the initial and middle parts of the urine stream, prostate secretion after urological prostate massage and part of the urine after this procedure.
They also perform cultural cultures or PCR diagnostics of ejaculate material and urogenital smears.
To make a diagnosis of prostatitis, blood tests are also necessary.A general capillary blood test allows you to confirm or deny the presence of inflammation, as well as exclude other diagnoses provoking the same symptoms.
The diagnosis of chronic non-inflammatory pelvic pain syndrome is more difficult, since it is based on the clinical picture and indirect laboratory indicators (including a general analysis of urine and blood).The intensity of the pain syndrome is determined using a visual analog pain scale, and the severity of psychological changes is determined using anxiety and depression rating scales.At the same time, research is needed to search for an infectious agent, since the range of pathogens can be very wide.Instrumental studies include urofluometry with determination of residual urine volume and transrectal ultrasound (TRUS) of the prostate.
Asymptomatic prostatitis is detected by histological examination of a prostate biopsy sample, prescribed if cancer is suspected.A blood test for prostate specific antigen (PSA) is done first.PSA in blood serum appears with enlargement and inflammation of the prostate, and normal criteria change with age.This study also helps to exclude suspicion of malignant prostate tumor.
Treatment and prevention of prostatitis
Treatment of acute prostatitis is carried out with antibiotics (fluoroquinolines and cephalosporins, macrolides), alpha-blockers, non-steroidal anti-inflammatory drugs, neuromodulators.Few antibiotics are able to penetrate the prostate;Pathogens are immune to certain drugs, so bacterial culture is necessary.
Conservative urological treatment may also include acupuncture, herbal medicine, remote shock wave therapy, spa physiotherapy procedures (after acute inflammation) and massage.
Prevention of prostatitis includes both medical procedures and the formation of healthy habits:
- use of barrier contraceptives;
- regular sexual activity under conditions of minimized risk of infection;
- physical activity;
- elimination of deficiency conditions - hypo- and avitaminosis, mineral deficiency;
- compliance with aseptic conditions and careful technique for performing invasive urological procedures;
- regular preventive examinations using laboratory tests.