ProstatitisIs a urological disease accompanied by inflammation of the tissues of the prostate gland. Damage to the prostate can be caused by an infection transmitted through the blood, lymph or unprotected intercourse. 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.
Frequency 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, over 30% of young people of reproductive age suffer from chronic prostatitis. In about one third of cases it occurs in men over 20 and under 40 years. According to the WHO, urologists diagnose chronic prostatitis in every tenth patient.
Causes of prostatitis
Infections.Pathogenic and opportunistic bacteria enter the prostate through the lymph and blood vessels. Secondary prostate infection is often a complication of inflammatory diseases of the rectum and urethra.
Types of infections:
- ascending- microbes rise to the gland from the outer opening of the urethra;
- down- Microbes enter the prostate along with the flow of infected urine.
Conditionally pathogenic microorganisms that provoke the disease (according to the Research Institute of Urology 1997-1999)
| Microorganisms | Number of studies | |
|---|---|---|
| % | ABS | |
| Staphylococcus epidermidis | 42. 3 | 55 |
| S. saprophyticus | June 17 | 23. |
| S. aureus | 4. 6 | 6 |
| S. haemolyticus | 3. 1 | four |
| S. hominis | 0. 8 | one |
| S. warneri | 1. 5 | 2 |
| Staphylococcus spp. | 3. 1 | four |
| Enterococcus faecalis | 11. 6 | fifteen |
| Streptococcus spp. | 3. 1 | four |
| TOTAL (g. +) | 87. 6 | 114 |
| P. aeruginosa | 3. 7 | five |
| E. coli | 4. 7 | 6 |
| Enterobacter spp. | 2, 3 | 3 |
| Proteus spp. | 1. 5 | 2 |
| TOTAL (city -) | 12. 3 | sixteen |
Weakening of immunity.One of the causes of inflammation of the prostate is the weakening of the body's immune defenses. This can be facilitated by frequent stress, unbalanced diet, fatigue, smoking, alcohol consumption. With reduced immunity, the body is most vulnerable to infections leading to the development of prostate disease.
Disorders of blood supply.The development of chronic prostatitis can be the result of a sedentary, sedentary lifestyle. With constant lack of physical activity, the work of the endocrine, cardiovascular and nervous systems is disturbed, as well as the blood circulation in the pelvic organs. The result is oxygen starvation of prostate tissue.
Irregular sexual activity.Both prolonged sexual abstinence and excessive sexual activity can contribute to prostatitis. Many men who are sexually active have nervous exhaustion, hormonal imbalance, impaired secretion of the gonads and a gradual fading of potency. Interrupted intercourse has a negative impact on the health of the prostate gland.
Chronic prostate damage. . . Chronic prostatitis can develop as a result of frequent injuries to the soft tissues of the prostate gland. This is most often seen 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.In prostatitis in men there is pain and cutting pain in the lower abdomen and lower back, as well as pain throughout the body. This symptom may worsen during ejaculation, especially during intercourse after prolonged abstinence.
Dysuria.Typical signs of prostatitis in men are frequent urge to urinate, burning and burning when emptying the bladder, pulling pain after urination in the perineum. Another symptom of inflammation of the prostate is difficulty urinating. In the absence of treatment of the disease, acute urinary retention may occur.
Sexual dysfunction.In uncomplicated prostatitis there is accelerated ejaculation, wear and tear of orgasmic sensations, pain during ejaculation, partial or complete decrease in libido. Prolonged erection at night is also a symptom of chronic prostatitis.
External manifestations.In prostatitis, some patients have 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 threads in the urine.
Types of prostatitis
Acute bacterial.Acute prostatitis develops as a result of infection of the prostate gland with Staphylococcus aureus, Escherichia coli, enterococci and other pathogenic bacteria. If left untreated, this disease can provoke 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 pulling 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 an infection into the gland. Chronic hypothermia, prolonged sexual abstinence and untimely urination contribute to the development of prostatitis. Chronic prostatitis, if left untreated, can provoke cystitis because inflammation in the prostate is a reservoir of bacteria that affect the genitourinary tract.
Symptoms of chronic prostatitis:
- pain in the scrotum, lower abdomen, perineum;
- dysuria;
- potency disorders.
Chronic nonbacterial.The causes of the disease include penetration of viruses or bacteria into the prostate (tuberculosis bacillus, Trichomonas, chlamydia), autoimmune processes, 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 pelvic pain (bothers the man for at least 3 months);
- recurrent groin pain;
- no symptoms of inflammation in urine, semen and prostate secretions.
Chronic asymptomatic. Asymptomatic chronic prostatitis is not associated with bacterial infection and symptomatic prostate syndromes. It has been suggested that this disease is an age-related physiological characteristic.
Symptoms of this type of chronic prostatitis:
- absence of major disease syndromes;
- increased content of leukocytes and bacteria in the urine.
The main symptom of the disease - the presence of an infection in the gland - can be detected only by biopsy or during surgery in the treatment of various pathologies of the prostate (adenoma, cancer).
She stagnated.Prostatitis develops not only against the background of anatomical and physiological changes in the venous and other body systems. The main cause of the disease is irregular sex life.
Signs of prostatitis:
- painful pain in the perineum radiating to the sacrum;
- increased urination in the morning;
- slightly difficult flow of urine (the symptom is observed in a chronic form of the disease);
- weakening of the erection;
- decreased libido;
- "Paleness" of orgasmic sensations during ejaculation.
Diagnosis of acute and chronic prostatitis
To choose the right method of treatment, the doctor prescribes a comprehensive diagnosis of the condition of the genitourinary system, including the following methods.
Digital rectal examination.If you suspect prostatitis, the urologist will perform a digital examination. The posterior surface of the prostate is adjacent to the rectum, so when a finger is inserted through the anus, the doctor can determine the condition of the gland. In the course of the examination its size, consistency and shape, surface condition, soreness are established.
Signs of prostatitis in men include:
- soft, inelastic consistency of the prostate;
- pain on palpation;
- enlarged gland;
- immobility of the rectal mucosa above the prostate.
Ultrasound procedure.Prostate ultrasound is prescribed before the start of treatment for acute prostatitis 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 process of urination: the duration of this physiological act and the rate of urine flow. If the velocity is 15 ml / s or more, this indicates normal urethral patency. A sign of prostatitis is a decrease in this value below 10 ml / s. This speed is a consequence of poor patency of the urinary tract.
Interpretation of uroflowmetry results
| Urine flow | Interpretation |
|---|---|
| >15ml / sec | Urinary tract obstruction is unlikely |
| <10ml / sec | Significant narrowing of the urethra or weakness of the detrusor is likely |
| 10-15 ml / sec | Indefinite result |
Cystoscopy.An endoscopic imaging system is inserted into the bladder for examination. This method of diagnosing acute and chronic prostatitis is used when diseases such as cancer, cystitis or bladder trauma are suspected.
Laboratory researches.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 the increased number of leukocytes in the biological material. To create an effective course of treatment, the type of bacteria is determined by PCR, RIF and inoculation on a culture medium.
Interpretation of laboratory results
| The secret of the prostate | Third urine sample (after prostate massage) | |||
|---|---|---|---|---|
| HP form | The number of leukocytes, uv. x 400 | Sowing results | The number of leukocytes, uv. x 400 | Sowing 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 | - |
| Non-inflammatory syndrome of chronic pelvic pain | <10 | - | - | - |
Prevention of prostatitis
Physical activity.For the prevention and treatment of prostate diseases, men should avoid physical inactivity. It is recommended:
- walking (4 km per day or more);
- exercise (squat, jump, bend);
- training of the muscles of the perineum and buttocks (10 tensions and relaxations).
Proper nutrition.To prevent acute and chronic prostatitis, men should include in their diet foods high in zinc and vitamin B. It is recommended to eat:
- seafood (oysters, seaweed);
- meat;
- pumpkin seeds;
- walnuts;
- bran;
- kefir;
- Rye bread.
Regular sex life.When preventing and treating a disease, a man needs:
- lead a rhythmic sex life;
- avoid interrupted intercourse;
- 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 chooses a group of drugs depending on the type of microbes that caused the disease, the sensitivity of the pathogen to different drugs and the presence of contraindications in the patient.
Characteristics of drugs
| The drug | Benefits | disadvantages |
|---|---|---|
| Fluoroquinolones |
|
|
| Macrolides |
|
Insufficiently active against gram-negative bacteria |
| Tetracyclines | Active against atypical pathogens |
|
Hormone therapy.Hormone treatment is needed to restore the normal hormonal balance between androgens and estrogens. Drugs with antiandrogenic activity reduce inflammation of the glandular tissues and prevent the transition of the disease to more severe stages.
Prostate massage.This method of treating chronic prostatitis can only be used outside of exacerbations. The man should take an inclined 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 the rectum. The massage is performed by light pressure until the prostate secretions are released through 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 eliminate stagnation, as well as increase the effectiveness of drug therapy. The treatment is performed by exposing the gland to ultrasonic waves, electromagnetic vibrations, and high temperatures (microclysters with warm water).
Surgical intervention.Surgical interventions in prostate diseases are rarely used. Such treatment is mandatory for the development of complications of acute or chronic prostatitis.
Indications for prostate surgery:
- acute urinary retention as a result of severe narrowing of the urethra;
- 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 in the seminal vesicles. Symptoms of the disease are pain in the pelvis, radiating to the sacrum, aggravated by erection and ejaculation, frequent urination, blood and / or pus in the semen and urine.
Coliculitis and urethritis.Due to its proximity to the secretory ducts of the prostate, the seminal tubercle often becomes inflamed as a result of infection by the infected gland. If left untreated, the symptoms of prostatitis are complemented by the characteristic symptom of urethritis - burning or tickling in the urethra when urinating. There is also pain during ejaculation as a result of 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 caused prostatitis. Typical symptoms of the disease are general weakness, impaired consciousness, delirium, a sharp rise in temperature, increased sweating, chills. Prostate abscess is a severe septic disease that must be treated in a hospital setting.
Prostate sclerosis.Prostate sclerosis develops against the background of regular exacerbations of chronic prostatitis as a result of non-compliance with the treatment prescribed by the urologist. This disease can form over several years, but if the hormonal balance in a man's body is disturbed, rapid development is possible. In prostate sclerosis, there is pain during bladder emptying, periodic and sluggish urine flow.
Formation of cysts and stones. . . The appearance of cysts in the gland is one of the probable options for the progression of chronic prostatitis. Infection with neoplasms can cause an abscess and significantly complicate the treatment of the disease. Single and multiple stones can form in the prostate. In this disease, in addition to the usual symptoms of chronic prostatitis, there are disorders of urine flow, frequent urination, pain in the perineum.
Infertility.In chronic prostatitis, the production and motor function of sperm is impaired. If left untreated, the disease also affects the fallopian tubes and seminal vesicles, making them impassable for sperm so that they are not thrown into the urethra during ejaculation. As a result, men who have chronic prostatitis often suffer from infertility.