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, affects the ability to work, the intimate sphere, limits freedom and provokes daily difficulties and psychological disorders.
Prostatitis occurs in an acute or chronic form and can be of infectious or non-infectious origin.
Causes of prostatitis
The causes of prostatitis are different: the acute form is associated with a bacterial infection that enters the prostate gland on an ascending path during urological and venereal diseases of an infectious nature, chronic prostatitis in 90% of cases is not associated with infections.Stagnation of prostatic secretion is formed both as a result of 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 interventions (catheterization, instillation and diversion of the urethra, urocystoscopy).
Triggers for 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, 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 pass 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 the 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 non-bacterial chronic prostatitis or chronic pelvic pain syndrome (CPPS).This form of the disease is not associated with infections, but is due to many reasons, mainly stagnant processes in the small pelvis.Stagnation of urine, causing inflammation, is formed against the background of urethritis, neurogenic narrowing of the bladder neck, stricture of the urethra and autoimmune inflammation.The blood supply to the pelvic organs deteriorates, which is explained by systemic cardiovascular diseases (CHD, atherosclerosis).The common venous system of the small pelvis determines the relationship of chronic prostatitis with 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 (from 38-39 degrees Celsius for acute prostatitis and subfebrile temperature for chronic prostatitis).
- Urinary dysfunction: frequent urges to urinate, not always effective, difficulty or increased frequency of urination, especially at night.The flow of urine is exhausted and there is always some residual amount in the bladder.
- Damage to the prostate: leukocytes and blood in the seminal fluid, 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 gland.
- Chronic fatigue, feeling of hopelessness, catastrophe, psychological stress against the background of chronic pain syndrome.
- Decreased working capacity (asthenia), depressed mood, irritability).
- Sexual dysfunction – erectile dysfunction, premature ejaculation, lack of orgasm.
- Irritable bowel syndrome and proctitis may occur.
In the chronic course of the disease, the signs of prostatitis are blurred (less pronounced), but are accompanied by general, neurological and mental symptoms.
Diagnosis of prostatitis
The key to successful and timely treatment of prostatitis is an accurate and comprehensive diagnosis.The low rate 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 the 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 secretion.This method allows you to choose a drug that is most effective for a particular strain of the pathogen, able to penetrate directly into the site of inflammation.
The "classic" method of laboratory diagnosis of prostatitis is considered culture (culture of urine, ejaculate, content of urogenital smears).The method is very accurate but time consuming.To detect bacteria, the smear is stained with Gram stain, but viruses, mycoplasma and ureaplasma are unlikely to be detected in this way.To increase the accuracy of the study, mass spectrometry and PCR (polymerase chain reaction) are used.Mass spectrometry is the ion analysis of the structure of a substance and the determination of each of its components.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, a special comprehensive PCR study of the microflora of the genitourinary system is used for special examination of urological patients.The result of the study is ready in one 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 pap smears.
The European Urological Association recommends the following set of laboratory tests:
- general analysis of urine;
- bacterial culture of urine, semen and ejaculate;
- PCR diagnostics.
The general urine test allows you to determine signs of inflammation (number of colony-forming units of microorganisms, number of leukocytes, red blood cells, transparency of urine) and the presence of calcifications (stones in the prostate).The general analysis is included in the methodology of several urological (glass or portion) samples.
Glass or portion samples consist of sequential collection of urine or other biological fluids in different containers.In this way, the localization of the infectious process is determined.Prostatitis is manifested by the detection of infectious agents, blood cells (leukocytes and erythrocytes) in the final portion of urine during a three-cup sample or after a urological massage of the prostate.
Two-cup test - culture of the middle part of the stream of urine before and after urological massage of the prostate.
Three-glass sample - the initial, middle and final portions of urine are taken during the same urination.
Four glass test - culture and general analysis of the initial and middle part of the stream of urine, prostatic secretion after urological massage of the prostate and a portion of urine after this procedure.
They also perform culture culture or PCR diagnosis of ejaculate and urogenital smear.
Blood tests are also needed to diagnose prostatitis.The general capillary blood test allows you to confirm or refute the presence of inflammation, as well as exclude other diagnoses that cause the same symptoms.
The diagnosis of non-inflammatory syndrome of chronic pelvic pain is more difficult, because 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 was determined using a visual analog pain scale, and the severity of psychological changes was determined using anxiety and depression rating scales.At the same time, research is needed to look for an infectious agent, since the range of pathogens can be very wide.Instrumental studies include uroflowmetry with determination of residual urine volume and transrectal ultrasound (TRUS) of the prostate gland.
Asymptomatic prostatitis is detected by histological examination of a biopsy of the prostate, prescribed when cancer is suspected.First, a prostate specific antigen (PSA) blood test is done.PSA in the blood serum appears in hypertrophy and inflammation of the prostate, and the normal criteria change with age.This test also helps rule out suspicions of a malignant prostate tumor.
Treatment and prevention of prostatitis
Acute prostatitis is treated with antibiotics (fluoroquinolines and cephalosporins, macrolides), alpha-blockers, non-steroidal anti-inflammatory drugs, neuromodulators.Few antibiotics can penetrate the prostate gland;pathogens are immune to some drugs, so a bacterial culture is necessary.
Conservative urological treatment may also include acupuncture, phytotherapy, remote shock wave therapy, thermal physiotherapy procedures (after acute inflammation), massage.
Prevention of prostatitis includes both medical procedures and the formation of healthy habits:
- use of barrier contraceptives;
- regular sexual activity in conditions of minimal risk of infection;
- physical activity;
- elimination of deficiency conditions - hypo- and avitaminosis, mineral deficiency;
- observance of aseptic conditions and careful technique for performing invasive urological interventions;
- regular preventive examinations with the help of laboratory tests.