Prostatitis is an inflammation of the prostate gland, one of the common problems in 40% of middle-aged and elderly men.Without directly threatening life, this disease leads to a significant decrease in its quality, affecting performance, the intimate sphere, limiting freedom and provoking daily difficulties and psychological disorders.
Prostatitis occurs in 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 through the infectious route during urological and venereal diseases of an infectious nature, chronic prostatitis in 90% of cases is not associated with infections.Stagnation of prostate secretion is formed 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).
The 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 reaction, lack of sleep, excessive exercise, 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 resolve without consequences, but in some cases the following complications develop:
- acute retention of urine;
- 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 papillomavirus 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 due to many reasons, mainly stagnant processes in the pelvis.Stagnation of urine, causing inflammation, is formed against the background of urethritis, neurogenic narrowing of the bladder neck, urethral stricture 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 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
- Temperature (from 38-39 degrees Celsius for acute prostatitis and low temperature for chronic prostatitis).
- Urinary dysfunction: frequent urge to urinate, not always effective, difficulty or increased frequency of urination, especially at night.The flow of urine is depleted and there is always a residual amount 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, over the pubis, penis, sacrum, bladder, scrotum.
- Painful urination and ejaculation.
- Convulsive muscle spasms.
- Stones in the prostate gland.
- Chronic fatigue, a sense 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.
In the chronic course of the disease, the signs of prostatitis are unclear (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 percentage of infectious prostatitis is explained in most cases by the fact that the pathogen was not 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 secretions.This method allows you to choose a drug that is more effective for a specific type of pathogen, able to penetrate directly into the site of inflammation.
The "classic" method of laboratory diagnosis of prostatitis is considered cultural (urine culture, ejaculate, content of urogenital smears).The method is very accurate, but it takes time.To detect bacteria, a stain is smeared 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 ion analysis of the structure of a substance and the determination of each of its components.The polymerase chain reaction allows you to detect DNA or RNA fragments 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 prostate include urine and ejaculate collection and urological smears.
The European Urological Association recommends the following group of laboratory tests:
- general analysis of urine;
- bacterial culture of urine, sperm and ejaculate;
- PCR diagnostics.
A general urine test allows you to determine the signs of inflammation (the number of units of microorganisms that form colonies, the number of leukocytes, red blood cells, the clarity of urine) and the presence of calcifications (prostate stones).General analysis is included in the methodology of some urological samples (glass or portion).
Glass or piece specimens consist of the successive collection of urine or other biological fluids in different containers.In this way, the localization 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 during a three-cup sample or after urological massage of the prostate.
Two-cup test - inoculation of the middle part of the urine stream before and after urological massage of the prostate.
Three-cup samples - the initial, middle and last portions of urine are taken during the same urination.
Four-cup test - culture and general analysis of the initial and middle parts of the urine stream, prostate secretion after urological massage of the prostate and part of the urine after this procedure.
They also perform culture or PCR diagnostics of ejaculate material and urogenital swabs.
To establish a diagnosis of prostatitis, blood tests are also required.A 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 chronic non-inflammatory pelvic pain syndrome is more difficult, as it is based on the clinical picture and indirect laboratory indicators (including the general analysis of urine and blood).The intensity of the pain syndrome is determined using a visual analogue pain scale, and the severity of psychological changes is determined using scales for the assessment of anxiety and depression.At the same time, research is required 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 examination (TRUS) of the prostate gland.
Asymptomatic prostatitis is detected by histological examination of a prostate biopsy specimen prescribed for suspected cancer.First, a blood test for Prostate Specific Antigen (PSA) is performed.Serum PSA appears with prostatic hypertrophy and inflammation, and normal criteria change with age.This study also helps to 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 are able to penetrate the prostate gland;pathogens are immune to some drugs, so bacterial culture is necessary.
Conservative urological treatment may also include acupuncture, herbal medicine, remote shock wave therapy, thermal physiotherapeutic 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 under conditions of minimized risk of infection;
- physical activity;
- elimination of deficiency conditions - hypo- and vitaminosis, lack of minerals;
- compliance with aseptic conditions and careful technique for performing invasive urological interventions;
- regular preventive examinations using laboratory tests.