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 through 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.
Incidence statistics
Prostatitis is one of the most widespread 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 a third of cases, it occurs in men over 20 and under 40. 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 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 rise to the gland from the external urethral opening;
- downward- microbes enter the prostate along with the current 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 | 17. 6 | 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 (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 |
Weakening of immunity.One of the causes of prostate inflammation is the weakening of the body's immune defenses. This 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.
Blood supply disorders.The development of chronic prostatitis can be the result of a sedentary, 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, is disrupted. The result is oxygen starvation of the prostate tissue.
Irregular sexual activity.Both prolonged sexual abstinence and excessive sexual activity can contribute to the appearance of prostatitis. Many men who are sexually active have nervous exhaustion, hormonal imbalance, impaired secretion of the sex glands, and a gradual fading of potency. Interrupted intercourse has a negative impact on the health of the prostate gland.
Chronic prostate injury. . . Chronic prostatitis can develop as a result of frequent trauma to the soft tissues of the prostate gland. This is most often 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 and cutting pains in the lower abdomen and lower back, as well as aches throughout the body. This symptom may worsen with ejaculation, especially during intercourse after prolonged abstinence.
Dysuria.Typical signs of prostatitis in men are frequent urge to urinate, burning and stinging when emptying the bladder, pulling pain after urination in the perineum. Another symptom of prostate inflammation is difficulty urinating. In the absence of treatment for the disease, acute urinary retention may occur.
Sexual disorders.With uncomplicated prostatitis, there is accelerated ejaculation, wear of orgastic sensations, pain during ejaculation, partial or complete decrease in libido. Prolonged erection at night is also a symptom of chronic prostatitis.
External manifestations.With 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 filaments 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, enterococcus and other pathogenic bacteria. If untreated, this disease can provoke blood poisoning. In this case, the man needs to be urgently hospitalized.
Symptoms observed 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 the infection into the gland. Chronic hypothermia, prolonged sexual abstinence, and untimely urination contribute to the development of prostatitis. Chronic prostatitis, if untreated, can provoke cystitis, since the inflammation in the prostate is a reservoir of bacteria that affect the genitourinary tract.
Chronic prostatitis symptoms:
- pain in the scrotum, lower abdomen, perineum;
- dysuria;
- violations of potency.
Chronic non-bacterial.The causes of the disease include the ingress of viruses or bacteria into the prostate (tubercle bacillus, Trichomonas, chlamydia), autoimmune processes, penetration of urine into the gland. Chronic prostatitis accounts for up to 95% of all types of prostate inflammation.
Signs of prostatitis are:
- chronic pain in the pelvic area (bothering 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 prostatic syndromes. There is an assumption that this disease is an age-related physiological feature.
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 an infection in the gland - can only be detected with 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 body systems. 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);
- weakening of erection;
- decreased libido;
- "Pallor" of orgasmic sensations during ejaculation.
Diagnostics of the acute and chronic prostatitis
To select the correct treatment method, the doctor prescribes a comprehensive diagnosis of the state of the genitourinary system, including the following methods.
Digital rectal examination.If there is a suspicion of prostatitis, the urologist conducts 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 study, 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 over 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 outflow. If the velocity is 15 ml / s or more, this indicates a 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 urinary tract patency.
Interpretation of uroflowmetry results
| Urine flow rate | Interpretation |
|---|---|
| > 15ml / sec | Urinary tract obstruction is unlikely |
| <10ml / sec | Significant narrowing of the urethra or detrusor weakness is likely |
| 10-15ml / sec | Indeterminate result |
Cystoscopy.For examination, an endoscopic imaging system is inserted into the bladder. This method for 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 course of treatment, the type of bacteria is determined by PCR, RIF and inoculation on a nutrient medium.
Interpretation of laboratory results
| Prostate secret | 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 chronic pelvic pain syndrome | <10 | - | - | - |
Prevention of prostatitis
Physical activity.For the prevention and treatment of prostate disease, a man must avoid physical inactivity. Recommended:
- walking (4 km per day or more);
- exercise (squats, jumps, bends);
- training of the muscles of the perineum and buttocks (10 tensions and relaxations).
Proper nutrition.For the prevention of acute and chronic prostatitis, men need to 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 sexual intercourse;
- avoid casual relationships.
Treatment of acute and chronic prostatitis
Prostate inflammation 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.
Characteristics of drugs
| A drug | Benefits | disadvantages |
|---|---|---|
| Fluoroquinolones |
|
|
| Macrolides |
|
Insufficiently active against gram-negative bacteria |
| Tetracyclines | Active against atypical pathogens |
|
Hormone therapy.Hormone treatment is necessary to restore the normal hormonal balance between androgens and estrogens. Drugs with antiandrogenic activity reduce inflammation of the tissues of the gland and prevent the transition of the disease to more severe stages.
Prostate massage.This method of treating chronic prostatitis can only be used outside exacerbations. A man needs to take an inclined position, rest his palms on a couch or table, spread his legs shoulder-width apart. The doctor conducting the treatment puts on sterile gloves on his hands, applies an ointment or gel (in some cases, a drug 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 applying slight pressure until the secretions of the prostate are separated through the urethral opening. Treatment involves 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, as well as increase the effectiveness of drug therapy. Treatment is performed by exposing the gland to ultrasonic waves, electromagnetic vibrations, as well as high temperatures (microclysters with warm water).
Surgical intervention.Surgical interventions for prostate disease are rarely used. Such treatment is mandatory for developing 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 pains 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 streams of the prostate, the seminal tubercle is often inflamed as a result of infection from the infected gland. If 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 the convulsive contraction of the urethra.
Abscess of the prostate.The appearance of purulent cavities on the surface of the gland is due to the pathogenic bacteria that caused 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 severe septic disease that must be treated in a hospital setting.
Sclerosis of the prostate.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 the course of 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 during emptying the bladder, an intermittent and sluggish stream of urine.
Formation of cysts and stones. . . The appearance of cysts in the gland is one of the likely options for the progression of chronic prostatitis. Infection with neoplasms can cause an abscess and greatly 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, the production and motor function of sperm is impaired. If untreated, the disease also affects the vas deferens and seminal vesicles, making them impassable for sperm, so they are not thrown into the urethra during ejaculation. As a result, men who have chronic prostatitis often suffer from infertility.