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 provoking everyday 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 varied: the acute form is associated with a bacterial infection that enters the prostate gland through the ascending 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 both as a result of infectious inflammation of the walls of the ducts 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).
Provocateurs 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 resolve 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 papillomavirus and other chronic infections.About 90% are due to nonbacterial chronic prostatitis or chronic pelvic pain syndrome (CPPS).This form of the disease is not associated with infections, but is due to 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, 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
- Fever (from 38-39 degrees Celsius for acute prostatitis and low-grade fever for chronic prostatitis).
- Urinary dysfunction: frequent urge to urinate, not always effective, difficulty or increased frequency of urination, especially at night.The urine stream is depleted, and there is always some 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, above the pubis, penis, sacrum, bladder, scrotum.
- Painful urination and ejaculation.
- Convulsive muscle spasms.
- Stones in the prostate gland.
- Chronic fatigue, a 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.
In the chronic course of the disease, the signs of prostatitis are blurred (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 an accurate and comprehensive diagnosis.The low proportion 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 select a drug that is most effective for a specific strain of pathogen, capable of penetrating directly to the site of inflammation.
The “classical” method of laboratory diagnosis of prostatitis is considered cultural (culture of urine, ejaculate, contents of urogenital smears).The method is very accurate, 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 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 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 in a day and reflects the complete picture of the microbial ratio in the body of the subject.
Tests for prostatitis include collection of urine and ejaculate and urological smears.
The European Urological Association recommends the following set of laboratory tests:
- general urinalysis;
- bacterial culture of urine, semen and ejaculate;
- PCR diagnostics.
A general urine test allows you 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 (prostate stones).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 into 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 final portion of urine during a three-glass sample or after urological massage of the prostate
Two-glass test - inoculation of the middle part of the urine stream before and after urological prostate massage.
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 parts of the urine stream, prostate secretion after urological prostate massage and a portion of urine after this procedure.
They also perform cultural culture or PCR diagnostics of ejaculate and urogenital smear material.
To make 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.
Diagnosis of non-inflammatory chronic pelvic pain syndrome is more difficult, as it is based on the clinical picture and indirect laboratory indicators (including 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 scales for assessing anxiety and depression.At the same time, research is required 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 examination (TRUS) of the prostate gland.
Asymptomatic prostatitis is detected by histological examination of a prostate biopsy specimen, prescribed for suspected cancer.A blood test for Prostate Specific Antigen (PSA) is performed first.PSA in the blood serum appears with hypertrophy and inflammation of the prostate, and the normal criteria change with age.This study also helps to exclude suspicions of a 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 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 in 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 interventions;
- regular preventive examinations using laboratory tests.