Contents
Prostatitis is an inflammatory disease of the prostate gland. Its most common form is chronic prostatitis. Almost a third of men of reproductive age suffer from inflammation of the prostate, and 90% of them are faced with a chronic course. Unlike the acute form, this pathology is characterized by a prolonged, over 3 months, manifestation of relatively mild symptoms. With a significant prevalence of chronic prostatitis, it has not been studied enough and is difficult to treat.
Classification and reasons
There are several approaches to the classification of forms of prostatitis. According to one of them, according to the causal factor, the following variants are distinguished: • infectious – bacterial, viral, fungal; • congestive (congestive) – due to venous congestion in the pelvic organs and scrotum, stagnation of prostatic secretion / ejaculate, caused by the lack of a regular sexual life, etc.
According to the way of distribution, prostatitis is classified into: • hematogenous – with the introduction of infection through the blood from infectious foci in the relevant diseases; • arising from contact – urinogenic with the spread of infection in an ascending way in patients with urethritis, with urethral strictures and descending in patients with renal diseases, canalicular – against the background of funiculitis (inflammation of the spermatic cord), orchiepididymitis (inflammation of the testicle with an appendage), etc .; • arisen in the lymphogenous way – when the infection penetrates through the lymphatic vessels from neighboring organs (for example, with thrombophlebitis of the hemorrhoidal veins, proctitis, etc.). • urethroprostatic reflux, in which urethral contents and/or urine are thrown into the prostate.
The classification of the forms of prostatitis of the National Institute of Health of the USA, which distinguishes the categories: I – acute; II – chronic bacterial; III – chronic abacterial • inflammatory chronic pelvic pain syndrome; • non-inflammatory chronic pelvic pain syndrome (otherwise – prostatodynia); IV – asymptomatic inflammatory.
The cause of the chronic bacterial form is most often bacteria: mainly E. coli, then Proteus, Enterobacteria, Klebsiella, Pseudomonas. Staphylococci, streptococci and enterococci are rarely the causative agents of the disease. In about 20% of cases, the infection is mixed – provoked by two or more microorganisms.
It has not been reliably established whether the causative agents of genital infections can be the direct cause of prostatitis, although it is known that their presence is a risk factor for the development of inflammation of the gland. In modern studies, the relationship of the chronic form of the disease with infection with ureaplasma, chlamydia, Trichomonas has been confirmed.
The following factors predispose to the development of chronic pathology: • Congestion directly in the gland or in the small pelvis, provoking disturbances in blood microcirculation and accompanied by a local increase in temperature, impaired intake of essential substances into the tissues (favorable conditions for the reproduction of pathogenic microorganisms). Such problems can be caused by insufficient physical activity, alcohol abuse, smoking, hemorrhoids, varicose veins of the legs, etc. • Damage to the antimicrobial urethral barrier (for example, when the urethral mucosa is affected by chlamydia, gonococci). • Hormonal changes, when low testosterone causes a decrease in the formation of prostate secretion and a weakening of the antimicrobial functions of the organ.
With the development of chronic prostatitis, there is a violation of the protective function of the gland, the emergence of a constant source of infection. That is why this pathology is often accompanied by complications such as epididymitis, vesiculitis (inflammation of the seminal vesicles), paraproctitis, etc.
Also, often chronic prostatitis is combined with stones in the prostate gland (the so-called calculous prostatitis). Such formations themselves may contain infectious agents and maintain chronic inflammation. In addition, the presence of stones injures the tissues of the gland, prevents the movement of biological fluids. At the same time, modern studies have not revealed a link between this disease and prostate cancer.
Symptoms
The manifestations of chronic prostatitis are very diverse and can differ markedly in different patients (moreover, in some patients there may be no signs at all, and the inflammatory process is detected by chance during a urological examination). There are no specific complaints for this pathology. The disease is characterized by periods of calm and exacerbation of symptoms.
It is customary to divide the symptoms into several groups.
Pain syndrome
The cause of pain in chronic prostatitis is a violation of the blood supply to the prostate gland, resulting in the formation of substances acting on the nerve endings. Patients may complain about: • Feelings of heaviness, pressure in the perineum; • sensations of burning, cutting and itching in the urethra (such sensations, especially noticeable after urination, sexual intercourse, are due to the acid reaction of the prostatic secretion); • pains of varying intensity, discomfort (torsion, aches, etc.) in the perineum, rectum, testicles; • increased pain after physical exertion, sexual intercourse, alcohol abuse.
Syndrome of urinary disorders
This syndrome includes: • increased and painful urge to urinate; • partial retention of urine; • irrepressible uncontrolled urge to urinate in small portions; • feeling of incomplete emptying of the bladder; • unfilled, discontinuous jet; • completion of urination by the release of a drop of urine, etc.
Syndrome of sexual dysfunction
In chronic prostatitis, the development of inflammation of the seminal tubercle (colliculitis) can be observed, causing a violation of sexual function, which is manifested by: • pain in the urethra, rectum during ejaculation; • premature ejaculation or excessive length of the act; • weak erection; • obliteration or loss of orgasm. The disease also leads to a deterioration in the quality of sperm, which negatively affects reproductive function (death of spermatozoa due to an increase in the acidity of the environment, gluing of spermatozoa, a decrease in the number of mobile ones, etc.).
Disorders of the nervous system include neurotic disorders caused by the fixation of the patient on his illness. The bacterial form of chronic prostatitis is mainly manifested by pain, impaired urination, premature ejaculation and the appearance of blood in the semen. This form may be accompanied by the development of urethritis (urethroprostatitis), for which small purulent-mucous discharge is typical.
In the abacterial form, pelvic pain is prolonged, while standard examination methods do not allow to identify the causative agent of the disease. With an inflammatory subtype, an increased number of leukocytes is found in the analysis of urine, semen, and prostate secretion, pelvic pain is combined with impaired urination. The non-inflammatory variant (it was it that was previously called “congestive prostatitis”) is manifested by pelvic pain, rare problems with urination, and the absence of signs of inflammation in the analyzes. Sometimes, in the presence of laboratory signs of inflammation, there are no symptoms. Then they talk about inflammatory asymptomatic prostatitis.
Diagnostics
The diagnosis begins with a clinical examination – a rectal examination of the prostate with an assessment of the size, shape, consistency, contours of the gland, the presence of seals, pain, etc.
Laboratory tests include the detection of leukocytes in prostate secretions and the third urine sample in the Meares-Stamey four-glass test. Laboratory detection of an infectious agent by PCR, bacterial culture can be useful for the selection of drugs.
Ultrasound makes it possible to suspect an inflammatory process in the prostate by uneven and fuzzy contours, an increase in volume, the presence of formations, etc. In case of recurrence of the disease, additional studies are carried out for anatomical abnormalities.
Treatment
The main treatment for chronic prostatitis is long-term, about a month, taking antibiotics together with alpha-blockers. To achieve the effect of treatment, it is important to give up alcohol and smoking, optimize the mode of work and rest.
Among the drugs with antibacterial activity, preference is given to fluoroquinolone drugs (especially active against chlamydia, gonococci), sulfonamides (trimethoprim-sulfamethoxazole). If there is no effect from taking the pills, injections (and directly into the prostate gland) of doxycycline, gentamicin, etc. can be prescribed. If the cancellation of the antibiotic is accompanied by a relapse of the disease, it is recommended to constantly take low-dose forms.
Alpha-blockers are prescribed for the purpose of symptomatic treatment: to reduce the tone of the smooth muscles of the prostate and bladder. The combination of these drugs with antibiotics has been proven to reduce the risk of recurrence of chronic bacterial prostatitis.
Additionally, the following may be prescribed: • massage of the prostate gland (not recommended in the presence of stones in the prostate); • local hyperthermia (tissue heating) transurethral or transrectal; • means of traditional medicine.
If it is established that the recurrence of the disease is due to anatomical features, the presence of prostatic calculi may be recommended surgical treatment.