Prostatitis. Symptoms. Diagnostics. Treatment of prostatitis

Prostatitis is an inflammatory lesion of a special organ of the male reproductive / reproductive system – the prostate gland (otherwise called the prostate), leading to a violation of its functional physiological activity. Prostatitis is diagnosed in 30% of males aged 18-45. The most common type of disease is chronic prostatitis (acute form is diagnosed in 5% of cases).

Chronic prostatitis – an inflammatory process in the prostate gland, which has taken a neglected form. Launched because after a certain time the inflamed tissues in the prostate gland are irrevocably modified. They cease to function correctly, as healthy tissues do. If you do not pay attention to the chronic process for a long time, then this can lead to very serious consequences for a man as a MAN. A significant part of the prostate tissue should not be allowed to undergo such a change.

Just do not think that chronic prostatitis is a synonym for impotence. Not! It annoys only in the stage of exacerbations and in severely neglected forms. Therefore, as soon as he declares himself, it is necessary to immediately suppress this aggravation. Very few people manage to cope with acute prostatitis in time, and for the majority it still becomes chronic.

Prostate

The main function of this organ is the development of a special secret, consisting of water (almost 95%), salts, phospholipids, enzymes, special proteins, etc. Each component of such a mixture plays a specific role, including:

  • providing a slightly alkaline/neutral environment to maintain sperm activity;
  • liquefaction of the spermatic environment to facilitate the movement of spermatozoa, preventing them from sticking together;
  • ensuring viability in adverse conditions, nutrition of spermatozoa, due to which the latter can “live” in the genitals of a woman for several days;
  • prevention of infection of the male urogenital system by transient / pathogenic microbes (the so-called antimicrobial function).

Protection against infections of the urogenital tract is carried out through a number of mechanisms, including:

  • zinc-peptide complex (also called the prostatic antibacterial factor) – in the secretion of the gland, the amount of zinc responsible for antimicrobial activity and participating in testosterone metabolism is a hundred times higher than the content of the element in other areas of the body;
  • antibacterial active substances;
  • local protective agents (immunoglobulins).

In addition, the prostate gland takes part in the process of urination (its smooth muscles are reduced), ejaculation (sperm is ejected through the ducts located on the sides of the seminal tubercle), in the exchange of hormones. Thus, a failure in even one of the components of this complex structure entails many serious consequences for the male genitourinary system.

Prostate adenoma – this is benign prostatic hyperplasia (BPH, in other words, a benign tumor. It is benign, because it is not cancer, although radish horseradish is not sweeter. But still, there is already a panacea for this ailment. Previously, prostate adenoma was treated radically – by removing the prostate, with At the same time, the quality of life of a man deteriorated dramatically due to problems with urination control.. Today, they act more humanely, only the tumor itself is removed, and the prostate gland is left.And after about a year of rehabilitation, the prostate gland almost completely restores its functioning, including normal uncomplicated urination.

Causes of the disease

The reason for the development of inflammation in the prostate is the entry of pathogenic or opportunistic microbes into the organ. Chronic prostatitis is provoked by bacteria such as Escherichia coli (detected in 75-80% of patients with chronic bacterial prostatitis), Enterobacteria, Proteus, Pseudomonas, Klebsiella, Enterobacter, Enterococcus faecalis, Serratia. Approximately 20% of patients have two or more varieties of pathogens at the same time. It is not known for sure whether the causative agents of STIs (genital infections) can be the direct cause of prostatitis, but the reliable fact is that their presence is a serious risk factor for inflammation of the organ. The latest research shows the relationship of chronic prostatitis with infection with chlamydia, Trichomonas and ureaplasma.

The main ways of infection:

  • as a result of reflux of urethral contents and / or urine as a result of urethroprostatic reflux;
  • against the background of urethritis, infection is possible mainly with pathogens that are sexually transmitted – gonococci, chlamydia, or less often, in case of violation of local antibacterial protection, myco- and ureaplasma and other bacterial agents (as a result of anal-genital contact – intestinal, genital-oral – respiratory) , herpes virus, cytomegalovirus, yeast;
  • along the vas deferens (relatively rare) against the background of vesiculitis, orchiepididymitis, the infection penetrates from the testicles, seminal vesicles, and appendages;
  • extremely rare (which even raises doubts among a number of doctors) against the background of pyelonephritis, cystitis, glomerulonephritis through urine containing infectious agents;
  • as a result of drift from other systems / organs through the lymphatic or blood vessels.

Factors contributing to the development of inflammation of the prostate:

  • violation of the urethral antimicrobial barrier (due to damage to the urethral mucosa, for example, with gonorrhea or chlamydia);
  • violation of blood microcirculation, which leads to a reduced supply of important products to the prostate and an increase in local temperature, which favors the reproduction of pathogenic microbes (the problem can be caused by varicose veins, hemorrhoids, alcohol or nicotine intoxication, neurogenic disorders, insufficient physical activity);
  • hormonal disorders (a drop in testosterone levels leads to a decrease in the production of prostatic secretions and a deterioration in the antimicrobial function of the gland).

Prostatitis symptoms and types

Symptoms of the disease, the intensity of which depends on the type of pathology, are divided into several types. The pain syndrome develops as a result of inadequate blood supply to the inflamed organ and, as a result, the formation of substances that affect the nerve endings. It notes:

  • discomfort, pain attacks in the perineum, especially after sexual intercourse, exercise, drinking alcohol;
  • discomfort and / or pain in the testicles (“torsion”, “ache”);
  • discomfort and / or soreness, sensation of pain in the urethra, due to an increase in the acidity of the prostatic secret (“burning” due to the acidic environment of the secret is especially noticeable after sexual contact, urination).

Syndrome of urinary disorders manifests itself:

  • increased frequency (sometimes up to three times / hour), uncontrollable urges with small portions of urine;
  • feeling of incomplete emptying;
  • weak fullness, discontinuity of the jet, a symptom of the “last drop” (each act of urination is accompanied by the release of a drop of urine after its completion).

Problems with orgasm, ejaculation, caused by the development of an inflammatory lesion of the seminal tubercle (the so-called colliculitis) against the background of prostatitis, are manifested:

  • prolonged intercourse or, conversely, premature ejaculation;
  • obliteration of orgasm;
  • pain during ejaculation (due to inflammation of the excretory prostatic ducts).

Reproductive dysfunction characterized by changes in sperm quality:

  • a decrease in pH (acidic environment reduces sperm motility, provokes their death);
  • bonding (so-called agglutination) of spermatozoa;
  • a decrease in the number of motile spermatozoa (the so-called asthenospermia) due to an increase in the acidity of the environment, a violation of the production of special products by the gland responsible for sperm viability.

In a number of episodes, prostatitis of a bacterial nature is accompanied by chronic urethritis with mild secretions of a purulent-mucous nature (the so-called urethroprostatitis).

Forms of chronic prostatitis:

  • bacterial – mainly manifested by pelvic pain and soreness during ejaculation, impaired urination, the appearance of blood in the semen, premature ejaculation (although there may be no symptoms at all!);
  • abacterial, otherwise chronic pelvic pain syndrome, is characterized by pelvic pain for three months or more and the absence of pathogenic flora detected by standard methods, it can be inflammatory (up to 65% of episodes, includes pelvic pain and severe problems with urination, the presence of leukocytes in urine, semen , prostatic secretion) and non-inflammatory (up to 40% of episodes, manifested by pelvic pain with rare urinary disorders, absence of inflammatory laboratory signs, in the past called “congestive prostatitis”);
  • inflammatory asymptomatic – manifested by the absence of symptoms in the presence of signs of inflammation in the analyzes. Patients are often concerned about the question of whether prostatitis can cause impotence? The disease does not directly cause impotence, although pain and discomfort can lead to a decrease in sexual desire. Also, inflammation of the prostate often causes damage to the seminal tubercle, which is responsible for the sensation of orgasm in men, which is manifested by blurred sensations and premature ejaculation. Chronic prostatitis has nothing to do with other forms of impotence.

Also, a number of studies have not revealed a significant relationship between chronic prostatitis and prostate cancer.

Diagnostics of the prostatitis

At the first stage of diagnosis, a clinical examination of the prostate gland (rectal examination) is performed. This study does not directly confirm inflammation, but allows us to draw conclusions about its presence by indirect signs:

  • resizing (reduction / increase), contours, shape of the prostate;
  • the presence of focal softening / seals, heterogeneous consistency;
  • manifestation of pain, swelling.

The following is a laboratory test:

  • analysis of prostatic secretion;
  • test (four-glass sample) Meares-Stamey.

A diagnostically important sign is the presence of leukocytes in the prostatic secretion and the third urinary portion of the sample. For a reliable diagnosis, their number should be 10 per field of view (in five or more fields). You can also suspect prostatitis with ultrasound: the volume parameters of the gland are increased, the contours are fuzzy / uneven, there are uncharacteristic formations, hyperechoic areas (diffuse or in the form of foci). Also, ultrasound can detect the presence of prostatic calculi – calcified areas, often serving as a focus of infection. Identification of the bacterial agent that caused the disease is especially necessary for the selection of adequate antibiotic therapy. Such a study is carried out by methods:

  • PCR – transient microflora, STI pathogens are detected;
  • blood test for antibodies to infectious agents (ELISA method)
  • bakposeva (otherwise by cultural research) – conditionally pathogenic microflora is detected.

A spermogram is used to assess the functional activity of the prostate gland. With a recurrent form of chronic prostatitis, additional studies are carried out for the presence of anatomical abnormalities that contribute to the development of the pathological process.

Treatment of prostatitis

The treatment of sexual disorders today is a very profitable industry. On TV, radio, in newspapers and magazines, “Drink our pills and you will forget about your illness” is constantly falling – but ordinary pills cannot solve the problem, you can only relieve symptoms for a while. Urologists cash in on patients with prostatitis and prostate adenoma. But prostatitis itself is a consequence, not a cause. Finding and addressing the causes in each individual patient is much more difficult than simply applying well-established symptom suppression regimens. Urologists know this very well and do not bother themselves with professional research. Therefore, finding the right path to recovery is a task that most often has to be solved by the patients themselves.

Chronic prostatitis is inevitably preceded by an acute phase, but when people talk about prostatitis, they usually mean its chronic form, which is quite difficult to treat. Unfortunately, in a short period of acute prostatitis, patients are in no hurry to pay attention to the disease and lose precious time. Over time, the symptoms of the primary acute phase smooth out. Chronic prostatitis has less pronounced symptoms in terms of pain, but its danger lies in the constant and systematic damage to the tissues of the prostate gland.

The main method of therapy for chronic prostatitis is a long-term (from 4 weeks) intake of antibacterial drugs, as well as alpha-blockers.

Antibiotic therapy is carried out mainly with fluoroquinolone preparations (since fluoroquinolones also have activity against gonococci and chlamydia, they are prescribed to people under 35 years of age, in whom concomitant infections are more common), trimethoprim-sulfamethoxazole. If oral administration of these antibiotics does not work, injections (including directly into the prostate) of gentamicin, doxycycline, carbenpenicillin may be prescribed.

In the case when a noticeable improvement is noted in the course of treatment with antibacterial agents, and when they are canceled, a relapse occurs quickly, it is recommended to carry out the so-called suppressive therapy – a daily constant intake of low doses of antibiotics.

Alpha-blockers (terazosin, doxazosin, etc.) reduce the tone of the smooth muscles of the bladder and prostate, which facilitates the manifestations of the disease. The combined use of such drugs with antibiotics significantly reduces the risk of recurrence of chronic bacterial prostatitis.

Important points that contribute to a speedy recovery are:

  • optimization of the regime of work and rest;
  • exclusion of alcohol intake;
  • to give up smoking.

For over 20 years in medicine, the method of local hyperthermia (local heating up to 39-43 degrees of prostate tissue) has been used in medicine to treat diseases of the prostate. The method can be carried out both transrectal and transurethral (the latter is less safe, but is used more often due to its greater efficiency). Up to 87% of patients with abacterial chronic prostatitis noted an improvement in their condition with this therapy. It is assumed that exposure to heat promotes the outflow of stagnant contents of the prostate, improving lymph and blood circulation in the tissues.

In some cases, in the chronic course of the disease, prostate massage is prescribed (although recently this technique has been used mainly for diagnostic purposes to obtain a prostatic secret). Massage is performed after urination and washing the urethra in the presence of discharge. The procedure is performed rectally, 2-3 times a week, for one minute. There have been no specific studies on the effectiveness of massage, and some of the available data are conflicting. It is believed that massage improves blood circulation in tissues, facilitates the penetration of antibacterial drugs into them, activates local defenses, and helps to free the ducts from dead cells and pus. The method is contraindicated in acute form of prostatitis, it is not recommended in the presence of adenoma and prostate calcifications.

With frequent recurrence of chronic prostatitis due to anatomical disorders, surgical intervention can be performed (including transurethral resection of the prostate in the presence of prostatic calculi).

The effectiveness of traditional medicine has not been scientifically proven, but some patients report relief from the use of chamomile infusions, tea with honey, unroasted pumpkin seeds, etc.

The effectiveness of chronic prostatitis therapy directly depends on the main causative factors of the disease and patient compliance with medical recommendations.

Prostatitis can cause urosepsis in patients with diabetes mellitus, with chronic renal failure and on dialysis, in immunocompromised or postoperative patients who have undergone urethral interventions.

Prevention

Measures to prevent recurrence of chronic prostatitis include:

  • normalization of the regime of work and rest;
  • complete nutrition;
  • active lifestyle;
  • exclusion of overheating and hypothermia;
  • quitting smoking and alcohol;
  • timely detection and elimination of foci of chronic infection;
  • prevention of STIs;
  • on the recommendation of a doctor – suppressive antibiotic therapy.

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