ProstatitisIt is a urological disease accompanied by inflammation of the prostate tissues. Prostate damage can be caused by an infection transmitted by blood, lymph, or unprotected sex. The development of prostatitis in men is facilitated by injuries and decreased 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 Organs reproductive and urinary organs.
Incidence statistics
Prostatitis is one of the most common diseases of the male genitourinary system in the world. According to several sources, it is seen in 60-80% of sexually mature men. According to official medical statistics, more than 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 prostate infection is often a complication of inflammatory diseases of the rectum and urethra.
Types of infection:
- upward- microbes rise to the gland from the external urethral opening;
- down- microbes enter the prostate along with the stream of infected urine.
Conditionally pathogenic microorganisms that cause the disease (according to the Research Institute of Urology 1997-1999)
| Microorganisms | Number of studies | |
|---|---|---|
| % | abdomen | |
| Staphylococcus epidermidis | 42, 3 | 55 |
| S. saprophyticus | 17, 6 | 23 |
| S. aureus | 4, 6 | 6 |
| S. haemolyticus | 3, 1 | four |
| S. hominis | 0, 8 | 1 |
| S. warneri | 1. 5 | two |
| 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 | two |
| TOTAL (gr. -) | 12, 3 | sixteen |
Weakened immunity.One of the causes of inflammation of the prostate 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 more vulnerable to infections that lead to the development of prostate diseases.
Blood supply disorders.The development of chronic prostatitis can be the result of a sedentary and sedentary lifestyle. With the constant lack of physical activity, the work of the endocrine, cardiovascular and nervous systems, as well as blood circulation in Organs pelvic organs, is interrupted. The result is a lack of oxygen in the prostate tissue.
Irregular sexual activity.Both prolonged sexual abstinence and excessive sexual activity can contribute to the onset of prostatitis. Many sexually active men experience nervous exhaustion, hormonal imbalance, impaired secretion of the sexual glands and a gradual decrease in potency. Interruption of sexual intercourse has a negative impact on prostate health.
Chronic prostate injury. . . Chronic prostatitis can develop as a result of frequent trauma to the soft tissues of the prostate. Most of the time, this is observed in patients whose professional activities are related to driving. The cause of prostatitis, in this case, is the constant tremor, vibration and excessive stress in the muscles of the perineum.
The main syndromes of prostatitis
Ache.In prostatitis in men, painful and sharp pains occur in the lower abdomen and in the lower back, as well as pains throughout the body. This symptom can get worse with ejaculation, especially during intercourse after prolonged withdrawal.
Dysuria.Typical signs of prostatitis in men are frequent urge to urinate, burning and burning when emptying the bladder, pulling the pain after urinating in the perineum. Another symptom of inflammation of the prostate is difficulty in urinating. In the absence of treatment for the disease, acute urinary retention may occur.
Sexual dysfunctions.In uncomplicated prostatitis, accelerated ejaculation occurs, wear of orgasmic sensations, pain during ejaculation, partial or total decrease in libido. Prolonged erection at night is also a symptom of chronic prostatitis.
External manifestations.In prostatitis, some patients have purulent or clear discharge from the urethra, which is more abundant in the morning. Patients may also notice a symptom, such as the presence of white flakes or filaments in the urine.
Types of prostatitis
Acute bacteria.Acute prostatitis develops as a result of infection of the prostate by Staphylococcus aureus, Escherichia coli, enterococcus and other pathogenic bacteria. If left untreated, this disease can cause blood poisoning. In this case, the man needs to be admitted urgently.
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 need to urinate;
- pain when urinating;
- difficulty urinating and acute urinary retention;
- white or colorless discharge from the urethra.
Chronic bacteria.The recurrent form of the disease occurs as a result of the infection penetrating the gland. Chronic hypothermia, prolonged sexual abstinence and early urination contribute to the development of prostatitis. Chronic prostatitis, if left untreated, can cause cystitis, since inflammation of the prostate is a reservoir of bacteria that affect the genitourinary tract.
Symptoms of chronic prostatitis:
- pain in the scrotum, lower abdomen, perineum;
- dysuria;
- power violations.
Chronic non-bacterial.The causes of the disease include the entry of viruses or bacteria into the prostate (tuberculosis bacillus, Trichomonas, chlamydia), autoimmune processes, penetration of urine into the gland. Chronic prostatitis is responsible for up to 95% of all types of prostate inflammation.
Signs of prostatitis are:
- chronic pain in the pelvic region (bothering the man for at least 3 months);
- recurrent groin pain;
- absence of symptoms of inflammation in the urine, semen and secretions from the prostate.
Asymptomatic chronic.Chronic asymptomatic prostatitis is not associated with bacterial infection and symptomatic prostatic syndromes. It is assumed that this disease is an age-related physiological characteristic.
Symptoms of this type of chronic prostatitis:
- absence of important syndromes of the disease;
- an increase in the 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 by biopsy or during surgical operations in the treatment of various pathologies of the prostate (adenoma, cancer).
Stagnant.Prostatitis develops not only in the context of anatomical and physiological changes in the venous and other systems of the body. The main cause of the disease is irregular sex life.
Signs of prostatitis:
- acute pain in the perineum, radiating to the sacrum;
- increased urination in the morning;
- mild difficulty in getting out of the urine (the symptom is seen in the chronic form of the disease);
- weakening of the erection;
- decreased libido;
- "Paleness" of orgasmic sensations during ejaculation.
Diagnosis of acute and chronic prostatitis
To select the correct treatment method, the doctor prescribes a comprehensive diagnosis of the condition of the genitourinary system, including the following methods.
Digital rectal examination.If you suspect a prostatitis disease, the urologist will do a digital exam. 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. During the study, its size, consistency and shape, surface condition and pain are determined.
Signs of prostatitis in men include:
- soft and inelastic consistency of the prostate;
- pain on palpation;
- enlarged gland;
- immobility of the rectal mucosa on the prostate.
Ultrasound procedure.Prostate ultrasound is prescribed prior to 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 prostate cysts and stones, 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 output. If the speed is 15 ml / s or more, this indicates normal urethra permeability. A sign of prostatitis is the decrease of this value below 10 ml / s. This speed is a consequence of the low permeability of the urinary tract.
Interpretation of urofluxometry results
| Urine flow rate | Interpretation |
|---|---|
| >15ml / sec | Obstruction of the urinary tract is unlikely |
| <10ml / s | It is likely that there is a significant narrowing of the urethra or weakness of the detrusor |
| 10-15ml / s | 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 bladder trauma are suspected.
Laboratory research.To diagnose and determine the microorganism that causes 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 the increase in the number of leukocytes in the biological material. To compose an effective treatment, the type of bacteria is determined by PCR, RIF and inoculation in nutrient medium.
Interpretation of laboratory results
| Secret of the prostate | 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 part of the urine and in the second part of the urine is ≥10 | + |
| Chronic pelvic pain inflammatory syndrome | >10 | - | The difference between the number of leukocytes in the third part of the urine and in the second part of the urine is ≥10 | - |
| Non-inflammatory chronic pelvic pain syndrome | <10 | - | - | - |
Prevention of prostatitis
Physical activity.For the prevention and treatment of prostate disease, men should avoid sedentary lifestyle. Recommended:
- walking (4 km per day or more);
- exercises (squats, jumps, curves);
- 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 rich in zinc and vitamin B. It is recommended to eat:
- seafood (oysters, seaweed);
- Me at;
- pumpkin seeds;
- nuts;
- Bran;
- kefir;
- Rye bread.
Regular sex life.When preventing and treating an illness, a man needs:
- lead a rhythmic sex life;
- avoid interrupted sexual intercourse;
- avoid casual relationships.
Treatment of acute and chronic prostatitis
Inflammation of the prostate is treated using the following methods.
Antibacterial therapy.If 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 |
|
Hormonal therapy.Hormonal treatment is necessary to restore the normal hormonal balance between androgens and estrogens. Drugs with antiandrogenic activity reduce inflammation of the gland's tissues and prevent the disease's transition to more severe stages.
Prostate massage.This method of treating chronic prostatitis can only be used outside of exacerbations. A man needs to stand in an inclined position, rest his palms on a sofa or table, spread his legs shoulder-width apart. The doctor who performs the treatment puts on sterile gloves on his hands, applies an ointment or gel (in some cases, a medication with an anesthetic component) on the index finger of his right hand and injects it through the anus into the rectum. The massage is carried out by applying light pressure until the secretions from the prostate are separated by opening the urethra. 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. The treatment is carried out by exposing the gland to ultrasonic waves, electromagnetic vibrations, as well as high temperatures (microclysters with hot water).
Surgical intervention.Surgical interventions for prostate disease are rarely used. This treatment is mandatory for the development of complications of acute or chronic prostatitis.
Indications for prostate surgery:
- acute urinary retention as a result of severe narrowing of the urethra;
- abscess (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. The symptoms of the disease are deep pains in the pelvis, radiating to the sacrum, aggravated by erection and ejaculation, frequent urination, appearance of blood and / or pus in the semen and urine.
Coliculitis and urethritis.Due to its proximity to the excretory flows from the prostate, the seminal tubercle is usually inflamed as a result of infection of the infected gland. If left 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.
Prostate abscess.The appearance of purulent cavities on the surface of the gland is due to the pathogenic bacteria that cause prostatitis. A characteristic symptom of the disease is general weakness, decreased consciousness, delirium, sharp rise in temperature, increased sweating and chills. Prostate abscess is a serious septic disease that must be treated in a hospital setting.
Prostate sclerosis.Prostate sclerosis develops in the context of regular exacerbations of chronic prostatitis as a result of non-adherence to the treatment prescribed by the urologist. This disease can form over several years; however, if the hormonal balance in the man's body is disturbed, rapid development is possible. With prostate sclerosis, pain is seen during emptying of the bladder, an intermittent and slow flow of urine.
Formation of cysts and calculations. . . 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 complicate the treatment of the disease. Simple 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 flow of urine, frequent urination, pain in the perineum.
Infertility.In chronic prostatitis, sperm production and motor function are impaired. If left untreated, the disease also affects the vas deferens and seminal vesicles, making them impassable for sperm, so they are not released into the urethra during ejaculation. As a result, men with chronic prostatitis often suffer from infertility.