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 causing everyday difficulties and psychological disorders.
Prostatitis occurs acutely or chronically and can be infectious or non-infectious in origin.
Causes of prostatitis
The causes of prostatitis are varied: the acute form is associated with a bacterial infection that enters the prostate via an 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 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, urethral instillation and diversion, 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 contribute to aseptic inflammation and also facilitate the introduction of the pathogen into the prostate tissue.
Acute bacterial inflammation can resolve itself 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 chronic nonbacterial prostatitis or chronic pelvic pain syndrome (CPPS).This form of the disease is not associated with infections, but is due to several reasons, mainly stagnant processes in the pelvis.Urine stagnation, 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 (DIC, 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 body's microbial environment;
- genetic and phenotypic predisposition.
Prostatitis symptoms
- 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 stream of urine runs out and there is always some residual quantity in the bladder.
- Damage to the prostate: leukocytes and blood in the 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.
- Chronic fatigue, feeling of hopelessness, catastrophe, psychological stress in the context 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, signs of prostatitis are blurred (less pronounced), but are accompanied by general, neurological and mental symptoms.
Prostatitis diagnosis
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 has not been detected.Chronic sexually transmitted infections can be asymptomatic, while their pathogens can penetrate 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 more effective drug for a specific strain of the pathogen, capable of penetrating directly into the site of inflammation.
The “classic” method of laboratory diagnosis of prostatitis is considered cultural (urine culture, ejaculate, contents of urogenital smears).The method is very accurate, but it takes time.To detect bacteria, a smear is stained with Gram stain, but in this way viruses, mycoplasma and ureaplasma are unlikely to be detected.To increase the accuracy of research, mass spectrometry and PCR (polymerase chain reaction) are used.Mass spectrometry is the ionic analysis of the structure of a substance and the determination of each of its components.The polymerase chain reaction allows you to detect DNA or RNA fragments 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 within a day and reflects the complete picture of the microbial ratio in the subject's body.
Tests for prostatitis include urine and ejaculate collection and urological swabs.
The European Urological Association recommends the following set of laboratory tests:
- general urinalysis;
- bacterial culture of urine, semen and ejaculate;
- Diagnosis by PCR.
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 various urological samples (glass or portion).
Glass or portion samples consist of the sequential collection of urine or other biological fluids in different containers.In this way, the location 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-cup sample or after urological prostate massage
Two-cup test - inoculation of the middle part of the urine stream before and after urological prostate massage.
Three-cup sample - the initial, middle and final portions of urine are collected during the same urination.
Four-glass test - culture and general analysis of the initial and middle parts of the urinary stream, prostate secretion after urological prostate massage and a portion of urine after this procedure.
They also perform cultural culture or PCR diagnosis of ejaculate and urogenital swab material.
To diagnose prostatitis, blood tests are also necessary.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 chronic non-inflammatory pelvic pain syndrome is more difficult, as it is based on the clinical picture and indirect laboratory indicators (including general urine and blood tests).The intensity of the pain syndrome is determined using a visual analogue pain scale, and the severity of psychological changes is determined using anxiety and depression assessment scales.At the same time, research is needed 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.
Asymptomatic prostatitis is detected by histological examination of a prostate biopsy sample, prescribed for suspected cancer.A blood test for prostate specific antigen (PSA) is performed first.PSA in blood serum appears with prostate hypertrophy and inflammation, and 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 with antibiotics (fluoroquinolines and cephalosporins, macrolides), alpha-blockers, non-steroidal anti-inflammatory drugs, neuromodulators.Few antibiotics can penetrate the prostate;pathogens are immune to some medications, 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.
Prostatitis prevention includes medical procedures and the formation of healthy habits:
- use of barrier contraceptives;
- regular sexual activity under conditions of minimized risk of infection;
- physical activity;
- elimination of deficiency conditions - hypo- and avitaminosis, mineral deficiency;
- adherence to aseptic conditions and careful technique for performing invasive urological interventions;
- regular preventive examinations through laboratory tests.