Prostatitis is an inflammation of the prostate gland that is a common problem in 40% of middle-aged and older men.Without directly endangering life, this leads to a significant deterioration in the quality of the disease, affects performance, the intimate sphere, limits freedom, and causes everyday difficulties and psychological disturbances.
Prostatitis occurs in an acute or chronic form and can be infectious or non-infectious in origin.
Causes of prostatitis
The causes of prostatitis are varied: the acute form is associated with bacterial infection, which enters the prostate gland in the course of infectious urological and sexual diseases, chronic prostatitis is not associated with infections in 90% of cases.Stagnation of prostatic secretion occurs both as a result of infectious inflammation of the walls of the ducts and as a result of 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).
The provocateurs for the development of infectious inflammations 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 impairing the blood supply to the pelvic organs, these factors themselves contribute to aseptic inflammation and facilitate the pathogen's entry into the prostate tissue.
Acute bacterial inflammation resolves 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 the prostate tissue;
- infertility.
Causes of chronic prostatitis
In 10% of cases, chronic prostatitis develops as a complication of acute inflammation of the prostate, as well as urethritis, chlamydia, human papillomavirus and other chronic infections.About 90% are due to non-bacterial chronic prostatitis or chronic pelvic pain syndrome (CPPS).This form of the disease is not associated with infections, but can be traced back to a number of reasons, primarily due to stagnant processes in the pelvis.Inflammatory urinary retention develops 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 pelvis determines the relationship between chronic prostatitis and anal fissures, hemorrhoids, proctitis and fistulas.
Chronic pelvic pain in men is associated with:
- low physical activity;
- low level of testosterone in the blood;
- changes in the body's microbial environment;
- genetic and phenotypic predisposition.
Symptoms of prostatitis
- Fever (38-39 degrees Celsius in case of acute prostatitis, low-grade fever in case of chronic prostatitis).
- Urinary disorder: frequent urge to urinate, not always effective, difficulty urinating or more frequent urination, especially at night.My urine flow is depleted and there is always a 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, pubis, penis, sacrum, bladder, scrotum.
- Painful urination and ejaculation.
- Spasmodic muscle spasms.
- Stones in the prostate gland.
- Chronic fatigue, feeling of hopelessness, catastrophe, psychological stress in 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.
During the chronic course of the disease, the signs of prostatitis are vague (less pronounced), but are associated with general, neurological and mental symptoms.
Diagnosis of prostatitis
The key to successful and timely treatment of prostatitis is an accurate and comprehensive diagnosis.In most cases, the low rate of infectious prostatitis can be explained by the fact that the causative agent could not be 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 makes it possible to select a drug that is most effective for a specific strain of the pathogen and is able to penetrate directly into the site of inflammation.
The "classic" method of laboratory diagnosis of prostatitis is cultural (urine culture, ejaculate, contents of urogenital smears).The method is very accurate but takes time.To detect bacteria, the smear is stained with Gram stain, but it is unlikely that viruses, mycoplasma and ureaplasma will be detected.Mass spectrometry and PCR (polymerase chain reaction) are used to increase the accuracy of the research.Mass spectrometry is the ion analysis of the structure of a substance and the determination of each of its components.Polymerase chain reaction allows the detection of DNA or RNA fragments of the causative agent of an infectious disease, including viruses and plasma.
Currently, a special comprehensive PCR test of the microflora of the urogenital tract is used for the special examination of urological patients.The result of the test is ready in one day and reflects a complete picture of the microbial ratio in the body of the person tested.
Examination of prostatitis includes the collection of urine and ejaculate, as well as urological smears.
The European Urological Association recommends the following laboratory tests:
- general urinalysis;
- bacterial culture of urine, sperm and ejaculate;
- PCR diagnostics.
A general urinalysis allows the determination of signs of inflammation (the number of colony-forming units of microorganisms, the number of leukocytes, red blood cells, the purity of urine) and the presence of calcifications (prostate stones).General analysis is included in the methodology of several urological (cup or dose) samples.
Vial or aliquot samples consist of the 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 and blood cells (leukocytes and erythrocytes) in the last part of the urine after a three-glass sample or a urological massage of the prostate.
Two-glass test - inoculation of the middle part of the urinary stream before and after urological prostate massage.
Three vial samples - the initial, middle and last portions of urine are taken during the same urination.
Four-glass test - culture and general analysis of the initial and middle part of the urine stream, prostate secretion after urological prostate massage and part of the urine after this procedure.
Culture or PCR diagnostics of the ejaculate and urogenital smear material is also carried out.
A blood test is also required for the diagnosis of prostatitis.A general capillary blood test allows you to confirm or deny the presence of inflammation, as well as to 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 needed to find the infectious agent, since the range of pathogens can be very wide.Instrumental tests include urofluometry with determination of residual urine volume and transrectal ultrasound (TRUS) of the prostate gland.
Asymptomatic prostatitis is detected by histological examination of a prostate biopsy sample prescribed for suspected cancer.First, a blood test is performed to detect prostate-specific antigen (PSA).PSA appears in the blood serum with hypertrophy and prostatitis, and the normal criteria change with age.This examination also helps rule out the suspicion of a malignant prostate tumor.
Treatment and prevention of prostatitis
Acute prostatitis is treated with antibiotics (fluoroquinolines and cephalosporins, macrolides), alpha-blockers, nonsteroidal anti-inflammatory drugs, and neuromodulators.Few antibiotics can penetrate the prostate gland;pathogens are immune to certain drugs, so bacterial culture is necessary.
Conservative urological treatment may also include acupuncture, herbal treatment, remote shock wave therapy, thermal physiotherapy procedures (after acute inflammation), and massage.
Prostatitis prevention includes both medical procedures and healthy habits:
- use of barrier-free contraceptives;
- regular sexual activity with minimal risk of infection;
- physical activity;
- elimination of deficiency states - hypo- and avitaminosis, mineral deficiency;
- adherence to aseptic conditions and careful technique of performing invasive urological interventions;
- regular preventive examinations with laboratory tests.