ProstatitisIs a urological disease that is accompanied by inflammation of the tissues of the prostate. Damage to the prostate can be caused by an infection carried through the blood, lymph, or unprotected intercourse. The development of prostatitis in men is facilitated by injuries and impaired 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 the reproductive and urinary organs.
Incidence statistics
Prostatitis is one of the most common diseases of the male genitourinary system in the world. According to various sources, it is seen in 60-80% of sexually mature men. According to official medical statistics, over 30% of young people of childbearing age suffer from chronic prostatitis. It occurs in about a third of the cases in men over 20 and under 40 years of age. According to the WHO, urologists diagnose chronic prostatitis in every tenth patient.
Causes of Prostatitis
Infections.Pathogenic and opportunistic bacteria enter the prostate via the lymph and blood vessels. Secondary infection of the prostate is often a complication of inflammatory diseases of the rectum and urethra.
Types of infection:
- ascending- microbes rise up into the gland from the external urethral opening;
- downward- Microbes enter the prostate along with the stream of infected urine.
Conditionally pathogenic microorganisms that cause the disease (according to Research Institute of Urology 1997-1999)
| Microorganisms | Number of studies | |
|---|---|---|
| %. | Section | |
| Staphylococcus epidermidis | 42. 3 | 55 |
| S. saprophyticus | 17. 6 | 23 |
| S. aureus | 4. 6 | 6th |
| S. haemolyticus | 3. 1 | four |
| S. hominis | 0, 8 | one |
| S. warneri | 1. 5 | 2 |
| Staphylococcus spp. | 3. 1 | four |
| Enterococcus faecalis | 11. 6 | fifteen |
| Streptococcus spp. | 3. 1 | four |
| TOTAL (size +) | 87. 6 | 114 |
| P. aeruginosa | 3. 7 | five |
| E. coli | 4. 7 | 6th |
| Enterobacter spp. | 2, 3 | 3rd |
| Proteus spp. | 1. 5 | 2 |
| TOTAL (large -) | 12. 3 | Sixteen |
Weakening immunity.One of the causes of prostate inflammation is the weakening of the body's immune system. This can be facilitated by frequent stress, unbalanced diet, overwork, smoking, and alcohol consumption. With decreased immunity, the body is most susceptible 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, sedentary lifestyle. With a constant lack of physical activity, the work of the endocrine, cardiovascular and nervous systems, as well as blood flow to the pelvic organs, are disrupted. 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 occurrence of prostatitis. Many men who are sexually active experience nervous exhaustion, hormonal imbalance, impaired secretion of the sex glands, and a gradual decline in potency. Interrupted 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 often this is observed in patients whose professional activity is related to driving. The cause of prostatitis in this case is constant shaking, vibration and excessive stress on the muscles of the perineum.
The main syndromes of prostatitis
Pain.With prostatitis in men, there is pain and cutting pain in the lower abdomen and lower back, as well as pain throughout the body. This symptom can worsen with ejaculation, especially during intercourse after prolonged abstinence.
Dysuria.Typical signs of prostatitis in men are increased urination, burning and stinging when emptying the bladder, and pain in the perineum after urinating. Another symptom of prostate inflammation is difficulty urinating. If the disease is not treated, acute urinary retention can occur.
Sexual dysfunction.With uncomplicated prostatitis, there is accelerated ejaculation, wear and tear of orgasmic sensations, pain during ejaculation, partial or complete decrease in libido. A prolonged erection at night is also a symptom of chronic prostatitis.
External manifestations.With prostatitis, some patients have purulent or marked discharge from the urethra, which is most common 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 results from infection of the prostate with 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 hospitalized urgently.
Symptoms Seen 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;
- painful urination;
- 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 penetration of an infection into the gland. Chronic hypothermia, prolonged sexual abstinence, and premature urination all contribute to the development of prostatitis. Chronic prostatitis, if left untreated, can cause cystitis because the inflammation in the prostate is a reservoir of bacteria that affect the genitourinary tract.
Chronic prostatitis symptoms:
- Pain in the scrotum, lower abdomen, perineum;
- Dysuria;
- Violations of potency.
Chronic not bacterial.The causes of the disease are the penetration of viruses or bacteria into the prostate (tubercle bacillus, trichomonas, chlamydia), autoimmune processes and the penetration of urine into the gland. Chronic prostatitis accounts for up to 95% of all types of prostate inflammation.
Signs of prostatitis are:
- chronic pelvic pain (which bother the man for at least 3 months);
- recurrent groin pain;
- Absence of symptoms of inflammation in urine, seminal and prostate secretions.
Chronically asymptomatic.Asymptomatic chronic prostatitis is not associated with bacterial infection and symptomatic prostatic asymptomatic syndromes. It is believed that this disease is an age-related physiological characteristic.
Symptoms of this type of chronic prostatitis:
- Absence of main syndromes of the disease;
- an increased level of leukocytes and bacteria in the urine.
The main symptom of the disease - the presence of infection in the gland - can only be determined with a biopsy or during surgical interventions in the treatment of various pathologies of the prostate (adenoma, cancer).
Stagnates.Prostatitis develops not only against the background of anatomical and physiological changes in the venous and other body systems. The main cause of the disease is an irregular sex life.
Signs of prostatitis:
- aching pain in the perineum radiating to the sacrum;
- increased urination in the morning;
- slight difficulty in urine outflow (the symptom is observed with the chronic form of the disease);
- Weakening of the erection;
- decreased libido;
- "Pallor" of orgasmic sensations during ejaculation.
Diagnosis of acute and chronic prostatitis
To choose the correct method of treatment, the doctor prescribes a comprehensive diagnosis of the condition of the genitourinary system, including the following methods.
Digital rectal exam.If you suspect prostatitis, the urologist will do a digital exam. The posterior surface of the prostate is adjacent to the rectum. So if a finger is inserted through the anus, the doctor can determine the condition of the gland. During the course of the study, the size, consistency and shape, surface condition and pain are determined.
Signs of prostatitis in men are:
- soft, inelastic consistency of the prostate;
- Pain on palpation;
- enlarged gland;
- Immobility of the rectal mucosa over the prostate.
Ultrasonic method.Ultrasound of the prostate is prescribed before the start of treatment for acute prostatitis to identify / exclude an abscess of the gland, and in the chronic course of the disease - to identify cysts and stones of the prostate, 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 process of urination: the duration of this physiological process and the speed of urine outflow. If the speed is 15 ml / s or more, this indicates normal patency of the urethra. A sign of prostatitis is a decrease in this value below 10 ml / s. This rate is a consequence of the poor patency of the urinary tract.
Interpretation of the results of uroflowmetry
| Urine flow rate | interpretation |
|---|---|
| >15 ml / s | Urinary tract obstruction is unlikely |
| <10 ml / s | Significant narrowing of the urethra or detrusor weakness is likely |
| 10-15 ml / s | Indefinite result |
Cystoscopy.An endoscopic imaging system is inserted into the bladder for examination. This method of 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 caused the disease, urinary and prostate secretions are examined if symptoms of chronic prostatitis or acute inflammation are present. A sign of the presence of pathogenic microflora is an increased number of leukocytes in biological material. To achieve an effective course of treatment, the type of bacteria is determined by PCR, RIF and inoculation on a nutrient medium.
Interpretation of laboratory results
| Prostate Secret | Third urine sample (after prostate massage) | |||
|---|---|---|---|---|
| HP shape | The number of leukocytes, uv. X 400 | Sowing results | The number of leukocytes, uv. X 400 | Sowing results |
| bacteria | >10 | + | The difference between the number of leukocytes in the third part of the urine and the second part of the urine is ≥ 10 | + |
| Chronic pelvic inflammatory pain syndrome | >10 | - - | The difference between the number of leukocytes in the third part of the urine and 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 diseases, a man must avoid physical inactivity. Recommended:
- Walking (4 km per day or more);
- Exercise (squats, jumps, bends);
- Training the muscles of the perineum and buttocks (10 tension and relaxation).
Right nutrition.To prevent acute and chronic prostatitis, men must include foods high in zinc and vitamin B in their diet. It is recommended to eat:
- Seafood (oysters, algae);
- Flesh;
- Pumpkin seeds;
- Walnuts;
- Bran;
- Kefir;
- Rye bread.
Regular sex life.In the prevention and treatment of any disease, a man needs:
- lead a rhythmic sex life;
- Avoid interrupted intercourse.
- Avoid casual relationships.
Treatment of acute and chronic prostatitis
Prostate inflammation is treated using the following methods.
Antibacterial therapy.When 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.
Properties of drugs
| A drug | Services | disadvantage |
|---|---|---|
| Fluoroquinolones |
|
|
| Macrolides |
|
Insufficiently active against gram-negative bacteria |
| Tetracyclines | Active against atypical pathogens |
|
Hormone therapy.Hormonal treatment is necessary to restore the normal hormonal balance between androgens and estrogens. Drugs with antiandrogenic activity reduce inflammation of the glandular tissue and prevent the transition of the disease into more severe stages.
Prostate massage.This method of treating chronic prostatitis can only be used outside of exacerbations. A man needs to assume a sloping position, place his palms on a couch or table, and spread his legs shoulder-width apart. The attending physician puts on his hands with sterile gloves, puts an ointment or gel (in some cases a drug with an anesthetic component) on the index finger of his right hand, and injects it through the anus into the rectum. Massage is performed by applying light pressure until the prostate secretions are separated through the opening of the urethra. The treatment includes at least 10 massages.
Physical therapy.To treat the symptoms of prostatitis, methods of normalizing and increasing blood flow in the pelvic area are used. This allows you to exclude stagnation and increase the effectiveness of drug therapy. The treatment is carried out by exposing the gland to ultrasound waves, electromagnetic vibrations and high temperatures (microclysters with warm water).
Surgical intervention.Surgical interventions for prostate diseases are rarely used. Such treatment is mandatory in order to develop complications of acute or chronic prostatitis.
Indications for prostate surgery:
- acute urinary retention as a result of severe narrowing of the urethra;
- Abscess (the 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. Symptoms of the disease include pain deep in the pelvis that extends to the sacrum, made worse by erection and ejaculation, frequent urination, the appearance of blood and / or pus in semen and urine.
Colliculitis and urethritis.Because of its proximity to the excretory streams of the prostate, the seminal tubercle is often inflamed as a result of infection by 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 due to the spasmodic contraction of the urethra.
Abscess of the prostate.The appearance of purulent cavities on the surface of the gland is due to the pathogenic bacteria that caused prostatitis. A characteristic symptom of the disease is general weakness, impaired consciousness, delirium, a sharp rise in temperature, increased sweating, chills. Prostate abscess is a serious septic condition that requires hospital treatment.
Sclerosis of the prostate.Prostatic sclerosis develops against the background of regular exacerbations of chronic prostatitis as a result of non-compliance with the treatment prescribed by the urologist. This disease can develop over several years. However, when the hormonal balance in a man's body is disturbed, rapid development is possible. With sclerosis of the prostate, pain is observed when emptying the bladder, an intermittent and sluggish flow of urine.
Formation of cysts and stones. . . The appearance of cysts in the gland is one of the likely options for chronic prostatitis to progress. Infection with neoplasms can cause an abscess and make treating the disease much more difficult. Single and multiple stones can also form in the prostate. With this disease, in addition to the usual symptoms of chronic prostatitis, there are violations of urine outflow, frequent urination and 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 that they are not thrown into the urethra during ejaculation. As a result, men with chronic prostatitis often suffer from infertility.