Prostatitis is an inflammation of the prostate gland, one of the most common problems affecting 40% of middle-aged and older men.Without directly endangering life, this disease leads to a significant deterioration in the quality of life, affects performance and intimate areas, limits freedom and leads to everyday difficulties and psychological disorders.
Prostatitis occurs in acute or chronic form and can be of infectious or non-infectious origin.
Causes of Prostatitis
The causes of prostatitis are diverse: the acute form is accompanied by a bacterial infection, which ascends into the prostate in urological and sexually transmitted diseases of an infectious nature; chronic prostatitis is not accompanied by infections in 90% of cases.Stagnation of prostate 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 include sexually transmitted diseases and invasive urological procedures (catheterization, urethral instillation and diversion, urocystoscopy).
As a rule, provocateurs for the development of infectious inflammation are hypothermia, persistent 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 deteriorating the blood supply to the pelvic organs, these factors themselves contribute to aseptic inflammation and also facilitate the introduction of the pathogen into the prostate tissue.
Acute bacterial inflammations can resolve without consequences, but in some cases the following complications occur:
- acute urinary retention;
- chronic prostatitis (chronic pelvic inflammatory 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, as well as urethritis, chlamydia, human papillomavirus and other chronic infections.About 90% are due to nonbacterial chronic prostatitis or chronic pelvic pain syndrome (CPPS).This form of the disease is not associated with infections, but has many causes, primarily stagnant processes in the pelvis.Against the background of urethritis, neurogenic narrowing of the bladder neck, urethral stricture and autoimmune inflammation, stagnation of urine occurs, which leads to inflammation.The blood supply to the pelvic organs deteriorates, which is explained by systemic cardiovascular diseases (CHD, arteriosclerosis).The common venous system of the pelvis determines the association of chronic prostatitis with anal fissures, hemorrhoids, proctitis and fistulas.
Chronic pelvic pain in men is associated with:
- low physical activity;
- low blood testosterone levels;
- changes in the body's microbial environment;
- genetic and phenotypic predisposition.
Symptoms of prostatitis
- Fever (of 38-39 degrees Celsius in acute prostatitis and mild fever in chronic prostatitis).
- Urinary dysfunction: frequent urge to urinate that is not always effective, difficulty or increased frequency of urination, especially at night.The urine stream is exhausted and a residual amount always remains 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, above the pubic bone, penis, sacrum, bladder, scrotum.
- Painful urination and ejaculation.
- Spasmodic muscle spasms.
- Stones in the prostate.
- Chronic fatigue, a feeling of hopelessness, catastrophe, psychological stress against 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.
In the chronic course of the disease, the signs of prostatitis are blurred (less pronounced), but are accompanied by general, neurological and psychological symptoms.
Diagnosis of prostatitis
The key to successful and timely treatment of prostatitis is an accurate and comprehensive diagnosis.In most cases, the low proportion of infectious prostatitis is explained by the fact that the pathogen has not been 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, prostatic secretion.This method allows you to choose a drug that is most effective for a particular strain of pathogen and can penetrate 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 precise, but takes time.To detect bacteria, a smear is stained with a Gram stain, although viruses, mycoplasma and ureaplasma are unlikely to be detected this way.To increase the accuracy of research, mass spectrometry and PCR (polymerase chain reaction) are used.Mass spectrometry is the ion analysis of the structure of a substance and the determination of each of its components.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 urogenital tract is used.The result of the study is available within a day and reflects the complete picture of the microbial ratio in the subject's body.
Tests for prostatitis include collection of urine and ejaculate and urological swabs.
The European Urological Association recommends the following laboratory tests:
- general urinalysis;
- Bacterial culture of urine, semen and ejaculate;
- PCR diagnostics.
A general urine test allows you to detect signs of inflammation (number of colony-forming units of microorganisms, number of leukocytes, red blood cells, clarity of urine) and the presence of calcifications (prostate stones).The general analysis of several urological (glass or portion) samples is part of the methodology.
Glass or portion samples consist of the sequential collection of urine or other biological fluids in different containers.In this way, the localization of the infectious process is determined.Prostatitis is indicated by the detection of infectious agents, blood cells (leukocytes and erythrocytes) in final urine during a three-glass sample or after urological massage of the prostate
Two-glass test – vaccination of the middle part of the urine stream before and after urological prostate massage.
Three-glass sample - the initial, middle and final urine portions are collected at the same urination.
Four-glass test – culture and general analysis of the beginning and middle part of the urine stream, prostate secretion after urological prostate massage and a portion of urine after this procedure.
They also carry out culture culture or PCR diagnostics of ejaculate and urogenital swab material.
Blood tests are also required to make a prostatitis diagnosis.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 non-inflammatory chronic pelvic pain syndrome is more difficult, as it is based on the clinical picture and indirect laboratory indicators (including a 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, there is a need for research to search for an infectious agent, as the spectrum of pathogens can be very wide.Instrumental examinations include urofluometry with determination of residual urine volume and transrectal ultrasound examination (TRUS) of the prostate.
Asymptomatic prostatitis is determined by histological examination of a prostate biopsy, which is prescribed if cancer is suspected.First, a blood test for prostate-specific antigen (PSA) is carried out.PSA in blood serum occurs with hypertrophy and inflammation of the prostate, 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
Treatment of acute prostatitis is carried out with antibiotics (fluoroquinolines and cephalosporins, macrolides), alpha-blockers, non-steroidal anti-inflammatory drugs and neuromodulators.Only a few antibiotics can penetrate the prostate;Pathogens are immune to some drugs, so bacterial culture is required.
Conservative urological treatment may also include acupuncture, herbal medicine, remote shock wave therapy, thermal physiotherapy (after acute inflammation) and massage.
Prevention of prostatitis includes both medical interventions 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 states – hypo- and avitaminosis, mineral deficiency;
- Compliance with aseptic conditions and careful technique for performing invasive urological procedures;
- regular preventive examinations using laboratory tests.