Prostatitis is inflammation of the prostate gland, one of the most 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 the working capacity, the intimate sphere, limiting freedom and provoking daily difficulties and psychological disorders.
Prostatitis occurs in an acute or chronic form, it can be of infectious and non-infectious origin.
Causes of prostatitis
The causes of prostatitis are many: the acute form is associated with a bacterial infection that enters the ascending prostate gland in urological and venereal diseases of an infectious nature, chronic prostatitis in 90% of cases is not associated with infections. Stagnation of prostatic secretion is formed due to infectious inflammation of the walls of the duct and systemic diseases.
Causes of acute prostatitis
Acute bacterial prostatitis is caused by enterobacteria, Gram-negative and Gram-positive cocci, chlamydia, mycoplasma, viruses. Risk factors for prostate infection are sexually transmitted diseases and invasive urological interventions (catheterization, instillation and bougienage of the urethra, urocystoscopy).
The provocateurs of the development of infectious inflammation are usually hypothermia, prolonged constipation or diarrhea, sedentary work, excessive sexual activity or sexual abstinence, chronic course of venereal and urological diseases, suppression of the immune response, lack of sleep, overtraining, chronic stress. Poor blood supply to the pelvic organs, these same factors contribute to aseptic inflammation, and also facilitate the introduction of the pathogen into the tissue of the prostate gland.
Acute bacterial inflammation can resolve without consequences, but in some cases the following complications form:
- acute urinary retention;
- chronic prostatitis (chronic pelvic inflammatory syndrome);
- abscess of the prostate;
- fibrosis of the prostate tissue;
The 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% is due to chronic abacterial prostatitis or chronic pelvic pain syndrome (CPPS). This form of the disease is not associated with infections, but is due to many reasons, mainly stagnant processes in the small pelvis. Stagnation of urine, which causes inflammation, is formed against the background of urethritis, neurogenic narrowing of the bladder neck, urethral stricture, autoimmune inflammation. The blood supply to the pelvic organs deteriorates, which is explained by systemic cardiovascular diseases (coronary heart disease, atherosclerosis). The general venous system of the small pelvis determines the connection of chronic prostatitis with cracks in the anus, hemorrhoids, proctitis, fistulas.
Chronic pelvic pain in men is associated with:
- low physical activity;
- low blood testosterone levels;
- changes in the microbial environment of the body;
- genetic and phenotypic predisposition.
Symptoms of prostatitis
- Fever (from 38-39 degrees Celsius in acute prostatitis and subfebrile condition in chronic).
- Urinary dysfunction: frequent urge to urinate, not always effective, difficulty or increased urination, especially at night. The urine stream is exhausted and a residual amount remains in the bladder all the time.
- Damage to the prostate: leukocytes and blood in the semen, pain during urological examination.
- Prostatorea is a small secretion from the urethra.
- Pain in the small pelvis, perineum, testicles, above the pubis, penis, sacrum, bladder, scrotum.
- Sore urination and ejaculation.
- Convulsive muscle spasms.
- Stones in the prostate gland.
- Chronic fatigue, a feeling of hopelessness, disaster, 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, proctitis can join.
In the chronic course of the disease, the signs of prostatitis are blurred (less pronounced), but they are united by general, neurological and mental symptoms.
Diagnosis of prostatitis
The key to effective and timely treatment of prostatitis is an accurate and complete diagnosis. The low percentage of infectious prostatitis is explained in most cases by the fact that the pathogen was not detected. Chronic sexually transmitted infections can be asymptomatic, while their pathogens can invade prostate gland tissue and cause inflammation. Therefore, laboratory research methods play a leading role in the diagnostic process.
To determine the sensitivity of bacteria to antibiotics, inoculation of biological fluids is performed: urine, sperm and prostatic secretions. This method allows you to select a more effective drug for a specific strain of the pathogen, capable of penetrating directly into the focus of inflammation.
The "classic" method of laboratory diagnostics of prostatitis is considered culturological (urine culture, ejaculate, content of urogenital smears). The method is very accurate, but it takes time. To detect bacteria, a Gram smear is produced, but viruses, mycoplasma and ureaplasmas are unlikely to be detected in this way. To improve the accuracy of the search, mass spectrometry and PCR (polymerase chain reaction) are used. Mass spectrometry is an ionic analysis of the structure of a substance and the determination of each of its components. The polymerase chain reaction allows the detection of 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 study by the PCR method of the microflora of the urogenital tract is used. The test result is ready in one day and reflects the complete picture of the microbial relationship in the subject's body.
Tests for prostatitis include urine and ejaculate collection and urological smears.
The European Association of Urology recommends the following series of laboratory tests:
- general urine analysis;
- bacterial culture of urine, sperm and ejaculate;
- PCR diagnostics.
A general urinalysis allows you to determine the signs of inflammation (the number of colony-forming units of microorganisms, the number of leukocytes, erythrocytes, transparency of urine) and the presence of calcifications (prostate stones). General analysis is included in the method of different urological samples (glass or portioned).
Glass or portioned samples consist of the sequential collection of urine or other biological fluids in different containers. Thus, the localization of the infectious process is determined. Prostatitis is evidenced by the detection of infectious agents, blood cells (leukocytes and erythrocytes) in the final portion of urine during a three-glass test or after urological massage of the prostate
Two-glass test: seeds the middle part of the urine stream before and after the urological massage of the prostate.
Three-glass sample: The initial, middle, and final portions of urine are taken during the same urination.
Four-glass sample: culture and general analysis of the initial and middle parts of the urine stream, prostate secretion after urological massage of the prostate and a portion of urine after this procedure.
Culturological seeding or PCR diagnostics of the ejaculate and urogenital smear material are also performed.
Blood tests are also needed to make a diagnosis of prostatitis. A general capillary blood test allows you to confirm or deny the presence of inflammation, as well as rule out 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 parameters (including general urine and blood tests). The intensity of the pain syndrome is determined by the visual analog pain scale, and the severity of psychological changes is determined by the anxiety and depression rating scales. At the same time, research is necessarily conducted to find an infectious agent, since the spectrum of pathogens can be very broad. From instrumental studies, urofluometry is prescribed with the determination of the residual volume of urine and transrectal ultrasound (TRUS) of the prostate gland.
Asymptomatic prostatitis is detected with a histological examination of a prostate biopsy, prescribed for suspected cancer. A blood test for prostate specific antigen (PSA) is done in advance. Serum PSA appears with prostate hypertrophy and inflammation, and the criteria for the norm change with age. This study also helps rule out suspicions of prostate cancer.
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, neuromodulators. Few antibiotics are able to penetrate the prostate gland, pathogens are immune to some drugs, therefore bacterial inoculation is required.
Conservative urological treatment can also include acupuncture, phytotherapy, external shock wave therapy, thermal physiotherapy (after acute inflammation), massage.
Prevention of prostatitis includes both medical manipulations and the formation of healthy habits:
- the use of barrier contraception;
- regular sexual activity under conditions of minimal risk of infection;
- physical activity;
- elimination of states of deficiency - hypo and avitaminosis, mineral deficiency;
- compliance with aseptic conditions and careful technique to perform invasive urological interventions;
- regular preventive examinations using laboratory tests.