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Prostatitis

symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the prostate gland (prostate) in men, which adversely affects both sexual function and urination. Pain in the perineum, groin, lower back and pelvis, and urodynamic disturbances (outflow of urine) may indicate the presence of prostatitis. Untreated prostatitis can cause male infertility and prostate cancer.

It is one of the most common gynecological diseases, which requires careful attention and competent systemic treatment. It is this approach to dealing with prostatitis that you will find in the urology department of a professional clinic. Highly qualified urologists - urologists have successfully treated acute and chronic prostatitis for many years. The complex therapy, caring attitude and individual approach to each case will certainly help patients recover and achieve stable long-term remission.

Popularity

Prostatitis ranks 5th out of 20 major urological diagnoses. It is believed that at the age of 30, 30% of the male population suffers from prostatitis, at the age of 40 - 40%, and after the age of 50, almost all men in one way or another bear the burden of prostate cancer. this disease. And if bacterial prostatitis is documented up to 35 years, then in more adulthood the non-infectious form predominates and in general it is diagnosed many times more often thanbacterial prostatitis.

Anatomy and physiology of the prostate

The prostate gland (prostate) is located in the lower anterior part of the small pelvis below the bladder. It is composed of glandular and smooth muscle tissue, surrounded by a fibrous capsule. The urethra passes through the body of the prostate from the bladder, into which the ejaculatory ducts open.

The prostate is a hormone-dependent organ. It is formed and works under the influence of male hormones - male hormones. Testosterone plays an important role in this process.

The prostate gland is connected to the tuberculous capsule, acting as a valve to the ejaculatory duct. As part of the male reproductive system, the prostate gland affects erections, ejaculation, and orgasm. The nerves responsible for an erection pass through the gland. In the chronic course of the disease, they participate in the inflammatory process, and erectile dysfunction develops.

The prostate gland secretes a secretion that is part of semen. It creates favorable conditions for sperm activity. Therefore, with chronic dysfunction of the gland, male infertility can be observed.

Pathogenesis

There are two main reasons for the development of prostatitis:

  • stagnation of prostate secretion against the background of circulatory disorders and lymphatic outflow in the main gland and adjacent organs;
  • conditionally pathogenic and pathogenic microflora.

Acute prostatitis is often associated with an infection of prostate tissue. But as a rule, both of these factors are interrelated and together create a vicious cycle that makes it difficult to treat prostatitis.

An inflamed prostate gland becomes painful. Pain may be felt in the perineum, groin, pelvis, and lower back. It increases sharply to palpation during digital rectal examination or defecation.

The enlarged prostate gland constricts the urethra. As a result, the process of draining urine out of the bladder becomes difficult. Urine flow becomes weak. The patient must strain the abdominal muscles to perform the act of urinating. In acute cases, urinary tract obstruction is sometimes present, and acute urinary retention is present.

Inflammation leads to a violation of the outflow of prostatic fluid and its stagnation. As a result, edema disrupts cellular metabolic and respiratory processes in the gland. This creates the conditions for the sequencing process. With prolonged prostatitis, nearby organs can also become inflamed: the seminal vesicles, Cooper's glands, seminal vesicles. The chronic form of the disease is associated with an increased risk of developing male infertility, adenomas, and prostate cancer.

In recent years, it has been found that in 70-80% of cases, prostatitis occurs due to stasis processes in the gland. Varicose veins are less common, but they also cause prostatitis, especially if accompanied by hemorrhoids and left varicocele (dilated testicular vein).

Classify

The US National Institutes of Health identifies 4 types of prostatitis:

  • Acute prostatitis (Type I)
  • Chronic bacterial prostatitis (Type II)
  • Chronic prostatitis / Chronic pelvic pain syndrome (Type III)
  • Asymptomatic chronic prostatitis (Type IV)

Due to the appearance of prostatitis are divided into two types:

  • non-infectious
  • Infectious

The inflammatory process can develop rapidly, accompanied by vivid symptoms (acute phase), or slowly, with gradually disappearing symptoms.

Prostatitis is not contagiousIn most cases, it is associated with stagnation of secretion of the prostate gland and impaired circulation of blood and lymph flow in the main gland and adjacent organs.

Infectious prostatitisdevelops due to the penetration of pathogenic or conditional microflora into the tissues of the prostate gland: bacteria, viruses, fungi. There are different ways for an infection to get into the prostate:

  • Urethra (ascending): the entrance is the urethra. It should be noted that the infection can also go down, for example, with pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphocytic: infection from nearby pelvic organs can enter the prostate via lymph from inflammation of the rectum (prostatitis) or bladder (cystitis), as well as from veinsinfected hemorrhoids.
  • Through blood (through blood): due to chronic infection in the body (tonsillitis, tooth decay) or complications of acute infection (flu, acute respiratory infection, tonsillitis . . . ).

The most common prostatitis triggers are:

  • bacteria: E. coli, Proteus, gardnerella (gram negative); staphylococcus, streptococcus (gram positive);
  • viruses (influenza, herpes, cytomegalovirus, ARVI pathogens);
  • mycoplasma;
  • chlamydia;
  • specific flora (gonococcus, Trichomonas, Mycobacterium tuberculosis).

By the nature of the course, prostatitis occurs:

  • Spicy
  • Chronic

Acute prostatitisusually occurs under the influence of pathogenic microflora (conditionally pathogenic) in the presence of pathogenic factors. It has a rapid course and pronounced symptoms. If not treated in time, pyogenic processes can develop, leading to the melting of the tissues of the prostate gland. Without proper treatment, acute prostatitis often becomes chronic.

Chronic prostatitistake a milder course, the symptoms are cleared. However, it can worsen over time, and then the symptoms will correspond to an acute course. At the same time, complete remission between exacerbations does not always occur, and the patient may experience constant discomfort. Chronic prostatitis can cause impotence, male infertility, adenomas, or prostate cancer.

There is a chronic form of the disease without symptoms, when the patient has no symptoms, but there is an increase in pyogenic factors (leukocytes) in prostate secretion.

Complications

Without appropriate therapy, the inflammatory process can lead to purulent fusion of prostate tissues. Furthermore, the infection can spread to nearby organs: seminal vesicles, Cooper glands, seminal vesicles, urethra. As a result, the following complications may occur:

  • prostate abscess
  • Scleroderma/fibrosis of the prostate (the gland's functional tissue is replaced by connective tissue)
  • prostate cyst
  • Prostate stones
  • Inflammation of the seminal vesicles (inflammation of the seminal vesicles)
  • Colitis (inflammation of the seminal vesicles)
  • Epididymitis (inflammation of the testicles and their appendages)
  • Posterior urethritis
  • Erectile dysfunction / impotence
  • Ejaculation disorder
  • Dry
  • Prostate tumor
  • Prostate cancer

Symptom

The different forms of prostatitis have their own characteristics in terms of the course and severity of symptoms. In general, prostatitis is characterized by the following manifestations:

  • Pain in the groin, lower back, perineum (may radiate along the spermatic cord).
  • Pain increases during defecation, digital sigmoidoscopy.
  • Violation of urodynamics (frequent urination, urinary retention, dysuria, weak flow, incomplete bladder emptying).
  • Prostatic hypersecretion (involuntary prostatic secretion, especially in the morning and during bowel movements).
  • Sexual dysfunction (decreased libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • Temperature rises to 39-40 degrees
  • Acute urinary retention
  • General poisoning
  • Increased white blood cells, protein and mucus in the urine
  • Blood in urine and semen
  • Leukocytosis in prostate secretion
  • Decreased birth and enlarged glands, increased blood flow according to ultrasound

Symptoms of Chronic Prostatitis

  • Body temperature is usually not higher than 37C
  • Pain is soothed and soothed
  • Discharge from the urethra during bowel movements
  • Urinary disorders
  • Reduced sex drive
  • erectile dysfunction
  • Ejaculation disorders (premature or delayed ejaculation)

The reasons

The main reasons leading to the development of prostatitis are infection and stagnation of the secretory process of the prostate gland. The following factors contribute to the occurrence of prostatitis:

  • Infections and opportunistic flora with weakened immunity
  • Hypodynamia
  • "Sedentary"
  • Prolonged sexual abstinence
  • Intermittent Coitus (with delayed ejaculation)
  • Excessive sexual activity leads to gland decline
  • Alcohol abuse
  • Decreased local immunity (hypothermia, use of immunosuppressants, immunodeficiency, autoimmune disease)
  • Injury to pelvic organs
  • Manipulation of the prostate gland and nearby organs (prostate biopsy, surgery, catheterization, cystoscopy, etc. )
  • Chronic diarrhea or constipation

Diagnose

To detect prostatitis, people use many methods, which can be divided into 3 groups: digital rectal examination, laboratory tests and instrumental methods.

Digital rectal examperformed by a urologist-urologist after a conversation with the patient. This method allows you to evaluate the size, shape and some structural features of the prostate gland. If the size of the prostate gland is enlarged and the surgery itself is painful, the doctor may make a preliminary diagnosis of prostatitis.

If the case is not acute, the doctor can conduct prostate massage during the examination to collect secretions of the prostate gland, this study is an important link in the diagnosis of prostatitis. If acute bacterial prostatitis is suspected, prostatitis massage is contraindicated: such manipulation can lead to the spread of pathogens and blood poisoning.

To clarify the diagnosis, the patient will be asked to undergoresearch tools, As:

  • transrectal ultrasound examination of the prostate and pelvic organs (shows structural features, the presence of inflammation and foci of pus, stones, cysts and other tumors);
  • dopplerography (features of blood flow in the gland);
  • Urinary flow measurement (determining the speed and duration of the act of urinating);
  • MRI of the pelvic organs (a highly informative and safe study that allows differential diagnosis with other diseases).

If necessary, the diagnosis of adjacent organs of the genitourinary system is carried out: ureteroscopy, urethrography and computed tomography of the urethra.

Research in the laboratoryis an essential component for the diagnosis of prostatitis:

  • Urinalysis (before and after prostate massage)
  • General blood analysis
  • Blood tests for proteins of the acute inflammatory phase (C-reactive proteins, etc. )
  • Microscopic examination of the prostate gland after massaging with her fingers
  • Microscopic examination of a scratch from the urethra
  • Spermogram (cytology and biochemistry of sperm)
  • Urine culture, prostate secretion and semen
  • Prostate-specific antigen (PSA) determination
  • Prostate biopsy and histological examination of glandular tissues

The last two studies are needed to rule out prostate cancer or adenomas.

The modern one has an excellent highly informative diagnostic facility. Urologists have extensive experience in diagnosing and successfully treating various forms of prostatitis, and the status of a polyclinic allows you to use the services of related specialists. mandarin. The medical center has developed research packages that include all necessary diagnostics at very attractive prices.

The treatment

Treating prostatitis is not an easy task. It requires a thoughtful, integrated approach. The treatment regimen for this disease includes drug treatment and physical therapy, in some cases requiring surgery.

Medical therapy

It involves the use of the following drugs:

  • Antibiotics (after determining susceptibility to them)
  • Antiseptic (topical)
  • Vascular preparations (improves microcirculation in the prostate)
  • Non-steroidal anti-inflammatory drugs
  • Alpha-1-adrenergic blockers (violation of urination)
  • Enzyme preparations (thinning the prostate, stimulating the immune system, reducing inflammation)
  • Immune conditioner
  • Antidepressants

Physiotherapy treatment

  • Electrical stimulation of the prostate gland (electrophoresis, galvanizing, pulse exposure)
  • Vibrate
  • Laser therapy with rectal sensor (for chronic prostatitis)

In chronic prostatitis, prostate massage can be used as a therapeutic procedure. In the acute stage of the disease, this operation is not done to avoid spreading and sepsis.

Surgical treatment

Surgery for prostatitis is rarely used. Such a need arises in cases of severely suppressed prostate tissue, no positive motivation for drug therapy, and pathological enlargement of the prostate gland obstructing the urethra.

Forecast

With early diagnosis and adequate treatment, acute prostatitis can be defeated. However, quite often the chronology of the process occurs even with correct and timely therapy.

With improper treatment and non-compliance with the terms of treatment (this is several months), the disease, as a rule, moves into the chronic stage. Chronic prostatitis greatly affects a man's quality of life, because not only the urinary system but also sexual function is affected. In 30% of cases, erectile dysfunction, inability to achieve orgasm, problems with ejaculation and infertility are observed. Chronic prostatitis cannot be completely cured, but with the right approach, you can achieve stable remission.

Benefits of going to a professional clinic

  • Successful treatment of prostatitis
  • Experienced urologists-gynecologists with the highest qualifications
  • Multidisciplinary, allowing the participation of experts in related fields in treatment
  • Modern high-precision diagnostic and treatment equipment
  • Europe's own clinical diagnostic laboratory
  • Comfortable and high-tech hospital
  • Package of urological diagnostic services with attractive price

Prostatitis prevention

  • Choose safe sex to avoid sexually transmitted infections (STIs)
  • Immune system support (vitamins, healthy nutrition, prevention of dysbacteriosis, proper antibiotic therapy, etc. )
  • Avoid hypothermia
  • Live an active lifestyle
  • Have sex regularly, if possible, with a partner (to avoid prostate blockages and sexually transmitted diseases)
  • Avoid interrupting coitus (this will help eliminate sperm stasis)
  • See a urologist once a year for preventive purposes and twice a year if you are over 50 years old or have a history of prostate disease.

frequently asked Questions

How informative is the PSA test in diagnosing prostatitis?

Prostate-specific antigen (PSA) is a marker for prostate cancer. It is known that in some cases of prostate cancer the clinical picture is similar to the manifestations of prostatitis. Therefore, the PSA test is used to differentiate between these two diseases. However, do not bet on PSA. This antigen is also elevated with prostate tumors, a type of benign glandular tissue. With prostatitis, PSA levels may also increase during periods of active inflammation. During remission, it gradually subsides. Therefore, PSA cannot be used as unconditional evidence of prostate cancer or prostatitis.

Why is prostatitis difficult to treat?

Prostate capillaries have a special structure that forms the hemostatic barrier. This makes it difficult for some antibiotics to penetrate the gland's tissues. In addition, microorganisms tend to form biofilms that reliably protect them from the action of antibacterial agents. Therefore, modern regimens for the treatment of prostatitis necessarily include proteolytic enzymes that can destroy biofilms. Bacteria become vulnerable and antibiotics work more effectively. Chronic prostatitis is the most stubborn treatment, the main feature of which is the presence of a wide variety of microorganisms in the plant. In about 50% of cases, Enterococcus faecalis is sown, resistant to all aminoglycosides and cephalosporins. This narrows the list of effective antimicrobials, which also complicates treatment.