Prostatitis is an inflammatory disease of the prostate gland (prostate) in men that negatively affects both sexual function and the urinary process. Pain in the perineum, groin, lower back and pelvis, urodynamic disorders (urinary outflow) may indicate the presence of prostatitis. Prostatitis that is not treated in time can cause male infertility and prostate cancer.
This is one of the most common male ailments, requiring careful attention and competent systemic treatment. It is this approach to solving the problem of prostatitis that you can find in the urology department of a professional clinic. Highly qualified urologists-andrologists have been successfully treating acute and chronic prostatitis for many years. Complex therapy, attentive attitude and individual approach to each case inevitably lead patients to recovery and stable long-term remission.
Among the 20 most important urological diagnoses, prostatitis ranks 5th. It is believed that by the age of 30 30% of the male population suffer from prostatitis, by the age of 40 - 40%, and after 50 almost all men put on itone way or another the burden of this disease. And if up to 35 years predominantly infectious prostatitis is detected, then at a more mature age the non-infectious form prevails, and in general it is diagnosed several times more often than bacterial inflammation of the prostate.
Anatomy and physiology of the prostate
The prostate gland (prostate) is located in the front lower part of the small pelvis under the bladder. It consists of glandular and smooth muscle tissue surrounded by a fibrous capsule. The urethra runs from the bladder, where the ejaculatory ducts open, through the body of the prostate.
The prostate is a hormone-dependent organ. It is formed and functions under the influence of male hormones - androgens. Testosterone plays a key role in this process.
The prostate gland is connected to the seminal tubercle, which acts as a valve for the ejaculatory duct. As part of the male reproductive system, the prostate affects erection, ejaculation, and orgasm. Nerves responsible for the erection pass through the gland. In the chronic course of the disease, they are involved in the inflammatory process and erectile dysfunction occurs.
The prostate produces a secret that is part of the semen. It creates favorable conditions for sperm activity. Therefore, with chronic dysfunction of the gland, male infertility can be observed.
There are two main reasons for the development of prostatitis:
- stagnation of prostatic secretion against the background of impaired blood circulation and outflow of lymph in the gland itself and neighboring organs;
- pathogenic and conditionally pathogenic microflora.
Acute prostatitis is usually associated with infection of the prostate tissue. However, as a rule, both factors are related and together form a vicious circle that complicates the treatment of prostatitis.
The inflamed prostate becomes painful. Pain can be felt in the perineum, groin, pelvis, and lower back. It increases sharply on palpation during rectal digital examination or during defecation.
The prostate enlarges and narrows the urethra. This makes it difficult for urine to drain from the bladder. The stream of urine becomes weak. The patient must contract the abdominal muscles in order for the act of urination to take place. In acute cases, obstruction of the urinary tract and acute urinary retention sometimes occur.
Inflammation leads to a violation of the outflow of prostate juice and its stagnation. The resulting edema disrupts the processes of cellular metabolism and respiration in the gland. This creates the conditions for the chronization of the process. With protracted prostatitis, neighboring organs can also become inflamed: seminal tubercles, Cooper's glands, seminal vesicles. The chronic form of the disease is associated with the 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 stagnant processes in the gland. Venous diseases are less common, but also cause prostatitis, especially when accompanied by hemorrhoids and varicocele on the left (dilation of the testicular vein).
The American National Institutes of Health distinguish 4 categories of prostatitis:
- Acute prostatitis (category I)
- Chronic bacterial prostatitis (category II)
- Chronic Prostatitis / Chronic Pelvic Pain Syndrome (Category III)
- Asymptomatic chronic prostatitis (category IV)
By the occurrence of prostatitis is divided into two types:
The inflammatory process can develop quickly, accompanied by vivid symptoms (acute stage), or slowly, with gradually increasing symptoms that are erased.
Non-infectious prostatitisIn most cases, it is associated with stagnation of the secretion of the prostate gland and impaired blood circulation and lymphatic flow in the gland itself and nearby organs.
Infectious prostatitisdevelops as a result of the penetration of pathogenic or conditionally pathogenic microflora into the tissues of the prostate: bacteria, viruses, fungi. There are several ways that an infection gets into the prostate:
- Urinogen (ascending): The entrance gate is the urethra. It should be noted that the infection can also be downstream, for example in purulent pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
- Lymphogen: Inflammation of the rectum (proctitis) or the bladder (cystitis) as well as infected haemorrhoidal veins can cause infections from neighboring pelvic organs to reach the prostate via the lymph.
- Hematogenous (through the blood): due to the presence in the body of chronic foci of infection (tonsillitis, decayed teeth) or complications of acute infections (flu, acute respiratory infections, tonsillitis, etc. ).
The most common causative agents of prostatitis are:
- Bacteria: E. coli, Proteus, Gardnerella (gram negative); staphylococci, streptococci (gram-positive);
- viruses (influenza, herpes, cytomegalovirus, ARVI pathogens);
- specific flora (gonococcus, trichomonas, mycobacterium tuberculosis).
By the nature of the course, prostatitis occurs:
Acute prostatitisusually occurs under the influence of pathogenic (conditionally pathogenic) microflora in the presence of predisposing factors. It has a rapid course and pronounced symptoms. If it is not cured in time, a purulent process can develop, leading to the melting of the tissues of the prostate. With improper treatment, acute prostatitis often becomes chronic.
Chronic prostate inflammationhas a milder course, erased symptoms. However, it can worsen from time to time, and then the symptoms correspond to an acute process. At the same time, complete remission does not always occur between exacerbations, and the patient can constantly feel discomfort. Chronic prostatitis can cause impotence, male infertility, adenomas or prostate cancer.
There is a chronic asymptomatic form of the disease, when the patient has no complaints, but there is an increased amount of purulent elements (leukocytes) in the prostatic secretion.
Without proper therapy, the inflammatory process can lead to purulent fusion of prostate tissue. In addition, inflammation can spread to nearby organs: seminal tubercles, Cooper's glands, seminal vesicles, urethra. Accordingly, the following complications may arise:
- prostate abscess
- Sclerosis / fibrosis of the prostate (the functional tissue of the gland is replaced by connective tissue)
- prostate cysts
- prostate stones
- Vesiculitis (inflammation of the seminal vesicles)
- Colliculitis (inflammation of the seminal nodule)
- Epididymo-orchitis (inflammation of the testicles and their appendages)
- Posterior urethritis
- Erectile dysfunction / impotence
- ejaculation disorder
- prostate adenoma
- prostate cancer
Different forms of prostatitis have their own characteristics of the course and severity of symptoms. In general, prostatitis is characterized by the following manifestations:
- Pain in groin, lower back, perineum (may radiate down spermatic cord).
- Pain increases with defecation, digital rectal exam.
- Violation of urodynamics (frequent urination, urinary retention, difficulty urinating, weak stream, incomplete emptying of the bladder).
- Prostatorrhea (involuntary secretion of prostate juice, especially in the morning and during bowel movements).
- Sexual dysfunction (decreased libido, erectile dysfunction, infertility).
Symptoms of acute prostatitis
- Temperature rise to 39-40 degrees
- Acute urinary retention
- General intoxication
- Leukocyturia, protein and mucus in the urine
- blood in the urine and semen
- Leukocytosis in prostate secretion
- Hypoechogenicity and enlargement of the gland, increased blood flow according to ultrasound
Symptoms of chronic prostatitis
- The body temperature is usually not higher than 37 ° C
- Pain sensations are dampened and smoothed
- Discharge from the urethra during a bowel movement
- Disturbances in urination
- Decreased libido
- erectile dysfunction
- Ejaculation disorders (premature or delayed ejaculation)
The main reasons for the development of prostatitis are infections and stagnation of prostatic secretions. The following factors contribute to the occurrence of prostatitis:
- Infections and opportunistic flora with weakened immunity
- "Sedentary work
- Prolonged sexual abstinence
- Coitus interruptus (with delayed ejaculation)
- Excessive sexual activity leading to glandular exhaustion
- alcohol abuse
- Decreased local immunity (hypothermia, use of immunosuppressants, immunodeficiency, autoimmune diseases)
- Injuries to the pelvic organs
- Manipulation of the prostate and nearby organs (prostate biopsy, surgery, catheterization, cystoscopy, etc. )
- Chronic diarrhea or constipation
To detect prostatitis, many methods are used, which can be divided into 3 groups: digital rectal examination, laboratory tests and instrumental methods.
Digital rectal examcarried out by a urologist-andrologist after a conversation with the patient. This method allows you to assess the size, shape and some features of the structure of the prostate. If the size of the prostate is increased and the procedure itself is painful for the patient, the doctor can provisionally diagnose prostatitis.
If the case is not acute, the doctor can perform prostate massage during the examination to obtain prostatic secretions, the examination of which is an important link in the diagnosis of prostatitis. If acute bacterial prostatitis is suspected, prostate massage is contraindicated: such manipulation can lead to the spread of the pathogen and blood poisoning.
To clarify the diagnosis, the patient is asked to undergoinstrumental research, such as:
- transrectal ultrasound examination of the prostate and pelvic organs (shows structural features, the presence of inflammation and purulent foci, stones, cysts and other neoplasms);
- Dopplerography (features of blood flow in the gland);
- Uroflowmetry (determining the speed and time of urination);
- Magnetic resonance imaging of the pelvic organs (a very informative and safe study that allows differential diagnosis with other diseases).
If necessary, diagnostics of nearby organs of the genitourinary system are carried out: ureteroscopy, urethrography and urethrocystography.
laboratory researchare a necessary part of the diagnosis of prostatitis:
- Urinalysis (before and after prostate massage)
- General blood analysis
- Blood test for proteins of the acute inflammatory phase (C-reactive protein etc. )
- Microscopic examination of the prostate secretion after her finger massage
- Microscopic examination of an abrasion from the urethra
- Spermogram (sperm cytology and biochemistry)
- Culture of urine, prostatic fluid and semen
- Determination of the prostate-specific antigen (PSA)
- Puncture biopsy of the prostate and histological examination of the glandular tissue
The last two studies are necessary to rule out prostate cancer or adenomas.
The modern has an excellent highly informative diagnostic base. Urologists have extensive experience in diagnosing and successfully treating various forms of prostatitis, and the status of a multidisciplinary clinic allows you to use the services of related specialists. The medical center has developed research packages that include all the necessary types of diagnostics at a very attractive price.
Treating prostatitis is not an easy task. It requires a thoughtful, integrated approach. The treatment protocol for this disease includes drug therapy and physical therapy, in some cases surgery is required.
It involves the use of the following drugs:
- Antibiotics (after determining sensitivity to them)
- antiseptics (local)
- Vascular preparations (improvement of microcirculation in the prostate)
- Non-steroidal anti-inflammatory drugs
- Alpha-1-adrenergic blockers (in violation of urination)
- Enzyme preparations (dilute the secret of the prostate, stimulate the immune system, reduce inflammation)
- Electrostimulation of the prostate (electrophoresis, galvanization, pulse exposure)
- vibratory massage
- Laser therapy with rectal sensor (for chronic prostatitis)
In chronic prostatitis, prostate massage can be used as a treatment method. In the acute stage of the disease, this manipulation is not carried out in order to avoid the spread of infection and sepsis.
Surgery for prostatitis is rarely resorted to. Such a need arises with severe suppuration of prostate tissue, the lack of positive dynamics for drug treatment and pathological enlargement of the prostate blocking the urethra.
With early diagnosis and appropriate treatment, acute prostatitis can be defeated. Not infrequently, however, even with correct and timely therapy, the process becomes chronic.
With improper treatment and non-compliance with the conditions of treatment (this is several months), the disease usually takes a chronic course. Chronic prostatitis greatly affects the quality of life of a man, since not only urinary, but also sexual function suffers from it. Erectile dysfunction, loss of orgasmic acuity, problems with ejaculation and infertility are observed in 30% of cases. It is completely impossible to cure chronic prostatitis, but with the right approach, you can achieve stable remission.
Benefits of visiting a professional clinic
- Successful treatment of various forms of prostatitis
- Experienced urologists-andrologists of the highest qualification
- Multidisciplinary, so that specialists from related fields can be involved in the treatment
- High-precision modern diagnostic and treatment devices
- Own European class clinical-diagnostic laboratory
- Comfortable and high-tech hospitals
- A package of urological diagnostics at an attractive price
- Choose safe sex to avoid sexually transmitted infections (STIs).
- Support of the immune system (vitamins, healthy nutrition, prevention of dysbacteriosis, sensible antibiotic therapy, etc. )
- Avoid hypothermia
- Lead an active lifestyle
- If possible, have regular sex with a partner (to avoid prostate congestion and STIs)
- Avoid coitus interruptus (this eliminates sperm congestion)
- Visit a urologist once a year for prevention and twice a year if you are over 50 or have a history of prostate disease.
frequently asked Questions
How useful is the PSA test in diagnosing prostatitis?
Prostate specific antigen (PSA) is a marker for prostate cancer. It is known that prostate cancer in some cases has a clinical picture similar to the manifestations of prostatitis. Therefore, the PSA test is used for the differential diagnosis between these two diseases. However, do not bet on PSA. This antigen also increases in prostate adenomas - a benign growth of glandular tissue. In prostatitis, PSA levels can also rise during periods of active inflammation. In the remission phase, it decreases. Therefore, PSA cannot be used as unconditional proof of prostate cancer or prostatitis.
Why is prostatitis difficult to treat?
Prostate capillaries have a special structure that creates a hematoprostatic barrier. This makes it difficult for some types of antibiotics to penetrate the tissues of the gland. In addition, microorganisms tend to form biofilms, which reliably protect them from the effects of antibacterial agents. Therefore, modern protocols for treating prostatitis necessarily involve proteolytic enzymes capable of destroying biofilms. Bacteria become more susceptible and antibiotics work more effectively. The most persistently treated chronic prostatitis, the main feature of which is a large variety of microflora in the crop. In about 50% of cases, Enterococcus faecalis is sown, which is resistant to all aminoglycosides and cephalosporins. This narrows the list of effective antimicrobials, which also makes treatment more difficult.