Prostatitis is an inflammation of the prostate gland, one of the common problems in 40% of middle-aged and elderly men. Without directly threatening life, this disease leads to a significant decline in its quality, affecting the ability to work, the intimate sphere, restricting freedom and provoking daily hardships and psychological disorders.
Prostatitis appears in acute or chronic form, it can be of infectious and non-infectious origin.
Causes of prostatitis
The causes of prostatitis are different: the acute form is associated with a bacterial infection that enters the prostate gland by infecting urological and venereal diseases of an infectious nature, chronic prostatitis in 90% of cases is not associated with infections. Stagnation of prostate secretion is formed as a result of infectious inflammation of the duct walls and systemic diseases.
Causes of acute prostatitis
Acute bacterial prostatitis is caused by enterobacteriaceae, gram-negative and gram-positive heads, chlamydia, mycoplasma, viruses. Risk factors for prostate infection are sexually transmitted diseases and invasive urological interventions (catheterization, instillation and bougienation of the urethra, urocystoscopy).
Provokers of the development of infectious inflammation are usually hypothermia, constipation or prolonged diarrhea, sedentary work, excessive sexual activity or sexual abstinence, chronic course of venereal and urological diseases, suppression of the immune response, lack of sleep, exercise, chronic stress. . Poor blood supply to the pelvic organs, these factors themselves contribute to aseptic inflammation, and also facilitate the introduction of the pathogen into the prostate gland tissue.
Acute bacterial inflammation can resolve without sequelae, but in some cases the following complications occur:
- acute urinary retention;
- chronic prostatitis (chronic pelvic inflammatory syndrome);
- epididymitis;
- prostate abscess;
- prostate tissue fibrosis;
- infertility.
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 caused by many reasons, mainly stagnant processes in the small pelvis. Urine stagnation, causing inflammation, is formed against the background of urethritis, neurogenic narrowing of the bladder neck, narrowing of the urethra, autoimmune inflammation. The blood supply to the pelvic organs deteriorates, which is explained by systemic cardiovascular diseases (coronary artery disease, atherosclerosis). The general venous system of the small pelvis determines the connection of chronic prostatitis with cracks in the anus, hemorrhoids, proctitis, fistula.
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
- Temperature (from 38-39 degrees Celsius in acute prostate and subfebrile condition in chronic).
- Urinary dysfunction: frequent urge to urinate, not always effective, difficulty or increased urination, especially at night. Urine flow is impoverished and all the time there is a residual amount of it in the bladder.
- Prostate damage: leukocytes and blood in semen, pain during urological examination.
- Fibromyalgia.
- Prostatorrhea is a small leak from the urethra.
- Pain in the pelvis, perineum, testicles, above the pubis, in the penis, sacrum, bladder, scrotum.
- Pain in urination and ejaculation.
- Convulsive muscle spasms.
- Stones in the prostate gland.
- Chronic fatigue, a feeling of despair, unhappiness, 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 may coalesce.
In the chronic course of the disease, the signs of prostatitis are vague (less pronounced), but they are accompanied by general, neurological and mental symptoms.
Diagnosis of prostatitis
The key to successful and timely treatment of prostatitis is an accurate and comprehensive 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 susceptibility of bacteria to antibiotics, biological fluids are inoculated: urine, semen, and prostate secretions. This method allows you to choose a drug that is most effective for a specific type of pathogen, capable of penetrating directly into the focus of inflammation.
The "classic" method of laboratory diagnosis of prostatitis is considered to be culturological (urine culture, ejaculate, urogenital stain content). The method is very accurate but time consuming. A Gram stain is produced to detect bacteria, but in this way viruses, mycoplasma and ureaplasma are unlikely to be detected. To improve the accuracy of the research, 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 with the PCR method of the microflora of the urogenital tract is used. The test result is ready within a day and reflects the full view of the microbial ratio in the subject's body.
Tests for prostatitis include urine and ejaculate collection and urological tests.
The European Urological Association recommends the following set of laboratory tests:
- general urine analysis;
- bacterial culture of urine, semen and ejaculate;
- PCR diagnostics.
A general urinalysis allows you to determine the signs of inflammation (number of units of microorganisms that form colonies, number of leukocytes, erythrocytes, transparency of urine) and the presence of calcifications (prostate stones). The general analysis is included in the method of some urological samples (glass or by portion).
Samples of glass or portions consist of the successive 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 last part of the urine during a three-cup test or after urological massage of the prostate.
Two-cup test - implantation of the middle part of the urine stream before and after urological prostate massage.
Three-glass sample - the initial, middle and last part of the urine are taken in the same urine.
Four-cup sample - culture and general analysis of the primary and secondary parts of the urine flow, prostate secretion after urological prostate massage, and part of the urine after this procedure.
Cultural culture or PCR diagnostics of ejaculate and urogenital strain material are also performed.
Blood tests are also required to establish the 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 clinical appearance and indirect laboratory parameters (including general urine and blood analysis). The intensity of pain syndrome is determined by the visual analog scale of pain, and the severity of psychological changes is determined by the scales for assessing anxiety and depression. At the same time, research is necessarily carried out to find an infectious agent, as the spectrum of pathogens can be very wide. From instrumental studies, urofluometry is described by placement of residual urine volume and transrectal ultrasound (TRUS) of the prostate gland.
Asymptomatic prostatitis is detected by a histological examination of a prostate biopsy, prescribed for suspected cancer. A blood test for Prostate Specific Antigen (PSA) is performed in advance. Serial PSA presents with hypertrophy and inflammation of the prostate and the rate criteria change with age. This study also helps to rule out suspicions of a malignant prostate tumor.
Treatment and prevention of prostatitis
Treatment of acute prostatitis is carried out with antibiotics (fluoroquinolones 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 of the drugs, therefore, bacterial inoculation is necessary.
Conservative urological treatment may also include acupuncture, phytotherapy, external shock wave therapy, thermal physiotherapy (after acute inflammation), massage.
Prevention of prostatitis involves both medical manipulations and the formation of healthy habits:
- use of obstructive contraception;
- regular sexual activity in conditions of minimized risk of infection;
- Physical activity;
- elimination of deficiency conditions - hypo- and vitaminosis, lack of minerals;
- observance of aseptic conditions and careful technique for performing invasive urological interventions;
- regular preventive examinations using laboratory tests.