ProstatitisIt is a urological disease accompanied by inflammation of the tissues of the prostate gland. Damage to the prostate can be caused by an infection transmitted through blood, lymph, or unprotected sex. The development of prostatitis in men is facilitated by injuries and poor blood supply to the pelvic organs, constant hypothermia, low physical activity, hormonal imbalance, and other factors. Prostatitis can be accompanied by vesiculitis, urethritis, and other infectious and inflammatory diseases of the reproductive and urinary organs.
Incidence statistics
Prostatitis is one of the most widespread diseases of the male genitourinary system in the world. According to various sources, it is observed in 60-80% of sexually mature men. According to official medical statistics, more than 30% of young people of reproductive age suffer from chronic prostatitis. In about a third of cases, it occurs in men older than 20 and younger than 40. According to the WHO, urologists diagnose chronic prostatitis in every 10th patient.
Causes of prostatitis
InfectionsOpportunistic and pathogenic bacteria enter the prostate through lymphatic and blood vessels. Secondary infection of the prostate is often a complication of inflammatory diseases of the rectum and urethra.
Types of infection:
- upward- microbes rise to the gland from the external urethral opening;
- down- germs enter the prostate along with the infected urine stream.
Conditionally pathogenic microorganisms that cause disease (according to the Urology Research Institute 1997-1999)
| Microorganisms | Number of studies | |
|---|---|---|
| % | ABS | |
| Staphylococcus epidermidis | 42, 3 | 55 |
| S. saprophyticus | 17, 6 | 2. 3 |
| S. aureus | 4. 6 | 6 |
| S. haemolyticus | 3. 1 | four |
| S. hominis | 0, 8 | one |
| S. warneri | fifteen | two |
| Staphylococcus spp. | 3. 1 | four |
| Enterococcus faecalis | 11, 6 | fifteen |
| Streptococcus spp. | 3. 1 | four |
| TOTAL (gr. +) | 87, 6 | 114 |
| P. aeruginosa | 3, 7 | five |
| E. coli | 4, 7 | 6 |
| Enterobacter spp. | 2. 3 | 3 |
| Proteus spp. | fifteen | two |
| TOTAL (gr. -) | 12, 3 | sixteen |
Weakening of immunity.One of the causes of inflammation of the prostate is the weakening of the body's immune defenses. This can be facilitated by frequent stress, unbalanced diet, overwork, smoking, and alcohol use. With reduced immunity, the body is more vulnerable to infections that lead to the development of prostate disease.
Blood supply disorders.The development of chronic prostatitis can be the result of a sedentary and sedentary lifestyle. With a constant lack of physical activity, the work of the endocrine, cardiovascular and nervous systems, as well as blood circulation in the pelvic organs, is disrupted. The result is the lack of oxygen in the prostate tissue.
Irregular sexual activityBoth prolonged sexual abstinence and excessive sexual activity can contribute to the development of prostatitis. Many sexually active men have nervous exhaustion, hormonal imbalance, poor secretion from the sex glands, and a gradual decrease in potency. The interruption of intercourse has a negative impact on the health of the prostate gland.
Chronic prostate injury. . . Chronic prostatitis can develop as a result of frequent trauma to the soft tissues of the prostate gland. This is most often seen in patients whose professional activities are related to driving. The cause of prostatitis in this case is constant shaking, vibration and excessive tension in the muscles of the perineum.
The main syndromes of prostatitis.
Pain.With prostatitis in men, there are sharp, cutting pains in the lower abdomen and back, as well as pains throughout the body. This symptom can be worsened by ejaculation, especially during sexual intercourse after prolonged abstinence.
DysuriaTypical signs of prostatitis in men are frequent urination, burning and stinging when emptying the bladder, pulling pain after urinating in the perineum. Another symptom of a swollen prostate is difficulty urinating. In the absence of treatment for the disease, acute urinary retention can occur.
Sexual dysfunctions.With uncomplicated prostatitis, there is accelerated ejaculation, wasting of orgasmic sensations, pain during ejaculation, partial or complete decrease in libido. Prolonged erection at night is also a symptom of chronic prostatitis.
External manifestations.With prostatitis, some patients have purulent or clear discharge from the urethra, which is more abundant in the morning. Patients may also notice a symptom such as the presence of white flocs or filaments in the urine.
Types of prostatitis
Acute bacterial.Acute prostatitis develops as a result of infection of the prostate gland with Staphylococcus aureus, Escherichia coli, enterococcus, and other pathogenic bacteria. If left untreated, this disease can lead to blood poisoning. In this case, the man must be hospitalized urgently.
Symptoms seen with this type of prostatitis:
- chills and fever (38 ° C and higher);
- sharp or drawing pains in groin, lower back, and perineum;
- frequent need to urinate;
- pain when urinating;
- difficulty urinating and acute urinary retention;
- White or colorless discharge from the urethra.
Chronic bacterial.The recurrent form of the disease occurs as a result of the penetration of the infection into the gland. Chronic hypothermia, prolonged sexual abstinence, and premature urination contribute to the development of prostatitis. Chronic prostatitis, if left untreated, can lead to cystitis, as inflammation of the prostate is a reservoir of bacteria that affect the genitourinary tract.
Symptoms of chronic prostatitis:
- pain in the scrotum, lower abdomen, perineum;
- dysuria
- violations of potency.
Chronic non-bacterial.The causes of the disease include the entry of viruses or bacteria into the prostate (tubercle bacillus, Trichomonas, chlamydia), autoimmune processes, penetration of urine into the gland. Chronic prostatitis accounts for up to 95% of all types of prostate inflammation.
The signs of prostatitis are:
- chronic pain in the pelvic area (bothering the man for at least 3 months);
- Recurring groin pain
- absence of symptoms of inflammation in urine, semen and prostate secretions.
Chronic asymptomatic.Asymptomatic chronic prostatitis is not associated with bacterial infection or symptomatic prostate syndromes. This disease is assumed to be an age-related physiological feature.
Symptoms of this type of chronic prostatitis:
- absence of the main syndromes of the disease;
- an increased content of leukocytes and bacteria in the urine.
The main symptom of the disease, the presence of an infection in the gland, can only be detected with a biopsy or during surgical operations in the treatment of various pathologies of the prostate (adenoma, cancer).
Stagnant.Prostatitis develops not only against the background of anatomical and physiological changes in the venous and other body systems. The main cause of the disease is irregular sex life.
Signs of prostatitis:
- sore pain in the perineum, radiating to the sacrum;
- increased urination in the morning;
- slight difficulty in passing urine (the symptom is observed in the chronic form of the disease);
- weakening of the erection;
- decreased libido;
- "Paleness" of orgasmic sensations during ejaculation.
Diagnosis of acute and chronic prostatitis.
To select the correct method of treatment, the doctor prescribes a comprehensive diagnosis of the state of the genitourinary system, including the following methods.
Digital rectal exam.If you suspect a prostatitis disease, the urologist performs a digital examination. The posterior surface of the prostate is adjacent to the rectum, so when a finger is inserted through the anus, the doctor can determine the state of the gland. In the course of the study, its size, consistency and shape, surface condition, pain are established.
Signs of prostatitis in men include:
- soft and inelastic consistency of the prostate;
- pain on palpation;
- enlarged gland;
- immobility of the rectal mucosa over the prostate.
Ultrasound procedure. Ultrasound of the prostate is prescribed before the start of treatment for acute prostatitis to identify / exclude an abscess of the gland and, in the chronic course of the disease, to identify cysts and stones of the prostate, as well as the degree of compressionof the urethra. The most effective method is rectal ultrasound.
Uroflowmetry.This method of diagnosing prostatitis is used to study the indicators of the urination process: the duration of this physiological act and the rate of urine output. If the rate is 15 ml / s or more, this indicates a normal patency of the urethra. A sign of prostatitis is a decrease in this value below 10 ml / s. This speed is a consequence of poor permeability of the urinary tract.
Interpretation of flowmetry results
| Urine flow rate | Interpretation |
|---|---|
| >15 ml / sec | Urinary tract obstruction is unlikely |
| <10 ml / sec | Significant narrowing of the urethra or detrusor weakness is likely to occur. |
| 10-15 ml / sec | Indeterminate result |
CystoscopyFor the exam, an endoscopic imaging system is inserted into the bladder. This method of diagnosing acute and chronic prostatitis is used when diseases such as cancer, cystitis, or trauma to the bladder are suspected.
Laboratory research.To diagnose and determine the microorganism that caused the disease, in the presence of symptoms of chronic prostatitis or acute inflammation, urine and prostate secretions are examined. A sign of the presence of pathogenic microflora is an increased number of leukocytes in the biological material. To compose an effective treatment course, the type of bacteria is determined by PCR, RIF, and inoculation into a nutrient medium.
Interpretation of laboratory results
| Prostate secret | Third urine sample (after prostate massage) | |||
|---|---|---|---|---|
| HP Form | The number of leukocytes, uv. x 400 | Sowing results | The number of leukocytes, uv. x 400 | Sowing results |
| Bacterial | >10 | + | The difference between the number of leukocytes in the third portion of urine and the second portion of urine is ≥10 | + |
| Chronic pelvic pain inflammatory syndrome | >10 | - | The difference between the number of leukocytes in the third portion of urine and the second portion of urine is ≥10 | - |
| Chronic non-inflammatory pelvic pain syndrome | <10 | - | - | - |
Prevention of prostatitis
Physical activity.For the prevention and treatment of prostate disease, a man must avoid physical inactivity. Recommended:
- walking (4 km per day or more);
- exercise (squats, jumps, curves);
- training of the perineum and gluteal muscles (10 tensions and relaxations).
Proper nutritionFor the prevention of acute and chronic prostatitis, men should include in their diet foods rich in zinc and vitamin B. It is recommended to eat:
- shellfish (oysters, seaweed);
- meat;
- Pumpkin seeds;
- walnuts
- saved;
- kefir
- Rye bread.
Regular sex life.When preventing and treating a disease, a man needs:
- lead a rhythmic sex life;
- avoid interrupted sexual relations;
- Avoid casual relationships.
Treatment of acute and chronic prostatitis.
Inflammation of the prostate is treated with the following methods.
Antibacterial therapy.If the prostatitis is bacterial, antibiotics are needed to treat it. The doctor selects a group of drugs based on the type of microbes that caused the disease, the sensitivity of the pathogen to various drugs, and the presence of contraindications in the patient.
Drug characteristics
| A drug | Profits | disadvantages |
|---|---|---|
| Fluoroquinolones |
|
|
| Macrolides |
|
Insufficiently active against gram-negative bacteria |
| Tetracyclines | Active against atypical pathogens |
|
Hormone therapy.Hormone treatment is necessary to restore the normal hormonal balance between androgens and estrogens. Medications with antiandrogenic activity reduce inflammation of the gland tissues and prevent the transition of the disease to more serious stages.
Prostate massage.This method of treating chronic prostatitis can only be used outside of exacerbations. A man needs to take a bent position, rest his palms on a sofa or table, spread his legs shoulder-width apart. The treating physician puts sterile gloves on his hands, applies an ointment or gel (in some cases, a drug with an anesthetic component) to the index finger of the right hand, and injects it through the anus into the rectum. The massage is done by applying light pressure until the secretions of the prostate separate through the opening of the urethra. The treatment involves at least 10 massage sessions.
Physiotherapy.To treat the symptoms of prostatitis, methods are used to normalize and increase blood circulation in the pelvic area. This allows you to exclude stagnation and increase the effectiveness of drug therapy. The treatment is carried out by exposing the gland to ultrasonic waves, electromagnetic vibrations, as well as high temperatures (microclysters with warm water).
Surgical intervention.Surgical interventions are rarely used for prostate disease. Such treatment is mandatory for the development of complications of acute or chronic prostatitis.
Indications for prostate surgery:
- acute urinary retention as a result of severe narrowing of the urethra;
- abscess (appearance of suppuration on the surface of the gland);
- sclerosis of the gland;
- adenoma that does not respond to conservative treatment.
Complications of prostatitis
VesiculitisUntreated prostatitis can cause inflammation in the seminal vesicles. Symptoms of the disease are deep pain in the pelvis, radiating to the sacrum, aggravated by erection and ejaculation, frequent urination, the appearance of blood and / or pus in the semen and urine.
Colliculitis and urethritis.Due to its proximity to the excretory currents of the prostate, the seminal tubercle often becomes inflamed as a result of an infection of the infected gland. If left untreated, the symptoms of prostatitis are complemented by the characteristic symptom of urethritis: burning or tingling in the urethra when urinating. There is also pain during ejaculation as a result of the convulsive contraction of the urethra.
Prostate abscess.The appearance of purulent caries on the surface of the gland is due to the pathogenic bacteria that caused prostatitis. A characteristic symptom of the disease is general weakness, impaired consciousness, delirium, sudden increase in temperature, increased sweating, chills. Prostate abscess is a serious septic disease that must be treated in a hospital.
Sclerosis of the prostate.Prostate sclerosis develops against the background of regular exacerbations of chronic prostatitis as a result of non-compliance with the treatment prescribed by the urologist. This disease can form over the course of several years, however, if the hormonal balance in a man's body is disturbed, rapid development is possible. With sclerosis of the prostate, pain is observed during the emptying of the bladder, a slow intermittent stream of urine.
Cyst and stone formation.. . . The appearance of cysts in the gland is one of the probable options for the progression of chronic prostatitis. Infection with neoplasms can cause an abscess and greatly complicate the treatment of the disease. Single and multiple stones can also form in the prostate. In this disease, in addition to the usual symptoms of chronic prostatitis, there are violations of urine output, frequent urination, pain in the perineum.
Sterility.In chronic prostatitis, sperm production and motor function are affected. If left untreated, the disease also affects the vas deferens and seminal vesicles, making them impassable for sperm, so they are not released into the urethra during ejaculation. As a result, men who have chronic prostatitis often suffer from infertility.