What is prostatitis? We will analyze the causes of occurrence, methods of diagnosis and treatment in the article by a urologist with 28 years of experience.
Definition of disease. Causes of disease
prostatitisIt is an inflammatory process of the prostate tissue, accompanied by pain in the lower back, perineum or pelvic region, as well as disturbances in the functioning of the lower urinary tract.
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The prostate (prostate) refers to the male reproductive system. It lies in front of the rectum, below the bladder and surrounds the urethra (urethra). That's why, when the prostate gets inflamed, it compresses the urethra, which leads to various problems when urinating. The main function of the prostate is the production of secretion (fluid), which is part of the semen and liquefies it to ensure normal sperm motility.
Pathological conditions of the prostate, such as cancer or benign hyperplasia, are more common in older patients. Prostatitis differs in that it affects men of all age groups, but most often the disease occurs in men of reproductive age (8 to 35% of cases).
Prostatitis most often occurs in the practice of a urologist. It can occur suddenly (acutely) or gradually, and its manifestations are constant and long-term (chronic). The chronic form is much more common than the acute one. Chronic prostatitis ranks fifth among the top twenty urological diagnoses.
Prostatitis can be an independent disease or it can be combined with benign prostatic hyperplasia and prostate cancer. In recent years, there has been a decrease in the incidence of prostatitis in the male population: if in 2012 the incidence was 275 per 100, 000 inhabitants, then in 2017 the primary incidence was 203 per 100, 000 inhabitants.
The reasons for developing prostatitisthey are bacterial (infectious) and nonbacterial (non-infectious).Infectious Prostatitismore common in men under 35 years of age. Most often this form of the disease is caused by gram-negative microorganisms, especially enterobacter, E. coli, serrated, pseudomonas and proteus, as well as sexually transmitted infections such as gonococcus, chlamydia, etc. Very rarely, prostatitis due to Mycobacterium tuberculosis may occur. In chronic bacterial prostatitis, the spectrum of pathogens is broader and may include atypical pathogens. It should be remembered that chronic bacterial prostatitis is a polyetiological disease, that is, it can have several causes.
Factors that contribute to the development of inflammationin the prostate:
- sexually transmitted infections;
- immunodeficiency states;
- prostate biopsy;
- invasive manipulations and operations;
- Lifestyle;
- diarrhea, constipation;
- homosexual contacts;
- frequent change of sexual partners;
- sedentary lifestyle, etc.
Chronic non-bacterial prostatitisdiagnosed in patients who complain of chronic pain in the prostate area, while an infectious (bacterial) agent causing the disease has not been found in them. Despite numerous studies, the cause of this type of chronic prostatitis is not fully understood, however, there are some factors that can cause its development:
- increased prostate pressure;
- muscle pain in the pelvic region;
- emotional disturbances;
- Autoimmune diseases (antibodies that are supposed to fight infections, sometimes for some reason attacking prostate cells);
- physical activity;
- irregular sex life;
- lifting weights, etc.
In some cases, prostatitis can occur after performing transurethral procedures such as urethral catheterization or cystoscopy, as well as after transrectal prostate biopsy.
Although the true incidence of various types of prostatitis has not been definitively established, the following data are provided:
- acute bacterial prostatitis accounts for approximately 5-10% of all cases of prostatitis;
- chronic bacterial prostatitis - 6-10%;
- non-bacterial chronic prostatitis - 80-90%;
- prostatitis, including prostatodynia (prostate neurovegetative disorders) - 20-30%.
If you experience similar symptoms, see your doctor. Do not self-medicate - it is dangerous for your health!
prostatitis symptoms
All forms of inflammationthe prostate, in addition to being asymptomatic, is united by the presence of the following symptoms:
- pain in the lower back;
- feeling of discomfort with intestinal peristalsis;
- pain in the perineum or pelvic region;
- disorders in the work of the lower urinary tract.
The main symptoms of the lower urinary tract in the presence of prostatitis:
- frequent need to urinate;
- difficulty urinating, ie, weak stream and need to "push";
- burning pain or its intensification when urinating.
In men with diagnosisacute bacterial prostatitisPelvic pain and urinary tract symptoms such as increased urination and urinary retention may occur. This can lead to the development of systemic manifestations such as fever, chills, nausea, vomiting and malaise. Acute bacterial prostatitis is characterized by a sharp onset of disease with a vivid clinical picture. This is a serious illness.
men with diagnosischronic bacterial prostatitisnote symptoms of a periodic nature, which wax and wane. With an exacerbation, pain and discomfort are noticed. Pain sensations are mainly located at the base of the penis, around or above the anus. Also, the pain can occur just above the pubic bone or in the lower back, spreading to the penis and testicles. Defecation also becomes painful. Sometimes there are signs of infection in the lower parts of the urinary system: burning pain and frequent urination, frequent fissure. These symptoms can be confused with the manifestations of acute bacterial prostatitis, but usually have a sudden onset, chills, fever, weakness, pain throughout the body, in the lower back as well as in the genitals, frequent and painful urination, pain with ejaculation. If you experience these symptoms, see a doctor urgently.
If the modern standard test has not established that chronic pain is caused by a pathological process in the prostate, then we are dealing with chronic nonbacterial prostatitis, also calledchronic pelvic pain syndrome(the term has been used since 2003). In the presence of chronic pelvic pain syndrome, a man's quality of life is significantly reduced, as this syndrome sometimes leads to various psychological and sexual disorders:
- increased fatigue;
- feeling helpless;
- erectile dysfunction;
- painful ejaculation;
- pain after intercourse, etc.
In chronic non-bacterial prostatitis / chronic pelvic pain syndrome, there is a feeling of discomfort or persistent pain in the lower back, most often at the base of the penis and around the anus, for at least 3 months. Painful sensations are located in a "target organ" or in several pelvic organs. Most of the time, in this form of prostatitis, the pain is located in the prostate (46%).
In chronic prostatitis, sexual disorders have several features. First, all components of a man's copulative (sexual) function are disturbed to varying degrees: libido, erection, ejaculation. Second, sexual dysfunction mainly occurs in people with a long history (over 5 years) of the disease. Third, sexual dysfunction is often the main reason for seeking medical attention.
Erectile dysfunction is seen by 30% of patients who suffer from chronic prostatitis, largely due to the psychogenic factor - a catastrophic perception of the disease.
Symptoms of prostatitis occur at least once in a lifetime in 50% of men.
pathogenesis of prostatitis
The developmental mechanism of prostatitis is multifaceted and very complex. Many factors are involved in its development. Most cases of acute bacterial prostatitis are caused by a cascade of processes triggered by an ascending urethral infection or intraprostatic reflux (urine reflux).
The penetration of microorganisms into the prostate is possible via the ascending route (through the urethra) or transrectally via the lymphatic route. Diarrhea and constipation associated with compromised rectal barrier function are considered a triggering factor in chronic prostatitis. However, the mechanism of penetration of microorganisms in the prostate is not clearly established.
Urinary disorder with prostatitis can result from:
- increase the smooth muscle tone of the prostatic urethra, increasing the activity of adrenergic receptors;
- prostate enlargement or urethral narrowing, resulting in turbulent urinary flow, bladder outlet obstruction, and intraprostatic reflux.
In the future, there is a violation of the drainage of the prostate ducts, stagnation of prostatic secretions, edema, activation of the arachidonic acid cascade, inflammation and ischemia. A vicious circle of pathological changes is formed.
Classification and developmental stages of prostatitis
There are 4 main categories (types) of prostatitis.
Chronic bacterial prostatitisdifferentspicy,it manifests as recurrent episodes of exacerbation with the presence or absence of complete remissions between them. Symptoms are generally less severe than those of acute prostatitis.
National American Institutes of Health Classification. . .
- Type I(acute bacterial prostatitis) - acute prostate infection: symptoms of the disease appear suddenly. Chills, fever, pain throughout the body, weakness, pain in the lower back and genitals, pain when urinating frequently and during ejaculation. Potential symptoms of acute bacterial prostatitis include blood in the urine and/or semen. It's rare. It is effectively treated with antibiotics.
- Type II(chronic bacterial prostatitis) - a chronic or recurrent infection of the prostate: the symptoms are the same as in acute prostatitis, but appear gradually and are less pronounced. Several courses of antibiotic therapy may be needed.
- Type III(chronic nonbacterial prostatitis and chronic pelvic pain syndrome): no evidence of infection.
- Type III A: presence of leukocytes in ejaculation / prostate secretion / third portion of urine obtained after prostate massage.
- III type B: absence of leukocytes in ejaculation / prostate secretion / third portion of urine obtained after prostate massage. Pain in the lower back and genitals, frequent need to urinate, difficulty urinating (often at night), burning or pain when urinating and ejaculation. It represents about 90% of all cases of prostatitis. There are no known causes or clinically proven treatments.
- Type IV(asymptomatic inflammatory prostatitis): Sometimes increased WBC count. No treatment needed. Detected on prostate biopsy.
The boundaries between the various forms of prostatitis are blurred.
Complications of Prostatitis
With inflammatory lesions of the prostate, nearby organs are involved in the pathological process: the seminal tubercle, Cooper's glands, seminal vesicles and posterior urethra. The infection can enter the prostate and adjacent organs simultaneously.
Vesiculitis- inflammation of the seminal vesicles. The pains are located in the groin and deep in the pelvis, radiating to the sacrum. Pain is usually unilateral as both seminal vesicles are affected to varying degrees. Vesiculitis may be asymptomatic. The only complaint of patients may be the presence of blood in the semen. Periodic pyuria (pus in urine) and piospermia (pus in ejaculation) are also seen.
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Posterior urethritis, colliculitis (inflammation of the seminal tubercle). . . In prostatitis, the infection penetrates the seminal tubercle, due to the proximity of the prostate to the excretory ducts.
Prostate abscess.The pathogens that cause prostatitis can also cause a prostate abscess. This is a severe septic (bacterial) disease, which is accompanied by weakness, fever, chills with sweat running down. In some cases, problems with consciousness and delirium are observed. The patient needs hospitalization.
Prostate sclerosis (fibrosis).It is a late complication of prostatitis, which is based on the replacement of prostate tissue with scars (degeneration of the connective tissue, ie, sclerosis), which leads to the gland shrinking, shrinking in size and completely losing function. As a rule, sclerotic symptoms develop long after the inflammatory process in the prostate begins.
Prostate cysts.These formations can contribute to the formation of stones in the prostate. The presence of an infection in a cyst can cause an abscess in the prostate. It is not difficult to diagnose a prostate cyst using ultrasound. They can also be detected with a digital rectal exam.
Prostate stones.They are quite common. The causes of the disease are not fully understood, but most experts agree that they arise as a result of a prolonged inflammatory process in the prostate. The stones are single and multiple, with a diameter of 1 to 4 mm. Large stones are rare. The stones clog the gland, because of which the secret gets stuck in it, the gland is stretched too much and separate cysts form, into which infection enters. Patients with prostate stones have to deal with constant, nagging pain in the perineum. Painful sensations spread to the glans penis and cause frequent urination, which becomes difficult and painful.
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Infertility.Long-term chronic prostatitis mainly reduces the motor function of sperm, making them completely immobile. One of the consequences is the violation of its production, the formation of immature sperm with abnormally altered shape (and in fewer numbers than before).
Ejaculation Disorder.All forms of prostatitis cause sexual dysfunction. At first, patients are faced with premature ejaculation, having a normal erection, which weakens and the degree of orgasm decreases. The long-term existence of chronic prostatitis contributes to decreased production of male sex hormones and weakened libido.
Erectile dysfunction.The relationship between chronic prostatitis/chronic pelvic pain syndrome and erectile dysfunction has been described. This disorder is especially painful for men.
Prostatitis Diagnosis
The appearance of the first signs of prostate inflammation requires immediate medical attention. The urologist will rule out many diseases with similar manifestations and determine which category (type) the disease belongs to. Before choosing a treatment, a specialist will perform the necessary tests and offer to take an evaluation test.
What questions can the doctor ask
At the consultation, the doctor will definitely specify: the duration of the clinical manifestations of the disease, the location and nature of the pain, for example, in the perineum, scrotum, penis and inner thigh; changes in the nature of the semen (presence of pus and blood).
At the reception, the urologist will offer to fill in special questionnaires, one of which is the chronic prostatitis symptom index.
The patient must ask the doctor questionsabout what tests and studies will need to be done, how to prepare for them, what treatment he plans to prescribe, and where I can get more information about the disease.
Chronic bacterial prostatitis is diagnosed when symptoms last for at least three months.
The search will include:
- Digital rectal examination of the gland to determine the extent of prostate enlargement and its consistency. <5_img_blockxx>
- Tests for secretions of the prostate, urine and/or ejaculation.
- Identification of urogenital infection.
- Ultrasound examination of the urinary system (kidneys, prostate, bladder with determination of residual urine). <6_img_blockxx>
- Urodynamic study.
In the case of acute bacterial prostatitis, a swollen, painful prostate can be found with a digital rectal exam. Prostate massage is contraindicated as it can cause bacteremia and sepsis.
The most important study in examining patients with acute bacterial prostatitis is the culture of prostate secretions. To categorize chronic prostatitis, quantitative culture and microscopy of urine specimens and prostate secretions obtained after prostate massage are still important methods.
Androflor - a comprehensive study of microbiocenosis of the urogenital tract in men by PCR. Allows to determine the qualitative and quantitative composition of the microflora. It is used to diagnose and manage the treatment of infectious inflammatory diseases of the genitourinary system.
After identifying the cause of the illness, the doctor will recommend a course of treatment. It should be remembered that standard methods only in 5-10% of cases can detect an infection, which eventually leads to prostatitis.
What is the relationship between prostatitis, prostate specific antigen (PSA) and prostate cancer
Measuring total and free PSA levels in prostatitis does not provide additional diagnostic information. It is known that in 60 and 20% of patients with acute and chronic bacterial prostatitis, the level of prostate specific antigen (PSA), respectively, increases. After completion of treatment, the PSA level decreases in 40% of patients. PSA is not considered a specific marker for prostate cancer because PSA levels can be elevated in benign prostatic hyperplasia and prostatitis.
Prostatitis treatment
The main role in the treatment of the pathology is attributed to drug therapy.
Treatment with alpha1 blockers
Alpha1 blockers are prescribed for patients who complain of difficulty urinating. These medications help facilitate urination and relax your prostate and bladder muscles. Some patients are given medication to reduce hormone levels, which can help reduce the gland and the discomfort. Muscle relaxants can help relieve pain caused by a swollen prostate that puts pressure on nearby muscles. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help in the presence of pain.
Standard antibiotic therapy, in most cases, does not lead to a decrease in the number of disease relapses and therefore an integrated approach is often used and prescribed as well.auxiliary drugs: biostimulants, extracts from various plants and insects and their biological components, which may be in the formrectal suppositories. . . Despite the large arsenal of drugs, the effectiveness of their use is still insufficient.
Physiotherapy in the treatment of prostatitis
For chronic prostatitis categories II, III A and III B, physiotherapeutic methods can additionally be used:
- prostate massage (prostate);
- laser therapy;
- hyperthermia and microwave thermotherapy;
- electrical stimulation with modulated currents from skin or rectal electrodes;
- acupuncture (acupuncture).
The efficacy and safety of these treatments are still under study. Also used to treat prostatitis. folk methods, for examplehirudotherapy.The efficacy and safety of this method for treating prostatitis has not been proven.
Stem Cell Injection
Cell therapy (stem cell injections) in the treatment of prostatitis is currently a promising technique in the early stages of development. At the moment, with regard to the injection of stem cells into the prostate, we can only have hypotheses about its mechanisms, as well as empirical data obtained by individual groups of researchers.
Surgical treatment of prostatitis
Surgical methods are only used to treat complications of prostatitis - abscess and suppuration of the seminal vesicles.
The treatment of chronic pelvic pain syndrome requires separate consideration. Asymptomatic inflammatory prostatitis (category IV) should not be treated unless the patient is planning prostate surgery. In that case, the patient receives a prophylactic course of antibiotic therapy.
Diet and Lifestyle for Prostatitis
A special diet is not necessary for prostatitis, but eating lots of vegetables, lean meat and dairy products improves bowel function. It is important to consume plenty of fiber, foods rich in vitamin E (wheat germ, corn oil, etc. ), sugar should be replaced by natural honey. Proper nutrition for prostatitis can improve bowel function and reduce the likelihood of relapse or speed recovery. It is recommended to adhere to a healthy lifestyle, drink more fluids and limit caffeine and alcohol.
Prediction. Prophylaxis
Acute prostatitis often becomes chronic, even with timely and adequate treatment.
Full recovery is not always possible, however, with consistent and correct therapy, following the doctor's recommendations, it is possible to eliminate discomfort and pain. Independenthome treatment of prostatitisit can be dangerous and lead to complications.
Not all cases of prostatitis can be identified as a cause, but there are a number of steps you can take to try to prevent prostatitis from occurring. The same steps can help control existing symptoms: