Prostatitis is inflammation of the prostate, one of the most common problems affecting 40% of middle-aged and older men. Without directly threatening life, this disease leads to a significant deterioration in its quality, affects the ability to work, intimate areas, restricts freedom and provokes everyday difficulties and mental disorders.
Prostatitis occurs in an acute or chronic form, it can be of infectious and non-infectious origin.
Causes of Prostatitis
The causes of prostatitis are diverse: the acute form is associated with a bacterial infection, which in urological and venereal diseases of an infectious nature invades the prostate, chronic prostatitis is not associated with infections in 90% of cases. Infectious inflammation of the duct walls and systemic diseases result in stagnation of the prostate secretion.
Causes of Acute Prostatitis
Acute bacterial prostatitis is caused by enterobacteria, gram-negative and gram-positive cocci, chlamydia, mycoplasma, viruses. Risk factors for a prostate infection are sexually transmitted diseases and invasive urological interventions (catheterization, instillation and bougienage of the urethra, urocystoscopy).
The provocateurs of the development of an infectious inflammation are usually hypothermia, persistent constipation or diarrhea, lack of exercise, excessive sexual activity or sexual abstinence, the chronic course of venereal and urological diseases, suppression of the immune response, lack of sleep, overtraining, chronic stress. Poor blood flow to the pelvic organs, these factors themselves contribute to aseptic inflammation and also facilitate the introduction of the pathogen into the tissue of the prostate.
Acute bacterial inflammation can go away without consequences, but in some cases the following complications appear:
- acute urinary retention;
- chronic prostatitis (chronic pelvic inflammatory syndrome);
- Epididymis;
- Abscess of the prostate;
- Fibrosis of prostate tissue;
- Infertility.
The causes of chronic prostatitis
In 10% of cases, chronic prostatitis develops as a complication of acute inflammation of the prostate, as well as urethritis, chlamydia, human papillomavirus, and other chronic infections. About 90% are due to chronic abacterial prostatitis or chronic pelvic pain syndrome (CPPS). This form of the disease is not associated with infections, but has many causes, most notably stagnant processes in the pelvis. Against the background of urethritis, neurogenic narrowing of the neck of the bladder, urethral stricture, autoimmune inflammation, urinary stagnation occurs, causing inflammation. The blood flow to the pelvic organs deteriorates, which is explained by systemic cardiovascular diseases (coronary artery disease, arteriosclerosis). The general venous system of the small pelvis determines the association of chronic prostatitis with cracks in the anus, hemorrhoids, proctitis, fistulas.
Chronic pelvic pain in men is associated with:
- low physical activity;
- low levels of testosterone in the blood;
- Changes in the microbial environment of the body;
- genetic and phenotypic predisposition.
Symptoms of prostatitis
- Fever (from 38-39 degrees Celsius in acute prostatitis and subfebrile condition in chronic).
- Urinary dysfunction: frequent urination, not always effective, difficulty or increased urination, especially at night. The stream of urine is exhausted and there is a residual amount of it in the bladder all the time.
- Damage to the prostate: white blood cells and blood in the semen, pain on urological examination.
- Fibromyalgia.
- Prostatorrhea is a small discharge from the urethra.
- Pain in the small pelvis, perineum, testicles, above the pubic bone, in the penis, sacrum, bladder, scrotum.
- Sore urination and ejaculation.
- Spasmodic muscle spasms.
- Stones in the prostate.
- Chronic fatigue, a feeling of hopelessness, disaster, 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 can follow.
In the chronic course of the disease, the signs of prostatitis are blurred (less pronounced), but there are also general, neurological and psychological symptoms.
Diagnosis of prostatitis
The key to successful and timely treatment for prostatitis is an accurate and comprehensive diagnosis. The low proportion of infectious prostatitis can be 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 the tissues of the prostate gland and cause inflammation. Therefore, laboratory research methods play a leading role in the diagnostic process.
To determine the sensitivity of bacteria to antibiotics, vaccination is carried out using biological fluids: urine, semen and prostate secretions. This method allows you to choose a drug that is most effective for a particular strain of the pathogen and that can penetrate directly into the focus of inflammation.
The "classic" method of laboratory diagnosis of prostatitis is considered to be cultural (urine culture, ejaculate, content of urogenital swabs). The method is very precise, but it takes time. A gram smear is taken to detect bacteria, but this is unlikely to detect viruses, mycoplasmas, and ureaplasma. To improve the accuracy of research, mass spectrometry and PCR (polymerase chain reaction) are used. Mass spectrometry is an ion analysis of the structure of a substance and the determination of each of its components. The polymerase chain reaction enables 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 examination of the microflora of the urogenital tract by the PCR method is used. The test result is ready within a day and reflects the complete picture of the microbial ratio in the test person's body.
Tests for prostatitis include urine and ejaculate collection and urologic swabs.
The European Urological Association recommends the following laboratory tests:
- general urinalysis;
- Bacterial culture of urine, semen and ejaculate;
- PCR diagnostics.
A general urinalysis allows you to determine the signs of inflammation (number of colony-forming units of microorganisms, number of leukocytes, erythrocytes, urine transparency) and the presence of calcifications (prostate stones). The general analysis is included in the method of multiple urological (glass or portion samples).
Glass or portion samples consist of the sequential collection of urine or other biological fluids in different containers. This determines the localization of the infectious process. Prostatitis is detected by the detection of infectious agents, blood cells (leukocytes and erythrocytes) in the last part of the urine during a three-glass test or after a urological massage of the prostate
Two-glass test - sowing the middle part of the urine stream before and after urological massage of the prostate.
Three-glass sample - the beginning, middle, and ending portions of urine are taken at the same urination.
Four-glass sample - culture and general analysis of the first and middle part of the urine stream, prostate secretion after urological massage of the prostate and a portion of urine after this procedure.
A cultural sowing or PCR diagnosis of ejaculate and urogenital smear material is also carried out.
Blood tests are also needed to diagnose prostatitis. A general analysis of the capillary blood allows you to confirm or deny the presence of inflammation, as well as rule out other diagnoses that are causing the same symptoms.
Diagnosis of non-inflammatory chronic pelvic pain syndrome is more difficult because it is based on the clinical picture and indirect laboratory parameters (including general urine and blood tests). The intensity of the 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 into an infectious agent is mandatory, as the spectrum of pathogens can be very broad. From instrumental studies, urofluometry with the determination of the residual volume of urine and transrectal ultrasound (TRUS) of the prostate is prescribed.
Asymptomatic prostatitis is diagnosed with a histological examination of a biopsy of the prostate, which is prescribed if cancer is suspected. A blood test for prostate-specific antigen (PSA) is carried out beforehand. Serum PSA occurs with hypertrophy and inflammation of the prostate, and the criteria for the norm change with age. This study also helps rule out any suspicion of a malignant tumor of the prostate.
Treatment and prevention of prostatitis
Treatment of acute prostatitis is carried out with antibiotics (fluoroquinolines and cephalosporins, macrolides), alpha-blockers, non-steroidal anti-inflammatory drugs, neuromodulators. Few antibiotics can penetrate the prostate, pathogens are immune to some of the drugs, so bacterial vaccination is required.
Conservative urological treatments can also include acupuncture, phytotherapy, external shock wave therapy, thermal physiotherapy (after acute inflammation), massage.
Prevention of prostatitis includes both medical manipulations and the formation of healthy habits:
- the use of barrier contraception;
- regular sexual activity in conditions with minimized risk of infection;
- physical activity;
- Elimination of deficiencies - hypo- and avitaminosis, mineral deficiency;
- Adherence to aseptic conditions and careful technique for performing invasive urological interventions;
- regular check-ups using laboratory tests.