Symptoms of prostatitis and prostate adenoma in men

Prostatitisis an inflammatory disease of the prostate gland. It is manifested by frequent urination, pain in the penis, scrotum, rectum, sexual disorders (erection dysfunction, premature ejaculation, etc. ), sometimes urinary retention, blood in the urine. The diagnosis of prostatitis is established by a urologist or andrologist according to a typical clinical picture, the results of a rectal examination. In addition, an ultrasound of the prostate, bakposev of prostate secretion and urine is performed. Treatment is conservative - antibiotic therapy, immunotherapy, prostate massage, lifestyle correction.

General information

Prostatitis is an inflammation of the seminal gland (prostate) - the prostate. It is the most common disease of the genitourinary system in men. It most often affects patients aged 25-50 years. According to various data, 30-85% of men over 30 years old suffer from prostatitis. Possible formation of abscess of the prostate gland, inflammation of the testicles and appendages, which threatens infertility. Infection leads to inflammation of the upper genitourinary system (cystitis, pyelonephritis).

The pathology develops with the penetration of an infectious agent that enters the prostate tissue from the organs of the genitourinary system (urethra, bladder) or from a distant inflammatory focus (with pneumonia, flu, tonsillitis, furunculosis).

Prostate adenoma is a benign neoplasm of the paraurethral glands located around the urethra in its prostatic section. The main symptom of prostate adenoma is a violation of urination due to the gradual compression of the urethra by one or more growing nodes. The pathology is characterized by a benign course.

Only a small proportion of patients seek medical help, however, a detailed examination reveals symptoms of the disease in every fourth man aged 40-50 and in half of men aged 50-60. The disease is detected in 65% of men aged 60-70, 80% of men aged 70-80 and more than 90% of men over 80. The severity of symptoms can vary significantly. Studies in the field of clinical andrology suggest that problems with urination occur in about 40% of men with BPH, but only one in five patients of this group seek medical help.

Causes of prostatitis

As an infectious agent in an acute process, Staphylococcus aureus (Staphylococcus aureus), Enterococcus (Enterococcus), Enterobacter (Enterobacter), Pseudomonas (Pseudomonas), Proteus (Proteus), Klebsiella (Klebsiella) and Escherichiali (Escherichiali). Most microorganisms belong to conditionally pathogenic flora and cause prostatitis only in the presence of other predisposing factors. Chronic inflammation is usually due to polymicrobial associations.

The risk of developing the disease increases with hypothermia, a history of specific infections and conditions associated with congestion in prostate tissue. There are the following predisposing factors:

• General hypothermia (one-time or permanent, related to working conditions).
• A sedentary lifestyle, a specialty that forces a person to stay in a sitting position for a long time (computer operator, driver, etc. ).
• Persistent constipation.
• Violations of the normal rhythm of sexual activity (excessive sexual activity, prolonged abstinence, incomplete ejaculation during "ordinary" sexual intercourse without emotional coloring).
• The presence of chronic diseases (cholecystitis, bronchitis) or chronic infectious foci in the body (chronic osteomyelitis, untreated caries, tonsils, etc. ).
• Past urological diseases (urethritis, cystitis, etc. ) and sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea).
• Conditions that cause suppression of the immune system (chronic stress, irregular malnutrition, regular lack of sleep, excessive training in athletes).

It is assumed that the risk of developing pathology increases with chronic intoxication (alcohol, nicotine, morphine). Several studies in the field of modern andrology prove that chronic perineal trauma (vibration, shock) in drivers, motorcyclists and cyclists is a provoking factor. However, the vast majority of experts believe that all these circumstances are not the real causes of the disease, but only contribute to the worsening of the latent inflammatory process in the prostate tissue.

A decisive role in the occurrence of prostatitis is played by congestion in the prostate tissue. Violation of capillary blood flow causes an increase in lipid peroxidation, edema, exudation of prostate tissue and creates conditions for the development of an infectious process.

The mechanism of prostate adenoma development has not yet been fully determined. Despite the widespread opinion that links the pathology with chronic prostatitis, there is no data that would confirm the connection between these two diseases. Researchers have not found any relationship between the development of prostate adenoma and the use of alcohol and tobacco, sexual orientation, sexual activity, sexually transmitted and inflammatory diseases.

There is a marked dependence of the incidence of prostate adenoma on the age of the patient. Scientists believe that adenomas develop as a result of hormonal imbalances in men during andropause (male menopause). This theory is supported by the fact that men who castrate before puberty never suffer from the pathology, and extremely rarely - men who castrate after it.

Symptoms of prostatitis

Acute prostatitis

There are three stages of acute prostatitis, which are characterized by the presence of a certain clinical picture and morphological changes:

• Acute catarrh. Patients complain of frequent, often painful urination, pain in the sacrum and perineum.
• Acute follicular. The pain becomes more intense, sometimes radiating to the anus, aggravated by defecation. Urination is difficult, urine flows in a thin stream. In some cases, there is urinary retention. A subfebrile state or moderate hyperthermia is typical.
• Acute parenchymal. Severe general intoxication, hyperthermia up to 38-40°C, chills. Dysuric disorders, often - acute urinary retention. Severe, throbbing pains in the perineum. Difficulty in defecation.

Chronic prostatitis

In rare cases, chronic prostatitis becomes the result of an acute process, however, as a rule, a chronic primary course is observed. The temperature occasionally rises to subfebrile values. The patient notices a slight pain in the perineum, discomfort during urination and defecation. The most characteristic symptom is a small flow from the urethra during defecation. The main chronic form of the disease develops over a considerable period of time. It is preceded by prostatosis (blood stagnation in capillaries), gradually turning into abacterial prostatitis.

Chronic prostatitis is often a complication of the inflammatory process caused by the causative agent of a specific infection (chlamydia, trichomonas, ureaplasma, gonococcus). Symptoms of a specific inflammatory process in many cases mask the manifestations of prostate damage. Perhaps a slight increase in pain during urination, slight pain in the perineum, little discharge from the urethra during defecation. A slight change in the clinical picture often goes unnoticed by the patient.

Chronic inflammation of the prostate gland can be manifested by a burning sensation in the urethra and perineum, dysuria, sexual disorders, increased general fatigue. The consequence of violations of power (or the fear of these violations) often becomes mental depression, anxiety and nervousness. The clinical framework does not always include all the listed groups of symptoms, it varies in different patients and changes over time. There are three main syndromes characteristic of chronic prostatitis: pain, dysuric, sexual disorders.

There are no pain receptors in the prostate tissue. The cause of pain in chronic prostatitis becomes almost inevitable due to the abundant innervation of the pelvic organs, involvement in the inflammatory process of nerve pathways. Patients complain of pain of varying intensity - from weak, painful sleep to intense and disturbing sleep. There is a change in the nature of the pain (intensification or weakening) with ejaculation, excessive sexual activity or sexual abstinence. The pain radiates to the scrotum, sacrum, perineum, sometimes in the lumbar region.

As a result of inflammation in chronic prostatitis, the volume of the prostate increases, squeezing the urethra. The lumen of the ureter is reduced. The patient has a frequent need to urinate, a feeling of incomplete emptying of the bladder. As a rule, dysuric phenomena are expressed in the early stages. Then compensatory hypertrophy of the muscular layer of the bladder and ureters develops. Symptoms of dysuria during this period weaken and then increase again with the decompensation of adaptive mechanisms.

In the initial stages, dyspotency may develop, which manifests itself differently in different patients. Patients may complain of frequent erections at night, blurring of orgasm or worsening of erection. Accelerated ejaculation is associated with a decrease in the level of the orgasmic center excitation threshold. Painful sensations during ejaculation can cause rejection of sexual activity. In the future, sexual dysfunctions become more pronounced. In the advanced stage, impotence develops.

The degree of sexual disorder is determined by many factors, including the sexual constitution and psychological mood of the patient. Violations of potency and dysuria can be due both to changes in the prostate gland and to the suggestibility of the patient, who, if he has chronic prostatitis, expects the inevitable development of sexual disorders and urination disorders. Especially often psychogenic dyspotency and dysuria develop in suggestible and anxious patients.

Impotence, and sometimes the very threat of possible sexual disorders, is difficult for patients to tolerate. Often there is a change in character, irritability, disgust, excessive concern for one's health, even "care for the disease. "

There are two groups of symptoms of the disease: irritative and obstructive. The first group of symptoms includes increased urination, constant urge (imperative) to urinate, nocturia, urinary incontinence. The group of obstructive symptoms includes difficulty urinating, delayed onset and increased time of urination, feeling of incomplete emptying, urination with a slow intermittent stream, the need to strain. There are three stages of prostate adenoma: compensated, subcompensated and decompensated.

Compensated phase

In the compensated phase, the dynamics of the act of urination changes. It becomes more frequent, less intense and less free. There is a need to urinate 1-2 times during the night. As a rule, nocturia in stage I prostate adenoma does not cause concern in a patient who associates constant night awakenings with the development of age-related insomnia. During the day, the normal frequency of urination can be maintained, however, patients with stage I prostate adenoma note a waiting period, especially pronounced after night sleep.

Then the frequency of urination during the day increases, and the volume of urine released for urination decreases. There are necessary incentives. The stream of urine, which previously formed a parabolic curve, discharges slowly and falls almost vertically. Bladder muscle hypertrophy develops, due to which the efficiency of its emptying is maintained. At this stage there is little or no urine left in the bladder (less than 50 ml). The functional condition of the kidneys and the upper urinary tract is maintained.

Undercompensated phase

In stage II of prostate adenoma, the bladder increases in volume, dystrophic changes develop in its walls. The amount of residual urine is over 50 ml and continues to increase. During the entire act of urination, the patient is forced to intensively strain the abdominal muscles and the diaphragm, which leads to an even greater increase in intravesical pressure.

The act of urination becomes multiphase, interrupted, wavy. The passage of urine along the upper urinary tract slows down. Muscular structures lose their elasticity, the urinary tract expands. Kidney function is impaired. Patients are concerned about thirst, polyuria and other symptoms of chronic progressive renal failure. When compensatory mechanisms fail, the third stage begins.

Decompensated phase

The bladder in patients with stage III prostate adenoma is stretched, filled with urine, easily determined by palpation and visually. The upper edge of the bladder can reach the level of the navel and above. Emptying is impossible even with strong abdominal muscle tension. The urge to empty the bladder becomes constant. There may be severe pain in the lower abdomen. Urine is excreted frequently, in drops or very small portions. In the future, the pain and the desire to urinate gradually weaken.

A characteristic paradoxical urinary retention develops, or paradoxical ischuria (the bladder is full, urine is constantly excreted drop by drop). The upper urinary tract is enlarged, the functions of the renal parenchyma are impaired due to the continuous obstruction of the urinary tract, leading to an increase in pressure in the pelvicalyceal system. The clinic of chronic renal failure is growing. If medical care is not provided, patients die from progressive CRF.

Complications

In the absence of timely treatment of acute prostatitis, there is a significant risk of developing a prostate abscess. With the formation of a purulent focus, the patient's body temperature rises to 39-40 ° C and can become inflamed in nature. Periods of heat alternate with strong chills. Strong pains in the perineum make it difficult to urinate and make defecation impossible.

Increased prostate edema leads to acute urinary retention. Rarely, an abscess spontaneously bursts into the urethra or rectum. When opened, purulent, cloudy urine with an unpleasant pungent odor appears in the urethra; when opened, the stool contains pus and mucus in the rectum.

Chronic prostatitis is characterized by an undulating course with periods of long-term remissions, during which the inflammation in the prostate is latent or manifests itself with extremely weak symptoms. Patients who are not bothered by anything often stop treatment and return only when complications develop.

The spread of infection through the urinary tract causes pyelonephritis and cystitis. The most common complication of the chronic process is inflammation of the testicles and epididymis (epdidymo-orchitis) and inflammation of the seminal vesicles (vesiculitis). The result of these diseases is often infertility.

Diagnosing

To assess the severity of prostate adenoma symptoms, the patient is asked to fill in a urination diary. During the consultation, the urologist performs a digital examination of the prostate. To rule out infectious complications, a sample and examination of prostate discharge and spots from the urethra is made. Additional testing includes:

• Ultrasound.In the prostate ultrasound process, the volume of the prostate gland is determined, stones and areas with congestion are detected, the amount of residual urine, the condition of the kidneys and urinary tract are assessed.
• Urodynamic study. Uroflowmetry allows you to reliably judge the degree of urine retention (the time of urination and the rate of urine flow is determined by a special device).
• Definition of tumor markers.To rule out prostate cancer, it is necessary to evaluate the level of PSA (prostate-specific antigen), the value of which should not normally exceed 4 ng / ml. In questionable cases, a prostate biopsy is performed.

Excretory cystography and urography for prostate adenoma have been performed less often in recent years due to the emergence of new, less invasive and safer research methods (ultrasound). Sometimes cystoscopy is performed to exclude diseases with similar symptoms or in preparation for surgical treatment.

Treatment of prostatitis

Treatment of acute prostatitis

Patients with an uncomplicated acute process are treated by a urologist on an outpatient basis. With severe intoxication, suspicion of a purulent process, hospitalization is indicated. Antibacterial therapy is performed. Preparations are selected taking into account the sensitivity of the infectious agent. Antibiotics that can penetrate prostate tissue well are widely used.

With the development of acute retention of urine in the lower part of prostatitis, they use the installation of a cystostomy, and not a urethral catheter, since there is a risk of the formation of a prostate abscess. With the development of an abscess, a transrectal or transurethral endoscopic opening of the abscess is performed.

Treatment of chronic prostatitis

Treatment of chronic prostatitis should be complex, including etiotropic therapy, physiotherapy, correction of immunity:

• Antibiotic therapy. The patient is prescribed long courses of antibacterial drugs (within 4-8 weeks). The selection of the type and dose of antibacterial drugs, as well as the determination of the duration of the treatment course is carried out individually. The drug is selected based on the sensitivity of the microflora according to the results of urine culture and prostate secretion.
• Prostate massage.Massage of the gland has a complex effect on the affected organ. During the massage, the inflammatory secretion accumulated in the prostate gland is squeezed into the channels, then enters the urethra and leaves the body. The procedure improves blood circulation in the prostate, which minimizes congestion and ensures better penetration of antibacterial drugs into the tissues of the affected organ.
• Physiotherapy.Laser exposure, ultrasonic waves and electromagnetic vibrations are used to improve blood circulation. If it is impossible to perform physiotherapeutic procedures, the patient is prescribed warm medicinal microclysters.

In chronic, long-term inflammation, consulting an immunologist is indicated to choose immunocorrective therapy tactics. The patient is given advice on lifestyle changes. Making some changes in the lifestyle of a patient with chronic prostate is a curative and preventive measure. The patient is recommended to normalize sleep and wakefulness, adopt a diet, perform moderate physical activity.

Conservative therapy

Conservative therapy is performed in the early stages and in the presence of absolute contraindications to surgery. To reduce the severity of the symptoms of the disease, alpha-blockers, 5-alpha reductase inhibitors, herbal preparations (African plum bark extract or sabal fruit) are used.

Antibiotics are prescribed to fight the infection that often accompanies prostate adenoma. At the end of the course of antibiotic therapy, probiotics are used to restore normal intestinal microflora. Perform immunity correction. Atherosclerotic vascular changes that develop in most elderly patients prevent the flow of drugs to the prostate gland, so special drugs are prescribed to normalize blood circulation.

Surgery

There are the following surgical methods for the treatment of prostate adenoma:

1. TOUR(transurethral resection). Minimally invasive endoscopic technique. The operation is performed with an adenoma volume of less than 80 cm3. Not applicable for renal failure.
2. Adenomectomy.It is performed in the presence of complications, the mass of the adenoma is more than 80 cm3. Currently, laparoscopic adenomectomy is widely used.
3. Laser vaporization of the prostate.It allows you to perform an operation with a tumor mass of less than 30-40 cm3. It is the method of choice for young patients with prostate adenoma, because it allows you to save sexual function.
4. Laser enucleation(holmium - HoLEP, thulium - ThuLEP). The method is known as the "gold standard" of surgical treatment of prostate adenoma. It allows you to remove an adenoma with a volume of more than 80 cm3 without open intervention.

There are a number of absolute contraindications for surgical treatment of prostate adenoma (decompensated diseases of the respiratory and cardiovascular system, etc. ). If surgical treatment is not possible, bladder catheterization or palliative surgery is performed - cystostomy, placement of urethral stent.

Prediction and prevention

Acute prostatitis is a disease that has a marked tendency to become chronic. Even with adequate treatment in time, more than half of patients end up with chronic prostatitis. Recovery is not always achieved, however, with correct and stable therapy and following the doctor's recommendations, it is possible to eliminate unpleasant symptoms and achieve a long-term stable remission in a chronic process.

Prevention is the elimination of risk factors. It is necessary to avoid hypothermia, alternate sedentary work and periods of physical activity, eat regularly and fully. Laxatives should be used for constipation. One of the preventive measures is the normalization of sexual life, since excessive sexual activity and sexual abstinence are risk factors in the development of prostatitis. If symptoms of a urological or sexually transmitted disease appear, you should consult a doctor in a timely manner.