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Prostatitis

Symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the prostate gland (prostate) in men, which has a negative impact on both sexual function and the urination process.Pain in the perineum, groin, lower back and pelvic area, disturbances in urodynamics (urine output) may indicate the presence of prostatitis.Untreated prostatitis can cause male infertility and prostate cancer.

This is one of the most common male diseases, which requires careful attention and competent systematic treatment.This is exactly the approach to solving the problem of prostatitis that you will find in the urology department of a professional clinic.Qualified urologists-andrologists have successfully treated acute and chronic prostatitis for many years.Complex therapy, careful attention and an individual approach to each case inevitably lead patients to lasting and long-term recovery and remission.

Prevalence

Prostatitis ranks 5th among the top 20 urological diagnoses.It is believed that at the age of 30, 30% of the male population suffers from prostatitis, at the age of 40 - 40%, and after 50 years, almost all men in one way or another bear the burden of this disease.And if up to 35 years of age mainly infectious prostatitis is recorded, then at a more mature age the non-infectious form prevails and is generally diagnosed several times more often than bacterial inflammation of the prostate.

Anatomy and physiology of the prostate gland

The prostate gland (prostate) is located in the lower front of the pelvis, below the bladder.It consists of glandular and smooth muscle tissue, surrounded by a fibrous capsule.The urethra passes through the body of the prostate from the bladder, into which the ejaculatory ducts open.

The prostate is a hormone-dependent organ.It is formed and functions under the influence of male hormones - androgens.Testosterone plays a leading role in this process.

The prostate gland is connected to the seminal tubercle, which acts as a valve for the ejaculatory duct.As part of the male reproductive system, the prostate affects erection, ejaculation and orgasm.Nerves responsible for erection pass through the gland.In the chronic course of the disease, they are involved in the inflammatory process and erectile dysfunction develops.

The prostate produces a secretion that is part of the sperm.Creates favorable conditions for sperm activity.Therefore, with chronic dysfunction of the gland, male infertility can occur.

Pathogenesis

There are two main reasons for the development of prostatitis:

  • stagnation of prostate secretion against the background of impaired blood circulation and lymphatic flow in the gland itself and neighboring organs;
  • pathogenic and conditionally pathogenic microflora.

Acute prostatitis is usually associated with infection of the prostate tissue.But, as a rule, both factors are interconnected and together create a vicious circle that complicates the treatment of prostatitis.

The inflamed prostate gland becomes painful.Pain can be felt in the perineum, groin, pelvis and lower back.It is significantly intensified by palpation during a digital rectal examination or defecation.

The prostate increases in size, squeezing the urethra.This makes it difficult for urine to flow from the bladder.The flow of urine becomes weak.The patient must strain the abdominal muscles in order to carry out the act of urination.In acute cases, urinary tract obstruction and acute urinary retention sometimes occur.

Inflammation leads to the interruption of the flow of prostate fluid and its stagnation.The resulting swelling disrupts the processes of cellular metabolism and respiration in the gland.This creates conditions for the process to become chronic.With prolonged prostatitis, neighboring organs can become inflamed: seminal tuberculosis, Cooper's glands, seminal vesicles.The chronic form of the disease is associated with risks of developing male infertility, adenoma and prostate cancer.

In recent years, it has been established that in 70-80% of cases, prostatitis appears due to stagnant processes in the gland.Venous disorders are less common, but they also cause prostatitis, especially if accompanied by hemorrhoids and varicocele on the left (enlargement of the testicular vein).

Distribution

The US National Institutes of Health identifies 4 categories of prostatitis:

  • Acute prostatitis (Category I)
  • Chronic bacterial prostatitis (Category II)
  • Chronic prostatitis / chronic pelvic pain syndrome (Category III)
  • Asymptomatic chronic prostatitis (Category IV)

Due to its appearance, prostatitis is divided into two types:

  • Not infectious
  • Infectious

The inflammatory process can develop rapidly, accompanied by vivid symptoms (acute phase) or slowly with gradually increasing erased symptoms.

Non-infectious prostatitisin most cases it is associated with stagnation of prostate secretions and impaired blood circulation and lymphatic flow in the gland itself and nearby organs.

Infectious prostatitisdevelops due to the penetration of pathogenic or opportunistic microflora into the prostate tissue: bacteria, viruses, fungi.There are different ways that the infection can enter the prostate:

  • Urinogenic (ascending): the portal of entry is the urethra.It should be noted that the infection can also enter through a descending route, for example, with purulent pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphogenic: infection from neighboring pelvic organs can enter the prostate through lymph due to inflammation of the rectum (proctitis) or bladder (cystitis), as well as from infected hemorrhoidal veins.
  • Hematogenous (through the blood): caused by the presence in the body of foci of chronic infection (tonsillitis, tooth decay) or complications of acute infections (flu, acute respiratory infections, tonsillitis, etc.).

The most common causative agents of prostatitis are:

  • bacteria: Escherichia coli, Proteus, Gardnerella (gram-negative);staphylococci, streptococci (gram-positive);
  • viruses (influenza, herpes, cytomegalovirus, ARVI pathogens);
  • mycoplasma;
  • chlamydia;
  • specific flora (gonococcus, trichomonas, mycobacterium tuberculosis).

According to the nature of the course, prostatitis appears:

  • spicy
  • chronic

Acute prostatitisusually occurs under the influence of pathogenic (opportunistic) microflora in the presence of predisposing factors.It has a rapid course and pronounced symptoms.If not treated in time, a purulent process may develop, leading to melting of the prostate tissue.If treated incorrectly, acute prostatitis often becomes chronic.

Chronic prostatitisprogress is easier, symptoms are gone.However, it can worsen from time to time, and then the symptoms will correspond to an acute process.However, complete remission between flare-ups does not always occur, and the patient may continue to feel discomfort.Chronic prostatitis can cause impotence, male infertility, adenoma or prostate cancer.

There is an asymptomatic chronic form of the disease, when the patient has no complaints, but the prostate secretion contains an increased number of purulent elements (leukocytes).

Complications

Without proper therapy, the inflammatory process can lead to purulent melting of prostate tissue.In addition, inflammation can spread to nearby organs: seminal tuberculosis, Cooper's glands, seminal vesicles, urethra.Therefore, the following complications may occur:

  • Prostate abscess
  • Sclerosis/fibrosis of the prostate (functional tissue of the gland is replaced by connective tissue)
  • Prostate cysts
  • Prostate stones
  • Vesiculitis (inflammation of the seminal vesicles)
  • Coliculitis (inflammation of the seminal tubercle)
  • Epididymo-orchitis (inflammation of the testicles and their appendages)
  • Posterior urethritis
  • Erectile dysfunction/impotence
  • Ejaculation disorder
  • Infertility
  • Adenoma of the prostate
  • Prostate cancer

Symptoms

Different forms of prostatitis have their own characteristics and severity of symptoms.In general, the following manifestations are characteristic of prostatitis:

  • Pain in the groin, in the lower back, in the perineum (may radiate along the spermatic cords).
  • The pain intensifies with defecation and digital rectal examination.
  • Urodynamic disorders (frequent urination, urinary retention, difficulty urinating, weak stream, incomplete emptying of the bladder).
  • Prostatorrhea (involuntary discharge of prostate fluid, especially in the morning and during bowel movements).
  • Disorders of sexual function (decreased sexual desire, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • The temperature rises to 39-40 degrees
  • Acute retention of urine
  • General intoxication
  • Leukocytosis, protein and mucus in the urine
  • Blood in urine and semen
  • Leukocytosis in prostate secretions
  • Hypoechogenicity and enlargement of the gland, increased blood circulation according to ultrasound data

Symptoms of chronic prostatitis

  • Body temperature is usually not higher than 37 C
  • Pain sensations are softened and softened
  • Discharge from the urethra during bowel movements
  • Urinary disorders
  • Decreased libido
  • Erectile dysfunction
  • Ejaculation disorders (premature or delayed ejaculation)

reason

The main reasons for the development of prostatitis are infections and stagnation of prostate secretions.The following factors contribute to the occurrence of prostatitis:

  • Infections and opportunistic flora with weakened immunity
  • Physical inactivity
  • "Sedentary" work.
  • Long-term sexual abstinence
  • Coitus interruptus (with delayed ejaculation)
  • Excessive sexual activity leading to depletion of the gland
  • Alcohol abuse
  • Reduction of local immunity (hypothermia, use of immunosuppressants, lack of immunity, autoimmune diseases)
  • Pelvic organ injuries
  • Manipulations in the prostate and nearby organs (prostate biopsy, surgery, catheterization, cystoscopy, etc.)
  • Chronic diarrhea or constipation

Diagnosing

Many methods are used to detect prostatitis, which can be divided into 3 groups: digital rectal examination, laboratory tests and instrumental methods.

Digital rectal examinationperformed by a urologist-andrologist after a conversation with the patient.This method allows you to evaluate the size, shape and some features of the structure of the prostate gland.If the size of the prostate increases and the procedure itself is painful for the patient, the doctor can pre-diagnose prostatitis.

If the case is not acute, the doctor during the examination can perform prostate massage to obtain prostate secretion, the study of which is an important link in the diagnosis of prostatitis.If acute bacterial prostatitis is suspected, prostate massage is contraindicated: such manipulation can lead to the spread of the pathogen and blood poisoning.

To clarify the diagnosis, the patient will be asked to undergoinstrumental studies, such as:

  • Transrectal ultrasound examination of the prostate gland and pelvic organs (reveals structural features, the presence of inflammation and purulent foci, stones, cysts and other neoplasms);
  • Dopplerography (characteristics of blood flow in the gland);
  • uroflowmetry (determining the speed and time of urination);
  • magnetic resonance of the pelvic organs (a very informative and safe study that allows differential diagnosis with other diseases).

If necessary, the diagnosis of the nearby organs of the genitourinary system is performed: urethroscopy, urethrography and urethrocystography.

Laboratory researchare a necessary component of the diagnosis of prostatitis:

  • General analysis of urine (before and after prostate massage)
  • General blood test
  • Blood test for proteins of the acute phase of inflammation (C-reactive protein, etc.)
  • Microscopic examination of prostate secretion after finger massage
  • Microscopic examination of an itch from the urethra
  • Spermogram (cytology and biochemistry of sperm)
  • Culture of urine, prostate secretion and sperm
  • Determination of prostate specific antigen (PSA)
  • Needle biopsy of the prostate and histological examination of the gland tissue

The last two studies are necessary to rule out prostate cancer or adenoma.

The modern one has an excellent diagnostic base, very informative.Urologists have extensive experience in successfully diagnosing and treating various forms of prostatitis, and the status of a multidisciplinary clinic allows you to use the services of specialists in similar fields.The medical center has developed research packages that include all necessary types of diagnostics at a very attractive price. 

Treatment

Treating prostatitis is not an easy task.It requires a thoughtful and integrated approach.The treatment protocol for this disease includes drug therapy and physiotherapeutic procedures, in some cases surgical intervention is required.

Drug therapy

Includes the use of the following drugs:

  • Antibiotics (after determining sensitivity to them)
  • Antiseptics (local)
  • Vascular medications (improving microcirculation in the prostate)
  • Nonsteroidal anti-inflammatory drugs
  • Alpha-1 blockers (for urinary problems)
  • Enzyme preparations (dilute prostate secretion, stimulate the immune system, relieve inflammation)
  • Immunomodulators
  • Antidepressants

Physiotherapy treatment

  • Electrical stimulation of the prostate (electrophoresis, galvanization, pulse action)
  • Vibro massage
  • Rectal sensor laser therapy (for chronic prostatitis)

For chronic prostatitis, prostate massage can be used as a therapeutic procedure.In the acute stage of the disease, this manipulation is not performed to avoid the spread of infection and sepsis.

Surgical treatment

Surgery for prostatitis is rarely used.This need arises in case of serious suffocation of the prostate tissue, lack of positive dynamics in drug treatment and pathological enlargement of the prostate gland blocking the urethra.

PREDICTION

With early diagnosis and adequate treatment, acute prostatitis can be overcome.However, quite often the process becomes chronic even with correct and timely therapy.

If the treatment is incorrect and the treatment conditions are not respected (several months), the disease usually takes a chronic course.Chronic prostatitis greatly affects a man's quality of life, because not only urinary function suffers, but also sexual function.In 30% of cases, erectile dysfunction, loss of orgasmic intensity, problems with ejaculation and infertility are observed.It is completely impossible to cure chronic prostatitis, but with the right approach, a lasting remission can be achieved.

Advantages of visiting a professional clinic

  • Successful treatment of various forms of prostatitis
  • Urologists-andrologists with the highest qualification experience
  • Multidisciplinary, allowing you to include specialists in similar fields in the treatment
  • Modern diagnostic equipment and high-precision treatment
  • Own European-class clinical diagnostic laboratory
  • Comfortable and high-tech hospitals
  • A package of urological diagnostic services at an attractive price

Prevention of prostatitis

  • Choose protected sex to avoid sexually transmitted infections (STIs)
  • Support the immune system (vitamins, healthy diet, prevention of dysbiosis, reasonable antibiotic therapy, etc.)
  • Avoid hypothermia
  • Lead an active lifestyle
  • Have sex regularly, if possible, with a partner (to avoid prostate stagnation and STIs)
  • Avoid intermittent intercourse (this will ease sperm stagnation)
  • Visit your urologist once a year for preventive purposes and twice a year if you are over 50 or have a history of prostate disease.

Frequently asked questions

How informative is the PSA test in the diagnosis of prostatitis?

Prostate-specific antigen (PSA) is a marker for prostate cancer.It is known that in some cases prostate cancer has a clinical picture similar to the manifestations of prostatitis.Therefore, the PSA test is used to distinguish between these two diseases.However, you should not bet on PSA.This antigen also increases in prostate adenoma, a benign growth of glandular tissue.With prostatitis, PSA levels can also rise during periods of active inflammation.During the remission phase it decreases.Therefore, PSA cannot be used as a definitive test of prostate cancer or prostatitis.

Why is prostatitis difficult to treat?

Prostate capillaries have a special structure that creates a hematoprostatic barrier.This makes it difficult for some types of antibiotics to penetrate the tissue of the gland.In addition, microorganisms tend to form biofilms, which reliably protect them from the action of antibacterial agents.Therefore, modern prostatitis treatment protocols necessarily include proteolytic enzymes that can destroy biofilms.Bacteria become vulnerable and antibiotics work more effectively.Chronic prostatitis is the most persistent treatment, the main feature of which is the wide variety of microflora in the culture.In approximately 50% of cases, Enterococcus faecalis is grown, resistant to all aminoglycosides and cephalosporins.This narrows the list of effective antimicrobial agents, which also complicates treatment.