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Prostatitis

symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the prostate (prostate) in men, which has a negative impact on sexual function and the urination process. Pain in the perineum, groin, lower back and pelvic region, urodynamic disorders (flow of urine) may indicate the presence of prostatitis. Prostatitis not treated in a timely manner can cause male infertility and prostate cancer.

It is one of the most common male ailments, requiring special attention and competent systemic treatment. It is this approach to solving the problem of prostatitis that you will find in the urological department of a professional clinic. Highly qualified urologists-andrologists have successfully treated acute and chronic prostatitis for many years. Complex therapy, an attentive attitude and an individual approach to each case inevitably lead patients to recovery and long-term stable remission.

Prevalence

Prostatitis ranks 5th among the top 20 urological diagnoses. It is believed that by the age of 30, 30% of the male population suffers from prostatitis, at 40 - 40%, and after 50 almost all men somehow bear the burdenof this disease. And if up to 35 years of age mainly infectious prostatitis is registered, then at older ages the non-infectious form prevails, and in general it is diagnosed several times more often than bacterial inflammation of the prostate.

Anatomy and physiology of the prostate

The prostate (prostate) is located in the lower front part of the small 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 forms and functions under the influence of male hormones - androgens. Testosterone plays a key role in this process.

The prostate is associated with 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. The 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 secret that is part of semen. It creates favorable conditions for sperm activity. Therefore, with chronic dysfunction of the gland, male infertility can be observed.

Pathogenesis

There are two main reasons for the development of prostatitis:

  • stagnation of prostate secretion against the background of circulatory disorders and lymph outflow in the gland itself and nearby organs;
  • pathogenic and conditionally pathogenic microflora.

Acute prostatitis is usually associated with infection of prostate tissue. But, as a rule, the two factors are interrelated and together create a vicious circle that makes it difficult to treat prostatitis.

The inflamed prostate becomes painful. Pain can be felt in the perineum, groin, pelvis, lower back. It increases sharply on palpation during digital rectal examination or defecation.

The prostate increases in size, constricting the urethra. Thus, the evacuation of urine from the bladder becomes difficult. The urine stream becomes weak. The patient must strain the abdominal muscles for the act of urination to take place. In acute cases, there is sometimes obstruction of the urinary tract, and acute retention of urine.

Inflammation leads to a violation of the outflow of juice from the prostate and its stagnation. The resulting edema disrupts the processes of cellular metabolism and respiration in the gland. This creates the conditions for the chronization of the process. With prolonged prostatitis, nearby organs can also become inflamed: the seminal tubercle, Cooper's glands, seminal vesicles. The chronic form of the disease is associated with the risk of developing male infertility, adenoma and prostate cancer.

In recent years, it has been found that in 70-80% of cases, prostatitis occurs 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 (expansion of the testicular vein).

Classification

The American National Institutes of Health identify 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 the appearance of prostatitis is divided into two types:

  • non-infectious
  • Infectious

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

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

Infectious prostatitisdevelops due to the penetration of pathogenic or conditionally pathogenic microflora into the tissues of the prostate: bacteria, viruses, fungi. Infection can enter the prostate in different ways:

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

The most common causative agents of prostatitis are:

  • bacteria: E. coli, Proteus, gardnerella (gram-negative); staphylococci, streptococci (gram-positive);
  • viruses (influenza, herpes, cytomegalovirus, ARVI pathogens);
  • mycoplasma;
  • chlamydia;
  • specific flora (gonococcus, Trichomonas, Mycobacterium tuberculosis).

By the nature of the course, prostatitis occurs:

  • Spicy
  • Chronic

Acute prostatitisusually occurs under the influence of pathogenic (conditionally pathogenic) microflora in the presence of predisposing factors. It has a rapid course and pronounced symptoms. If it is not cured in time, a purulent process may develop, leading to the tissues of the prostate gland being sloughed off. With improper treatment, acute prostatitis often becomes chronic.

Chronic prostatitishas a milder course, symptoms cleared. However, it may get worse from time to time, then the symptoms will correspond to an acute process. At the same time, complete remission between exacerbations does not always occur, and the patient may constantly experience discomfort. Chronic prostatitis can lead to impotence, male infertility, prostate adenoma or cancer.

There is an asymptomatic chronic form of the disease, when the patient does not complain, but there is an increased amount of purulent elements (leukocytes) in the secretion of the prostate.

Complications

Without proper treatment, the inflammatory process can lead to purulent fusion of prostate tissue. In addition, the inflammation can spread to neighboring organs: seminal tubercle, Cooper's glands, seminal vesicles, urethra. As a result, the following complications may occur:

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

Symptoms

Different forms of prostatitis have their own characteristics of course and severity of symptoms. In general, prostatitis is characterized by the following manifestations:

  • Pain in the groin, lower back, perineum (may radiate down the spermatic cord).
  • Pain increases with defecation, digital rectal examination.
  • Violation of urodynamics (frequent urination, urinary retention, difficulty urinating, weak flow, incomplete emptying of the bladder).
  • Prostatorrhea (involuntary secretion of prostatic juice, especially in the morning and during bowel movements).
  • Sexual function disorders (decreased libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • Temperature rise to 39-40 degrees
  • Acute urinary retention
  • General poisoning
  • Leukocyturia, protein and mucus in urine
  • Blood in urine and semen
  • Hyperleukocytosis in prostatic secretion
  • Hypoechogenicity and enlargement of the gland, increased blood flow according to ultrasound

Symptoms of chronic prostatitis

  • Body temperature is usually no higher than 37°C
  • Pain sensations are reduced and smoothed
  • Discharge from the urethra during bowel movements
  • Urination disorders
  • Decreased libido
  • erectile dysfunction
  • Ejaculation disorders (premature or delayed ejaculation)

The reasons

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

  • Infections and opportunistic flora with weakened immunity
  • Hypodynamia
  • "Sedentary work
  • Prolonged sexual abstinence
  • Coitus interruptus (with delayed ejaculation)
  • Excessive sexual activity leading to exhaustion of the glands
  • Alcohol abuse
  • Decreased local immunity (hypothermia, use of immunosuppressants, immunodeficiency, autoimmune diseases)
  • Pelvic organ injuries
  • Manipulations on the prostate and neighboring organs (prostatic biopsy, surgery, catheterization, cystoscopy, etc. )
  • Chronic diarrhea or constipation

Diagnostic

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

digital rectal examinationconducted by a urologist-andrologist after a conversation with the patient. This method allows you to assess the size, shape and some features of the structure of the prostate. If the size of the prostate is enlarged and the procedure itself is painful for the patient, the doctor may pre-diagnose prostatitis.

If the case is not acute, the doctor may perform prostate massage during the examination in order to obtain prostatic 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 research, such as:

  • transrectal ultrasound examination of the prostate 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);
  • urinary flowmetry (determination of the speed and time of the act of urination);
  • magnetic resonance imaging of the pelvic organs (a very informative and safe study that allows differential diagnosis with other diseases).

If necessary, a diagnosis of neighboring organs of the genitourinary system is performed: ureteroscopy, urethrography and urethrocystography.

Laboratory researchare a necessary component of the diagnosis of prostatitis:

  • Urinalysis (before and after prostate massage)
  • General blood test
  • Blood test for acute phase inflammatory proteins (C-reactive protein, etc. )
  • Microscopic examination of prostate secretion after finger massage
  • Microscopic examination of a scraping from the urethra
  • Spermogram (cytology and biochemistry of sperm)
  • Culture of urine, prostatic secretions and semen
  • Determination of prostate specific antigen (PSA)
  • Biopsy by puncture of the prostate and histological examination of the glandular tissues

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

The modern has an excellent, very informative diagnostic basis. 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 related specialists. The medical center has developed research packages that include all types of diagnostics needed at a very attractive price.

Treatment

Treatment of prostatitis is not an easy task. This requires a thoughtful and integrated approach. The treatment protocol for this disease includes drug therapy and physiotherapy, in some cases surgery is required.

medical therapy

It involves the use of the following drugs:

  • Antibiotics (after determining their sensitivity)
  • Antiseptics (locally)
  • Vascular preparations (improvement of microcirculation in the prostate)
  • Nonsteroidal anti-inflammatory drugs
  • Alpha-1-adrenergic blockers (in violation of urination)
  • Enzyme preparations (clarify the secret of the prostate, stimulate the immune system, relieve inflammation)
  • Immunomodulators
  • Antidepressants

Physiotherapy treatment

  • Electrical stimulation of the prostate (electrophoresis, galvanization, pulsed exposure)
  • Vibromassage
  • Laser therapy with a rectal sensor (for chronic prostatitis)

In chronic prostatitis, prostate massage can be used as a treatment procedure. In the acute stage of the disease, this manipulation is not carried out in order to avoid the spread of infection and sepsis.

Surgical treatment

Prostatitis surgery is rarely performed. Such a need arises in case of severe suppuration of prostate tissues, the absence of positive dynamics for drug treatment and pathological enlargement of the prostate gland that blocks the urethra.

Provide

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

With improper treatment and non-compliance with the conditions of treatment (it is several months), the disease usually takes on a chronic course. Chronic prostatitis greatly affects the quality of life of a man, since not only urinary function, but also sexual function suffers. In 30% of cases, erectile dysfunction, loss of orgasmic acuity, ejaculation problems and infertility are observed. It is completely impossible to cure chronic prostatitis, but with the right approach you can achieve stable remission.

Benefits of going to a professional clinic

  • Successful treatment of various forms of prostatitis
  • Experienced urologists-andrologists of the highest qualification
  • Multidisciplinary, allowing to involve specialists in related fields in the treatment
  • Modern high-precision diagnostic and treatment equipment
  • 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 safe sex to avoid sexually transmitted infections (STIs)
  • Support the immune system (vitamins, healthy diet, prevention of dysbacteriosis, reasonable antibiotic therapy, etc. )
  • Avoid hypothermia
  • lead an active life
  • Have regular sex, if possible, with only one partner (to avoid prostate congestion and STIs)
  • Avoid coitus interruptus (this will eliminate sperm stasis)
  • See a urologist once a year for prevention 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 for diagnosing 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 for the differential diagnosis between these two diseases. However, do not bet on PSA. This antigen also increases with prostate adenoma - a benign growth of glandular tissue. With prostatitis, PSA levels can also rise during times of active inflammation. In the remission phase, it decreases. Therefore, PSA cannot be used as definitive proof of prostate cancer or prostatitis.

Why is prostatitis difficult to treat?

The capillaries of the prostate have a special structure that creates a blood-prostatic barrier. This makes it difficult for certain types of antibiotics to penetrate the tissues of the gland. In addition, microorganisms tend to form biofilms that reliably protect them from the action of antibacterial agents. Therefore, modern prostatitis treatment protocols necessarily include proteolytic enzymes capable of destroying biofilms. Bacteria become vulnerable and antibiotics work more effectively. The most stubbornly treated chronic prostatitis, a key feature of which is a wide variety of microflora in the culture. In about 50% of cases, Enterococcus faecalis is sown, resistant to all aminoglycosides and cephalosporins. This narrows the list of effective antimicrobial agents, which also complicates treatment.