Prostatitis is an inflammation of the prostate gland, one of the common problems in 40% of middle-aged and older men. Without directly threatening life, this disease leads to a significant decrease in its quality, affecting performance, the intimate sphere, limiting freedom and provoking everyday difficulties and psychological 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 that enters the prostate gland ascending in urological and venereal diseases of an infectious nature, chronic prostatitis in 90% of cases is not associated with infections. Stagnation of the prostate secretion is formed as a result of infectious inflammation of the duct walls and systemic diseases.
Causes of Acute Prostatitis
Acute bacterial prostatitis is caused by enterobacteria, Gram-negative and Gram-positive cocci, chlamydia, mycoplasma, viruses. Risk factors for infection of the prostate are sexually transmitted diseases and invasive urological interventions (catheterization, instillation and bougienage of the urethra, urocystoscopy).
The provocateurs of the development of infectious inflammation are usually hypothermia, prolonged constipation or diarrhea, sedentary work, 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 supply to the pelvic organs, these factors in themselves contribute to aseptic inflammation, and also facilitate the introduction of the pathogen into the tissue of the prostate gland.
Acute bacterial inflammation can resolve without consequences, but in some cases the following complications form:
- acute urinary retention;
- chronic prostatitis (chronic pelvic inflammatory syndrome);
- epididymitis;
- abscess of the prostate;
- fibrosis of the prostate tissue;
- infertility.
The causes of chronic prostatitis
In 10% of cases, chronic prostatitis develops as a complication of acute inflammation of the prostate gland, as well as urethritis, chlamydia, human papillomavirus and other chronic infections. About 90% is due to abacterial chronic prostatitis or chronic pelvic pain syndrome (CPPS). This form of the disease is not associated with infections, but is due to many reasons, primarily stagnant processes in the small pelvis. Stagnation of urine, causing inflammation, is formed against the background of urethritis, neurogenic narrowing of the bladder neck, urethral stricture, autoimmune inflammation. The blood supply to the pelvic organs deteriorates, which is explained by systemic cardiovascular diseases (coronary artery disease, atherosclerosis). The general venous system of the small pelvis determines the connection 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 urge to urinate, not always effective, difficulty or increased urination, especially at night. The stream of urine is depleted, and all the time there is some residual amount of it in the bladder.
- Damage to the prostate: leukocytes and blood in the semen, pain during urological examination.
- Fibromyalgia.
- Prostatorrhea is a small discharge from the urethra.
- Pain in the small pelvis, perineum, testicles, above the pubis, in the penis, sacrum, bladder, scrotum.
- Sore urination and ejaculation.
- Convulsive muscle spasms.
- Stones in the prostate gland.
- 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 join.
In the chronic course of the disease, the signs of prostatitis are blurred (less pronounced), but they are joined by general, neurological and mental symptoms.
Diagnostics of the prostatitis
The key to successful and timely treatment of prostatitis is an accurate and comprehensive diagnosis. The low proportion of infectious prostatitis is 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 tissue 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, inoculation of biological fluids is performed: urine, semen, and prostate secretions. This method allows you to select a drug that is most effective for a specific strain of the pathogen, capable of penetrating directly to the focus of inflammation.
The "classical" method of laboratory diagnostics of prostatitis is considered to be culturological (culture of urine, ejaculate, contents of urogenital smears). The method is very accurate, but it takes time. To detect bacteria, a Gram smear is produced, but in this way it is unlikely to detect viruses, mycoplasma and ureaplasma. To improve the accuracy of research, mass spectrometry and PCR (polymerase chain reaction) are used. Mass spectrometry is an ionic analysis of the structure of a substance and the determination of each of its components. The polymerase chain reaction allows 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 study by the PCR method of the microflora of the urogenital tract is used. The test result is ready in a day and reflects the full picture of the microbial ratio in the subject's body.
Tests for prostatitis include urine and ejaculate collection and urologic smears.
The European Urological Association recommends the following set of laboratory tests:
- general urine analysis;
- bacterial culture of urine, semen and ejaculate;
- PCR diagnostics.
A general analysis of urine allows you to determine the signs of inflammation (the number of colony-forming units of microorganisms, the number of leukocytes, erythrocytes, urine transparency) and the presence of calcifications (prostate stones). The general analysis is included in the method of several urological (glass or portioned) samples.
Glass or portioned samples consist in the sequential collection of urine or other biological fluids in different containers. Thus, the localization of the infectious process is determined. Prostatitis is evidenced by the detection of infectious agents, blood cells (leukocytes and erythrocytes) in the final portion of urine during a three-glass test or after 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 initial, middle and final portions of urine are taken at the same urination.
Four-glass sample - culture and general analysis of the initial and middle parts of the urine stream, prostate secretion after urological massage of the prostate and a portion of urine after this procedure.
Culturological sowing or PCR diagnostics of ejaculate and material of urogenital smears are also performed.
Blood tests are also required to make a diagnosis of prostatitis. A general analysis of capillary blood allows you to confirm or deny the presence of inflammation, as well as exclude other diagnoses that cause the same symptoms.
Diagnosis of non-inflammatory chronic pelvic pain syndrome is more difficult, as it is based on the clinical picture and indirect laboratory parameters (including general analysis of urine and blood). The intensity of the pain syndrome is determined by the visual analogue scale of pain, and the severity of psychological changes is determined by the scales for assessing anxiety and depression. At the same time, research is necessarily carried out to find an infectious agent, since the spectrum of pathogens can be very wide. From instrumental studies, urofluometry is prescribed with the establishment of residual urine volume and transrectal ultrasound (TRUS) of the prostate gland.
Asymptomatic prostatitis is detected with a histological examination of a biopsy of the prostate, prescribed for suspected cancer. A blood test for Prostate Specific Antigen (PSA) is performed beforehand. Serum PSA appears with hypertrophy and inflammation of the prostate, and the criteria for the norm change with age. This study also helps to rule out suspicions 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 are able to penetrate the prostate gland, pathogens are immune to some of the drugs, therefore, bacterial inoculation is necessary.
Conservative urological treatment may 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 of minimized risk of infection;
- physical activity;
- elimination of deficiency states - hypo- and avitaminosis, mineral deficiency;
- compliance with aseptic conditions and careful technique for performing invasive urological interventions;
- regular preventive examinations using laboratory tests.