Prostatitis is an inflammation of the prostate gland, one of the common problems in 40% of men in middle age and older.Not directly life-threatening, this disease significantly reduces quality, affects performance, intimate range, limits freedom and causes daily difficulties and psychological disorders.
Prostatitis occurs in an acute or chronic form and may be of infectious or non-infectious origin.
Causes of prostatitis
The causes of prostatitis are diverse: the acute form is associated with bacterial infection that enters the prostate along the ascending path in urinary and venereal diseases of an infectious nature, chronic prostatitis in 90% of cases is not associated with infection.Stasis of the prostate is formed as a result of both inflammation of the duct wall and systemic diseases.
Causes of acute prostatitis
Acute bacterial prostatitis is caused by enterobacteria, gram-negative and gram-positive cocci, chlamydia, mycoplasma, and viruses.Risk factors for prostate infection are sexually transmitted diseases and invasive urological interventions (catheterization, urethral instillation and diversion, urinary cystoscopy).
Factors that promote the development of infectious inflammation are usually hypothermia, prolonged constipation or diarrhea, sedentary work, excessive sexual activity or sexual abstinence, chronic sexually transmitted and urinary diseases, suppressed immune response, lack of sleep, overtraining, chronic stress.By impairing the blood supply to the pelvic organs, these factors themselves contribute to sterile inflammation and also facilitate the penetration of pathogens into prostate tissue.
Acute bacterial inflammation can resolve without consequences, but in some cases the following complications develop:
- acute urinary retention;
- chronic prostatitis (chronic inflammatory pelvic pain syndrome);
- epididymitis;
- prostate abscess;
- fibrosis of prostate tissue;
- infertility.
Causes of chronic prostatitis
In 10% of cases, chronic prostatitis develops as a complication of acute prostatitis, as well as urethritis, chlamydia, human papillomavirus and other chronic infections.About 90% are due to chronic nonbacterial prostatitis or chronic pelvic pain syndrome (CPPS).This form of the disease is not associated with infection but has many causes, mainly due to stagnant processes in the pelvic area.Stagnant urine, causing inflammation, is formed against the background of urethritis, neurogenic bladder neck stenosis, urethral stricture and autoimmune inflammation.The blood supply to the pelvic organs is impaired, which is caused by systemic cardiovascular diseases (IHD, atherosclerosis).The general venous system of the small pelvis determines the association between chronic prostatitis and anal fissures, hemorrhoids, proctitis, and fistula.
Chronic pelvic pain in men is associated with:
- low physical activity;
- low blood levels of testosterone;
- changes in the body's microbial environment;
- genetic predisposition and phenotype.
Symptoms of prostatitis
- Fever (from 38-39 degrees Celsius for acute prostatitis and mild fever for chronic prostatitis).
- Urinary dysfunction: frequent urge to urinate, not always effective, difficulty urinating or increased frequency of urination, especially at night.The urine flow is depleted and there is always some residual urine in the bladder.
- Prostate damage: white blood cells and blood in semen, pain during urological examination.
- Fibromyalgia.
- Prostatitis is a phenomenon in which small amounts of fluid secrete from the urethra.
- Pain in the pelvis, perineum, testicles, above the pubic bone, penis, sacrum, bladder, scrotum.
- Painful urination and ejaculation.
- Convulsive muscle spasms.
- Stones in the prostate.
- Chronic fatigue, feelings of hopelessness, catastrophizing, psychological stress due to chronic pain syndrome.
- Decreased performance (asthenia), decreased mood, irritability).
- Sexual dysfunction – erectile dysfunction, premature ejaculation, lack of orgasm.
- Irritable bowel syndrome and proctitis may occur.
In the chronic stage of the disease, signs of prostatitis fade (less pronounced) but are accompanied by general, neurological and psychiatric symptoms.
Diagnosis of prostatitis
The key to successful and timely treatment of prostatitis is accurate and comprehensive diagnosis.The low incidence of infectious prostatitis is explained in most cases by the fact that the pathogen is not detected.Chronic sexually transmitted diseases may be asymptomatic, while their pathogens can penetrate prostate tissue and cause inflammation.Therefore, laboratory research methods play a key role in the diagnostic process.
To determine the sensitivity of bacteria to antibiotics, biological fluids are injected: urine, semen, prostatic secretions.This method allows you to choose the drug that is most effective against a specific strain of the pathogen, capable of penetrating directly into the site of inflammation.
The “classical” laboratory method of diagnosing prostatitis is considered cultural (urine culture, ejaculation, contents of urogenital smear).This method is very accurate but time consuming.To detect bacteria, the smear is stained with Gram stain, but in this way it is difficult to detect viruses, mycoplasma and ureaplasma.To increase the accuracy of research, mass spectrometry and PCR (polymerase chain reaction) methods are used.Mass spectrometry is the ionic analysis of the structure of a substance and the identification of its individual components.Polymerase chain reaction allows you to detect DNA or RNA fragments of infectious pathogens, including viruses and plasma.
Currently, for special examination of urological patients, a special comprehensive PCR study of the microflora of the genitourinary tract is used.Research results will be available within a day and reflect a comprehensive picture of the proportion of microorganisms in the subject's body.
Diagnostic tests for prostatitis include urine collection, ejaculation testing, and urinary smears.
The European Association of Urology recommends the following set of laboratory tests:
- General urinalysis;
- bacterial culture of urine, semen and ejaculate;
- PCR diagnosis.
A general urine test allows you to determine signs of inflammation (number of colony-forming units of microorganisms, number of white blood cells, red blood cells, urine clarity) and the presence of calcifications (prostate stones).General analysis is included in the method of several urinary samples (vitreous or partial).
A glass sample or partial sample involves the sequential collection of urine or other biological fluid into different containers.In this way, the localization of the infectious process is determined.Prostatitis is manifested by the detection of infectious agents, blood cells (white blood cells and red blood cells) in the last part of the urine when sampling three glasses or after urinary massage of the prostate
Two-cup test - inject the middle part of the urine stream before and after urinary prostate massage.
A three-cup sample - the beginning, middle and end of the urine is collected during the same voiding session.
Four-cup test - general culture and analysis of the first and middle part of the urine stream, prostatic secretion after urinary prostate massage and a portion of urine after this procedure.
They also perform culture or PCR diagnostics of ejaculate and urogenital smears.
To diagnose prostatitis, blood tests are also required.A general capillary blood test allows you to confirm or refute the presence of inflammation, as well as rule out other diagnoses that cause similar symptoms.
Diagnosis of chronic non-inflammatory pelvic pain syndrome is more difficult because it is based on the clinical picture and indirect laboratory indicators (including general analysis of urine and blood).The intensity of the pain syndrome was determined using a visual analog pain scale, and the severity of psychological changes was determined using a scale to assess anxiety and depression.At the same time, research is needed to find the infectious agent, because the range of pathogens can be very wide.Specific studies include uroflowmetry with determination of residual urine volume and transrectal ultrasound (TRUS) examination of the prostate.
Asymptomatic prostatitis is detected by histological examination of a prostate biopsy specimen, which is indicated for suspected cancer.A blood test for prostate-specific antigen (PSA) is done first.Serum PSA appears with prostatitis and hypertrophy, and normal values vary with age.This study also helped rule out suspicions of malignant prostate tumor.
Treatment and prevention of prostatitis
Treatment of acute prostatitis is carried out with antibiotics (fluoroquinolines and cephalosporins, macrolides), alpha blockers, nonsteroidal anti-inflammatory drugs, neuromodulators.Very few antibiotics are able to penetrate the prostate;The pathogen is immune to certain drugs, so bacterial culture is necessary.
Conservative urological treatment may also include acupuncture, herbal medicine, remote shock wave therapy, thermal physical therapy procedures (after acute inflammation), massage.
Prevention of prostatitis includes both medical procedures and the formation of healthy habits:
- use barrier contraceptives;
- regular sexual activity in conditions that minimize the risk of infection;
- physical activity;
- eliminate deficiency conditions - vitamin deficiency and vitamin deficiency, mineral deficiency;
- adherence to aseptic conditions and careful technique to perform invasive urological interventions;
- Regular preventative screening using laboratory tests.