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Prostatitis

symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the prostate gland (prostate) in men, which negatively impacts both sexual function and the urination process. Pain in the perineum, groin, lumbar and pelvic area, urodynamic disorders (outflow of urine) may indicate the presence of prostatitis. Prostatitis not treated in a timely manner can cause male infertility and prostate cancer.

This is one of the most common male ailments, requiring careful 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 urologist-andrologists have been successfully treating acute and chronic prostatitis for many years. Complex therapy, careful attitude and individual approach to each case inevitably lead patients to recovery and stable long-term 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 years almost all men in one way or another bear the brunt of this disease. And if up to 35 years of predominantly infectious prostatitis is recorded, then in a more mature age the non-infectious form prevails and in general it is diagnosed many 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 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, where 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 gland 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 which is part of the semen. Create 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 prostatic secretion against the background of circulatory disorders and lymphatic outflow into the gland itself and nearby organs;
  • pathogenic and conditionally pathogenic microflora.

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

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

The prostate increases in size, constricting the urethra. Therefore, the outflow 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 an obstruction of the urinary tract and acute urinary retention.

Inflammation leads to a violation of the outflow of prostate juice and its stagnation. The resulting edema disrupts the processes of cellular metabolism and respiration in the gland. This creates the conditions for the process history. 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 frequent, but 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 identifies 4 categories of prostatitis:

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

Due to the occurrence of prostatitis it is divided into two types:

  • not infectious
  • Infectious

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

Non-infectious prostatitisin most cases, it is associated with stagnation of the secretion of the prostate gland and impaired blood and lymphatic circulation 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 gland: bacteria, viruses, fungi. There are several ways that infection enters the prostate:

  • Urinogenic (ascending): the entrance gate is the urethra. It should be noted that the infection can also go 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 the lymph due to inflammation of the rectum (proctitis) or bladder (cystitis), as well as from infected hemorrhoidal veins.
  • Hematogenic (through the blood) - due to the presence in the body of foci of chronic infection (tonsillitis, decayed teeth) or complications of acute infections (flu, 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 treated in time, a purulent process can develop, which leads to the dissolution of the tissues of the prostate gland. With improper treatment, acute prostatitis often becomes chronic.

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

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

Complications

Without adequate therapy, the inflammatory process can lead to purulent fusion of the prostate tissues. Also, inflammation can spread to nearby organs: the seminal tubercle, Cooper's glands, seminal vesicles, urethra. As a result, the following complications can occur:

  • prostate abscess
  • Prostate sclerosis / fibrosis (functional tissue of the gland is replaced by connective tissue)
  • prostatic 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
  • Prostate adenoma
  • Prostate Cancer

Symptoms

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

  • Pain in the groin, lower back, perineum (can radiate along 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).
  • Prostatorrea (involuntary secretion of prostate juice, especially in the morning and during bowel movements).
  • Disorders of sexual function (decreased libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • Increase in temperature to 39-40 degrees
  • Acute urinary retention
  • General intoxication
  • Leukocyturia, protein and mucus in the urine
  • Blood in the urine and semen
  • Leukocytosis in the prostatic secretion
  • Hypoechogenicity and enlargement of the gland, increased blood flow according to ultrasound

Symptoms of chronic prostatitis

  • Body temperature usually does not exceed 37 ° C
  • The pain sensations are attenuated and smoothed out
  • Discharge from the urethra during bowel movements
  • Disorders of urination
  • 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 the secretion of the prostate. The following factors contribute to the appearance of prostatitis:

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

Diagnostics

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

Digital rectal examconducted 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 gland. If the size of the prostate is enlarged and the procedure itself is painful for the patient, the doctor can preliminarily diagnose prostatitis.

If the case is not acute, the doctor may perform a prostate massage during the examination 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 research, how:

  • 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 (features of blood flow in the gland);
  • uroflowmetry (determination of the speed and time of the act of urination);
  • MRI of the pelvic organs (a highly informative and safe study that allows differential diagnosis with other diseases).

If necessary, diagnostics of nearby 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 proteins of the acute phase of inflammation (C-reactive protein, etc. )
  • Microscopic examination of prostatic secretion after finger massage
  • Microscopic examination of a curettage of the urethra
  • Spermogram (cytology and biochemistry of spermatozoa)
  • Culture of urine, prostatic secretion and sperm
  • Determination of prostate specific antigen (PSA)
  • Prostate puncture biopsy and histological examination of glandular tissues

The latter two studies are needed to rule out prostate cancer or adenoma.

The modern one has an excellent, highly informative diagnostic basis. Urologists have extensive experience in the successful diagnosis and treatment of 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 kinds of necessary diagnostics at a very attractive price.

Treatment

Treatment of prostatitis is not an easy task. It 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)
  • Non-steroidal anti-inflammatories
  • Alpha-1-adrenergic blockers (in violation of urination)
  • Enzyme preparations (thin the prostate secret, stimulate the immune system, relieve inflammation)
  • Immunomodulators
  • Antidepressants

Physiotherapy treatment

  • Electrical stimulation of the prostate (electrophoresis, galvanization, pulsed exposure)
  • Vibromassage
  • Rectal sensor laser therapy (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 to avoid the spread of infections and sepsis.

Surgical treatment

Surgery is rarely used for prostatitis. This need arises in case of severe suppuration of the prostatic tissues, absence of positive dynamics for pharmacological treatment and pathological enlargement of the prostate gland that blocks the urethra.

Forecast

With early diagnosis and proper treatment, acute prostatitis can be defeated. However, quite often the chronology of the process also occurs with correct and timely therapy.

With improper treatment and non-compliance with the terms of treatment (this is several months), the disease, as a rule, has a chronic course. Chronic prostatitis greatly affects a man's quality of life, because not only urinary function suffers, but also sexual function. Erectile dysfunction, loss of orgasmic acuity, ejaculation problems and infertility are observed in 30% of cases. It is completely impossible to cure chronic prostatitis, but with the right approach, stable remission can be achieved.

Advantages of going to a professional clinic

  • Successful treatment of various forms of prostatitis
  • Highly qualified expert urologists-andrologists
  • Multidisciplinary, allowing specialists in related fields to be involved in the treatment
  • Modern high precision diagnostic and therapeutic 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 nutrition, prevention of dysbacteriosis, reasonable antibiotic therapy, etc. )
  • Avoid hypothermia
  • Lead an active lifestyle
  • Having sex regularly, if possible, with a partner (to avoid prostate congestion and sexually transmitted diseases)
  • Avoid coitus interrupted (this will eliminate semen stasis)
  • Visit a urologist once a year for preventive purposes and twice a year if you are over 50 or have a history of prostate disease.

Frequent questions

How informative is the PSA test in 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, don't bet on PSA. This antigen also increases with prostate adenoma, a benign growth of glandular tissue. With prostatitis, PSA levels can also rise during periods of active inflammation. In the phase of remission, it decreases. Therefore, PSA cannot be used as unconditional proof of prostate cancer or prostatitis.

Why is prostatitis difficult to treat?

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