Prostatitis is an inflammation of the prostate, one of the common problems in 40% of middle-aged and elderly men. Without directly threatening life, this disease entails a significant decrease in its quality, affecting work capacity, the intimate sphere, limiting freedom and causing daily difficulties and psychological disturbances.
Prostatitis occurs acutely or chronically, and may be of infectious or non-infectious origin.
Causes of prostatitis
The causes of prostatitis are varied: the acute form is associated with a bacterial infection that enters the prostate, ascending into urological and venereal diseases of an infectious nature, chronic prostatitis in 90% of cases is not associated with infections. Stagnation of prostate secretion is formed as a result of infectious inflammation of the duct walls and systemic disease.
Causes of Acute Prostatitis
Acute bacterial prostatitis is caused by enterobacteria, Gram-negative and Gram-positive cocci, chlamydia, mycoplasma, viruses. Risk factors for prostate infection are sexually transmitted diseases and invasive urological interventions (catheterization, urethral instillation and bougienage, urocystoscopy).
The triggers for the development of infectious inflammation are generally hypothermia, prolonged constipation or diarrhea, sedentary work, excessive sexual activity or sexual abstinence, chronic course of venereal and urological diseases, suppression of the immune response, lack of sleep, overtraining, chronic stress. With poor blood supply to the pelvic organs, these factors contribute to aseptic inflammation and also facilitate the introduction of the pathogen into prostate tissue.
Acute bacterial inflammation may resolve without consequences, but in some cases the following complications form:
- acute urinary retention;
- chronic prostatitis (chronic pelvic inflammatory syndrome);
- epididymitis;
- prostate abscess;
- prostate tissue fibrosis;
- infertility.
The Causes of Chronic Prostatitis
In 10% of cases, chronic prostatitis develops as a complication of acute inflammation of the prostate, as well as urethritis, chlamydia, human papillomavirus, and other chronic infections. About 90% is due to chronic bacterial prostatitis or chronic pelvic pain syndrome (CPPS). This form of the disease is not associated with infections, but it is due to several reasons, mainly to stagnation processes in the small pelvis. Stagnation of urine, causing inflammation, is formed in the context of urethritis, neurogenic bladder neck narrowing, 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.
prostatitis symptoms
- 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 exhausted, and all the while there is a residual amount of it in the bladder.
- Prostate damage: leukocytes and blood in 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.
- Pain when urinating and premature ejaculation.
- Convulsive muscle spasms.
- Stones in the prostate.
- Chronic fatigue, feeling of hopelessness, disaster, psychological stress in the context of chronic pain syndrome.
- Decreased performance (asthenia), decreased mood, irritability).
- Sexual dysfunction - erectile dysfunction, premature ejaculation, lack of orgasm.
- Irritable bowel syndrome, proctitis may join.
In the chronic course of the disease, signs of prostatitis are cloudy (less pronounced) but are accompanied by general, neurological, and mental symptoms.
diagnosis of prostatitis
The key to proper 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 has not been detected. Chronic sexually transmitted infections can be asymptomatic, while their pathogens can invade prostate tissue and cause inflammation. Therefore, laboratory research methods play an important role in the diagnostic process.
To determine the sensitivity of bacteria to antibiotics, the inoculation of biological fluids is performed: urine, semen and prostate secretions. This method allows selecting a more effective drug for a specific strain of the pathogen, capable of directly penetrating the focus of inflammation.
The "classic" method of laboratory diagnosis of prostatitis is considered culturological (urine culture, ejaculation, urogenital smear content). The method is very accurate, but it takes time. To detect bacteria, a Gram smear is produced, but this is unlikely to detect viruses, mycoplasma, and ureaplasma. To improve the accuracy of the search, 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 one day and reflects the complete picture of the microbial proportion in the subject's body.
Tests for prostatitis include collection of urine and ejaculation and urological smears.
The European Urological Association recommends the following set of laboratory tests:
- general urine analysis;
- bacterial culture of urine, semen and ejaculation;
- PCR diagnosis.
A general analysis of the urine allows you to determine the signs of inflammation (the number of colony-forming units of microorganisms, the number of white blood cells, erythrocytes, urine transparency) and the presence of calcifications (calculi in the prostate). General analysis is included in the method of various urological samples (in glass or portions).
Glass samples or servings consist of sequentially collecting urine or other biological fluids in different containers. Thus, the location of the infectious process is determined. Prostatitis is evidenced by detection of infectious agents, blood cells (leukocytes and erythrocytes) in the final portion of the urine during a three-glass test or after urological prostate massage
Two cup test - sow the middle part of the urine stream before and after urological prostate massage.
Three-glass sample - the initial, middle and final portions of urine are collected at the same urination.
Four-glass sample - culture and general analysis of the initial and middle part of the urinary stream, prostate secretion after urological prostate massage and part of the urine after the procedure.
Culturological seeding or PCR diagnosis of ejaculate and urogenital smear material are also performed.
Blood tests are also needed to diagnose prostatitis. A general analysis of capillary blood can confirm or deny the presence of inflammation, as well as exclude other diagnoses that cause the same symptoms.
Diagnosis of chronic non-inflammatory 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). Pain syndrome intensity is determined by the visual analogue pain scale, and the severity of psychological changes is determined by anxiety and depression rating scales. At the same time, research is necessarily carried out to find an infectious agent, since the spectrum of pathogens can be very broad. Based on instrumental studies, urofluometry is prescribed with the establishment of residual urine volume and transrectal ultrasound (TRUS) of the prostate.
Asymptomatic prostatitis is detected with a histological examination of a prostate biopsy, prescribed for suspected cancer. A blood test for prostate specific antigen (PSA) is performed beforehand. Serum PSA appears with prostate hypertrophy and inflammation, and the criteria for the norm change with age. This study also helps to rule out suspicions of a malignant prostate tumor.
Treatment and prevention of prostatitis
Treatment of acute prostatitis is made with antibiotics (fluoroquinolines and cephalosporins, macrolides), alpha-blockers, non-steroidal anti-inflammatory drugs, neuromodulators. Few antibiotics can penetrate the prostate, pathogens are immune to some of the drugs, so bacterial inoculation is necessary.
Conservative urological treatment may also include acupuncture, herbal medicine, external shock wave therapy, thermal physiotherapy (after acute inflammation), and massage.
Prevention of prostatitis includes medical manipulations and the formation of healthy habits:
- the use of barrier contraception;
- regular sexual activity under conditions of minimal 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 exams through laboratory tests.