Prostatitis is inflammation of the prostate, 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 the capacity for work, the intimate sphere, limiting freedom and causing daily 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 varied: the acute form is associated with a bacterial infection that enters the ascending prostate in urological and venereal diseases of an infectious nature, chronic prostatitis in 90% of cases is not associated with infections. Stagnation of the secretion of the prostate is formed as a result of infectious inflammation of the walls of the ducts and systemic diseases.
Causes of acute prostatitis
Acute bacterial prostatitis is caused by Enterobacteriaceae, Gram-negative and Gram-positive cocci, chlamydia, mycoplasmas, and viruses. The risk factors for prostate infection are sexually transmitted diseases and invasive urological interventions (catheterization, instillation and movement 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, chronic course of venereal and urological diseases, suppression ofimmune response, lack of sleep, overtraining, chronic stress. Poor blood supply to the pelvic organs, these factors themselves contribute to aseptic inflammation, and also facilitate the introduction of the pathogen into the tissues of the prostate.
Acute bacterial inflammation can resolve itself 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 prostate tissue;
- 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% are due to chronic abacterial prostatitis or chronic pelvic pain syndrome (CPPS). This form of the disease is not associated with infections, but due to many reasons, mainly stagnant processes in the small pelvis. Stagnation of urine, causing inflammation, is formed against the background of urethritis, neurogenic narrowing of the neck of the bladder, 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 (38 to 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 urine stream is exhausted and there is still some residual amount in the bladder.
- Damage to the prostate: leukocytes and blood in semen, pain during urological examination.
- Fibromyalgia.
- Prostatorrhea is a small discharge from the urethra.
- Pain in the small pelvis, perineum, testes, above the pubis, in the penis, sacrum, bladder, scrotum.
- Painful urination and ejaculation.
- Convulsive muscle spasms.
- Stones in the prostate.
- Chronic fatigue, feeling of hopelessness, catastrophe, 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.
During the chronic course of the disease, the signs of prostatitis are blurred (less pronounced), but they are joined by general, neurological and mental symptoms.
Diagnosis of prostatitis
The key to successful and timely treatment of prostatitis is accurate and complete diagnosis. The low proportion of infectious prostatitis is in most cases explained by the fact that the pathogen was not detected. Chronic sexually transmitted infections can be asymptomatic, while their pathogens can invade prostate tissue and cause inflammation. Therefore, laboratory research methods play a major role in the diagnostic process.
To determine the sensitivity of bacteria to antibiotics, an inoculation of biological fluids is carried out: urine, semen and prostatic secretions. This method allows you to select the most effective drug for a specific strain of the pathogen, able to directly penetrate the focus of inflammation.
The "classic" method of laboratory diagnosis of prostatitis is considered culturological (urine culture, ejaculate, contents of urogenital smears). The method is very precise, but it takes time. To detect bacteria, a Gram smear is taken, but in this way it is unlikely to detect viruses, mycoplasmas and ureaplasma. To improve research accuracy, 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 in-depth study by the PCR method of the microflora of the urogenital tract is used. The test result is ready within 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 Association of Urology recommends the following set of laboratory tests:
- general urinalysis;
- bacterial culture of urine, semen and ejaculate;
- PCR diagnosis.
A general analysis of the urine allows to determine the signs of inflammation (the number of units forming colonies of microorganisms, the number of leukocytes, erythrocytes, the transparency of the urine) and the presence of calcifications (prostate stones). The general analysis is included in the method of several urological samples (glass or portions).
Glass or portion samples consist of the sequential collection of urine or other body fluids in different containers. Thus, the localization of the infectious process is determined. Prostatitis is demonstrated by the detection of infectious agents, blood cells (leukocytes and erythrocytes) in the last portion of urine during a three-glass test or after urological massage of the prostate
Two-glass test - sow 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 during the same urination.
Four-glass sample - culture and general analysis of the initial and middle parts of the urine stream, secretion from the prostate after urological massage of the prostate and part of the urine after this procedure.
Culturological seeding or PCR diagnostics of ejaculate and urogenital smear material are also performed.
Blood tests are also needed to make a diagnosis of prostatitis. A general analysis of capillary blood allows you to confirm or rule out the presence of inflammation, as well as to 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 urine and blood analysis). The intensity of the pain syndrome is determined by the Visual Analog Pain Scale, and the severity of psychological changes is determined by the 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 wide. From instrumental studies, urofluometry is prescribed with establishment of the residual urine volume and transrectal ultrasound (TRUS) of the prostate.
Asymptomatic prostatitis is detected with histological examination of a prostate biopsy, prescribed for suspected cancer. A blood test for prostate specific antigen (PSA) is done beforehand. Serum PSA appears with an enlarged and inflamed prostate, and the criteria for the norm change with age. This study also helps to rule out suspicion of a malignant prostate tumor.
Treatment and prevention of prostatitis
Treatment of acute prostatitis is carried out with antibiotics (fluoroquinolins and cephalosporins, macrolides), alpha-blockers, nonsteroidal anti-inflammatory drugs, neuromodulators. Few antibiotics are able to penetrate the prostate, pathogens are immune to certain drugs, therefore, bacterial inoculation is required.
Conservative urological treatment can also include acupuncture, herbal medicine, 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 under conditions of minimized risk of infection;
- physical activity;
- elimination of deficiency states - hypo- and avitaminosis, mineral deficiency;
- observance of aseptic conditions and careful technique to perform invasive urological interventions;
- regular preventive examinations using laboratory tests.