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Prostatitis

symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the prostate (prostate) in men, which has a negative effect on both sexual function and urination. Pain in the perineum, groin, lower back and pelvic area, urodynamic disorders (urine flow) may indicate the presence of prostatitis. Prostatitis that is not treated in time can cause male infertility and prostate cancer.

It is one of the most common male diseases that requires careful attention and competent systemic treatment. This approach to solving the problem of prostatitis can be found in the urology department of a professional clinic. Highly qualified urologists and andrologists have been successfully treating acute and chronic prostatitis for years. Complex therapy, attentive attitude and individual approach to each case inevitably result in patients' recovery and stable, long-term remission.

Prevalence

Prostatitis ranks 5th among the 20 main urological diagnoses. It is believed that at the age of 30, 30% of the male population suffers from prostatitis, at the age of 40 - 40%, and after the age of 50, almost all men bear the burden of the disease. And if by the age of 35 predominantly infectious prostatitis is recorded, then at a more mature age the non-infectious form prevails and is usually diagnosed more often than bacterial inflammation of the prostate.

Anatomy and physiology of the prostate

The prostate gland (prostate) is located in the anterior lower part of the pelvis below the bladder. It consists of glandular and smooth muscle tissue, surrounded by a fibrous sheath. The urethra passes from the bladder through the body of the prostate, into which the ejaculatory ducts open.

The prostate is a hormone-dependent organ. It develops and works under the influence of male hormones - androgens. Testosterone plays a key role in this process.

The prostate gland is connected to 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. During the chronic course of the disease, they participate in the inflammatory process, erectile dysfunction develops.

The prostate produces a secret that is part of the sperm. It creates favorable conditions for sperm activity. Therefore, in case of chronic dysfunction of the gland, male infertility is observed.

Pathogenesis

There are two main reasons for the development of prostatitis:

  • stagnation of prostate secretion against the background of circulatory disorders and lymph outflow in the gland and neighboring organs;
  • pathogenic and conditionally pathogenic microflora.

Acute prostatitis is usually associated with an infection of the prostate tissue. But usually both factors are interrelated and together they create a vicious circle that makes prostatitis difficult to treat.

An inflamed prostate becomes painful. Pain is felt in the perineum, groin, pelvis, lower back. It increases sharply to palpation during digital rectal examination or defecation.

The prostate enlarges, constricting the urethra. Thus, the outflow of urine from the bladder becomes difficult. The stream of urine weakens. The patient must strain the abdominal muscles to urinate. In acute cases, urinary tract obstruction and acute urinary retention sometimes occur.

Inflammation leads to a violation of the outflow and stagnation of prostate juice. The resulting edema disrupts the processes of cell metabolism and respiration in the gland. This creates the conditions for the chronology of the process. In case of protracted prostatitis, neighboring organs can also become inflamed: the testicles, Cooper's glands, seminal vesicles. The chronic form of the disease is associated with the risk of 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 common, but they can also cause prostatitis, especially if accompanied by hemorrhoids and varicocele (dilation of the testicular vein) on the left side.

Classification

The US 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)
  • Asymptomatic chronic prostatitis (category IV)

Due to the occurrence of prostatitis, they can be divided into two types:

  • not contagious
  • Infectious

The inflammatory process can develop quickly, with vivid symptoms (acute stage), or slowly, with gradually increasing symptoms disappearing.

Non-infectious prostatitisin most cases, it is associated with stagnation of prostate secretion, as well as a violation of blood circulation and lymph flow in the gland itself and nearby organs.

Infectious prostatitisit develops due to the penetration of pathogenic or conditionally pathogenic microflora into the tissues of the prostate gland: bacteria, viruses, fungi. The infection can enter the prostate in different ways:

  • Urinogenic (ascending): the entrance gate is the urethra. It should be noted that the infection can also travel downward, for example, in cases of purulent pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphogenous: infection of the adjacent pelvic organs can enter the prostate through the lymph from prostatitis (proctitis) or bladder inflammation (cystitis), as well as from infected hemorrhoidal veins.
  • Hematogenous (through the blood): due to complications of chronic infection (tonsillitis, carious teeth) or acute infections (influenza, acute respiratory infections, tonsillitis, etc. ).

The most common causes 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 prostatitisit usually 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 cured in time, a purulent process can develop, which can lead to the melting of the tissues of the prostate. If not treated properly, acute prostatitis often becomes chronic.

Chronic prostatitisit has a milder course, the symptoms have disappeared. However, it can sometimes get worse, and then the symptoms correspond to an acute process. At the same time, complete remission between exacerbations does not always occur, and the patient may constantly feel 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 proper therapy, the inflammatory process can lead to purulent fusion of prostate tissue. Moreover, the inflammation can spread to nearby organs: the seminal tube, Cooper's glands, seminal vesicles, urethra. Accordingly, the following complications may occur:

  • prostate abscess
  • Sclerosis / fibrosis of the prostate (the functional tissue of the gland is replaced by connective tissue)
  • prostate cysts
  • prostate stones
  • Vesiculitis (inflammation of the seminal vesicles)
  • Colliculitis (inflammation of the testicles)
  • Epididymoorchitis (inflammation of the testes and their appendages)
  • Posterior urethritis
  • Erectile dysfunction / impotence
  • Ejaculation disorder
  • Infertility
  • Prostate adenoma
  • Prostate cancer

Symptoms

Different forms of prostatitis have their own characteristics regarding 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).
  • The pain increases with defecation and digital rectal examination.
  • Violation of urodynamics (frequent urination, urinary retention, difficulty urinating, weak flow, incomplete emptying of the bladder).
  • Prostatorrhea (involuntary secretion of prostate juice, especially in the morning and during bowel movements).
  • Disorders of sexual functions (reduced libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

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

Symptoms of chronic prostatitis

  • Body temperature usually does not exceed 37 degrees
  • The feeling of pain dulls and smoothes out
  • Discharge from the urethra during defecation
  • Urinary disorders
  • Decreased libido
  • erectile dysfunction
  • Ejaculation disorders (early or delayed ejaculation)

The reasons

The main causes of prostatitis are infections and stagnation of prostate secretion. The following factors contribute to the appearance of prostatitis:

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

Diagnostics

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

Digital rectal examinationurologist-andrologist graduated after the conversation with the patient. This method makes it possible to evaluate the size, shape and some characteristics of the prostate. If the size of the prostate increases and the procedure itself is painful for the patient, the doctor can pre-diagnose prostatitis.

If the case is not acute, the doctor can perform a prostate massage during the examination to determine the secretion of the prostate, the examination 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.

In order to clarify the diagnosis, the patient is invited to the examinationinstrumental research, as:

  • transrectal ultrasound examination of the prostate and pelvic organs (reveals the presence of structural features, inflammation and purulent foci, stones, cysts and other tumors);
  • dopplerography (characteristics of the gland's blood flow);
  • uroflowmetry (determining the speed and time of the act of urination);
  • magnetic resonance imaging of the pelvic organs (a very informative and safe examination that allows differential diagnosis with other diseases).

If necessary, diagnostics of the nearby organs of the urogenital system are carried out: ureteroscopy, urethrography and urethrocystography.

Laboratory researchthe necessary components for the diagnosis of prostatitis:

  • Urine test (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 prostate discharge after finger massage
  • Microscopic examination of a scraping from the urethra
  • Spermogram (sperm cytology and biochemistry)
  • Culture of urine, prostatic secretions and sperm
  • Determination of prostate specific antigen (PSA).
  • Prostate puncture biopsy and histological examination of glandular tissue

The last two tests are necessary to rule out prostate cancer or adenoma.

It has an excellent, highly informative modern diagnostic base. Urologists have extensive experience in the diagnosis and successful treatment of various forms of prostatitis, and the status of the multidisciplinary clinic allows the use of the services of related specialists. The medical center has developed research packages that include all the necessary types of diagnostics at extremely attractive prices.

Treatment

Treating prostatitis is not an easy task. It requires a thoughtful, integrated approach. The treatment protocol for this disease includes drug therapy and physiotherapy, in some cases surgery is required.

Medical therapy

This includes the use of the following medicines:

  • Antibiotics (after determination of sensitivity to them)
  • Antiseptics (locally)
  • Vascular preparations (improving prostate microcirculation)
  • Nonsteroidal anti-inflammatory drugs
  • Alpha-1-adrenergic blockers (with violation of urination)
  • Enzyme preparations (dilute prostate secretion, stimulate the immune system, relieve inflammation)
  • Immunomodulators
  • Antidepressants

Physiotherapy treatment

  • Electrical stimulation of the prostate (electrophoresis, electroplating, pulse exposure)
  • Vibro massage
  • Laser therapy with a rectal sensor (for chronic prostatitis)

In case of chronic prostatitis, prostate massage can be used as a treatment procedure. In the acute stage of the disease, this manipulation is not performed to avoid the spread of infection and sepsis.

Surgical treatment

Surgery for prostatitis is rarely used. This need arises in the case of severe swelling of the prostate tissue, lack of positive dynamics of drug treatment, and pathological enlargement of the prostate, which blocks the urethra.

Forecast

Acute prostatitis can be overcome with early diagnosis and appropriate treatment. However, quite often the chronification of the process occurs even with correct and timely therapy.

In the case of improper treatment and non-compliance with treatment conditions (it lasts for several months), the disease usually has a chronic course. Chronic prostatitis greatly affects a man's quality of life, as not only urinary but also sexual functions suffer. In 30% of cases, erectile dysfunction, loss of orgasmic sharpness, problems with ejaculation and infertility are observed. It is completely impossible to cure chronic prostatitis, but with the right approach, you can achieve a stable remission.

The benefits of going to a professional clinic

  • Successful treatment of various forms of prostatitis
  • Experienced urologist-andrologist with the highest qualifications
  • It is multidisciplinary, enabling the involvement of specialists from related fields in the treatment
  • High-precision modern diagnostic and treatment equipment
  • Our own European-class clinical diagnostic laboratory
  • Comfortable and high-tech hospitals
  • Urological diagnostic service package at an attractive price

Prevention of prostatitis

  • Choose safe sex to avoid sexually transmitted infections (STIs).
  • Support of the immune system (vitamins, healthy diet, prevention of dysbacteriosis, reasonable antibiotic therapy, etc. )
  • Avoid hypothermia
  • Lead an active lifestyle
  • Have regular sex with a partner if possible (to avoid prostate congestion and sexually transmitted infections)
  • Avoid interrupting intercourse (this will get rid of sperm stagnation)
  • See a urologist once a year for prevention and twice a year if you are over 50 or have previously had prostate disease.

Frequently Asked 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 the clinical picture of prostate cancer is similar to the manifestations of prostatitis. Therefore, the PSA test is used for the differential diagnosis of these two diseases. However, don't bet on PSA. This antigen is also elevated in prostate adenoma - a benign growth of glandular tissue. In the case of prostatitis, the PSA level may also rise during periods of active inflammation. It decreases during the remission phase. Therefore, PSA cannot be used as absolute evidence 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 certain types of antibiotics to penetrate the tissues of the gland. In addition, microorganisms tend to form biofilms, which reliably protect them from the effects of antibacterial agents. Therefore, modern prostatitis treatment protocols 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 the diversity of the microflora found in the fruit. In about 50% of cases, Enterococcus faecalis is resistant to all aminoglycosides and cephalosporins. This narrows the list of effective antimicrobial agents, which also complicates the treatment.