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Prostatitis

symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the prostate (prostate) in men, which negatively affects both sexual function and urination. Pain in the perineum, groin, lower back and pelvis, urodynamic disorders (urine swelling) may indicate the presence of prostatitis. Untreated prostatitis in time can cause male infertility and prostate cancer.

This is one of the most common male diseases that requires careful attention and competent systemic treatment. You will find exactly such an approach to solving the problem of prostatitis at the urology department of a professional clinic. Highly qualified urologists-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 is on the 5th place 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 this disease in one way or another. And if up to the age of 35, predominantly infectious prostatitis is recorded, then at a more mature age the non-infectious form prevails, and in general it is diagnosed several times more often than bacterial inflammation of the prostate.

Anatomy and physiology of the prostate

The prostate gland is located in the front lower part of the 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 urinary bladder into which the ejaculatory ducts open.

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

The prostate 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. 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 that is part of the semen. It creates 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 prostate secretions on the background of circulatory disorders and lymph outflow in the gland itself and neighboring organs;
  • pathogenic and conditionally pathogenic microflora.

Acute prostatitis is usually associated with an infection of the prostate tissue. But, as a rule, both factors are interconnected and together they create a vicious circle that complicates the treatment of prostatitis.

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

The prostate increases in size, narrowing the urethra. Because of this, the outflow of urine from the bladder is difficult. The stream of urine becomes weak. The patient must strain the abdominal muscles in order for the act of urination to occur. In acute cases, urinary tract obstruction and acute urinary retention sometimes occur.

Inflammation leads to a violation of the outflow of prostate juice and its stagnation. The resulting edema disturbs the processes of cellular metabolism and respiration in the gland. This creates the conditions for the chronology of the process. In case of prolonged prostatitis, neighboring organs can also become inflamed: 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 established that in 70-80% of cases, prostatitis is caused by stagnant processes in the gland. Venous disorders are less common, but also cause prostatitis, especially if they are accompanied by hemorrhoids and left-sided varicocele (dilation of the testicular vein).

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 appearance of prostatitis, it is divided into two types:

  • non-infectious
  • Contagious

The inflammatory process can develop quickly, accompanied by vivid symptoms (acute stage), or slowly with the gradual disappearance of symptoms.

Non-infectious prostatitisin most cases, it is associated with stagnation of prostate secretions and disturbed 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: bacteria, viruses, fungi. There are different ways for an infection to enter the prostate:

  • Urinogenic (ascending): the entrance gate is the urethra. It should be noted that infection can also occur downstream, for example, in purulent pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphogenic: infection from adjacent pelvic organs can enter the prostate through lymph due to inflammation of the rectum (proctitis) or bladder (cystitis), as well as from infected hemorrhoidal veins.
  • Hematogenous (blood-borne): due to the presence in the body of foci of chronic infection (tonsillitis, carious teeth) or complications of acute infections (flu, 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, pathogenic ARVI);
  • mycoplasma;
  • chlamydia;
  • specific flora (gonococcus, trichomonas, Mycobacterium tuberculosis).

By the nature of the flow, 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 melting of the prostate tissue. With improper treatment, acute prostatitis often becomes chronic.

Chronic prostatitishas a milder course, erased symptoms. However, it may worsen from time to time and then the symptoms will 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, prostate adenoma or 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 prostate secretion.

Complications

Without proper therapy, the inflammatory process can lead to purulent adhesions of the prostate tissue. Moreover, inflammation can spread to nearby organs: seminal tubercle, Cooper's glands, seminal vesicles, urethra. Consequently, the following complications may occur:

  • prostate abscess
  • Sclerosis/fibrosis of the prostate (functional tissue of the gland is replaced by connective tissue)
  • prostate cysts
  • prostate stones
  • Vesiculitis (inflammation of the seminal vesicles)
  • Coliculitis (inflammation of the seminal tubercle)
  • Epididymorrhitis (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 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, retention of urine, difficult urination, weak stream, incomplete emptying of the bladder).
  • Prostatorrhea (involuntary secretion of prostate juice, especially in the morning and during bowel movements).
  • Disorders of sexual function (reduced libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

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

Symptoms of chronic prostatitis

  • Body temperature is usually not higher than 37C
  • Pain sensations are muted and smoothed
  • Discharge from the urethra during bowel movements
  • Urinary disorders
  • Decreased libido
  • erectile dysfunction
  • Ejaculation disorders (premature or delayed ejaculation)

Reasons

The key reasons for the occurrence of prostatitis are infections and stagnation of prostate secretions. The following factors contribute to the development of prostatitis:

  • Infections and opportunistic flora with weakened immunity
  • Hypodynamia
  • "Sitting work
  • Prolonged sexual abstinence
  • Coitus interruptus (with delayed ejaculation)
  • Excessive sexual activity leads to exhaustion of the glands
  • Alcohol abuse
  • Reduced local immunity (hypothermia, use of immunosuppressive drugs, immunodeficiency, autoimmune diseases)
  • Pelvic organ injuries
  • Manipulations on the prostate and nearby organs (biopsy of the prostate, 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 examinationwhich is carried out by a urologist-andrologist after talking with the patient. This method allows you to assess the size, shape and some characteristics of the prostate structure. If the size of the prostate is increased, and the procedure itself is painful for the patient, the doctor can preliminarily diagnose prostatitis.

If the case is not acute, the doctor can massage the prostate during the examination to obtain prostate secretions, 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 pathogens and blood poisoning.

To clarify the diagnosis, the patient will be asked to undergoinstrumental research, such as:

  • transrectal ultrasound examination of the prostate and pelvic organs (reveals structural characteristics, the presence of inflammation and purulent foci, stones, cysts and other neoplasms);
  • dopplerography (characteristics of blood flow in the gland);
  • uroflowmetry (determining the speed and time of urination);
  • magnetic resonance imaging of the pelvic organs (highly informative and safe study that enables differential diagnosis with other diseases).

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

Laboratory researchare a necessary component of the diagnosis of prostatitis:

  • Urine analysis (before and after prostate massage)
  • General blood analysis
  • Blood test for proteins of the acute phase of inflammation (C-reactive protein, etc. )
  • Microscopic examination of prostate secretions after finger massage
  • Microscopic examination of urethral scrapings
  • Spermogram (cytology and biochemistry of sperm)
  • Culture of urine, prostate secretions and semen
  • Determination of prostate specific antigen (PSA)
  • Puncture biopsy of the prostate and histological examination of the gland tissue

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

Modern has an excellent highly informative diagnostic database. Urologists have extensive experience in the diagnosis and successful treatment of various forms of prostatitis, and the status of a multidisciplinary clinic enables the use of the services of related specialists. The medical center has developed research packages that include all necessary types of diagnostics at a very attractive price.

Treatment

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

Medical therapy

It includes the use of the following drugs:

  • Antibiotics (after establishing sensitivity to them)
  • Antiseptics (topical)
  • Vascular preparations (improving microcirculation in the prostate)
  • Nonsteroidal anti-inflammatory drugs
  • Alpha-1-adrenergic blockers (for urinary disorders)
  • Enzyme preparations (dilute the secret of the prostate, stimulate the immune system, relieve inflammation)
  • Immunomodulators
  • Antidepressants

Physiotherapy treatment

  • Electrical stimulation of the prostate (electrophoresis, galvanization, pulse exposure)
  • Vibro massage
  • Rectal sensor laser therapy (for chronic prostatitis)

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

Surgical treatment

Prostatitis surgery is rarely resorted to. Such a need arises in case of strong suppuration of the prostate tissue, lack of positive dynamics of drug treatment and pathological enlargement of the prostate blocking the urethra.

Forecast

With early diagnosis and adequate treatment, acute prostatitis can be overcome. However, chronicity of the process often occurs even with proper and timely therapy.

With improper treatment and non-compliance with the treatment schedule (this is several months), the disease usually takes a chronic course. Chronic prostatitis greatly affects a man's quality of life, because not only urinary, but also sexual function suffers. 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.

Advantages of going to a professional clinic

  • Successful treatment of various forms of prostatitis
  • Experienced urologists-andrologists with the highest qualifications
  • Multidisciplinary, it allows the inclusion of specialists from related fields in the treatment
  • Modern equipment for high-precision diagnostics and treatment
  • 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 of the immune system (vitamins, healthy diet, prevention of dysbacteriosis, reasonable antibiotic therapy, etc. )
  • Avoid hypothermia
  • Lead an active lifestyle
  • Have sex regularly, if possible, with one partner (to avoid prostate congestion and STIs)
  • Avoid interrupting coitus (this will get rid of sperm 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.

Frequently Asked Questions

How informative is the PSA test in the diagnosis of 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 differential diagnosis between these two diseases. However, don't bet on PSA. This antigen also grows with prostate adenoma - a benign growth of glandular tissue. In prostatitis, PSA levels may also rise during periods of active inflammation. It decreases in the phase of remission. Therefore, PSA cannot be used as absolute evidence of prostate cancer or prostatitis.

Why is prostatitis difficult to treat?

Prostate capillaries 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 have a tendency to form biofilms that 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. Chronic prostatitis, the key feature of which is a wide array of microflora in the crop, is the most stubbornly treated. In about 50% of cases, Enterococcus faecalis, resistant to all aminoglycosides and cephalosporins, is sown. This narrows the list of effective antimicrobial agents, which also complicates treatment.