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Prostatitis

symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the prostate gland (prostate) in men, which has a negative impact on both sexual function and the process of urination. Pain in the perineum, groin, lower back and pelvic area, urodynamic disturbances (urine outflow) may indicate the presence of prostatitis. Untreated prostatitis 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, attentive attitude and individual approach to each case inevitably lead patients to recovery and stable long-term remission.

Prevalence

Prostatitis ranks 5th among the 20 major urological diagnoses. It is believed that at the age of 30, 30% of the male population suffers from prostatitis, at 40 years - 40%, and after 50 years, almost all men one way or another bear the burden of this disease. And if up to 35 years 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 gland

The prostate gland (prostate) is located in the front lower part of the small pelvis under 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, into which the ejaculatory ducts open.

The prostate is a hormone-dependent organ. It is formed 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. 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 the activity of spermatozoa. 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 the prostate secretion against 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 infection of the prostate tissue. But, as a rule, both factors are interrelated and together create a vicious circle that makes it difficult to treat prostatitis.

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

The prostate increases in size, constricting the urethra. Thus, the outflow of urine from the bladder becomes difficult. The stream of urine becomes weak. The patient has to strain the abdominal muscles in order for the act of urination to take place. In acute cases, sometimes there is 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 chronization of the process. With protracted prostatitis, neighboring 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 common, but they 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)
  • Asymptomatic chronic prostatitis (Category IV)

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

  • non-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 circulation and lymph flow 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 different ways for infection to enter the prostate:

  • Urinogenic (ascending): the entrance gate is the urethra. It should be noted that the infection can also get downstream, for example, with purulent pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphogenic: infection from neighboring 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.
  • Hematogenous (through the blood): 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 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 happens:

  • 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 cured in time, a purulent process may develop, leading to the melting of the tissues of the prostate gland. With improper treatment, acute prostatitis often becomes chronic.

Chronic prostatitishas a milder course, erased symptoms. However, it may aggravate 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, 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 prostate secretion.

Complications

Without proper therapy, the inflammatory process can lead to purulent fusion of prostate tissues. Moreover, inflammation can spread to nearby organs: the seminal tubercle, 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 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 (may radiate along the spermatic cord).
  • The pain increases with defecation, digital rectal examination.
  • Violation of urodynamics (frequent urination, urinary retention, difficulty urinating, 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 (decreased libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

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

Symptoms of chronic prostatitis

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

The reasons

The key 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
  • Hypodynamia
  • "Sedentary work
  • Prolonged sexual abstinence
  • Coitus interruptus (with delayed ejaculation)
  • Excessive sexual activity leading to gland depletion
  • 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 examinationconducted by a urologist-andrologist after a conversation with the patient. This method allows you to evaluate 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 may preliminarily diagnose prostatitis.

If the case is not acute, the doctor may conduct a prostate massage during the examination to obtain prostate secretion, the study of which is an important link in the diagnosis of prostatitis. If there is a suspicion of acute bacterial prostatitis, 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, such as:

  • 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);
  • magnetic resonance imaging of the pelvic organs (a highly informative and safe study that allows for differential diagnosis with other diseases).

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

Laboratory researchare a necessary component of the diagnosis of prostatitis:

  • Urinalysis (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 the prostate secretion after her finger massage
  • Microscopic examination of a scraping from the urethra
  • Spermogram (cytology and biochemistry of sperm)
  • Culture of urine, prostate secretion and semen
  • Determination of prostate specific antigen (PSA)
  • Puncture biopsy of the prostate and histological examination of gland tissues

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

The modern one has an excellent highly informative diagnostic base. Urologists have extensive experience in diagnosing and successfully treating 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 the 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, in some cases surgery is required.

Medical therapy

It involves the use of the following drugs:

  • Antibiotics (after determining sensitivity to them)
  • Antiseptics (locally)
  • Vascular preparations (improvement of microcirculation in the prostate)
  • Non-steroidal anti-inflammatory drugs
  • Alpha-1-adrenergic blockers (in violation of urination)
  • Enzyme preparations (thinn the secret of the prostate, stimulate the immune system, relieve inflammation)
  • Immunomodulators
  • Antidepressants

Physiotherapy treatment

  • Electrical stimulation of the prostate (electrophoresis, galvanization, pulse exposure)
  • Vibromassage
  • Laser therapy with a rectal sensor (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 in order to avoid the spread of infection and sepsis.

Surgical treatment

Surgery for prostatitis is rarely resorted to. Such a need arises in case of severe suppuration of the prostate tissues, the absence of positive dynamics for drug treatment and a pathological enlargement of the prostate gland that blocks the urethra.

Forecast

With early diagnosis and adequate treatment, acute prostatitis can be defeated. However, quite often the chronization of the process occurs even 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, takes a chronic course. Chronic prostatitis greatly affects the quality of life of a man, because not only urinary, but also sexual function suffers. In 30% of cases, erectile dysfunction, loss of orgasmic acuity, 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.

Benefits of going to a professional clinic

  • Successful treatment of various forms of prostatitis
  • Experienced urologists-andrologists of the highest qualification
  • Multidisciplinary, allowing to involve specialists in related fields in the treatment
  • High-precision modern diagnostic and treatment equipment
  • Own clinical diagnostic laboratory of the European class
  • 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
  • Have sex regularly, if possible, with one partner (to avoid congestion in the prostate and STIs)
  • Avoid coitus interruptus (this will get rid of sperm stasis)
  • Visit a urologist once a year for preventive purposes and 2 times a year if you are over 50 or have a history of 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 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, do not bet on PSA. This antigen also rises with prostate adenoma - a benign growth of gland tissue. With prostatitis, PSA levels can also rise during periods of active inflammation. In the remission phase, it decreases. Therefore, PSA cannot be used as unconditional 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 into the tissues of the gland. 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, a key feature of which is a wide variety of microflora in the crop. In about 50% of cases, Enterococcus faecalis is sown, resistant to all aminoglycosides and cephalosporins. This narrows the list of effective antimicrobial agents, which also complicates treatment.