Prostatitis is an inflammation of the prostate gland, one of the most common problems in 40% of middle-aged and older men. Without directly endangering life, this disease leads to a significant reduction in its quality, affecting the ability to work, the intimate sphere, restricting freedom and provoking daily difficulties and psychological disorders.
Prostatitis occurs in acute or chronic form, can be of infectious and non-infectious origin.
Causes of prostatitis
The causes of prostatitis are diverse: the acute form is associated with a bacterial infection that enters the prostate gland ascending in 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 walls of the canal and systemic diseases.
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, instillation and buccal urethra, urocystoscopy).
Provokers of infectious inflammation are usually hypothermia, prolonged constipation or diarrhea, sedentary work, excessive sexual activity or sexual abstinence, chronic venereal and urological diseases, suppression of the immune response, lack of sleep, lack of sleep, overtraining, chronic stress. Poor blood supply to the pelvic organs, these factors in themselves contribute to aseptic inflammation, and also facilitate the introduction of the pathogen into the prostate tissue.
Acute bacterial inflammation can pass without sequelae, but in some cases the following complications occur:
- acute urinary retention;
- chronic prostatitis (chronic pelvic inflammatory syndrome);
- epididymitis;
- prostate abscess;
- prostate tissue fibrosis;
- infertility.
Causes of chronic prostatitis
In 10% of cases, chronic prostatitis develops as a complication of acute inflammation of the prostate gland, as well as urethritis, chlamydia, human papillomavirus and other chronic infections. About 90% are due to abacterial chronic prostatitis or chronic pelvic pain syndrome (CPPS). This form of the disease is not associated with infections, but is due to many causes, primarily stagnant processes in the pelvis. Stagnation of urine, causing inflammation, is formed against the background of urethritis, neurogenic narrowing of the bladder neck, stricture of the urethra, 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 pelvis determines the relationship of chronic prostatitis with cracks in the anus, hemorrhoids, proctitis, fistulas.
Chronic pelvic pain in men is associated with:
- low physical activity;
- low testosterone levels in the blood;
- changes in the microbial environment of the body;
- genetic and phenotypic predisposition.
Symptoms of prostatitis
- Fever (38-39 degrees Celsius in acute prostatitis and subfebrile in chronic).
- Urinary dysfunction: frequent urge to urinate, not always effective, difficulty or increased urination, especially at night. The flow of urine is depleted and there is some residual amount of it in the bladder all the time.
- Damage to the prostate: leukocytes and blood in the semen, pain on urological examination.
- Fibromyalgia.
- Prostatitis is a small discharge from the urethra.
- Pain in the small pelvis, perineum, testicles, over the pubis, in the penis, sacrum, bladder, scrotum.
- Painful urination and ejaculation.
- Convulsive muscle spasms.
- Prostate stones.
- Chronic fatigue, feelings of hopelessness, disaster, psychological stress on the background of chronic pain syndrome.
- Decreased performance (asthenia), low mood, irritability).
- Sexual dysfunction - erectile dysfunction, premature ejaculation, lack of orgasm.
- Irritable bowel syndrome, proctitis may join.
In 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 an accurate and comprehensive diagnosis. The low proportion of infectious prostatitis in most cases is explained 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 testing methods play a leading role in the diagnostic process.
To determine the susceptibility of bacteria to antibiotics, inoculation of biological fluids is performed: urine, semen and prostate secretions. This method allows you to choose the drug that is most effective for a specific strain of the pathogen, able to penetrate directly into the site of inflammation.
The "classic" method for laboratory diagnosis of prostatitis is considered culturological (urine culture, ejaculate, urogenital smear content). The method is very accurate, but time consuming. Gram smears are produced to detect bacteria, but viruses, mycoplasma and ureaplasma are unlikely to be detected. Mass spectrometry and PCR (polymerase chain reaction) are used to improve the accuracy of the studies. 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, a special comprehensive PCR test of the urogenital tract microflora is used for the special examination of urological patients. The test result is ready in one day and reflects the full picture of the microbial ratio in the subject's body.
Prostatitis tests include urine and ejaculate collection and urological smears.
The European Urological Association recommends the following set of laboratory tests:
- general urine analysis;
- bacterial culture of urine, semen and ejaculate;
- PCR diagnostics.
The general analysis of urine allows you to determine the signs of inflammation (the number of colony-forming units of microorganisms, the number of leukocytes, erythrocytes, urine transparency) and the presence of calcifications (prostate stones). The general analysis is included in the method of several urological (glass or portion samples).
Glass or portion samples consist of the sequential collection of urine or other biological fluids in different containers. In this way the localization of the infectious process is determined. Prostatitis is detected by detecting infectious agents, blood cells (leukocytes and erythrocytes) in the final portion of urine during a three-cup test or after urological prostate massage.
Two-cup test - seeding the middle part of the urine stream before and after urological prostate massage.
Sample of three cups - at the same urination take the initial, middle and final portions of urine.
Four glass samples - culture and general analysis of the initial and middle part of the urine, prostate secretion after urological massage of the prostate and a portion of urine after this procedure.
Cultural seeding or PCR diagnostics of ejaculate and urogenital smear material is also performed.
Blood tests are also needed to diagnose prostatitis. The general analysis of capillary blood allows you to confirm or deny the presence of inflammation, as well as to exclude other diagnoses that cause the same symptoms.
The diagnosis of non-inflammatory chronic pelvic pain syndrome is more difficult because it is based on the clinical picture and indirect laboratory parameters (including general analysis of urine and blood). The intensity of the pain syndrome is determined by the visual analog scale of pain, and the severity of psychological changes is determined by the scales for assessing anxiety and depression. At the same time, it is mandatory to conduct tests to detect an infectious agent, as the range of pathogens can be very wide. Instrumental examinations prescribe urofluometry to determine the volume of residual urine and transrectal ultrasound (TRUS) of the prostate.
Asymptomatic prostatitis is detected by histological examination of a prostate biopsy prescribed when cancer is suspected. Before that, a blood test for prostate specific antigen (PSA) is performed. Serum PSA occurs in hypertrophy and inflammation of the prostate, and the criteria for normal change with age. This test also helps rule out suspicion of a malignant prostate tumor.
Treatment and prevention of prostatitis
The treatment of acute prostatitis is performed with antibiotics (fluoroquinolines and cephalosporins, macrolides), alpha-blockers, non-steroidal anti-inflammatory drugs, neuromodulators. Few antibiotics are able to penetrate the prostate gland, pathogens are immunized with some of the drugs, therefore bacterial inoculation is required.
Conservative urological treatment may 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 in conditions of minimal risk of infection;
- physical activity;
- elimination of deficiency states - hypo- and avitaminosis, mineral deficiency;
- observance of aseptic conditions and careful technique when performing invasive urological interventions;
- regular preventive examinations with the help of laboratory tests.