Prostatitis is inflammation of the prostate and is one of the common problems of 40% of middle-aged and elderly men. In the case of not directly threatening life, this disease can cause a significant decline in its quality, affect work ability, private space, restrict freedom, and cause daily difficulties and psychological barriers.
Prostatitis occurs in an acute or chronic form, and it can be infectious and non-infectious.
Causes of prostatitis
There are many causes of prostatitis: the acute form is related to bacterial infection, which enters the prostate in the urinary system and infectious diseases, and 90% of chronic prostatitis has nothing to do with infection. Due to infectious inflammation of the catheter wall and systemic disease, the prostate secretion is stagnated.
Causes of acute prostatitis
Acute bacterial prostatitis is caused by enterobacteria, gram-negative and gram-positive cocci, chlamydia, mycoplasma, and viruses. The risk factors for prostate infection are sexually transmitted diseases and invasive urological interventions (urethral catheterization, ureteral infusion, and cystoscopy).
The triggers for the development of infectious inflammation are usually hypothermia, long-term constipation or diarrhea, sedentary work, excessive sexual activity or abstinence, chronic course of sexually transmitted diseases and urinary system diseases, immune response suppression, insufficient sleep, overtraining, chronic pressure. Pelvic cavityInsufficient blood supply to the organs, these factors themselves can cause aseptic inflammation, and also help to introduce pathogens into the prostate tissue.
Acute bacterial inflammation can subside without any consequences, but in some cases the following complications can occur:
- Acute urinary retention;
- Chronic prostatitis (chronic pelvic inflammatory syndrome);
- Epididymitis;
- Prostate abscess;
- Prostatic tissue fibrosis;
- Infertility.
Causes of chronic prostatitis
In 10% of cases, chronic prostatitis is a complication of acute inflammation of the prostate and urethritis, chlamydia, human papillomavirus and other chronic infections. About 90% is due to bacterial chronic prostatitis or chronic pelvic pain syndrome (CPPS). This form of disease has nothing to do with infection, but it is caused by a variety of reasons, mainly the stagnant process in the small pelvis. Under the background of urethritis, neurogenic stenosis of the bladder neck, urethral stricture, and autoimmune inflammation, urinary stasis is formed, causing inflammation. The blood supply to the pelvic organs deteriorates, which is caused by systemic cardiovascular disease (coronary artery disease, atherosclerosis). The general venous system of the small pelvis determines the connection between chronic prostatitis and anal cracks, hemorrhoids, proctitis, and fistulas.
Chronic pelvic pain in men is related to the following factors:
- Low physical activity;
- Low testosterone levels in the blood;
- Changes in the body's microbial environment;
- Genetic and phenotypic tendencies.
Symptoms of prostatitis
- Fever (acute prostatitis is 38-39 degrees Celsius, chronic is low fever).
- Urinary dysfunction: Urinary frequency is not always effective, and urination is difficult or increased, especially at night. The urine stream is exhausted, and some remains in the bladder.
- Damage to the prostate: white blood cells and blood in semen, pain during urological examination.
- Fibromyalgia.
- Prostatic fluid is a small amount of secretion from the urethra.
- Pain in the small pelvis, perineum, testicles, upper pubic bone, penis, sacrum, bladder, and scrotum.
- Painful urination and ejaculation.
- Spastic muscle cramps.
- Prostate stones.
- Psychological stress in the context of chronic fatigue, despair, disaster, and chronic pain syndrome.
- Decreased performance (weakness), decreased mood, irritability).
- Sexual dysfunction-erectile dysfunction, premature ejaculation, lack of orgasm.
- Irritable bowel syndrome and proctitis can be added.
In the chronic course of the disease, the signs of prostatitis are vague (less obvious), but are accompanied by general, neurological and psychiatric symptoms.
Diagnosis of prostatitis
The key to successful and timely treatment of prostatitis is accurate and comprehensive diagnosis. In most cases, the low rate of infectious prostatitis is because the pathogen has not been detected. Chronic sexually transmitted infections can be asymptomatic, and their pathogens can invade prostate tissue and cause inflammation. Therefore, laboratory research methods play a leading role in the diagnosis process.
In order to determine the susceptibility of bacteria to antibiotics, biological fluids need to be inoculated: urine, semen, and prostate secretions. This method allows you to choose the most effective drug for a specific pathogen strain, which can penetrate directly to the focal point of inflammation.
The "classic" method of laboratory diagnosis of prostatitis is considered cultural science (urine culture, ejaculation, urogenital smear contents). This method is very accurate, but it takes time. In order to detect bacteria, a Gram smear is produced, but it is unlikely to detect viruses, mycoplasma, and ureaplasma. In order to improve the accuracy of the research, mass spectrometry and PCR (polymerase chain reaction) are used. Mass spectrometry is the ionic analysis of the structure of a substance and determines each of its components. Polymerase chain reaction allows the detection of DNA or RNA fragments of infectious disease pathogens, including viruses and plasma.
At present, for the special examination of urological patients, a special comprehensive study is carried out by PCR method of the microbial community of the genitourinary tract. The test results can be obtained within a day and reflect the full picture of the proportion of microorganisms in the subject.
Tests for prostatitis include urine and semen collection and urinary system smears.
The European Urological Association recommends the following set of laboratory tests:
- General urinalysis;
- Bacterial culture of urine, semen and ejaculation;
- PCR diagnosis.
A general analysis of urine allows you to determine the signs of inflammation (number of microbial colony forming units, white blood cells, red blood cells, urine transparency) and the presence of calcification (prostate stones). General analysis is included in several methods of urology (glass or aliquot) samples.
Glass or aliquots include the continuous collection of urine or other biological fluids in different containers. Therefore, the location of the infection process is determined. Evidence of prostatitis is the detection of infectious pathogens, blood cells (white blood cells and red blood cells) in the last part of the urine during the three-cup test or after urological massage of the prostate
Two-cup test-spread the middle part of the urine stream before and after the prostate urology massage.
Three cups of samples-collect the first, middle and last part of urine during the same urination.
Four cups of samples-culture and general analysis of the initial and intermediate parts of the urine stream, prostate secretions after prostatic urology massage, and part of the urine after this procedure.
Also carried out semen and urogenital smear material culture seeding or PCR diagnosis.
Blood tests are also needed to diagnose prostatitis. The general analysis of capillary blood allows you to confirm or deny the presence of inflammation and rule out other diagnoses that cause the same symptoms.
The diagnosis of non-inflammatory chronic pelvic pain syndrome is more difficult because it is based on clinical manifestations and indirect laboratory parameters (including general analysis of urine and blood). The intensity of pain syndrome is determined by the visual analog scale of pain, and the severity of psychological changes is determined by the scale for assessing anxiety and depression. At the same time, research must be conducted to find the source of infection, because the range of pathogens may be very wide. From the perspective of instrumental research, urine fluorescence measurement is prescribed by transrectal ultrasound (TRUS) that determines residual urine volume and prostate.
Asymptomatic prostatitis is detected by histological examination of a prostate biopsy, and a prescription is prescribed for suspected cancer. Get a blood test for prostate-specific antigen (PSA) in advance. Serum PSA appears with enlarged prostate and inflammation, and the standard standard changes with age. This study also helps to rule out the suspicion of prostate cancer.
Treatment and prevention of prostatitis
Use antibiotics (fluoroquinolines, cephalosporins, macrolides), α-receptor blockers, non-steroidal anti-inflammatory drugs, and neuromodulators to treat acute prostatitis. Few antibiotics can penetrate the prostate, pathogens are immune to certain drugs, so bacterial inoculation is required.
Conservative urological treatment may also include acupuncture, phytotherapy, external shock wave therapy, thermal physiotherapy (after acute inflammation), and massage.
The prevention of prostatitis includes the development of medical procedures and healthy habits:
- Use barrier contraception;
- Regularly engage in sexual activities with minimal risk of infection;
- physical activities;
- Eliminate deficiencies-vitamin deficiencies and vitamin deficiencies, mineral deficiencies;
- Observe aseptic conditions and careful techniques for invasive urological interventions;
- Use laboratory tests for regular preventive inspections.