Prostatitis: symptoms and treatment

What is prostatitis? We will analyze the causes of appearance, methods of diagnosis and treatment in the article of a doctor, urologist with 28 years of experience.

Definition of disease. Causes of the disease

ProstatitisIt is an inflammatory process of the prostate tissue, accompanied by pain in the lumbar area, perineum or pelvic region, as well as alterations in the work of the lower urinary tract.

The prostate gland (prostate) refers to the male reproductive system. It is located in front of the rectum, below the bladder, and surrounds the urethra (urethra). That is why, when the prostate gland becomes inflamed, it compresses the urethra, leading to various urination problems. The main function of the prostate is the production of secretion (fluid), which is part of the semen and liquefies it to ensure normal sperm motility.

Pathological conditions of the prostate gland, such as cancer or benign hyperplasia, are more common in older patients. Prostatitis differs in that it affects men of all age groups, but the disease most often occurs in men of reproductive age (8 to 35% of cases).

Prostatitis occurs most often in the practice of a urologist. It can occur suddenly (acute) or gradual, and its manifestations are constant and long-term (chronic). The chronic form is much more common than the acute. Chronic prostatitis ranks fifth among the top twenty urologic diagnoses.

Prostatitis can be an independent disease or combined with benign prostatic hyperplasia and prostate cancer. In recent years, there has been a decrease in the incidence of prostatitis in the male population: if in 2012 the incidence was 275 per 100, 000 of the population, then in 2017 the primary incidence was 203 per 100, 000 of the population.

The reasons for the development of prostatitisthey are bacterial (infectious) and non-bacterial (non-infectious).Infectious prostatitismore common in men under 35 years of age. Most often, this form of the disease is caused by gram-negative microorganisms, especially enterobacter, E. coli, serration, pseudomonas, and proteus, as well as sexually transmitted infections, such as gonococcus, chlamydia, etc. Very rarely, prostatitis can occur due to Mycobacterium tuberculosis. In chronic bacterial prostatitis, the spectrum of pathogens is broader and can include atypical pathogens. It should be remembered that chronic bacterial prostatitis is a polyetiological disease, that is, it can have several causes.

Factors that contribute to the development of inflammation.in the prostate gland:

• sexually transmitted infections;
• immunodeficiency states;
• prostate biopsy;
• invasive manipulations and operations;
• Lifestyle;
• diarrhea, constipation;
• homosexual contacts;
• frequent change of sexual partners;
• sedentary lifestyle, etc.

Chronic nonbacterial prostatitisdiagnosed in patients who complain of chronic pain in the prostate area, while in them an infectious (bacterial) causative agent of the disease has not been found. Despite numerous studies, the cause of this type of chronic prostatitis is not fully understood, however, there are some factors that can cause its development:

• increased prostate pressure;
• muscle pain in the pelvic region;
• emotional disorders;
• Autoimmune disorders (antibodies that are supposed to fight infection, sometimes for some reason attack the cells of the prostate gland);
• physical activity;
• irregular sex life;
• lifting weights, etc.

In some cases, prostatitis can occur after performing transurethral procedures such as urethral catheterization or cystoscopy, as well as after a transrectal prostate biopsy.

Although the true incidence of various types of prostatitis has not been definitively established, the following data is provided:

• Acute bacterial prostatitis accounts for approximately 5-10% of all prostatitis cases;
• chronic bacterial prostatitis - 6-10%;
• non-bacterial chronic prostatitis: 80-90%;
• prostatitis, including prostatodynia (autonomic disorders of the prostate gland): 20-30%.

If you find similar symptoms, see your doctor. Do not self-medicate, it is dangerous for your health!

Symptoms of prostatitis.

All forms of inflammation.the prostate gland, in addition to the asymptomatic, is united by the presence of the following symptoms:

• pain in the lumbar region;
• feeling of discomfort with intestinal peristalsis;
• pain in the perineum or pelvic region;
• disturbances in the work of the lower urinary tract.

The main symptoms of the lower urinary tract in the presence of prostatitis:

• frequent need to urinate;
• Difficulty urinating, that is, a weak stream and the need to "strain";
• burning pain or its intensification when urinating.

In men with a diagnosisacute bacterial prostatitisPelvic pain and urinary tract symptoms occur, such as increased urination and urinary retention. This can lead to the development of systemic manifestations such as fever, chills, nausea, vomiting, and malaise. Acute bacterial prostatitis is characterized by an acute onset of the disease with a vivid clinical picture. This is a serious illness.

Diagnosed menchronic bacterial prostatitiswatch for recurring symptoms, increasing and decreasing. With an exacerbation, pain and discomfort are noted. Pain sensations are mainly localized at the base of the penis, around or above the anus. Also, pain can occur just above the pubic bone or in the lower back, spreading to the penis and testicles. Defecation also becomes painful. Sometimes signs of infection of the lower parts of the urinary system develop: burning pain and frequent urination, frequent urgency. These symptoms can be confused with the manifestations of acute bacterial prostatitis, but it usually has a sudden onset, chills, fever, weakness, pain throughout the body, in the lower back, as well as in the genitals, frequent and painful urination, pain. with ejaculation. If you find such symptoms, you should urgently consult a doctor.

If the modern standard examination has not established that chronic pain is caused by a pathological process in the prostate gland, then this is a non-bacterial chronic prostatitis, which is also calledchronic pelvic pain syndrome(the term has been used since 2003). In the presence of chronic pelvic pain syndrome, the quality of life of a man is significantly reduced, since this syndrome sometimes leads to various psychological and sexual disorders:

• increased fatigue;
• feeling helpless;
• erectile dysfunction;
• painful ejaculation;
• pain after intercourse, etc.

In chronic non-bacterial prostatitis / chronic pelvic pain syndrome, there is a persistent feeling of discomfort or pain in the lower back, most often at the base of the penis and around the anus, for at least 3 months. Painful sensations are localized to a "target organ" or various pelvic organs. Most often, with this form of prostatitis, the pain is localized in the prostate gland (46%).

In chronic prostatitis, sexual disorders have several characteristics. First, all components of a man's copulative (sexual) function are altered to varying degrees: libido, erection, ejaculation. Second, sexual dysfunction occurs mainly in people with a long history (more than 5 years) of the disease. Third, sexual dysfunction is often the main reason for seeking medical attention.

Erectile dysfunction is seen in 30% of patients with chronic prostatitis, largely due to the psychogenic factor, a catastrophic perception of the disease.

Symptoms of prostatitis occur at least once in a lifetime in 50% of men.

Pathogenesis of prostatitis

The mechanism of development of prostatitis is multifaceted and very complex. Many factors are involved in its development. Most cases of acute bacterial prostatitis are caused by a cascade of processes triggered by an ascending urethral infection or intraprostatic reflux (urine reflux).

The penetration of microorganisms into the prostate gland is possible ascending (through the urethra) or transrectally through the lymphatic route. Diarrhea and constipation associated with impaired rectal barrier function are considered triggers for chronic prostatitis. However, the mechanism of penetration of microorganisms into the prostate is not yet clearly established.

Urinary disorder with prostatitis can be due to:

• increase the tone of the smooth muscles of the prostatic urethra by increasing the activity of adrenergic receptors;
• enlarged prostate or narrowing of the urethra, resulting in turbulent urine flow, bladder outlet obstruction, and intraprostatic reflux.

In the future, there is a violation of the drainage of the ducts of the prostate gland, stagnation of prostate secretions, edema, activation of the arachidonic acid cascade, inflammation and ischemia. A vicious cycle of pathological changes forms.

Classification and stages of development of prostatitis.

There are 4 main categories (types) of prostatitis.

1. Acute bacterial prostatitis(category I).
2. Chronic bacterial prostatitis(category II).
3. Chronic non-bacterial prostatitis / syndromechronic pelvic pain (category III). It can be inflammatory (category III A) or non-inflammatory (category III B).
4. Asymptomatic inflammatory prostatitis.Histological prostatitis identified by prostate biopsy (category IV).

Chronic bacterial prostatitisUnlikespicy,it manifests as recurrent episodes of exacerbation with the presence or absence of complete remissions between them. The symptoms are usually less severe than those of acute prostatitis.

Classification of the American National Institutes of Health. . .

• Type i(acute bacterial prostatitis) - acute infection of the prostate gland: symptoms of the disease appear suddenly. Chills, fever, pain throughout the body, weakness, pain in the lower back and genital area, frequent and painful urination, pain during ejaculation. Potential symptoms of acute bacterial prostatitis include blood in the urine and / or semen. It's strange. It is effectively treated with antibiotics.
• Type II(chronic bacterial prostatitis) - a chronic or recurrent infection of the prostate gland - the symptoms are the same as in acute prostatitis, but appear gradually and are less pronounced. Several cycles of antibiotic therapy may be required.
• III type(chronic nonbacterial prostatitis and chronic pelvic pain syndrome): no evidence of infection.
• III A type: presence of leukocytes in ejaculation / prostate secretion / third portion of urine obtained after prostate massage.
• III type B: absence of leukocytes in ejaculation / prostate secretion / third portion of urine obtained after prostate massage. Lower back and genital pain, frequent urination, difficulty urinating (often at night), burning or pain when urinating, and ejaculation. It represents approximately 90% of all cases of prostatitis. There are no known causes or clinically proven treatments.
• Type IV(Asymptomatic inflammatory prostatitis): Sometimes increased white blood cell count. It does not require treatment. Detected in prostate biopsy.

The boundaries between the various forms of prostatitis are blurred.

Complications of prostatitis

With inflammatory lesions of the prostate gland, nearby organs are involved in the pathological process: the seminal tubercle, Cooper's glands, the seminal vesicles, and the posterior urethra. The infection can simultaneously penetrate the prostate gland and surrounding organs.

Vesiculitis- Inflammation of the seminal vesicles. The pains are located in the groin area and deep in the pelvis, radiating to the sacrum. The pain is usually unilateral, as both seminal vesicles are affected to varying degrees. Vesiculitis can be asymptomatic. The only complaint from patients may be the presence of blood in the semen. Pyuria (pus in the urine) and piospermia (pus in the ejaculation) are also noted periodically.

Posterior urethritis, colliculitis (inflammation of the seminal tubercle). . . With prostatitis, the infection penetrates the seminal tubercle, this is due to the proximity of the prostate gland to the excretory ducts.

Abscess of the prostate gland.The pathogens that cause prostatitis can also lead to a prostate gland abscess. This is a serious septic (bacterial) disease, which is accompanied by weakness, fever, chills with giddy sweat. In some cases, altered consciousness and delirium are observed. The patient needs hospitalization.

Sclerosis of the prostate (fibrosis).This is a late complication of prostatitis, which is based on the replacement of scarred prostate tissue (degeneration of connective tissue, that is, sclerosis), which leads to the fact that the gland shrinks, decreases in size and completely loses its function. As a general rule, sclerotic symptoms develop long after the onset of the inflammatory process in the prostate gland.

Prostate cystsThese formations can contribute to stone formation in the prostate gland. The presence of an infection in a cyst can lead to a prostate abscess. It is not difficult to diagnose a prostate cyst using ultrasound. They can also be detected with a digital rectal examination.

Prostate stonesThey are quite common. The causes of the disease are not fully understood, but most experts agree that they arise as a result of a prolonged inflammatory process in the prostate gland. The stones are simple and multiple, with a diameter of 1 to 4 mm. Large stones are rare. Stones clog the gland, due to which the secret stagnates in it, the gland is overstretched, and separate cysts form, into which the infection enters. Patients with stones in the prostate gland have to deal with a constant dull ache in the perineum. The painful sensations spread to the glans of the penis and cause a frequent urge to urinate, which becomes difficult and painful.

Sterility.Long-term chronic prostatitis mainly reduces the motor function of sperm, rendering them completely immobile. One of the consequences is a violation of their production, the formation of immature spermatozoa that have an abnormally altered shape (and a lower number than before).

Ejaculation disorder.Prostatitis in all its forms causes sexual dysfunction. At first, patients are faced with premature ejaculation, have a normal erection, which then weakens, and the degree of orgasm decreases. The prolonged existence of chronic prostatitis contributes to a decrease in the production of male sex hormones and a weakening of libido.

Erectile dysfunction.The relationship between chronic prostatitis / chronic pelvic pain syndrome and erectile dysfunction has been described. This disorder is especially painful for men.

Prostatitis diagnosis

The appearance of the first signs of inflammation of the prostate requires immediate medical attention. The urologist will exclude many diseases that have similar manifestations and will determine to which category (type) the disease belongs. Before choosing a treatment, a specialist will carry out the necessary tests and offer to undergo an evaluation test.

What questions might the doctor ask

At the appointment, the doctor will definitely specify: the duration of the clinical manifestations of the disease, the location and nature of the pain, for example, in the perineum, scrotum, penis and inner thigh; changes in the nature of semen (presence of pus and blood).

At the reception, the urologist will offer to fill out special questionnaires, one of which is the index of symptoms of chronic prostatitis.

The patient should ask the doctor questions.what tests and studies will need to be done, how to prepare for them, what treatment you plan to prescribe, and where I can get more information about the disease

Chronic bacterial prostatitis is diagnosed when symptoms last at least three months.

The survey will include:

• Digital rectal examination of the gland to determine the degree of enlargement of the prostate and its consistency.

• Prostate secretion, urine and / or ejaculation tests.
• Identification of urogenital infection.
• Ultrasound examination of the urinary system (kidneys, prostate, bladder with determination of residual urine).

• Urodynamic study.

In the case of acute bacterial prostatitis, a painful and swollen prostate gland can be found on digital rectal examination. Prostate massage is contraindicated as it can cause bacteremia and sepsis.

The most important study in the examination of patients with acute bacterial prostatitis is the culture of prostate secretions. To classify chronic prostatitis, quantitative culture and microscopy of urine samples and prostate secretions obtained after massage of the prostate remain important methods.

Androflor: a comprehensive study of the microbiocenosis of the urogenital tract in men by PCR. Allows you to determine the qualitative and quantitative composition of the microflora. It is used to diagnose and control the treatment of inflammatory infectious diseases of the genitourinary system.

After identifying the cause of the disease, the doctor will recommend a course of treatment. It should be remembered that standard methods can only detect an infection in 5-10% of cases, which eventually leads to prostatitis.

What is the relationship between prostatitis, prostate specific antigen (PSA), and prostate cancer?

Measurement of total PSA and free PSA levels in prostatitis does not provide additional diagnostic information. It is known that in 60 and 20% of patients with acute and chronic bacterial prostatitis, the level of prostate specific antigen (PSA) increases, respectively. Once the treatment is finished, the PSA level decreases in 40% of the patients. PSA is not considered a specific marker for prostate cancer because PSA levels can be elevated in benign prostatic hyperplasia and prostatitis.

Treatment of prostatitis

The main role in the treatment of pathology is assigned to drug therapy.

Treatment with alpha1 blockers

Alpha1 blockers are prescribed for patients who complain of difficulty urinating. These medications help make urination easier and relax the muscles of the prostate gland and bladder. Some patients are prescribed medications to lower hormone levels, which can help shrink the gland and reduce discomfort. Muscle relaxants can help relieve pain caused by an edematous prostate that puts pressure on nearby muscles. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help if there is pain.

Standard antibiotic therapy in most cases does not lead to a decrease in the number of relapses of the disease, and therefore an integrated approach is often used and also prescribed.auxiliary drugs- biostimulants, extracts of various plants and insects and their biological components, which can be in the formrectal suppositories. . . Despite the large arsenal of drugs, the effectiveness of their use remains insufficient.

Physiotherapy in the treatment of prostatitis.

For chronic prostatitis of categories II, III A and III B, physiotherapeutic methods can also be used:

• massage of the prostate gland (prostate);
• laser therapy;
• hyperthermia and microwave thermotherapy;
• electrical stimulation with modulated currents from skin or rectal electrodes;
• acupuncture (acupuncture).

The efficacy and safety of these treatments are still under study. It is also used for the treatment of prostatitis.popular methods, p. exhirudotherapy.The efficacy and safety of this method for the treatment of prostatitis have not been demonstrated.

Stem cell injection

Cell therapy (stem cell injections) in the treatment of prostatitis is currently a promising technique in the early stages of development. At the moment, regarding the injection of stem cells into the prostate, we can only have hypotheses about its mechanisms, as well as empirical data obtained by individual groups of researchers.

Surgical treatment of prostatitis.

Surgical methods are used only to treat complications of prostatitis - abscess and suppuration of seminal vesicles.

Treatment of chronic pelvic pain syndrome requires a separate consideration. Asymptomatic inflammatory prostatitis (category IV) should not be treated unless the patient plans to have prostate surgery. In this case, the patient receives a prophylactic course of antibiotic therapy.

Diet and lifestyle for prostatitis.

No special diet is required for prostatitis, but eating lots of vegetables, lean meat, and dairy products will improve bowel function. It is important to consume enough fiber, foods rich in vitamin E (wheat germ, corn oil, etc. ), sugar must be replaced with natural honey. Proper nutrition for prostatitis can improve bowel function and reduce the likelihood of relapse or speed recovery. It is recommended to follow a healthy lifestyle, drink more fluids and limit caffeine and alcohol.

Forecast. Prophylaxis

Acute prostatitis often becomes chronic, even with proper and timely treatment.

It is not always possible to achieve full recovery, however, with correct consistent therapy and following the doctor's recommendations, it is possible to eliminate discomfort and pain. Independenttreating prostatitis at homeit can be dangerous and cause complications.

Not all cases of prostatitis can be identified as a cause, but there are a number of steps you can take to try to prevent prostatitis from occurring. The same steps can help control existing symptoms:

1. Drink much liquid. Drinking plenty of fluids leads to frequent urination, which facilitates the removal of infectious agents from the prostatic urethra.
2. Empty your bladder regularly.
3. Avoid irritation of the urethra. Limit your intake of caffeine, spicy foods, and alcohol.
4. Reduce pressure on the prostate. Men who cycle frequently need to use a split seat to relieve pressure in the prostate area.
5. Be sexually active.