Prostatitis - symptoms and treatment

What is prostatitis? We will analyze the causes of occurrence, diagnosis and methods of treatment in the articles of doctors, urologists with 28 years of experience.

Definition of disease. The cause of the disease

ProstatitisIs an inflammatory process in the prostate tissue, accompanied by pain in the lower back, perineum or pelvis, as well as disturbances in the work of the lower urinary tract.

The prostate gland (prostate) refers to the male reproductive system. It sits in front of the rectum, under the bladder, and surrounds the urethra (urethra). That is why, when the prostate gland becomes inflamed, it presses on the urethra, which in turn causes various problems with urination. The main function of the prostate is the production of secretions (fluids), which are part of semen and dilute it to ensure normal sperm movement.

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

Prostatitis occurs most often in the practice of urologists. It can occur suddenly (acute) or gradually, and its manifestations are continuous and prolonged (chronic). The chronic form is more common than the acute one. Chronic prostatitis ranks fifth among the twenty major urological diagnoses.

Prostatitis can be disease independent or combined with benign prostate 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 thousand population, then in 2017 the main incidence was 203 per 100 thousand population.

Causes of the development of prostatitisbacterial (infectious) and non -bacterial (non -infectious).Infectious prostatitismost common in men under the age of 35 years. 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 may include atypical pathogens. It should be noted that chronic bacterial prostatitis is a polyetiological disease, that is, it can have several causes.

Factors that contribute to the development of inflammationin the prostate gland:

• sexually transmitted infections;
• state of immunodeficiency;
• prostate biopsy;
• invasive manipulation and surgery;
• Lifestyle;
• diarrhea, constipation;
• homosexual acquaintances;
• frequent exchange of sexual partners;
• inactive lifestyle, etc.

Prostatitis is not chronic bacterialdiagnosed in patients who complain of chronic pain in the prostate area, while the causative agent of an infectious disease (bacteria) has not been found in it. Although there are many studies, the cause of chronic prostatitis of this type is not fully understood, but there are several factors that can lead to its development:

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

In some cases, prostatitis may occur after performing a transurethral procedure such as urethral catheterization or cystoscopy, as well as after a transctal biopsy of the prostate.

Although the exact incidence of various types of prostatitis has not been determined definitively, the following data are available:

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

If you experience similar symptoms, see a doctor. Don’t treat yourself - it endangers your health!

Symptoms of prostatitis

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

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

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

• frequent urination;
• difficulty urinating, i. e. poor flow and the need to "strain";
• burning pain or intensity during urination.

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

Men with a diagnosischronic bacterial prostatitisnote the periodic symptoms, which increase and decrease. With exacerbation, pain and discomfort are observed. The sensation of pain is localized mostly at the base of the penis, around or above the anus. Also, the pain can occur right above the pubic bone or in the lower back, spreading to the penis and testicles. Defecation also becomes painful. Sometimes there are signs of infection in the lower part of the urinary system: burning pain and frequent urination, frequent urination. These symptoms can be confused with manifestations of acute bacterial prostatitis, but usually include sudden attacks, 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 experience such symptoms, you should see a doctor immediately.

If a standard modern examination has not proved that chronic pain is caused by a pathological process in the prostate gland, then we are dealing with chronic non -bacterial prostatitis, which is also calledchronic pelvic pain syndrome(this term has been in use since 2003). If there is a chronic pelvic pain syndrome, a man's quality of life is significantly reduced, as 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 syndrome / chronic pelvic pain syndrome, there is persistent discomfort or pain in the lower back, more often at the base of the penis and around the anus, for at least 3 months. The painful sensation is localized in one "target organ" or several pelvic organs. Often, with this form of prostatitis, the pain is localized in the prostate gland (46%).

In chronic prostatitis, sexual disorders have a number of features. First, all components of a man's copulative (sexual) function are disrupted at different levels: libido, erection, ejaculation. Second, sexual dysfunction occurs mainly in people with a long history of the disease (more than 5 years). Third, sexual dysfunction is often a major reason for seeking medical treatment.

Erectile dysfunction is observed by 30% of patients suffering from chronic prostatitis, largely due to psychogenic factors - 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. A large number of cases of acute bacterial prostatitis are caused by a cascade of processes triggered by ascending urethral infection or intraprostatic reflux (backflow of urine).

Penetration of microorganisms into the prostate gland is possible via the ascending route (via the urethra) or transrectally via the lymphatic route. Diarrhea and constipation associated with rectal barrier function disorders are considered to be factors provoking chronic prostatitis. However, the mechanism of penetration of microorganisms into the prostate remains unclear.

Urinary disorders with prostatitis can occur as a result of:

• improve the smooth muscle tone of the prostate urethra by increasing the activity of adrenergic receptors;
• prostate enlargement or urethral narrowing, resulting in turbulent urine flow, blockage of the bladder outlet, and intraprostatic reflux.

In the future, there are violations of the drainage of the prostate gland ducts, stagnation of prostate secretion, edema, activation of the arachidonic acid cascade, inflammation and ischemia. A spiral of violent pathological changes is formed.

Classification and stage 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). May 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 prostatitisNot likespicy,manifests itself as recurrent episodes of exacerbation with the presence or absence of complete remission between them. Symptoms are usually less severe than acute prostatitis.

Classification of the American National Institutes of Health. . .

• Yes 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 urination, pain, pain during ejaculation. Potential symptoms of acute bacterial prostatitis include blood in the urine and / or semen. It is rare. 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 less pronounced. Several courses of antibiotic therapy may be required.
• Type III(chronic non -bacterial prostatitis and chronic pelvic pain syndrome): no evidence of infection.
• III Types: the presence of leukocytes in ejaculatory / prostate secretions / third part of urine obtained after prostate massage.
• Type III B: absence of leukocytes in ejaculatory / prostate / third part of urine secretion obtained after prostate massage. Pain in the lower back and genitals, frequent urination, difficulty urinating (often at night), burning or pain and painful ejaculation. It is about 90% of all cases of prostatitis. There is no known cause or clinically proven treatment.
• Type IV(asymptomatic inflammatory prostatitis): Sometimes an increase in the number of white blood cells increases. Does not require treatment. Detected on 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 gland, seminal vesicles, and posterior urethra. The infection can penetrate simultaneously into the prostate gland and surrounding organs.

Vesiculitis- inflammation of the seminal vesicles. The pain is localized in the groin area and deep in the pelvis, radiating to the sacrum. The pain is usually unilateral, as the two seminal vesicles are affected to varying degrees. Vesiculitis may be asymptomatic. The patient's only complaint was the presence of blood in the semen. Periodic pyuria (pus in urine) and pyospermia (pus in ejaculation) were also observed.

Posterior urethritis, colicitis (inflammation of the seminal tuberculosis). . . With prostatitis, the infection penetrates into the seminal tubercle, this is due to the distance of the prostate gland with the excretory tract.

Prostate gland abscess.Pathogens that cause prostatitis can also cause abscesses of the prostate gland. This is a severe septic (bacterial) disease, which is accompanied by weakness, fever, chills with flowing sweat. In some cases, disturbed consciousness and confusion were observed. The patient needs hospital treatment.

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

Prostate cyst.This formation can contribute to the formation of stones in the prostate gland. The presence of an infection in the cyst can cause a prostate abscess. It is not difficult to diagnose prostate cysts using ultrasonography. They can also be detected with a digital rectal examination.

Prostate stones.They are quite ordinary. The cause of the disease is not fully understood, but most experts agree that the disease arises as a result of a prolonged inflammatory process in the prostate gland. The stones are single and double, with a diameter of 1 to 4 mm. Large rocks are rare. The stones clog the gland, because the secretion gets stuck in it, the gland dilates, and separate cysts form, where the infection enters. Patients with stones in the prostate gland should face persistent dull pain in the perineum. The painful sensation spreads to the glandular penis and often causes urination, which becomes difficult and painful.

Infertility.Chronic long -term prostatitis primarily reduces sperm motor function, rendering it 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 smaller number of them than before).

Ejaculatory disorders.Prostatitis of all forms causes sexual dysfunction. Initially, the patient is confronted with premature ejaculation, experiences a normal erection, which then weakens, and the level of orgasm decreases. The presence of prolonged chronic prostatitis contributes to decreased production of male sex hormones and decreased libido.

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

Diagnosis of prostatitis

The appearance of the first signs of inflammation of the prostate gland requires immediate medical attention. Urologists will exclude many diseases that have similar manifestations, and determine the category (type) of these diseases. Before choosing a treatment, the specialist will perform the necessary examinations and offer to undergo an evaluation test.

What questions might a doctor ask

During the appointment, the doctor will certainly determine: the duration of clinical manifestations of the disease, the location and nature of pain, for example, in the perineum, scrotum, penis and inner thighs; changes in the nature of semen (presence of pus and blood).

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

The patient should ask the doctorabout what tests and studies to do, how to prepare for it, what treatment to prescribe and where I can get more information about the disease.

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

This survey will include:

• Digital anal examination of the gland to determine the extent of prostate enlargement and its consistency.

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

• Urodynamic studies.

In case of acute bacterial prostatitis, a swollen and painful prostate gland can be found with 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 secretion. To categorize chronic prostatitis, quantitative culture and microscopy of urine samples and prostate secretions obtained after prostate massage are still 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 administer the treatment of inflammatory infectious diseases of the genitourinary system.

After identifying the cause of the disease, the doctor will recommend treatment. Keep in mind that the standard method only in 5-10% of cases can detect an infection, 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 in prostatitis did not provide additional diagnostic information. It is known that in 60 and 20% of patients with acute and chronic bacterial prostatitis, the levels of prostate-specific antigen (PSA) respectively increase. After the end of treatment, PSA levels decreased in 40% of patients. PSA is not considered a specific marker for prostate cancer because PSA levels can be increased in prostate hyperplasia and benign 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 relieve urination and relax the muscles of the prostate gland and bladder. Some patients are given medications to lower hormone levels, which can help shrink the glands and reduce discomfort. Muscle relaxation can help relieve pain caused by an edematous prostate that puts pressure on nearby muscles. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help if pain is present.

Standard antibiotic therapy in most cases does not result in a decrease in the number of relapses, and therefore an integrated approach is often used and even prescribed.additional medication: biostimulants, extracts of various plants and insects and their biological components, which can take the form ofrectal suppositories. . . Although there are many drugs, the effectiveness of their use is not enough.

Physiotherapy in the treatment of prostatitis

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

• prostate gland massage (prostate);
• laser therapy;
• microwave hyperthermia and thermotherapy;
• electrical stimulation with current modulating skin or rectal electrodes;
• acupuncture (acupuncture).

The efficacy and safety of this treatment are still being studied. Also used for the treatment of prostatitisfolk methods, e. g.hirudotherapy.The effectiveness and safety of this method for the treatment of prostatitis has not been proven.

Stem cell injections

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

Surgical treatment of prostatitis

Surgical methods are used only to treat complications of prostatitis - abscesses and swelling of the seminal vesicles.

Treatment of chronic pelvic pain syndrome requires separate consideration. Asymptomatic inflammatory prostatitis (category IV) cannot be treated unless the patient plans to undergo prostate surgery. In this case, the patient is given prophylactic antibiotic therapy.

Diet and lifestyle for prostatitis

A special diet for prostatitis is not required, but eating lots of vegetables, lean meats and dairy products will improve intestinal function. It is important to consume enough fiber, foods rich in vitamin E (wheat germ, corn oil, etc. ), sugar should be replaced with natural honey. Proper nutrition for prostatitis can improve bowel function and reduce the chances of a quick relapse or recovery. It is recommended to adhere to a healthy lifestyle, drink more fluids, and limit caffeine and alcohol.

Prediction. Prophylaxis

Acute prostatitis often becomes chronic, even with timely treatment.

Complete recovery is not always achievable, however, with proper consistent therapy and according to the doctor’s recommendations, it is possible to get rid of the discomfort and pain. Freetreatment of prostatitis at homecan be harmful and result in complications.

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

1. Drink plenty of fluids. Drinking a lot of fluids causes frequent urination, thus facilitating the elimination of infectious agents from the prostate urethra.
2. Empty your bladder regularly.
3. Avoid urethral irritation. Limit caffeine, spicy foods, and alcohol.
4. Reduce pressure on the prostate. Men who frequently ride bikes should use separate seats to reduce pressure on the prostate area.
5. Stay sexually active.