Inflammation of the prostate gland is a dangerous disease, but not all men are aware of the possible risks and complications. The inflammatory process must be treated. The consequences of prostatitis, if the disease is left to chance, are reflected in the functioning of the entire organism as a whole.
Symptoms of prostatitis are pain, difficulty urinating, weakened erection. These manifestations of the disease are directly related to changes in the prostate gland that occur against the background of the inflammatory process.
With prostatitis, the prostate gland becomes irritated and swollen. An increase in the size of the organ causes specific symptoms due to compression of the urethra and irritation of pain receptors located nearby tissues.
In addition to severe symptoms, which significantly worsen a man’s quality of life, the inflammatory process is dangerous due to structural changes in the tissues of the organ. They occur with low-grade inflammation and are characterized by scar formation. Replacement of the muscle and glandular tissues of the organ with connective tissue leads to disruption of the functionality of the gland. This disease is known as prostate sclerosis, and is diagnosed during a long course of chronic prostatitis without qualified treatment.
The consequences of prostatitis in this case are irreversible without surgical intervention. Symptoms of sclerotic changes in prostate tissue:
- inability to fully empty the bladder;
- inflammation of the bladder and seminal vesicles;
- sharp and cutting pain in the perineum;
- erectile disfunction.
The only treatment for prostate sclerosis is surgery.
The disease is difficult to treat. One of the dangerous consequences of glandular sclerosis is the formation of residual urine, which enters the kidneys and provokes their infection. In addition to discomfort and lack of erection, the pathology can cause the development of acute renal failure. Such complications of prostatitis are observed 5-10 years after the onset of the disease. Factors predisposing to prostate scarring due to prostatitis are older age, vascular atherosclerosis, circulatory disorders, and hypertension.
To treat this pathology, minimally invasive surgical methods are used, for example, laser vaporization of connective tissue. During the procedure, the changed areas of the organ literally evaporate due to laser exposure.
Chronic prostatitis
Acute inflammation of the prostate is characterized by specific symptoms. The disease is successfully treated with antibiotics, but after symptoms have resolved, patients are required to undergo long-term maintenance therapy to restore prostate function.
Many people are interested in: what will happen if prostatitis is not treated, and what are the dangers of this disease?
An incomplete course of treatment for prostate inflammation eventually results in the development of chronic, sluggish prostatitis. The symptoms of this form of the disease are mild, and most often manifest themselves as an increased urge to go to the toilet. Chronic prostatitis may not manifest itself for a long time and may not bother a man, but changes will occur in the prostate gland. Over time, the disease always makes itself felt with a sudden exacerbation of symptoms. This is manifested by acute pain, stagnation of urine, and increased body temperature. During the examination, changes in the organ are usually noted - scars in the tissues, irritation, enlargement of the prostate. Prostatitis and its consequences may not appear immediately, but make themselves felt many years after the onset of the disease.
Chronic prostatitis leads to dysfunction of the organ. This negatively affects a man’s hormonal levels and well-being. First of all, reproductive function suffers. It is very difficult to treat this form of the disease; therapy boils down to preventing an exacerbation of symptoms.
Prostatitis worsens well-being and sex life
Adenoma and malignant neoplasms
The consequences of prostatitis are not always manifested by the development of prostate adenoma - this disease can be considered as an independent pathology. First of all, the development of adenoma is caused by increased production of dihydrotestosterone with a simultaneous decrease in the rate of testosterone synthesis. Predisposing factors are also genetic predisposition and natural aging of the body.
Nevertheless, the relationship between chronic prostatitis and the development of adenoma is clearly visible. A sluggish inflammatory process leads to prostate dysfunction. The prostate is a hormone-dependent organ, therefore, if its functioning is disrupted, there is a disruption in the production and absorption of sex hormones. At the same time, there is an increase in androgen synthesis. Dihydrotestestron serves as a kind of fuel for the functioning of the prostate gland, so its excess is absorbed by the gland tissue. Against this background, there is a rapid enlargement of the prostate and structural changes in the tissues of the organ, known as benign hyperplasia or adenoma.
Symptoms of adenoma are primarily associated with impaired urine outflow and bladder function. Quite often, men are faced with the inability to urinate. The development of acute urinary retention requires hospitalization and catheter placement.
Prostate adenoma cannot be treated. Even surgical intervention does not guarantee the absence of relapse in the future, except for radical prostatectomy. Even after laser prostate surgery, men must take pills that block androgen production for life to prevent recurrence of prostate hyperplasia.
The relationship between prostate cancer and prostatitis is controversial. On the one hand, oncopathology occurs in men who have never encountered prostatitis in their lives, but on the other hand, the percentage of cancer among patients who have had prostate inflammation is much higher. Thus, doctors agree that prostatitis is not a guarantee of the development of cancer, but is a serious prerequisite for malignant neoplasm in the prostate. Such consequences of prostatitis are very dangerous; they significantly shorten a man’s life and in some cases lead to death.
Prostatitis is considered a provoking factor for tumors in the prostate
Disorders of the urinary system
The consequences of chronic prostatitis for men often result in disruption of the urinary system. Constant compression of the urethra by the swollen prostate leads to a narrowing of its lumen. This prevents the bladder from emptying normally. Symptoms of this condition:
- constant urge to urinate;
- feeling of incomplete emptying of the bladder;
- the need to strain the groin muscles when urinating;
- weak stream of urine;
- burning and pain in the urethra.
With prostatitis, complications lie in the risk of kidney dysfunction. This is due to stagnation of residual urine in the bladder due to its dysfunction, which provides a favorable environment for the proliferation of pathogenic microorganisms. With infected urine, pathogenic agents are thrown into the kidneys, causing them to become infected. Inflammation of the kidneys can lead to serious impairment of their function, including the development of failure.
To eliminate a condition in which the bladder does not empty completely, an operation is performed during which a valve is installed to ensure stable operation of the urinary system. This is a last resort; a catheter is usually used to empty the bladder.
Reproductive system dysfunction
The most common complication of prostatitis, which makes itself felt quite quickly, is disruption of the reproductive system, a gradual decrease in fertility with further infertility.
First of all, potency suffers. Usually this is not due to physiological changes, but to psychological stress due to specific symptoms of prostatitis. Over time, due to the thickening of prostate juice and a decrease in the lumen of the urethra, problems with ejaculation appear - the patient either ejaculates too quickly or cannot achieve orgasm during sex. All this ultimately leads to erectile dysfunction, up to complete sexual impotence.
Decreased fertility is due to changes in the composition of prostate juice. The first thing that chronic prostatitis leads to is a violation of sperm motility. This is due to a reduction in the number of lecithin grains in the prostate secretion. As the disease progresses, these protein compounds completely disappear, so over time the man loses the ability to fertilize and is diagnosed with infertility.
Prostatitis reduces the ability to conceive
The only way to prevent such consequences is a timely course of comprehensive treatment of prostatitis. If, after treatment of the underlying disease, a man still has problems with erection, additional therapy is indicated to restore sexual function. It is important to remember: almost any complication can be prevented if you do not let the disease take its course. Any signs of erectile dysfunction, decreased desire for the opposite sex, or other consequences of prostatitis in men should be discussed with your doctor in a timely manner.
Complications from the nervous system
In addition to functional disorders in the functioning of the organs of the genitourinary system, as a result of untreated prostatitis, problems with the nervous system remain. These complications include:
- depression;
- apathy;
- asthenic syndrome;
- neuroses.
Such disturbances in the functioning of the nervous system always entail a decrease in cognitive functions - memory, attention, mental abilities. In this case, performance always suffers, which negatively affects the patient’s quality of life.
Disorders of the nervous system are caused by constant stress and psycho-emotional stress that accompany the symptoms of prostatitis. Due to the constant urge to go to the toilet, a man does not get enough sleep, and this becomes the first alarm signal indicating the imminent appearance of nervous disorders.
A psychotherapist and neurologist can help cure such complications. To do this, it is necessary to take medications that normalize the activity of the nervous system and allow you to fight stress and increased mental stress. Particular attention should be paid to depression remaining after an exacerbation of prostatitis. This is a dangerous condition that has a destructive effect on the nervous system and human psyche.
If you are depressed, you cannot do without the help of a specialist.
Complications of acute bacterial inflammation
Complications that are difficult to treat and radically change the patient’s life are observed with chronic prostatitis. As a rule, such consequences develop over years, but do not appear overnight. At the same time, acute infectious prostatitis can lead to serious complications that require urgent hospitalization. We are talking about a prostate abscess - a dangerous pathology in which a cavity filled with pus forms in the prostate gland and necrotic changes in the tissue begin. This condition can lead to infection of the entire body. Abscess rupture, without timely hospitalization, can cause death.
Prostatitis is a dangerous pathology that leads to serious consequences that affect the entire body as a whole. Complications can be prevented only by timely treatment of this disease.
Until August 10 The Institute of Urology, together with the Ministry of Health, is conducting the “Russia without prostatitis". Within which the drug is available at a discounted price of 99 rubles. , to all residents of the city and region!
is a prolonged inflammation of the prostate gland, leading to disruption of the morphology and functioning of the prostate. It manifests itself as a prostatic triad: pain in the pelvis and genitals, urinary disorders, sexual disorders. Diagnostics includes palpation of the gland, examination of prostate secretions, ultrasound, uroflowmetry, urethroscopy, and puncture biopsy of the prostate gland. Complex medication and physiotherapeutic treatment, prostate massage, and instillation of the posterior urethra are indicated. Surgical intervention is advisable for complicated forms of chronic prostatitis.
ICD-10
N41.1
General information
Chronic prostatitis is the most common male disease: about 50% of men suffer from some form of prostate inflammation. Chronic prostatitis most often affects men aged 20 to 40 years, who are in the period of greatest sexual, reproductive and labor activity. In this regard, the identification and treatment of chronic prostatitis in modern andrology acquires not only a medical, but also a socially significant aspect.
Causes
However, for the development of chronic prostatitis, it is not so much the presence and activity of microorganisms that is important, but the state of the pelvic organs and blood circulation in them, the presence of concomitant diseases, and the level of protective mechanisms. Therefore, a number of factors can contribute to the occurrence of chronic prostatitis. First of all, these are urological diseases - pyelonephritis, cystitis, urethritis, urethral stricture, uncured acute prostatitis, orchitis, epididymitis, etc.
A microbial etioagent can enter the prostate from distant foci of infection, for example, in the presence of sinusitis, tonsillitis, caries, chronic bronchitis, pneumonia, pyoderma, etc. Local and general hypothermia, overheating, exposure to a humid environment, fatigue, and poor nutrition predispose to chronic inflammation. , rare urination, etc.
Non-bacterial chronic prostatitis is usually associated with congestive (congestive) phenomena in the prostate gland, caused by stasis of the venous circulation in the pelvic organs and impaired drainage of the prostate acini. Local congestion leads to overflow of the prostate vessels with blood, swelling, incomplete emptying of secretions, disruption of the barrier, secretory, motor, and contractile functions of the gland.
Stagnant changes are usually caused by behavioral factors: prolonged sexual deprivation, the practice of interrupted or prolonged sexual intercourse, excessive sexual activity, physical inactivity, chronic intoxication, occupational hazards (vibration). The development of non-bacterial inflammation is predisposed by pathology of the pelvic organs and the nervous structures that innervate them (for example, spinal cord injuries), prostate adenoma, hemorrhoids, constipation, androgen deficiency, and other causes.
Classification
According to the modern classification of prostatitis, developed in 1995, there are three categories of the disease:
- II. Chronic prostatitis of bacterial origin.
- III. Inflammation of non-bacterial origin / pelvic pain syndrome is a symptom complex that is not associated with obvious signs of infection and lasts for 3 or more months.
- III A. Chronic process with the presence of an inflammatory component (detection of leukocytes and infectious agents in the prostate secretion);
- III B. Chronic pathology with the absence of an inflammatory component (leukocytes and pathogens in the prostate secretion).
- IV. Asymptomatic chronic prostatitis (no complaints when leukocytes are detected in prostatic secretions).
In the presence of an infectious component, they speak of bacterial (infectious) chronic prostatitis; in the absence of microbial pathogens – non-bacterial (non-infectious). It is believed that in 90-95% of all cases there is non-bacterial inflammation and only in 10-5% - bacterial inflammation.
Symptoms of chronic prostatitis
The disease manifests itself with local and general symptoms. Local manifestations include the prostatic triad, characterized by pain, dysuria and sexual dysfunction. The pain is constant, aching in nature, localized in the perineum, genitals, above the pubis, in the groin. The pain syndrome intensifies at the beginning and end of urination, with pain radiating to the head of the penis, scrotum, sacrum, and rectum.
Pain may increase after sexual intercourse or due to prolonged abstinence; weaken or intensify after orgasm, become more intense immediately at the moment of ejaculation. The intensity of the pain syndrome varies from sensations of discomfort to severe manifestations that disrupt sleep and performance. Pain with limited localization in the sacrum is often regarded as osteochondrosis or radiculitis, and therefore the patient can be treated independently for a long time, without resorting to the help of a doctor.
Urination is frequent and painful. In this case, there may be difficulty in starting voiding, weakening or intermittency of the urine stream, a feeling of incomplete emptying of the bladder, frequent urges at night, and a burning sensation in the urethra. The presence of floating threads can be detected in the urine. After defecation or physical activity, discharge (prostatorrhea) appears from the urethra, caused by a decrease in prostate tone. There may be itching, a feeling of cold or increased sweating in the perineum, local changes in skin color associated with stagnation of blood circulation.
Chronic prostatitis is accompanied by severe sexual dysfunction. The phenomena of dyspotence can be expressed in deterioration, painful erection, prolonged and frequent nocturnal erections, difficulty or early ejaculation, loss of sexual desire (decreased libido), erased orgasms, hemospermia, infertility. Sexual disorders are always difficult for a man to experience and lead to psycho-emotional disorders, including neurosis and depression, which further worsen sexual function.
Exacerbations are accompanied by a slight increase in body temperature and deterioration in well-being. The general condition is characterized by increased irritability, lethargy, anxiety, fatigue, loss of appetite, sleep disturbance, decreased ability to work, creative and physical activity. Almost a quarter of patients have no symptoms of the disease for a long time, which leads to a late visit to an andrologist.
Complications
Diagnostics
The information necessary for the diagnosis of chronic prostatitis is obtained through a comprehensive laboratory and instrumental examination. The primary examination includes clarifying the anamnesis and complaints, conducting an external examination of the genitals for discharge, rashes, irritations, and a digital rectal examination of the prostate in order to determine the contours, boundaries, consistency, and soreness of the gland.
To determine structural and functional changes in the prostate gland, prostate ultrasound (TRUS) is indicated. Important methods in the diagnosis of chronic prostatitis are the study of prostate secretions, general urine analysis, bacteriological examination of a smear from the urethra and urine, a 3-glass urine sample, PCR and RIF examination of scrapings for pathogens of sexually transmitted infections, determination of prostate-specific antigen (PSA). Clinically significant is the detection of causative agents of chlamydia, mycoplasmosis, herpes, cytomegalovirus, trichomoniasis, gonorrhea, candidiasis, as well as nonspecific bacterial flora.
Collection of prostate secretions for examination is carried out after urination and massage of the prostate gland. Signs of the disease are an increase in the number of leukocytes in the field of view, a decrease in the number of lecithin grains, and the presence of pathogenic microflora. A general urine test may reveal leukocyturia, pyuria, and erythrocyturia. Bacteriological culture of urine allows us to identify the degree and nature of bacteriuria. In case of reproductive disorders, a spermogram and MAR test are indicated.
The degree and causes of urination disorders can be determined by urodynamic studies (uroflowmetry, cystometry, profilometry, electromyography). With the help of these studies, chronic prostatitis can be differentiated from stress urinary incontinence, neurogenic bladder, etc. For hematuria, hemospermia, and obstructive urination, endoscopic examination is indicated - urethroscopy, cystoscopy. To exclude adenoma and prostate cancer, a PSA determination is required, in some cases a prostate biopsy with morphological examination of tissue is required.
Treatment of chronic prostatitis
The disease is not easy to cure, but it should be remembered that recovery is still possible and largely depends on the patient’s mood, the timeliness of his contact with a specialist, and the strict adherence to all the urologist’s instructions. The basis for the treatment of a bacterial inflammatory process is antimicrobial therapy in accordance with an antibiogram lasting at least 2 weeks. To reduce pain and inflammation, NSAIDs (diclofenac, ibuprofen, naproxen, piroxicam) are prescribed; To relax the muscles of the prostate, restore urodynamics and outflow of prostatic secretions, the use of a-blockers (tamsulosin, alfuzosin) is indicated.
In order to improve drainage of the prostate gland, local microcirculation and muscle tone, a course of therapeutic prostate massage is carried out. A prostate massage session should end with the release of at least 4 drops of prostate secretion. Prostate massage is contraindicated in acute bacterial prostatitis, prostate abscess, hemorrhoids, prostate stones, rectal fissures, prostate hyperplasia and prostate cancer.
To relieve pain, paraprostatic blockades and acupuncture may be recommended. Physiotherapy is important in treatment with the prescription of medicinal electrophoresis, ultrasound, ultraphonophoresis, magnetic therapy, laser magnetotherapy, inductometry, mud therapy, SMT, hot sitz baths at a temperature of 40 - 45 ° C, enemas with hydrogen sulfide and mineral waters, instillations into the urethra.
If complications develop, surgical treatment is indicated: elimination of urethral strictures; TUR of the prostate or prostatectomy for prostate sclerosis; transurethral resection of the bladder for sclerosis of its neck, puncture and drainage of prostate cysts and abscesses; circumcision for phimosis caused by recurrent urinary tract infections, etc.
Prognosis and prevention
The prognosis is determined by the timeliness and adequacy of treatment, the patient’s age, and the presence of concomitant pathologies. Prevention of the disease requires compliance with sexual hygiene, timely treatment of urogenital and extragenital infections, normalization of the regularity of sexual life, sufficient physical activity, prevention of constipation, and timely emptying of the bladder. To exclude relapses, dynamic examinations by an andrologist (urologist) are necessary; preventive courses of physiotherapy, multivitamins, immunomodulators; exclusion of hypothermia, overheating, stress, bad habits.
Prostatitis is a urological disease accompanied by inflammation of the prostate tissue. Prostate damage can be caused by an infection transmitted through blood, lymph, or unprotected sexual intercourse. The development of prostatitis in men is facilitated by injuries and impaired blood supply to the pelvic organs, constant hypothermia, low physical activity, hormonal imbalance and other factors. Prostatitis may be accompanied by vesiculitis, urethritis and other infectious and inflammatory diseases of the reproductive and urinary organs.Morbidity statistics
Prostatitis is one of the most widespread diseases of the male genitourinary system in the world. According to various sources, it is observed in 60-80% of sexually mature men. According to official medical statistics, in Russia over 30% of young people of reproductive age suffer from chronic prostatitis. In about a third of cases, it occurs in men over 20 and under 40 years of age. According to WHO, urologists diagnose chronic prostatitis in every tenth patient.
Proportion of men suffering from chronic prostatitis (%), according to a study by Mehik A. et al., 2010.
Dependence of the prevalence of all categories of prostatitis on age (number of cases per 1000 person-years) according to the study by Roberts R. et al. 2008
Causes of prostatitis
Infections. Pathogenic and opportunistic bacteria enter the prostate through lymphatic and blood vessels. Secondary infection of the prostate is often a complication of inflammatory diseases of the rectum and urethra.
Types of infection:
- ascending- microbes rise to the gland from the external urethral opening;
- descending- microbes enter the prostate along with a stream of infected urine.
Opportunistic microorganisms that provoke the disease (according to the Research Institute of Urology 1997-1999)
| Microorganisms | Number of studies | |
| % | abs | |
| Staphylococcus epidermidis | 42,3 | 55 |
| S. saprophyticus | 17,6 | 23 |
| S. aureus | 4,6 | 6 |
| S. haemolyticus | 3,1 | 4 |
| S. hominis | 0,8 | 1 |
| S. warneri | 1,5 | 2 |
| Staphylococcus spp. | 3,1 | 4 |
| Enterococcus faecalis | 11,6 | 15 |
| Streptococcus spp. | 3,1 | 4 |
| TOTAL (gr.+) | 87,6 | 114 |
| P. aeruginosa | 3,7 | 5 |
| E. coli | 4,7 | 6 |
| Enterobacter spp. | 2,3 | 3 |
| Proteus spp. | 1,5 | 2 |
| TOTAL (gr.-) | 12,3 | 16 |
Weakening of the immune system. One of the causes of prostate inflammation is a weakening of the body's immune defense. Frequent stress, unbalanced nutrition, overwork, smoking, and alcohol consumption can contribute to this. With reduced immunity, the body is most vulnerable to infections leading to the development of prostate disease.
Blood supply disorders. The development of chronic prostatitis can be a consequence of a sedentary lifestyle. With a constant lack of physical activity, the functioning of the endocrine, cardiovascular and nervous systems, as well as blood circulation in the pelvic organs, is disrupted. The result of this is oxygen starvation of the prostate tissue.
Irregular sexual activity. Both prolonged sexual abstinence and excessive sexual activity can contribute to the appearance of prostatitis. Many men who have a vigorous sex life experience nervous exhaustion, hormonal imbalance, impaired secretion of the sex glands, as well as a gradual loss of potency. Interrupted sexual intercourse has a negative impact on the health of the prostate gland.
Chronic prostate injuries. Chronic prostatitis can develop due to frequent trauma to the soft tissue of the prostate gland. Most often this is observed in patients whose professional activities involve driving vehicles. The cause of prostatitis in this case is constant shaking, vibration and excessive stress on the muscles of the perineum.
Main syndromes of prostatitis
Pain. With prostatitis, men experience aching and cutting pain in the lower abdomen and lower back, as well as aches throughout the body. This symptom may intensify with ejaculation, especially during sexual intercourse after prolonged abstinence.
Dysuria. Typical signs of prostatitis in men are frequent urge to urinate, burning and stinging when emptying the bladder, nagging pain after urination in the perineal area. Another symptom of prostate inflammation is difficulty urinating. If the disease is left untreated, acute urinary retention may occur.
Sexual disorders. With uncomplicated prostatitis, accelerated ejaculation, loss of orgiastic sensations, pain during ejaculation, and partial or complete decrease in sexual desire are observed. A symptom of chronic prostatitis is also a prolonged erection at night.
External manifestations. With prostatitis, some patients experience purulent or clear discharge from the urethra, which is most abundant in the morning. Patients may also notice a symptom such as the presence of white flakes or strings in the urine.
Types of prostatitis
Acute bacterial. Acute prostatitis develops as a result of infection of the prostate gland with Staphylococcus aureus, Escherichia coli, Enterococcus and other pathogenic bacteria. If left untreated, this disease can cause blood poisoning. In this case, the man needs to be urgently hospitalized.
Symptoms observed with this type of prostatitis:
- chills and fever (38 °C and above);
- sharp or nagging pain in the groin, lower back and perineum;
- frequent urge to urinate;
- painful urination;
- difficulty urinating and acute urinary retention;
- white or colorless discharge from the urethra.
Chronic bacterial. The recurrent form of the disease occurs as a result of infection entering the gland. The development of prostatitis is promoted by chronic hypothermia, prolonged sexual abstinence, and untimely urination. Chronic prostatitis, if left untreated, can provoke cystitis, since the focus of inflammation in the prostate is a reservoir of bacteria that affects the genitourinary tract.
Symptoms of chronic prostatitis:
- pain in the scrotum, lower abdomen, perineum;
- dysuria;
- potency disorders.
Chronic nonbacterial. The causes of the disease include the entry of viruses or bacteria into the prostate (tuberculosis bacillus, trichomonas, chlamydia), autoimmune processes, and penetration of urine into the gland. Chronic prostatitis accounts for up to 95% of all types of prostate inflammation.
Signs of prostatitis are:
- chronic pain in the pelvic area (bothers a man for at least 3 months);
- recurrent pain in the groin;
- absence of symptoms of inflammation in urine, semen and prostate secretions.
Chronic asymptomatic. Asymptomatic chronic prostatitis is not associated with bacterial infection and symptomatic prostatic syndromes. There is an assumption that this disease is an age-related physiological feature.
Symptoms of this type of chronic prostatitis:
- absence of major disease syndromes;
- increased levels of leukocytes and bacteria in the urine.
The main symptom of the disease - the presence of infection in the gland - can only be detected through a biopsy or during surgical operations in the treatment of various prostate pathologies (adenoma, cancer).
Stagnant. Prostatitis develops not only against the background of anatomical and physiological changes in the venous and other body systems. The main cause of the disease is irregular sex life.
Signs of prostatitis:
- aching pain in the perineum, radiating to the sacrum;
- frequent urination in the morning;
- slight difficulty in the outflow of urine (a symptom observed in the chronic form of the disease);
- weakening of erection;
- decreased libido;
- “pallor” of orgiastic sensations during ejaculation.
Diagnosis of acute and chronic prostatitis
To select the correct treatment method, the doctor prescribes a comprehensive diagnosis of the condition of the genitourinary system, including the following methods.
Digital rectal examination. If prostatitis is suspected, the urologist performs a digital examination. The back surface of the prostate is adjacent to the rectum, so by inserting a finger through the anus, the doctor can determine the condition of the gland. During the study, its size, consistency and shape, surface condition, and pain are determined.
Signs of prostatitis in men include:
- soft, inelastic consistency of the prostate;
- pain on palpation;
- increased size of the gland;
- immobility of the rectal mucosa above the prostate.
Ultrasonography. Ultrasound of the prostate is prescribed before the start of treatment for acute prostatitis, in order to identify/exclude an abscess of the gland, and in the chronic course of the disease - to identify cysts and stones of the prostate, as well as the degree of compression of the urethra. The most effective method is ultrasound through the rectum.
Uroflowmetry. This method of diagnosing prostatitis is used to study indicators of the urination process: the duration of this physiological act and the rate of urine outflow. If the rate is 15 ml/s or more, this indicates normal urethral patency. A sign of prostatitis is a decrease in this value below 10 ml/s. This speed is a consequence of poor patency of the urinary tract.
Cystoscopy. To conduct the study, an endoscopic imaging system is inserted into the bladder. This method for diagnosing acute and chronic prostatitis is used when diseases such as cancer, cystitis or bladder injury are suspected.
To make a diagnosis and determine the microorganism that caused the disease, in the presence of symptoms of chronic prostatitis or acute inflammation, urine and prostate secretions are examined. A sign of the presence of pathogenic microflora is an increased number of leukocytes in biological material. To create an effective course of treatment, the type of bacteria is determined by PCR, RIF and culture on a nutrient medium.
Interpretation of laboratory results
| Prostate secret |
Third portion of urine (after prostate massage) |
|||
| HP form | Leukocyte count, uv. x 400 |
results sowing |
Leukocyte count, uv. x 400 |
Culture results |
| Bacterial | >10 | + | + | |
| Chronic pelvic pain inflammatory syndrome | >10 | - | The difference between the number of leukocytes in the third portion of urine and the second portion of urine is ≥ 10 | - |
| Non-inflammatory chronic pelvic pain syndrome | <10 | - | - | - |
Prevention of prostatitis
Physical activity. To prevent and treat prostate disease, a man must avoid physical inactivity. Recommended:
- walking (4 km per day or more);
- exercise (squats, jumping, bending);
- training the muscles of the perineum and buttocks (10 tensions and relaxations each).
Proper nutrition. To prevent acute and chronic prostatitis, men need to include foods high in zinc and vitamin B in their diet. It is recommended to eat:
- seafood (oysters, seaweed);
- meat;
- pumpkin seeds;
- walnuts;
- bran;
- kefir;
- Rye bread.
Regular sex life. When preventing and treating the disease, a man must:
- lead a rhythmic sex life;
- avoid interrupted sexual acts;
- avoid casual connections.
Treatment of acute and chronic prostatitis
Treatment of prostate inflammation is carried out using the following methods.
Antibacterial therapy. If prostatitis is bacterial, then treatment involves taking antibiotics. The doctor selects a group of drugs depending on the type of microbes that caused the disease, the sensitivity of the pathogen to various drugs, as well as the presence of contraindications in the patient.
Characteristics of drugs
| A drug | Advantages | Flaws |
| Fluoroquinolones | Excellent bioavailability Equivalent to oral and parenteral pharmacokinetics Active against typical and atypical pathogens |
Affect the central nervous system Phototoxic May cause allergies |
| Macrolides | Moderately active against gram-positive bacteria Penetrates well into prostate tissue Low toxicity |
Insufficiently active against gram-negatives bacteria |
| Tetracyclines | Active against atypical pathogens | Inactive against Pseudomonas aeruginosa Insufficiently active against staphylococci, Escherichia coli |
Hormonal therapy. Treatment with hormones is necessary to restore the normal hormonal balance between androgens and estrogens. Drugs with antiandrogenic activity reduce inflammation of the gland tissue and prevent the disease from progressing to more severe stages.
Prostate massage. This method of treating chronic prostatitis can only be used outside of exacerbations. A man needs to take an inclined position, rest his palms on a couch or table, and place his feet shoulder-width apart. The doctor conducting the treatment puts on sterile gloves, applies an ointment or gel (in some cases a drug with an anesthetic component) to the index finger of the right hand and inserts it through the anus into the rectum. The massage is performed by applying slight pressure until the prostate secretion is released through the opening of the urethra. Treatment involves at least 10 massage sessions.
Physiotherapy. To treat the symptoms of prostatitis, methods are used aimed at normalizing and increasing blood circulation in the pelvic area. This allows you to eliminate congestion and also increase the effectiveness of drug therapy. Treatment is performed by exposing the gland to ultrasonic waves, electromagnetic vibrations, and elevated temperatures (microenemas with warm water).
Surgical intervention. Surgical interventions for prostate disease are rarely used. Such treatment is mandatory for developed complications of acute or chronic prostatitis.
Indications for prostate surgery:
- acute urinary retention as a result of severe narrowing of the urethra;
- abscess (appearance of suppuration on the surface of the gland);
- sclerosis of the gland;
- adenoma that is not amenable to conservative treatment.
Complications of prostatitis
Vesiculitis. Untreated prostatitis can cause inflammation in the seminal vesicles. Symptoms of the disease are pain deep in the pelvis, extending to the sacrum, intensifying with erection and ejaculation, frequent urination, the appearance of blood and/or pus in semen and urine.
Colliculitis and urethritis. Due to its proximity to the excretory flows of the prostate, the seminal tubercle often becomes inflamed as a result of infection from the infected gland entering it. If left untreated, the symptoms of prostatitis are complemented by a characteristic sign of urethritis - burning or tickling in the urethra when urinating. There is also pain during ejaculation as a result of convulsive contraction of the urethra.
Prostate abscess. The appearance of purulent cavities on the surface of the gland is caused by pathogenic bacteria that cause prostatitis. A characteristic symptom of the disease is general weakness, disturbances of consciousness, delirium, a sharp increase in temperature, increased sweating, and chills. Prostate abscess is a severe septic disease, the treatment of which must be carried out in a hospital setting.
Prostate sclerosis. Prostate sclerosis develops against the background of regular exacerbations of chronic prostatitis as a result of non-compliance with the treatment prescribed by the urologist. This disease can develop over several years, but if the hormonal balance in a man’s body is disturbed, rapid development is possible. With sclerosis of the prostate, pain is observed during emptying of the bladder, an intermittent and sluggish stream of urine.
Formation of cysts and stones. The appearance of cysts in the gland is one of the likely options for the progression of chronic prostatitis. Infection of the tumors can cause an abscess and significantly complicate the treatment of the disease. Single and multiple stones can also form in the prostate. With this disease, in addition to the usual symptoms of chronic prostatitis, there are disturbances in the outflow of urine, frequent urination, and pain in the perineum.
Infertility. With chronic prostatitis, the production and motor function of sperm are impaired. If untreated, this disease also affects the vas deferens and seminal vesicles, making them impassable for sperm, so they are not thrown into the urethra during ejaculation. As a result, men who have chronic prostatitis often suffer from infertility.
Chronic inflammation of the prostate gland occurs in men of any age. In most cases, the catalyst is an infectious factor: Trichomonas, staphylococci and gonococci. Bacteria that enter the body provoke inflammation of the urethral canal, the prostate gland itself.
The chronic form of prostatitis is often asymptomatic. The disease itself is determined only after the transition to an acute form. Late diagnosis is also explained by the fact that the first symptoms of chronic prostatitis in men are often ignored.
Statistics show a constant “rejuvenation” of the disease. Increasingly, patients aged 30 years are turning to urologists.
Chronic prostatitis - what is it?
The prostate gland is located under the bladder. The main functions are reduced to protecting the vesica urinaria from the ingress of seminal fluid, as well as the production of prostate secretion, a necessary component of male semen. Inflammation of the gland tissue, provoked by infection, congestion and other factors, gradually becomes permanent.Chronic prostatitis leads to degenerative changes. The structure of the tissues gradually deforms. Often, against the background of inflammation, stones appear in the ducts. Some types of prostatitis cause the development of cancer.
An international classification system has been developed to facilitate differentiation between different prostate diseases.
Chronic prostatitis - causes
It is generally accepted that inflammation of the prostate gland is caused by two main factors: bacterial and abacterial.The first is associated with the entry of pathogens and infections into the patient’s body. Most often, the catalyst is sexually transmitted bacteria.
The second cause of occurrence is not associated with an infectious agent. The catalyst for inflammation can be:
- Hypothermia of the body.
- Hormonal imbalances associated with aging and irregular sex life.
- Bad habits.
- Injury to the pelvic organs.
- Stagnation caused by metabolic disorders and a sedentary lifestyle.
Urologists name several additional factors that aggravate the situation and influence the severe course of the disease:
- Sexual abstinence.
- Inferior ejaculation (choosing interrupted sexual intercourse as a method of contraception).
- Stress.
- Bad habits – alcohol abuse and smoking.
- Poor nutrition.
- Inflammatory diseases suffered in the past. They often act as a cause of prostatitis in chronic form.
Classification of chronic inflammation of the prostate
Varieties of prostatitis received their own ICD-10 code - N41. To clarify the diagnosis and differentiate the infection of the catalyst, a separate classification B95-B97 is used. The symptom rating scale divides the disease into several groups and subgroups:- I - acute inflammation, accompanied by a sharp rise in temperature and fever.
- II - chronic prostatitis, provoked by an infectious factor.
- III - class includes a disease in which pelvic pain syndrome begins to manifest itself. It is customary to distinguish two subgroups:
- IIIA - there are signs of an inflammatory process. Low-grade fever is maintained.
- IIIB - no inflammation.
- IV - prostatitis in which there are no symptomatic manifestations. Deviations from the norm are detected exclusively by instrumental diagnostic methods.
- N41.1 is diagnosed with chronic prostatitis.
- N41.8 inflammatory diseases of the prostate gland.
- N41.9 an exact diagnosis has not been made.
How does chronic prostatitis manifest itself - its symptoms
The first signs of chronic prostatitis in men appear at an advanced stage of the disease. Often, early development has no clinical manifestations. Symptoms, even if present, are temporary, short-term and of low intensity.According to clinical manifestations, three stages of prostatitis development are distinguished:
- Initial indirect signs of chronic prostatitis - as already noted, the onset of the disease is not expressed by clearly distinguishable symptoms. Manifestations are subtle or absent altogether.
Signs you should pay attention to: burning sensation during ejaculation, decreased potency, painful urination. - Secondary signs of chronic inflammation of the prostate - at this stage, pathological changes occur in the structure of tissues, the appearance of scar-like formations, and a decrease in genitourinary function.
The stage is characterized by a sharp deterioration in potency and urination, increased sweating, severe pain in the pelvic area, lumbar spine, and scrotum. - Signs of an advanced disease - the prostate ceases to function normally. Healthy tissues begin to metamorphose. The gland increases in size. Blood and pus appear in the urine, there is a constant feeling of incomplete emptying of the bladder, and night trips to the toilet become more frequent. Erectile function decreases so much that we can talk about complete sexual impotence.
Pain syndrome
Chronic prostatitis in the late stage of development has pronounced symptoms. Characteristic clinical manifestations are pain of severe intensity that does not go away on its own and requires the use of analgesics and antispasmodics.Pain syndrome accompanies the entire period of development of the disease. During the primary signs of prostatitis, discomfort and burning in the urethral canal are of low intensity and are therefore often ignored. Pain is often falsely attributed to radiculitis or fatigue. After pain relief or taking an antispasmodic such as No-Shpa, the symptom usually goes away.
Over time, the clinical picture becomes more intense. The pain syndrome manifests itself more intensely and remains after taking analgesics. Unpleasant sensations accompany every act of urination, defecation and ejaculation.
The pain radiates from the spine to the scrotum, sometimes to the limbs, and is accompanied by cramps and numbness. Skin rashes, itching and burning of tissue in the prostate and genital areas are a normal reaction of the body to internal inflammation.
Temperature increase
Chronic inflammation of the prostate gland in acute form is accompanied by fever and fever. There is a sharp increase in temperature, reaching 39-40°. The indicators are stable. Body temperature does not decrease even after taking antipyretics.Sluggish prostatitis is characterized by a low-grade fever. Constant indicators of chronic inflammation, within 37-37.2°.
Reducing the temperature and taking medications on your own to reduce external manifestations is strictly prohibited!
Dysuria
The first signs of chronic prostatitis appear in various urination disorders. Over time, the symptoms become more intense, which helps to identify the disease. Manifestations of dysuria:- Frequent urge to go to the toilet at night.
- Feeling of incomplete emptying of the bladder.
- Hematuria (blood in urine), purulent discharge.
- Pain during urination.
Clinical signs and the intensity of their manifestation directly affect the diagnosis and require mandatory additional research. Symptoms may indicate other inflammatory diseases of the genitourinary system, etc.
Disorders of the genital organs
Chronic prostatitis leads to the appearance of scar formations that impair blood supply. Lack of nutrients leads to the following manifestations:- Decreased potency - with chronic prostatitis, sexual disorders are observed. One of the characteristic symptoms is a normal erection, which sharply decreases during sexual intercourse. In the advanced stage, stable potency occurs.
- Infertility - after the appearance of scars in the seminal ducts, the viability of sperm decreases. Inflammation changes the structure and composition of the ejaculate. In the advanced stage, the sperm thickens and lumps appear.
- Pain during sexual intercourse - discharge from the urethral canal is observed. During sexual relations, discomfort and painful symptoms are felt, especially during ejaculation. Often psychosomatic reasons lead to persistent impotence of the patient.
The main symptoms of chronic prostatitis: pain, increased body temperature, dysuria, dysfunction of the genital organs. When making a diagnosis, the intensity and duration of the period from the onset of clinical signs, as well as related symptoms, are taken into account.
How can chronic inflammation of the prostate be detected?
Prostatitis has no symptoms that can accurately differentiate the disease. Some disorders of the genitourinary system have similar symptoms. An accurate diagnosis can be made only after a complete examination of the patient, including laboratory tests and methods of instrumental detection of the disease.Having suspected the presence of disturbances in the functioning of the pelvic organs, the urologist will prescribe a mandatory rectal examination. If tissue changes are detected upon palpation, several laboratory tests are prescribed.
Laboratory research methods
Clinical blood and urine tests differentiate the presence of an inflammatory process and can often explain the catalyst for the development of the disease. When making a diagnosis, additional information will be required from the results of the following laboratory tests:- Cytological and bacteriological analysis of urine. The PSA level is established. Protein levels increase sharply with inflammation of the gland tissue.
- Taking a smear from the urethra.
- Microscopy of prostate secretions - based on the results, malfunctions in the prostate gland are determined. Differentiate cancer from chronic tissue inflammation.
Sowing prostate secretions is prohibited during an acute period of the disease, accompanied by high body temperature, exacerbation of hemorrhoids, or fissures in the anus. - Tests for STIs (sexually transmitted infections) - one of the common catalysts for inflammation of the prostate gland is pathogenic microorganisms.
Trichomonas, staphylococci and gonococci can all cause the disease. Prostatitis develops during the active phase of bacterial proliferation, and after the infection has already been cured.
Laboratory tests are an obligatory component of the diagnosis of prostatitis and the subsequent choice of treatment method.
Instrumental detection of the disease
There are three main methods of testing for prostatitis. Each instrumental diagnostic method provides information about changes in the structure of gland tissue and has its own indications and contraindications:- Tomography - MRI is often prescribed to diagnose chronic prostatitis. The study allows you to obtain a layer-by-layer image of the prostate. MRI signs accurately indicate chronic inflammation, and also indicate the beginning of tissue degeneration into a malignant formation.
Magnetic resonance technology is absolutely harmless, but has contraindications due to the inability to study patients with pacemakers, metal staples and shunts (left during surgical operations). - Transrectal TRUS is an informative method that reliably indicates the presence of inflammation. Sonographic signs of structural changes in the prostate gland according to the type of chronic prostatitis include: deviations from the norm in volume and size, structure, and the presence of pathological formations.
Ultrasound techniques are not prescribed for acute inflammation of the rectum, the presence of cracks in the anus, or hemorrhoids. - Ultrasound - transabdominal technique has no contraindications. The method is less informative compared to TRUS and MRI. Sonographic signs make it difficult to determine the space of the abdominal cavity. Diagnostic results are often controversial and require clarification. The advantage of ultrasound is the simplicity and speed of the study.
The accuracy of the echographic picture largely depends on the experience of the doctor conducting the study.
Differential search for disease
After receiving the results of clinical and biochemical studies, the symptoms of chronic inflammation of the prostate gland are assessed. Common diagnostic standards have been developed that are valid throughout the world.To facilitate the task of the urologist, the NIH-CPSI symptom index has been invented, made in the form of a questionnaire or survey. The doctor fills out the fields in the document and then makes a diagnosis.
There are computer programs based on the NIH-CPSI index. The doctor is required to fill out a questionnaire, and the system will independently conduct a summary assessment of symptoms for chronic prostatitis. The effectiveness of the technique has been proven all over the world.
After calculating the results of the questionnaire, when making a diagnosis, an additional assessment of instrumental and clinical studies is taken into account: the presence of echo signs of chronic prostatitis, an increased PSA level, identification of an infectious marker by microscopy of secretions. The more data the urologist has, the more accurate the result will be.
What is dangerous about chronic prostatitis - its consequences
The consequences of chronic prostatitis in men are disorders in the functioning of the genitourinary system. These include:- Impotence.
- Acute urinary retention.
- Infertility.
When making a diagnosis, the presence of prostatic intraepithelial neoplasia, a harbinger of oncology and fibrous changes, is taken into account. Advanced disease often leads to the need for surgery: prostatectomy.
Diagnosis of prostatitis and differentiation of the disease from related disorders of the pelvic organs is an important task for doctors and patients. Detection of the first symptoms depends entirely on the man himself. If you experience any discomfort when urinating, decreased erection, or persistent low-grade fever, these are reasons to immediately seek professional medical help. Delay is dangerous!
