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prostatitis

symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the prostate gland (prostate) in men, which has a negative impact on both sexual function and the urination process.Pain in the perineum, groin, lower back and pelvic area, disturbances in urodynamics (urine leakage) may indicate the presence of prostatitis.Untreated prostatitis can cause male infertility and prostate cancer.

This is one of the most common male diseases that requires careful attention and competent systemic treatment.You will find exactly such an approach to solving the problem of prostatitis in the urology department of a professional clinic.Highly qualified urologists-andrologists have been successfully treating acute and chronic prostatitis for many years.Complex therapy, careful attention and an individual approach to each case inevitably lead patients to recovery and stable, long-term remission.

Distribution

Prostatitis is in 5th place among 20 main urological diagnoses.It is estimated that at the age of 30, 30% of the male population suffers from prostatitis, at the age of 40 - 40%, and after the age of 50, almost all men in one way or another bear the burden of this disease.And if by the age of 35 mostly infectious prostatitis is registered, then in older age the non-infectious form prevails and in general it is diagnosed several times more often than bacterial inflammation of the prostate.

Anatomy and physiology of the prostate gland

The prostate gland (prostate) is located in the lower front part of the pelvis, below the bladder.It consists of glandular and smooth muscle tissue surrounded by a fibrous capsule.The urethra passes through the body of the prostate from the bladder into which the ejaculatory ducts open.

The prostate is a hormone-dependent organ.It is formed and functions under the influence of male hormones - androgens.Testosterone plays a leading role in this process.

The prostate gland is connected to the seminal tubercle, which acts as a valve for the ejaculatory duct.As part of the male reproductive system, the prostate affects erection, ejaculation and orgasm.The nerves responsible for erection pass through the gland.In the chronic course of the disease, they are involved in the inflammatory process and erectile dysfunction develops.

The prostate produces a secretion that is part of semen.Creates favorable conditions for sperm activity.Therefore, male infertility can occur with chronic gland dysfunction.

Pathogenesis

There are two main reasons for the development of prostatitis:

  • stagnation of prostate secretion against the background of impaired blood circulation and lymphatic drainage in the gland itself and neighboring organs;
  • pathogenic and conditionally pathogenic microflora.

Acute prostatitis is usually associated with an infection of the prostate tissue.But, as a rule, both factors are interconnected and together create a vicious circle that complicates the treatment of prostatitis.

An inflamed prostate gland becomes painful.Pain can be felt in the perineum, groin, pelvis and lower back.Sharply intensifies on palpation during rectal digital examination or defecation.

The prostate increases in size, pinching the urethra.This makes it difficult for urine to flow out of the bladder.The stream of urine becomes weak.The patient must tense his abdominal muscles in order for the act of urination to take place.In acute cases, urinary tract obstruction and acute urinary retention sometimes occur.

Inflammation leads to disruption of the outflow of prostatic juice and its stagnation.The resulting edema disrupts the processes of cell metabolism and respiration in the gland.This creates conditions for the process to become chronic.In case of prolonged prostatitis, neighboring organs can become inflamed: the seminal tubercle, Cooper's glands, seminal vesicles.The chronic form of the disease is associated with risks of developing male infertility, adenoma and prostate cancer.

In recent years, it has been established that in 70-80% of cases, prostatitis occurs due to stagnant processes in the gland.Venous disorders are less common, but they also cause prostatitis, especially if accompanied by hemorrhoids and varicocele on the left (enlargement of the testicular vein).

Classification

The US National Institutes of Health identifies 4 categories of prostatitis:

  • Acute prostatitis (Category I)
  • Chronic bacterial prostatitis (Category II)
  • Chronic Prostatitis / Chronic Pelvic Pain Syndrome (Category III)
  • Asymptomatic chronic prostatitis (Category IV)

Due to its appearance, prostatitis is divided into two types:

  • Non-infectious
  • Infectious

The inflammatory process can develop quickly, accompanied by bright symptoms (acute stage) or slowly with erased, gradually increasing symptoms.

Non-infectious prostatitisin most cases, it is associated with stagnation of prostate secretion and impaired blood circulation and lymph flow in the gland itself and nearby organs.

Infectious prostatitisdevelops due to the penetration of pathogenic or opportunistic microflora into the tissue of the prostate: bacteria, viruses, fungi.There are different ways that an infection can enter the prostate:

  • Urinogenic (ascending): the portal of entry is the urethra.It should be noted that the infection can also enter in a descending way, for example, with purulent pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphogenic: infection from adjacent pelvic organs can enter the prostate through the lymph due to inflammation of the rectum (proctitis) or bladder (cystitis), as well as from infected hemorrhoidal veins.
  • Hematogenous (through the blood): caused by the presence in the body of foci of chronic infection (tonsillitis, carious teeth) or complications of acute infections (influenza, acute respiratory infections, tonsillitis, etc.).

The most common causes of prostatitis are:

  • bacteria: Escherichia coli, Proteus, Gardnerella (gram-negative);staphylococci, streptococci (gram-positive);
  • viruses (influenza, herpes, cytomegalovirus, ARVI pathogens);
  • mycoplasma;
  • chlamydia;
  • specific flora (gonococci, trichomonads, mycobacteria tuberculosis).

According to the nature of the course, prostatitis occurs:

  • Spicy
  • Chronic

Acute prostatitisusually occurs under the influence of pathogenic (opportunistic) microflora in the presence of predisposing factors.It has a rapid course and pronounced symptoms.If not treated in time, a purulent process can develop, leading to melting of the prostate tissue.With improper treatment, acute prostatitis often becomes chronic.

Chronic prostatitisthere is a milder course, erased symptoms.However, it can worsen from time to time, and then the symptoms will correspond to an acute process.However, complete remission between exacerbations does not always occur, and the patient may constantly experience discomfort.Chronic prostatitis can cause impotence, male infertility, prostate adenoma or cancer.

There is a chronic asymptomatic form of the disease, when the patient has no complaints, but the prostatic secretion contains an increased number of purulent elements (leukocytes).

Complications

Without proper therapy, the inflammatory process can lead to purulent melting of the prostate tissue.In addition, inflammation can spread to nearby organs: seminal tuberculosis, Cooper's glands, seminal vesicles, urethra.Accordingly, the following complications may occur:

  • Abscess of the prostate
  • Sclerosis/fibrosis of the prostate (functional tissue of the gland is replaced by connective tissue)
  • Prostate cysts
  • Stones in the prostate
  • Vesiculitis (inflammation of the seminal vesicles)
  • Coliculitis (inflammation of the seminal tubercle)
  • Epididymorchitis (inflammation of the testicles and their appendages)
  • Posterior urethritis
  • Erectile dysfunction/impotence
  • Ejaculation disorder
  • Infertility
  • Adenoma of the prostate
  • Prostate cancer

Symptoms

Different forms of prostatitis have their own characteristics and severity of symptoms.In general, the following manifestations are characteristic of prostatitis:

  • Pain in the groin, lower back, perineum (may radiate along the spermatic cords).
  • The pain worsens with defecation and digital rectal examination.
  • Urodynamic disorders (frequent urination, retention of urine, difficulty urinating, weak stream, incomplete emptying of the bladder).
  • Prostatorrhea (involuntary discharge of prostate juice, especially in the morning and during bowel movements).
  • Disorders of sexual function (reduced libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • The temperature rises to 39-40 degrees
  • Acute urinary retention
  • General intoxication
  • Leukocyturia, albumen and mucus in the urine
  • Blood in urine and semen
  • Leukocytosis in prostatic secretion
  • Hypoechogenicity and enlargement of the gland, increased blood flow according to ultrasound data

Symptoms of chronic prostatitis

  • Body temperature usually does not exceed 37 ° C
  • Pain sensations are dulled and smoothed
  • Discharge from urethra during bowel movement
  • Urinary disorders
  • Decreased libido
  • Erectile dysfunction
  • Ejaculation disorders (premature or delayed ejaculation)

Reasons

The main reasons for the development of prostatitis are infections and stagnation of prostatic secretion.The following factors contribute to the occurrence of prostatitis:

  • Infections and opportunistic flora with weakened immunity
  • Lack of physical activity
  • "Sedentary" work
  • Long-term sexual abstinence
  • Interrupted intercourse (with delayed ejaculation)
  • Excessive sexual activity leading to exhaustion of the gland
  • Alcohol abuse
  • Reduced local immunity (hypothermia, use of immunosuppressants, immune deficiency, autoimmune diseases)
  • Pelvic organ injuries
  • Manipulations of the prostate and nearby organs (prostate biopsy, surgery, catheterization, cystoscopy, etc.)
  • Chronic diarrhea or constipation

Diagnosis

Many methods are used to detect prostatitis, which can be divided into 3 groups: digital rectal examination, laboratory tests and instrumental methods.

Digital rectal examinationperformed by a urologist-andrologist after talking with the patient.This method allows you to evaluate the size, shape and some characteristics of the structure of the prostate gland.If the size of the prostate is increased and the procedure itself is painful for the patient, the doctor can pre-diagnose prostatitis.

If the case is not acute, the doctor can massage the prostate during the examination to obtain prostatic secretion, the study of which is an important part of the diagnosis of prostatitis.If acute bacterial prostatitis is suspected, prostate massage is contraindicated: such manipulation can lead to the spread of the pathogen and blood poisoning.

To clarify the diagnosis, the patient will be asked to undergoinstrumental studies, such as:

  • transrectal ultrasound examination of the prostate gland and pelvic organs (reveals structural features, the presence of inflammation and purulent foci, stones, cysts and other neoplasms);
  • Dopplerography (features of blood flow in the gland);
  • uroflowmetry (determining the speed and time of urination);
  • nuclear magnetic resonance of the pelvic organs (a highly informative and safe study that allows differential diagnosis with other diseases).

If necessary, diagnostics of the nearby organs of the genitourinary system are carried out: urethroscopy, urethrography and urethrocystography.

Laboratory studiesare a necessary component of the diagnosis of prostatitis:

  • General urine analysis (before and after prostate massage)
  • General blood test
  • Blood test for proteins from the acute phase of inflammation (C-reactive protein, etc.)
  • Microscopic examination of prostatic discharge after finger massage
  • Microscopic examination of urethral scrapings
  • Spermogram (cytology and biochemistry of sperm)
  • Culture of urine, prostatic secretion and semen
  • Determination of prostate specific antigen (PSA)
  • Needle biopsy of the prostate and histological examination of glandular tissue

The last two tests are necessary to rule out prostate cancer or adenoma.

The modern one has an excellent highly informative diagnostic base.Urologists have extensive experience in the diagnosis and successful treatment of various forms of prostatitis, and the status of a multidisciplinary clinic allows you to use the services of specialists in related fields.The medical center has developed research packages that include all necessary types of diagnostics at a very attractive price. 

Treatment

Treating prostatitis is not an easy task.It requires a thoughtful, integrated approach.The treatment protocol for this disease includes drug therapy and physical therapy procedures, in some cases surgical intervention is necessary.

Drug therapy

It includes the use of the following drugs:

  • Antibiotics (after determining sensitivity to them)
  • Antiseptics (local)
  • Vascular drugs (improving microcirculation in the prostate)
  • Nonsteroidal anti-inflammatory drugs
  • Alpha-1 blockers (for urinary problems)
  • Enzyme preparations (dilute prostate secretion, stimulate the immune system, relieve inflammation)
  • Immunomodulators
  • Antidepressants

Physiotherapy treatment

  • Electrical stimulation of the prostate (electrophoresis, galvanization, pulse action)
  • Vibration massage
  • Rectal sensor laser therapy (for chronic prostatitis)

In chronic prostatitis, prostate massage can be used as a therapeutic procedure.In the acute stage of the disease, this manipulation is not performed to avoid the spread of infection and sepsis.

Surgical treatment

Surgery for prostatitis is rarely resorted to.This need arises in case of serious suppuration of prostate tissue, lack of positive dynamics in drug treatment and pathological enlargement of the prostate gland blocking the urethra.

Forecast

With early diagnosis and adequate treatment, acute prostatitis can be overcome.However, quite often the process becomes chronic even with proper and timely therapy.

If the treatment is incorrect and the treatment deadlines are not observed (several months), the disease usually turns into a chronic form.Chronic prostatitis significantly affects a man's quality of life, as it affects not only urinary function, but also sexual function.Erectile dysfunction, loss of orgasmic intensity, ejaculation problems and infertility are observed in 30% of cases.It is completely impossible to cure chronic prostatitis, but with the right approach, a stable remission can be achieved.

Advantages of visiting a professional clinic

  • Successful treatment of various forms of prostatitis
  • Experienced urologists-andrologists with the highest qualifications
  • Multidisciplinary, which allows you to include specialists in related fields in the treatment
  • High-precision modern equipment for diagnosis and treatment
  • Own clinical diagnostic laboratory of European class
  • Comfortable and high-tech hospitals
  • A package of urological diagnostic services at an attractive price

Prevention of prostatitis

  • Choose protected sex to avoid sexually transmitted infections (STIs)
  • Support of the immune system (vitamins, healthy diet, prevention of dysbiosis, reasonable antibiotic therapy, etc.)
  • Avoid hypothermia
  • Lead an active lifestyle
  • Have sex regularly, if possible, with one partner (to avoid prostate stagnation and STIs)
  • Avoid interrupting intercourse (this will relieve sperm stagnation)
  • See your urologist once a year for preventive purposes and twice a year if you are over 50 or have a history of prostate disease.

Frequently asked questions

How informative is the PSA test in diagnosing prostatitis?

Prostate-specific antigen (PSA) is a marker for prostate cancer.It is known that in some cases, prostate cancer has a clinical picture similar to the manifestations of prostatitis.Therefore, the PSA test is used to distinguish between these two diseases.You shouldn't bet on PSA though.This antigen is also increased in prostate adenoma, a benign growth of glandular tissue.In prostatitis, PSA levels can also rise during periods of active inflammation.During the remission phase, it decreases.Therefore, PSA cannot be used as definitive evidence of prostate cancer or prostatitis.

Why is prostatitis difficult to treat?

The capillaries of the prostate have a special structure that creates a hematoprostatic barrier.This makes it difficult for certain types of antibiotics to penetrate the tissue of the gland.In addition, microorganisms tend to form biofilms, which reliably protect them from the action of antibacterial agents.Therefore, modern prostatitis treatment protocols necessarily include proteolytic enzymes that can destroy biofilms.Bacteria become vulnerable and antibiotics work more effectively.Chronic prostatitis, the main characteristic of which is the wide variety of microflora in the culture, is most persistently treated.In approximately 50% of cases, Enterococcus faecalis, resistant to all aminoglycosides and cephalosporins, is cultured.This narrows the list of effective antimicrobial agents, which also complicates treatment.