Prostatitis - symptoms and treatment

What is prostatitis? We will analyze the causes of the event, the diagnosis and the methods of 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 lower back, perineum or pelvic region, as well as disturbances 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, which further leads to various problems with urination. 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 ages, but most often the disease 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 gradually and its manifestations are constant and long-term (chronic). The chronic form is much more common than the acute one. Chronic prostatitis ranks fifth among the twenty leading urological diagnoses.

Prostatitis can be an independent disease or be associated 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 thousand of the population, then in 2017 the primary incidence was 203 per 100 thousand of the population.

The reasons for the development of prostatitisthey are bacterial (infectious) and non-bacterial (non-infectious).Infectious prostatitismore common in males under the age of 35. Most often this form of the disease is caused by gram-negative microorganisms, in particular 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 pathogen spectrum is broader and may include atypical pathogens. It should be remembered that chronic bacterial prostatitis is a polyetiological disease, that is, it can have several causes.

Factors contributing to the development of inflammationin the prostate gland:

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

Chronic non-bacterial prostatitisdiagnosed in patients complaining of chronic pain in the prostate area, while an infectious (bacterial) causative agent of the disease was not found in them. Despite numerous studies, the cause of this type of chronic prostatitis is not fully understood, however, there are some factors that can cause it to develop:

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

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

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

• 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 (autonomic disorders of the prostate gland) - 20-30%.

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

Symptoms of prostatitis

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

• pain in the lumbar region;
• feelings 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 diagnosedacute 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 strong onset of the disease with a vivid clinical picture. This is a serious disease.

Men diagnosedchronic bacterial prostatitisnotice symptoms of a periodic nature, which increase and decrease. With an exacerbation, pain and discomfort are noted. Pain sensations are mainly located at the base of the penis, around or above the anus. Additionally, the 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 and frequent urination, frequent stimulation. These symptoms can be confused with the manifestations of acute bacterial prostatitis, but 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 need to urgently consult a doctor.

If the standard modern examination has not established 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(the term has been in use since 2003). In the presence of 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 nonbacterial 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 in one "target organ" or in several pelvic organs. Most often, with this form of prostatitis, pain is localized in the prostate gland (46%).

In chronic prostatitis, sexual disorders have a number of characteristics. First, all components of a man's copulative (sexual) function are disturbed at various levels: libido, erection, ejaculation. Second, sexual dysfunction mainly occurs 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 detected by 30% of chronic prostatitis patients, 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 transrectal via the lymphatic route. Diarrhea and constipation associated with reduced rectal barrier function are considered a trigger in chronic prostatitis. However, the mechanism of penetration of microorganisms into the prostate is not yet clearly established.

Urinary disorder with prostatitis can result from:

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

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

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. Prostatitis / chronic non-bacterial 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,manifests itself as recurrent episodes of exacerbation with the presence or absence of complete remissions between them. Symptoms are generally less severe than those of acute prostatitis.

National American Institutes of Health classification. . .

• Type I.(acute bacterial prostatitis) - acute infection of the prostate gland: the symptoms of the disease appear suddenly. Chills, fever, pain throughout the body, weakness, pain in the lower back and genitals, frequent and painful urination, pain during ejaculation. Potential symptoms of acute bacterial prostatitis include blood in the urine and / or semen. It's 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 are less pronounced. Several courses of antibiotic therapy may be required.
• III type(chronic non-bacterial prostatitis and chronic pelvic pain syndrome): no evidence of infection.
• III A type: presence of leukocytes in the ejaculate / prostatic secretion / third portion of urine obtained after prostate massage.
• III type B: absence of leukocytes in the ejaculate / prostatic secretion / third portion of urine obtained after prostate massage. Pain in the lower back and genitals, frequent urge to urinate, difficulty urinating (often at night), burning or painful urination, and ejaculation. It accounts for about 90% of all cases of prostatitis. There are no known causes or clinically proven treatments.
• IV type(asymptomatic inflammatory prostatitis): sometimes an increase in white blood cell count. No treatment required. Detected on prostate biopsy.

The boundaries between the various forms of prostatitis are blurred.

Complications of prostatitis

With inflammatory lesions of the prostate gland, neighboring organs are involved in the pathological process: the seminal tubercle, Cooper's glands, 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 localized in the groin area and deep in the pelvis, radiating to the sacrum. The pain is usually one-sided, as both seminal vesicles are affected to varying degrees. Vesiculitis can be asymptomatic. Patients' only complaint may be the presence of blood in the semen. Periodic pyuria (pus in the urine) and pyospermia (pus in the ejaculate) are also noted.

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

Abscess of the prostate gland.Pathogens that cause prostatitis can also result in an abscess of the prostate gland. This is a severe septic (bacterial) disease, which is accompanied by weakness, fever, chills with profuse sweat. In some cases, disturbances of consciousness and delirium are observed. The patient needs hospitalization.

Prostate sclerosis (fibrosis).This is a late complication of prostatitis, which is based on the replacement of prostate tissue with scarring (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 rule, sclerotic symptoms develop long after the onset of the inflammatory process in the prostate gland.

Prostate cyst.These formations can contribute to the formation of stones 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 exam.

Prostate stones.They are quite common. The causes of the disease are not fully understood, but most experts agree that they result from a prolonged inflammatory process in the prostate gland. The stones are single 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 excessively stretched and separate cysts are formed, into which the infection enters. Patients with stones in the prostate gland are faced with constant dull pain in the perineum. Painful sensations spread to the glans and cause a frequent urge to urinate, which becomes difficult and painful.

Infertility.Long-term chronic prostatitis primarily 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 fewer than before).

Ejaculation disorder.Prostatitis of all forms causes sexual dysfunction. At first, patients face premature ejaculation, with a normal erection, which then weakens and the degree of orgasm decreases. 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 ailment is particularly painful for men.

Diagnosis of prostatitis

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

What questions might the doctor ask

At the appointment, the doctor will certainly 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 the sperm (presence of pus and blood).

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

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

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

The survey will include:

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

• Tests of secretions from the prostate, urine and / or ejaculate.
• Identification of urogenital infection.
• Ultrasound examination of the urinary system (kidneys, prostate, bladder with determination of the urinary residue).

• Urodynamic study.

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

The most important study in the examination of patients with acute bacterial prostatitis is the culture of prostatic secretions. To classify chronic prostatitis, quantitative culture and microscopy of urine samples and prostatic 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 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 only in 5-10% of cases can detect an infection, which ultimately 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. After the end of the treatment, the PSA level decreases in 40% of 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 medicines help relieve urination and relax the muscles of the prostate gland and bladder. Some patients are prescribed drugs to lower hormone levels, which can help shrink the gland and reduce discomfort. Muscle relaxants can help relieve pain caused by an edematous prostate putting pressure on nearby muscles. Non-steroidal anti-inflammatory drugs (NSAIDs) can help if pain is present.

Standard antibiotic therapy in most cases does not lead to a decrease in the number of relapses of the disease, so an integrated approach is often used, and it is also prescribedauxiliary 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;
• microwave hyperthermia and thermotherapy;
• electrical stimulation with modulated currents of skin or rectal electrodes;
• acupuncture (acupuncture).

The efficacy and safety of these treatments are still being studied. Also used for the treatment of prostatitisfolk methods, for examplehirudotherapy.The efficacy and safety of this method for the treatment of prostatitis has not been proven.

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 from individual groups of researchers.

Surgical treatment of prostatitis

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

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

Diet and lifestyle for prostatitis

No special diet is needed for prostatitis, but eating plenty 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 should 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 that you follow a healthy lifestyle, drink more fluids and limit caffeine and alcohol.

Forecast. Prophylaxis

Acute prostatitis often becomes chronic, even with prompt and adequate treatment.

It is not always possible to achieve full recovery, however, with proper and consistent therapy and following the doctor's recommendations, discomfort and pain can be eliminated. Independenthome treatment of prostatitisit can be dangerous and lead to complications.

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

1. Drink lots of fluids. Drinking plenty of fluids leads to frequent urination, thus facilitating the flushing 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 the pressure on the prostate. Men who cycle frequently need to use a split seat to relieve pressure on the prostate area.
5. Stay sexually active.