Prostatitis

Prostatitis is a disease characterized by the presence of localized inflammation and / or infection in the prostate gland.

You may experience a wide range of clinical signs and symptoms.

Anatomy

The prostate is a small gland that is part of the male reproductive system and a hormone-dependent organ. The shape and size were compared to a large nut. A normal prostate gland weighs about 20 grams, has a volume of 15-25 ml and is 3 cm long, 4 cm wide and 2 cm deep.

The prostate gland is located in the small pelvis, under the bladder and above the rectum. Passes through the urethra, urethra, glandular thickness. The prostate is surrounded by a capsule of smooth muscle, collagen, and elastic fibers; The anterior, lateral and posterior surfaces are covered with three layers of dense connective tissue (fascia). The posterior surface of the prostate is bordered by the ampulla of the rectum. They are separated by a retrovesic fascia or Denonville fascia that allows palpation of the posterior surface of the prostate gland.

The prostate gland is approximately 70% glandular tissue and 30% fibromuscular stroma. It is customary to divide the body into 3 zones.

Transition zone.The transition zone accounts for 10% of glandular tissue and 20% of malignant prostate tumors. In this area, men develop one of the main age-related diseases - benign prostatic hyperplasia, which can cause you to urinate due to excessive tissue growth.

Central zone.The area surrounding the discharge channels. Glandular tissue consists of connective tissue and muscle elements. Tumors in this area are extremely rare.

Peripheral zone.It covers the back and sides of the prostate gland and contains 70% of glandular tissue. This is an area that is palpated from the rectum and allows the urologist to assess the condition of the prostate gland. Up to 70% of malignant tumors are located in the peripheral zone. Therefore, digital rectal examination is an important diagnostic method and should be performed in patients over 45 years of age.

Prostate functions:

• production of prostate secretion, which is an integral part of sperm and involved in the liquefaction of ejaculation, as well as saturation with various enzymes and vitamins, citric acid, zinc ions, which help to improve sperm motility and activity;
• The prostate contains smooth muscle fibers that help release sperm from the urethra during ejaculation, prevent sperm from entering the bladder, and participate in the urinary retention mechanism.

Prostatitis, benign prostatic hyperplasia and prostate cancer are the three main diseases of the prostate.

All three diseases can occur in the same prostate at the same time. That is, the presence of prostatitis does not exclude the presence of prostate hyperplasia and prostate cancer in the patient, and vice versa.

Causes of prostatitis

According to statistics, prostatitis is the most common urological disease - after prostate hyperplasia and prostate cancer - the third most common disease in men under 50 and in men over 50.

Prostatitis accounts for 6-8% of outpatient urological visits.

The most common cause of prostatitis is E. coli strains, which are found in 80% of cases. More rare pathogens are enterococci, Pseudomonas aeruginosa, Klebsiella and other gram-negative bacteria. The role of sexually transmitted infections (such as chlamydial trachoma) in prostatitis is still unclear and under investigation. In patients with HIV infection and other serious changes in the immune system, the causative agents are cytomegalovirus, mycobacterium tuberculosis, fungi and other rare pathogens. There are data on the presence of microorganisms in the prostate gland that are not detected in standard studies, but play a role in the development of inflammatory changes and the development of subsequent prostatitis symptoms.

Possible causes of prostatitis are:

• urinary intraprostatic reflux as a result of dysfunctional urination (urine, with certain predisposing factors, can enter the prostate gland through the ducts of the prostate and cause an inflammatory process);
• unprotected anal sex;
• narrowing of the circumcision (phimosis);
• autoimmune diseases;
• functional and anatomical changes in the pelvic floor muscles;
• changes in the central nervous system, including functional and anatomical changes in the brain;
• traumatic and unusual sexual activity;
• psychological factors (a number of studies have shown the effect of psychological stress on the development of symptoms of chronic prostatitis - some patients have been diagnosed with psychosomatic disorders with reduced prostatitis symptoms and the possibility of relapse during treatment).

Risk factors for prostatitis include: abstinence or excessive sexual activity, ejaculation restriction, smoking, working at night, a sedentary lifestyle, inadequate fluid intake, and poor diet.

Symptoms

• pain or burning when urinating (dysuria);
• urinary diseases;
• discoloration of urine;
• appearance of blood in the urine;
• abdominal, groin or back pain;
• pain in the perineum;
• pain or discomfort in the penis and testicles;
• pain with ejaculation;
• increased body temperature (with acute bacterial prostatitis).

Diagnostics

According to the well-known NIH classification of prostatitis (US National Institutes of Health), there are four categories of diseases traditionally expressed in Roman numerals:

• I - acute bacterial prostatitis;
• II - chronic bacterial prostatitis;
• III - chronic abacterial prostatitis / chronic pelvic pain syndrome (CP / CPPS);
• IIIa - chronic prostatitis / chronic pelvic pain syndrome with signs of inflammation;
• IIIb - chronic prostatitis / chronic pelvic pain syndrome without signs of inflammation;
• IV - asymptomatic (asymptomatic) chronic prostatitis.

Despite the prevalence of prostatitis, acute bacterial prostatitis is not common - 5% of all cases of the disease. However, its diagnosis is quite simple, because the picture of the disease is most pronounced: a man often complains of painful urination, pain in the abdomen and perineum. An increase in body temperature is characteristic, and often to high values - less than 39 ° C.

The diagnosis of acute bacterial prostatitis involves a digital rectal examination (rectal examination) that involves feeling (palpating) the prostate gland through the anus (rectum) with the index finger.

Digital rectal examination (DRE) is an important diagnostic manipulation if any pathology of the prostate gland is suspected. Therefore, men are advised not to refuse to hold it.

In acute bacterial prostatitis, the prostate is acutely painful, edematous, and most enlarged during palpation. Ultrasound examination can show not only the enlargement of the prostate gland, but also the foci of purulent adhesions of prostate tissue (abscess) - but this is rare and is usually the result of a working process.

Laboratory diagnosis primarily involves a general urine test that shows an increase in the number of leukocytes. Bacteriological urine culture is recommended. Based on the results of the analysis, it is possible to determine the presence of bacteria and sensitivity to antibiotics, and thus adjust the prescribed antibiotic therapy. A general blood test is also done to assess the general condition of the body and its response to the inflammatory process.

Taking prostate secretions for the diagnosis of acute prostatitis is contraindicated due to the increased risk of a life-threatening condition: bacteremia and sepsis. Determination of oncomarker (PSA) and its fractions is not recommended - due to low data content and data distortion in the background of inflammation.

Treatment of prostatitis

Antibiotic therapy is the main therapy for all categories of prostatitis patients.

Alpha-blockers are also an effective group of drugs. As a result of their actions, the tone of the smooth muscles of the prostate gland, bladder neck and prostate part of the urethra decreases, thereby improving urination and reducing the likelihood of urine entering the prostate gland (urinary intraprostatic reflux), which is one of the causes of prostatitis. The most effective and popular drugs are Tamsulosin and Silodosin. They are also widely used to improve urination in patients with prostate hyperplasia.

It is possible to use anti-inflammatory drugs (Diclofenac), which effectively reduce pain and discomfort during urination, reduce prostate swelling, and at the same time help to improve the quality of urinary excretion.

Acute bacterial prostatitis is often the reason for hospitalization in a hospital where antibiotic therapy is prescribed in the form of intravenous injections. Once the patient's condition has stabilized, the patient continues to take antibiotics in tablet form for 15 days or more to prevent the transition from acute prostatitis to chronic bacterial prostatitis.

According to statistics, 10% of patients with acute prostatitis develop chronic bacterial prostatitis. Another 10% of patients will develop chronic pelvic pain syndrome (chronic prostatitis IIIb) in the future.

How is prostatitis treated in the clinic?

Urologists treat prostatitis and other diseases of the genitourinary system on the basis of international clinical guidelines. This means that they not only use their professional knowledge, but also are guided by scientifically proven and accepted world-class methods of diagnosis and therapy.

Our doctors do not prescribe ineffective drugs and examinations "just in case" and do not treat non-existent diseases. When making a diagnosis, urologists rely on information obtained from the patient's examination, clinical picture, laboratory and instrumental studies. If surgical treatment is required, surgery is performed at the clinic.