Chronic prostatitis is a serious problem. Even modern urology can not answer many questions about this pathology. Experts believe that chronic prostatitis is the result of all health problems, including tissue damage, as well as dysfunction of not only the urinary tract and prostate gland, but also other organs.
The pathology is diagnosed mainly in men of reproductive age. In older men, chronic prostatitis is often accompanied by benign prostate neoplasms.
Classification of the disease
The classification of prostatitis was developed in 1995 by scientists from the US National Institutes of Health:
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- 1 type- Acute bacterial prostatitis. Inflammation of the prostate gland is diagnosed in 5% of cases.
- type 2- Bacterial chronic prostatitis.
- 3 types- chronic bacterial prostatitis. There is another name for this pathology - chronic pelvic pain syndrome.
- Type 3A- Inflammatory form of chronic prostatitis. Chronic prostatitis is diagnosed in 60% of cases.
- Type 3B- Non-inflammatory form of chronic prostatitis. The diagnosis is made in 30% of cases.
- 4 types- asymptomatic prostatitis.
There is also a classification of chronic prostatitis, developed in 1990.
Symptoms of chronic prostatitis
Discomfort and pain in the pelvic region lasting more than 3 months are the main symptoms of chronic prostatitis.
In addition, urinary disorders and erectile dysfunction are observed:
- The pain occurs in the perineum and can spread to the anus, groin, inner thigh, sacrum, lower back and scrotum. On the one hand, pain in the testicles is often not a sign of chronic prostatitis;
- erection does not occur despite adequate conditions, but complete impotence is not observed;
- premature ejaculation is observed in the early stages of the disease;
- frequent urination, urinary incontinence, pain and burning sensation in the process of emptying the bladder.
The clinical picture may be different depending on the type of chronic prostatitis.
infectious form:
- frequent urination at night;
- pain in the thigh, perineum, glans penis and rectum, aggravated by movement;
- painful urination;
- poor urine flow.
Specific infectious:
- mucous discharge from the urethra;
- the above symptoms.
Non-infectious prostatitis:
- acute pain in the perineum;
- pain in the thigh and head of the penis;
- The pain is aggravated by the forced cessation of sexual intercourse or prolonged absence of intimate life.
It is important!The disease progresses in waves. Symptoms may weaken or worsen, but their presence clearly indicates the presence of an inflammatory process.
Symptoms may vary depending on the stage of development of the pathology.
The following stages of pathology development are distinguished:
- Exudative.The patient feels pain in the pubis, groin and scrotum. There is often a feeling of discomfort after urination and sexual intercourse. It can damage the erection.
- Alternative.The pain intensifies, is localized in the groin, pubic area and spreads to the sacrum. Urinary excretion is accelerated, but occurs without difficulty. Erection does not suffer.
- Proliferative.Urination is more common during exacerbations. Decreases urine flow.
- Cicatricial.Sclerosis of the prostate tissue occurs. There is a feeling of heaviness in the sacrum and pubic area. Increased urination. Erection weakens. Ejaculation may not be complete.
Symptoms may vary depending on the course of the disease, but in any case, will gradually increase.
Causes of chronic prostatitis
There are many factors that cause chronic prostatitis. The disease occurs under the influence of infectious agents. The patient has hormonal, neurovegetative, immunological and hemodynamic disorders. Biochemical factors affect the flow of urine back to the prostate lobes and the disruption of the growth factors responsible for the proliferation of living cells.
Causes influencing the formation of pathology:
- infections of the genitourinary system;
- hypodynamics;
- irregular sex life;
- continuous catheterization of the bladder;
- regular hypothermia.
Developmentbacterial diseasespromotes intraprostatic urinary reflux.
Chronic bacterial prostatitisIt develops against the background of neurogenic disorders of the pelvic floor muscles, as well as the elements responsible for the activity of the bladder wall, prostate and urethra.
formationmyofascial trigger points, located near the organs of the genitourinary system and prostate gland, can cause pelvic pain syndrome. Spots that result from certain diseases, surgeries, and injuries can cause pain in the pubic area, perineum, and adjacent areas.
Diagnosis of pathology
The presence of a complex of symptoms allows to diagnose chronic prostatitis without much difficulty. However, in some cases it may be pathologically asymptomatic. In this case, in addition to the standard examination and questioning of the patient, additional research methods are required.Neurological examination and study of the patient's immunological condition are mandatory..
It is important!Special questionnaires and questionnaires allow you to more accurately identify the patient's subjective feelings and get a complete picture of the health status, pain intensity, ejaculation, erection and urinary disorders.
Laboratory diagnostics
Laboratory diagnostics allows to distinguish between bacterial and bacterial forms of pathology, as well as to identify the type of pathogen and make the most accurate diagnosis.In the fourth urine or prostate secretion sample, chronic inflammation of the prostate is confirmed when there are more than 10 leukocytes or bacterial associations in the PZ.When the number of leukocytes increases, but the bacteria are not scattered, the material is examined for the detection of chlamydia or other STD pathogens.
- The viral, fungal and bacterial flora, leukocytes and mucus in the discharge from the urethra are sent to the laboratory for detection.
- Scratching of the urethra is examined by PCR. This allows the identification of sexually transmitted pathological agents.
- Perform a microscopic examination of prostate secretion to count the number of macrophages, leukocytes, amyloids, and Trousseau-Lallemand organs. Immunological research and bacteriological research are scheduled. Determine the level of non-specific antibodies.
- A blood sample is taken ten days after a digital rectal examination to determine the concentration of PSA. 4. At a rate above 0 ng / ml, the patient undergoes a prostate biopsy to rule out oncology.
Diagnosis is based on the results of research.
Instrumental diagnostics
Transrectal ultrasound of the gland will help to clarify the stage and form of the disease. Ultrasound examination allows to exclude other diagnoses, to monitor the effectiveness of treatment, as well as to determine the size of the prostate, its ecostructure, homogeneity and density of seminal vesicles. Urodynamic studies and myography of the pelvic floor muscles will allow the detection of infravesical obstruction and neurogenic disorders, often accompanied by pathology.
Computed tomography and MRI are used to make a differential diagnosis, especially with prostate cancer. These methods will detect abnormalities in the pelvic organs and spine.
Differential Diagnosis
Differential diagnosis is important because the patient is at greater risk of disease.
Differential diagnosis is made with the following diseases:
- pseudodissingergy, functional disorders of the detrusor-sphincter system, bladder dysfunction of neurogenic origin, complex regional pain syndrome;
- bladder stricture, hypertrophic changes in the neck of the bladder, prostate adenoma;
- osteitis of the pubic joint, cystitis;
- pathology of the rectum.
If symptoms occur, the prostate gland should be examined by a urologist or andrologist. Get an ultrasound. If necessary, a biopsy of the prostate gland is scheduled.
Pathological treatment methods
Chronic prostatitis is treated by a urologist or andrologist. The treatment is complex. Correction depends on the patient's lifestyle, thinking characteristics and habits. It is important to exercise more, minimize alcohol intake, get rid of nicotine addiction, eat properly and normalize your sex life. But without a basic course of therapy it will not work. Taking medication is a prerequisite for complete recovery.
Instructions for hospitalization
Treatment is often outpatient. However, if the disease is incurable and there is a tendency to relapse, the patient is sent to a hospital where treatment is more effective.
Medical treatment
This method is aimed at eliminating the existing infection, normalizing blood circulation, improving the drainage of the prostate lobules, improving the hormonal background and immune status. Therefore, doctors prescribe antibiotics, vasodilators, immunomodulators, anticholinergics and anti-inflammatory drugs.
If the pathology is bacterial in nature, antibiotics are definitely recommended. The agent is determined based on the results of bacterial culture of prostate secretion.This will allow the pathogen to be isolated by determining its sensitivity to a particular drug. With a well-designed scheme, the effectiveness of treatment reaches more than 90%.
In the bacterial form, a short course of antibiotics is prescribed. It is continued only if the scheme gives a positive result. The effectiveness of therapy is about 40%.
The duration of the course of antibiotics with chronic pelvic pain is not more than a month. Treatment with positive dynamics continues for another month. If there is no effect, the drug is replaced with another that may be more effective.
Antibacterial agents from the group of fluoroquinolones are the main drugs for the treatment of pathology.They have high bioavailability, are active against most gram-negative bacteria, ureaplasma and chlamydia, accumulate in the tissues of the prostate gland.
If treatment with fluoroquinolones is not effective, penicillins may be prescribed.
Antibacterial drugs are used for prophylactic purposes.
After treatment with antibiotics, therapy with a-blockers is prescribed.This treatment strategy is effective for patients with persistent obstructive and irritating symptoms.
If urinary incontinence and pain persist, tricyclic antidepressants with analgesic effects may be prescribed.
With severe urinary incontinence, a urodynamic study is performed before starting therapy and acting on the results obtained.
Non-drug treatment
Non-pharmacological methods of therapy allow to increase the concentration of antibacterial drugs in the tissues of the gland, but overdose is not recommended.
The following methods are used for this purpose:
- electrophoresis;
- laser therapy;
- phonophoresis;
- Microwave hyperthermia (applied transrectally).
When applying the latter method, the temperature is selected individually. The temperature, set in the range of 39-40 degrees, allows you to increase the concentration of the drug in the body, activates the immune system at the cellular level, eliminates bacteria, eliminates congestion. Increasing the range to 40-45 degrees allows you to achieve a sclerosing and analgesic effect.
Laser and magnetic therapy are used together. The effect is similar to the effect of the above methods, but also has a biostimulatory effect on the body.
Transrectal massage is performed only in the absence of contraindications.
Surgical method
Chronic prostatitis generally does not require surgery. Exceptions are complications that endanger the patient's health and life. Modern surgical treatment allows the use of endoscopic surgery. It is minimally invasive. Rehabilitation is faster and there is minimal damage to the body.
The surgical method is prescribed for:
- sclerosis of the prostate gland;
- prostate adenoma;
- sclerosis of the seminal tubercle;
- calcification of the prostate gland.
It is important!Surgery is contraindicated in the acute stage. Surgical treatment is prescribed by the surgeon based on the results of the study and the general clinical picture.
Prognosis for chronic prostatitis
Doctors are reluctant to predict the outcome of the disease. Achieving complete recovery is rare. In general, chronic prostatitis progresses to long-term remission. Symptoms disappear, urine and blood counts return to normal. It is necessary to follow all the recommendations of a specialist to prevent the activation and complications of chronic prostatitis.