About 40 - 60% of the urological patients of the clinic are patients with chronic prostatitis.Symptoms of prostatitis in men are often the cause of depressive conditions and changes in the psyche.
The disease that every third man suffers over 25-30 years old does not threaten life, but the difficulties of its diagnosis and treatment determine a long chronic course and often lead to disability.
The idea of the functions of the prostate, the mechanisms and the causes of the development of inflammation allow us to correctly understand the symptoms and the need for timely treatment.
The functional value of the prostate gland
Its main function is the secretion of a specific fluid (secret) 40 - 50 glands that form the entire glandular tissue of the organ.The secret of 90 - 95% consists of water and the main trace elements, phospholipids, sperm amino acids, which gives sperm a specific smell, enzymes, proteins, citric acid and fructose.All components have their own purpose and are strictly balanced.
The secret of the prostate provides:
- The formation and maintenance of a neutral or slightly alkaline environment in the urethra and sperm.This environment provides sperm for the life of sperm.
- Sperm thinning, necessary to prevent sperm bonding with each other and ensuring their promotion.In the process of intercourse, sperm mixed with prostate juice.
- The viability of spermatozoa: the substances contained in the secret are a nutrient medium for germ cells, thanks to which they can be located for several days in the female genital organs until the fertilization of the egg.
- Protection of the genitourinary system from infection using zinc, sperm, polyamins and immunoglobulin A. The concentration of zinc in the prostate is 100 times higher than in other organs.It has a pronounced antimicrobial activity, accumulates in iron in the form of protein complexes and is in sperm in a free state;Spermine and polyamins also have high anti -bacterial activity, and immunoglobulins are involved in the immune protection of the prostate and urethra.
The prostate iron also participates:
- in hormonal metabolism through the transformation of testosterone coming from the blood, into active dihydrotestosterone;The latter regulates the secretory activity of the gland;This process proceeds with the participation of the same zinc;
- in the act of urination using smooth muscle fibers contained in the capsule of the gland;
- in the process of ejaculation together with the muscles of the bottom of the pelvis and the part of the urethra passing through the prostate;
- in the formation of the sensation of orgasm due to the vasation of the ducts passing along the side surface of the seed tubercle;It contains receptors transmitting impulses to the brain during ejaculation.
Thus, the prostate, along with the participation in the general hormonal status of a man and ensuring its possibility of reproduction, protects the urogenital organs from aggression of conditionally pathogenic and pathogenic microorganisms.
Causes and contributing factors
The main cause of inflammation of the prostate is to get into it pathogenic and conditionally pathogenic microbes.In 60%, this is an E. coli.In recent studies, the role of the participation of gonococcal and trichomonna infections in inflammation is confirmed.In case of violation of the protective barrier of the gland and a decrease in local immune defense, the penetration of such an infection as yeast-like, mycoplasma and ureapaplasma, herpes virus and cytomegalinirus, microorganisms that cause respiratory diseases (with the oral-genital method of contact), intestinal microflora (in cases of anal sex).
For diseases of tuberculosis, dissemination of mycobacteria through the bloodstream into the prostate is possible.Isolated cases of tuberculosis prostatitis are found, but rarely.
Ways to penetrate infection into the gland:
- hematogenous - with blood from other foci of infection;This occurs through the venous vessels of the prostate, communicating with the veins of the penis, testicle, rectum, bladder and kidneys (including with tuberculosis lesion)
- lymphogenous - through lymph vessels
- urethrogenic - through the urethra
Contributing factors:
- Violation of the hormonal background, in particular, a decrease in the level of testosterone, as a result of which the antimicrobial prostatic barrier is reduced.
- Varicocele (expansion of the veins of the seed), hemorrhoids, varicose veins of the lower extremities.These diseases are the result of a genetic defect in the venous valves, which leads to disorders of blood microcirculation in organs located in the pelvis, an increase in local temperature, reduced in normal (compared to the total body temperature), and the creation of favorable conditions for the vital activity of microorganisms.
- Osteochondrosis, hernia of the lumbar spine and other innervation disorders, a sedentary lifestyle.They can lead to prolonged spasm (narrowing) of the vessels of the prostate or, conversely, to their long -term expansion.The first leads to impaired blood supply, the second - to stagnant blood phenomena.
- Intoxication is alcohol, leading to paralysis of small vessels, and nicotine, contributing to their prolonged spasm.
- Various infectious diseases, diabetes mellitus, frequent and long negative mental effects, stress states, sleep disturbances - all this helps to reduce general immunity.
Types of prostatitis
Basically, the first symptoms of prostatitis are explained by the deterioration of blood supply to the gland as a result of inflammation or vascular spasm leading to oxygen deficiency, impaired metabolic processes with the formation of underestimated decay products.They cause powerful irritation of a large number of nerve receptors associated with the ends of the nerves of the testicles, bladder, rectum, penis, muscles of the bottom of the pelvis.
In accordance with the classification proposed by the National Institute of Health (depending on the course of the inflammatory process), acute bacterial prostatitis is distinguished, which is rare (about 5% of all cases) and chronic prostatitis.The latter can develop after acute, but in 90% - 98% of cases is primary.It is assumed that he leads to sexual disorders and infertility.
The chronic form is divided into:
- Bacterial.
- Abacterial, or chronic pelvic pain (in the absence of bacteria in studies).It, in turn, is divided into inflammatory and non -inflammatory.
- Asymptomatic inflammatory (in the absence of obvious symptoms).
Clinical manifestations
Acute prostatitis
The acute course is provoked by any microorganisms and is characterized by almost simultaneous damage to all the glandular lobules.The most common cause is gonococcus.The inflammatory process can be in the form of an abscess or diffuse not inflammation.The most characteristic symptoms of acute prostatitis are as follows:
- Chills and high body temperature (up to 38.5O and above).
- Severe intoxication - weakness, aches in the joints, headache, increase in the frequency of the pulse, lack of appetite, etc.
- Severe pain in the perineum, in the inguinal and lumbar areas.
- Urination disorders - frequent and false urge, soreness and difficulty in urination, acute urinary retention.
- Belovoy or transparent discharge from the urethra.
A finger examination of the prostate through the rectum is impossible due to severe pain.Moreover, it is contraindicated due to the possibility of dissemination (spread) of infection in the blood and the development of a septic state.
Chronic prostatitis
The recommended classification reflects the fact that the signs of chronic prostatitis in men are very diverse, and the views of doctors on the causes and mechanisms of the development of the disease are largely different.Diagnosis is based on complaints of the patient, clinical examination on a finger examination of the gland through the rectum (rectal) and ultrasound examination.At the same time, the degree of pain, size and volume, contours, uniformity of consistency and the presence of softening or sealing areas are evaluated.
Partially the functional ability of the organ and, most importantly, the presence or absence of inflammation processes, as well as the form of the disease, allows you to evaluate the study of the prostatic secretion.It is obtained as a result of a finger massage of a prostate with subsequent bacteriological analysis of the material (secret), the conduct of PCR (polymerase chain reaction) to detect conditionally pathogenic microorganisms and pathogens of sexual infections and a spermogram analysis.
General symptoms of various forms of chronic prostatitis:
- Discomfort or/and moderate pains in the form of “aches” and severity in the perineum, which occur or intensify after drinking alcoholic beverages, physical activity, sexual contact.Sometimes they are passing a paroxysmal in nature.
- A sense of discomfort and crusia in the urethra during urination or sexual contact, minor serous-grace discharge from the urethra (mainly after a long-term delay in urine).
- Sudden frequent urge to urinate (sometimes up to 3 times within 1 hour) and a feeling of insufficient emptying of the bladder, which is explained by a violation of the nervous regulation of the prostate, its muscle fibers and the bladder.
- Reducing the ability to fertilize, which is caused by an increase in the acidity of the secret, a decrease or absence of sperm mobility, their agglutination (gluing) with heads.
- Pain for orgasm or erased sensations of orgasm, ejaculation disorders, expressed in its premature or, conversely, in the excessive duration of sexual intercourse.These phenomena are associated with the inflammatory process in the field of the seminal tubercle or its scarring as a result of inflammation.
The information presented allows us to understand the need and importance of timely appeal to a qualified specialist in the event of certain symptoms and abandoning various non -traditional methods of self -medication.Treatment is prescribed only after a complete and thorough examination in order to establish the cause and form of the disease.
Differential diagnosis
Differential diagnosis of acute prostatitis and distinctive signs of chronic prostatitis in men are reflected in the table:
| The form of prostatitis | The main symptoms | Laboratory data |
| Acute bacterial |
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| Chronic bacterial |
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| Chronic abacterial (chronic pelvic pain syndrome): |
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| inflammatory |
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| non -inflammatory, or stagnant (40% of patients with prostatitis) |
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| Asymptomatic inflammatory prostatitis |
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