Chronic prostatitis is a serious problem. Even modern urology is not able to answer many questions regarding this pathology. Experts believe that chronic prostatitis is a disease that is the result of a whole range of health problems, which include tissue damage, as well as dysfunctions not only of the urinary tract and prostate gland, but also of other organs.
Pathology is diagnosed mainly in men of reproductive age. In older men, chronic prostatitis is often accompanied by benign neoplasms of the prostate.
Disease classification
The classification of prostatitis was developed by scientists at the US National Institutes of Health in 1995:
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- 1 type- acute bacterial prostatitis. It is diagnosed in 5% of cases of inflammation of the prostate gland.
- type 2- bacterial chronic prostatitis.
- 3 type- chronic bacterial prostatitis. This pathology has another name - chronic pelvic pain syndrome.
- 3A type- an inflammatory form of chronic prostatitis. It is diagnosed in 60% of cases of chronic prostatitis.
- 3B type- non-inflammatory form of chronic prostatitis. Diagnosed in 30% of cases.
- 4 type- asymptomatic prostatitis.
There is also a classification of chronic prostatitis, compiled in 1990.
Symptoms of chronic prostatitis
Feeling of discomfort and pain in the pelvic area, which last more than 3 months, are the main symptoms of chronic prostatitis.
In addition, urinary disorders and erectile dysfunction are observed:
- pain occurs in the perineum, may radiate to the anus, groin, inner thigh, sacrum, lower back and scrotum. Pain on the one hand, extending into the testicle, is often not a symptom of chronic prostatitis;
- erection does not occur, despite the presence of adequate conditions, but complete impotence is not observed;
- in the early stages of the development of the disease, premature ejaculation is observed;
- frequent urination, urinary incontinence, pain and burning sensation in the process of emptying the bladder.
The clinical picture may differ depending on the type of chronic prostatitis.
infectious form:
- frequent urination at night;
- pain in the thighs, perineum, glans penis and rectum, aggravated by movement;
- painful urination;
- weak stream of urine.
Specific infectious:
- mucous discharge from the urethra;
- the above symptoms.
Non-infectious prostatitis:
- acute pain in the perineum;
- pain in the thighs and head of the penis;
- the pain intensifies with the forced interruption of sexual intercourse or a prolonged absence of intimate life.
Important!The disease proceeds in waves. Symptoms may either weaken or intensify, 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 development of pathology are distinguished:
- Exudative.The patient experiences pain in the pubis, groin and scrotum. There is frequent urination and a feeling of discomfort after intercourse. An erection can hurt.
- Alternative.The pain intensifies, is localized in the groin, pubic part and gives to the sacrum. Urination is speeded up, but occurs without difficulty. Erection does not suffer.
- Proliferative.During an exacerbation, urination becomes more frequent. The stream of urine becomes weak.
- Cicatricial.Prostate tissue sclerosis occurs. There is a feeling of heaviness in the sacrum and pubic region. Increased urination. The erection becomes weak. Ejaculation may be completely absent.
Symptoms may vary depending on the course of the disease, but in any case, they will gradually increase.
Causes of chronic prostatitis
There are many factors that lead to chronic prostatitis. The disease occurs under the influence of infectious agents. The patient has hormonal, neurovegetative, immunological and hemodynamic disorders. Biochemical factors, reflux of urine into the prostate lobes and impaired functioning of growth factors, which are responsible for the proliferation of living cells, affect.
Reasons that affect the formation of pathology:
- infections of the genitourinary system;
- hypodynamia;
- irregular sex life;
- continuous catheterization of the bladder;
- regular hypothermia.
developmentdiseases of a bacterial naturepromotes intraprostatic urinary reflux.
Chronic abacterial prostatitisdevelops against the background of neurogenic disorders of the pelvic floor muscles, as well as elements responsible for the functioning of the bladder wall, prostate and urethra.
Formationmyofascial trigger points, which are located next to the organs of the genitourinary system and the prostate gland, can provoke pelvic pain syndrome. Points that are the result of certain diseases, surgical interventions and injuries can provoke pain in the pubic region, perineum and adjacent areas.
Diagnosis of pathology
The presence of a complex of symptoms makes it possible to diagnose chronic prostatitis without much difficulty. However, in some cases, the pathology may be asymptomatic. In this case, in addition to the standard examination and questioning of the patient, additional research methods are required.A neurological examination and study of the patient's immunological status is mandatory..
Important!Special questionnaires and questionnaires allow you to more accurately determine the patient's subjective feelings and get a complete picture of the state of health, pain intensity, ejaculation, erection and urination disorders.
Laboratory diagnostics
Laboratory diagnostics makes it possible to distinguish between a bacterial and abacterial form of pathology, as well as to determine the type of pathogen and make the most accurate diagnosis.Chronic inflammation of the prostate is confirmed when the fourth sample of urine or prostate secretion contains more than 10 leukocytes in the PZ, or bacterial associations.When the number of leukocytes is increased, but the bacteria are not sown, the material is examined for the detection of chlamydia or other STD pathogens.
- The discharge from the urethra is sent to the laboratory to detect viral, fungal and bacterial flora, leukocytes and mucus in it.
- Scraping from the urethra is examined by PCR. This allows you to identify pathological agents that are sexually transmitted.
- Perform a microscopic examination of the secretion of the prostate to count the number of macrophages, leukocytes, amyloid and Trousseau-Lallemand bodies. An immunological study and a bacteriological study are prescribed. Determine the level of non-specific antibodies.
- Blood sampling is carried out ten days after a digital rectal examination to determine the concentration of PSA in it. At a rate above 4. 0 ng / ml, the patient undergoes a prostate biopsy to rule out oncology.
The diagnosis is exposed on the basis of results of researches.
Instrumental diagnostics
To clarify the stage and form of the disease will help transrectal ultrasound of the gland. Ultrasound allows you to exclude other diagnoses, monitor the effectiveness of the treatment, as well as determine the size of the prostate, its echostructure, homogeneity and density of the seminal vesicles. Urodynamic studies and myography of the pelvic floor muscles will allow revealing infravesical obstruction and neurogenic disorders that often accompany pathology.
Tomography and MRI are used to make a differential diagnosis, in particular, with prostate cancer. These methods will reveal violations in the pelvic organs and the spinal column.
Differential Diagnosis
Differential diagnosis is important, as there is a risk that the patient has a more serious disease.
Differential diagnosis is established with such diseases:
- pseudodyssinergia, functional disorder of the detrusor-sphincter system, bladder dysfunction of neurogenic origin, complex regional pain syndrome;
- stricture of the bladder, 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 scan. If necessary, a biopsy of the prostate gland is prescribed.
Pathology treatment methods
Chronic prostatitis is treated by a urologist or andrologist. The therapy is carried out in a complex manner. Correction is subject to the patient's lifestyle, features of thinking and his habits. It is important to move more, minimize alcohol intake, get rid of nicotine addiction, eat right and normalize your sex life. However, to do without a course of basic therapy will not work. Taking medications is the main condition for a complete recovery.
Indications for hospitalization
Most often, treatment is carried out on an outpatient basis. But in cases where the disease cannot be corrected and has a tendency to relapse, the patient is referred to a hospital where the treatment is more effective.
Medical method of treatment
This method is aimed at eliminating the existing infection, normalizing blood circulation, improving the drainage of the prostate lobules, correcting 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 prescribed based on the results of bacterial culture of prostate secretion.This will make it possible to isolate the pathogen with the subsequent determination of its sensitivity to a particular drug. With a well-designed scheme, the effectiveness of treatment reaches more than 90%.
In the abacterial form, a short course of antibiotics is prescribed. It is continued only if the scheme gives a positive result. The effectiveness of therapy is approximately 40%
With chronic pelvic pain, the duration of the course of antibiotics is no more than a month. With positive dynamics, treatment is continued for another month. If there is no effect, the drug is replaced by another, which 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, ureaplasmas and chlamydia, accumulate in the tissues of the prostate gland.
When treatment with fluoroquinolones is not effective, penicillins may be prescribed.
Antibacterial drugs are used for preventive purposes.
After treatment with antibiotics, therapy with the use of a-blockers is prescribed.This treatment strategy is effective for patients who have persistent obstructive and irritative symptoms.
If urination disorders and pain persist, tricyclic antidepressants may be prescribed, which have an analgesic effect.
With severe violations of urination, before starting therapy, a urodynamic study is performed and act on the basis of the results obtained.
Non-drug therapy
Non-drug methods of therapy make it possible to increase the concentration of antibacterial drugs in the tissues of the gland, but it is not recommended to exceed the dose.
For this purpose, the following methods are used:
- 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, relieves congestion. Increasing the range to 40-45 degrees allows you to achieve a sclerosing and analgesic effect.
Laser and magnetic therapy are used in combination. The effect is similar to the effect of the above methods, but it also has a biostimulating effect on the organ.
Transrectal massage is carried out only in the absence of contraindications.
Surgical method
Chronic prostatitis generally does not require surgery. The exception is complications that pose a threat to the health and life of the patient. Modern surgical treatment allows the use of endoscopic surgery. It is minimally invasive. Rehabilitation is faster, and minimal damage is caused to the body.
The surgical method is prescribed for:
- sclerosis of the prostate;
- prostate adenoma;
- sclerosis of the seed tubercle;
- calcification in the prostate.
Important!Surgery is contraindicated in the acute stage. Surgical treatment is prescribed by the surgeon based on the results of the study and the overall clinical picture.
Prognosis for chronic prostatitis
Doctors are cautious in predicting the outcome of the disease. It is rare to achieve full recovery. Basically, chronic prostatitis goes into a stage of long-term remission. Symptoms disappear, urine and blood counts return to normal. So that chronic prostatitis does not become more active and does not cause complications, it is necessary to follow all the recommendations of a specialist.