Prostatitis is an inflammatory disease of the prostate gland. It is manifested by frequent urination, pain in the penis, scrotum, rectum, sexual disorders (erectile dysfunction, early ejaculation, etc.), sometimes urinary retention, an admixture of blood in urine. The diagnosis of prostatitis is established by a urologist or andrologist according to the typical clinical picture, the results of rectal examination. Additionally, an ultrasound of the prostate is performed, a back-up of prostatic secretions and urine. Conservative treatment – antibacterial therapy, immunotherapy, prostate massage, lifestyle correction.
ICD 10
N41.0 N41.1
Meaning
Prostatitis is an inflammation of the seminal (prostate) gland – prostate. It is the most common disease of the genitourinary system in men. Most often affects patients aged 25-50 years. According to various data, prostatitis affects 30-85% of men over the age of 30. Possible abscess of the prostate gland, inflammation of the testicles and appendages, which threatens infertility. The ascent of infection leads to inflammation of the upper parts of the genitourinary system (cystitis, pyelonephritis).
Pathology develops when an infectious agent enters the prostate tissue from the organs of the genitourinary system (urethra, bladder) or from a remote inflammatory focus (with pneumonia, flu, sore throat, furunculosis).
Causes
Staphylococcus aureus, Enterococcus, Enterobacter, Pseudomonas, Proteus, Klebsiella and E. Coli can act as an infectious agent in the acute process. Most microorganisms belong to conditionally pathogenic flora and cause prostatitis only in the presence of other predisposing factors. Chronic inflammation is usually caused by polymicrobial associations.
The risk of developing the disease increases with hypothermia, a history of specific infections and conditions accompanied by congestion in the prostate tissues. The following predisposing factors are distinguished:
- General hypothermia (single or permanent, related to working conditions).
- Sedentary lifestyle, a specialty that forces a person to stay in a sitting position for a long time (computer operator, driver, etc.).
- Constant constipation.
- Violations of the normal rhythm of sexual activity (excessive sexual activity, prolonged abstinence, incomplete ejaculation during emotionally deprived “habitual” sexual intercourse).
- The presence of chronic diseases (cholecystitis, bronchitis) or chronic infectious foci in the body (chronic osteomyelitis, untreated caries, tonsillitis, etc.).
- Transferred urological diseases (urethritis, cystitis, etc.) and sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea).
- Conditions that cause suppression of the immune system (chronic stress, irregular and inadequate nutrition, regular lack of sleep, overtraining in athletes).
It is assumed that the risk of pathology increases with chronic intoxication (alcohol, nicotine, morphine). Some studies in the field of modern andrology prove that the provoking factor is a chronic injury of the perineum (vibration, concussion) in motorists, motorcyclists and cyclists. However, the overwhelming majority of specialists believe that all these circumstances are not the real causes of the disease, but only contribute to the exacerbation of the latent inflammatory process in the prostate tissues.
A decisive role in the occurrence of prostatitis is played by stagnant phenomena in the prostate tissues. Violation of capillary blood flow causes increased lipid peroxidation, edema, exudation of prostate tissues and forms conditions for the development of the infectious process.
Symptoms of prostatitis
Acute prostatitis
There are three stages of acute prostatitis, which are characterized by the presence of a certain clinical picture and morphological changes:
- Acute catarrhal. Patients complain of frequent, often painful urination, pain in the sacrum and perineum.
- Acute follicular. The pains become more intense, sometimes radiate into the anus, and increase during defecation. Urination is difficult, urine flows out in a thin stream. In some cases, urinary retention is noted. Subfebrility or moderate hyperthermia is typical.
- Acute parenchymal. Severe general intoxication, hyperthermia up to 38-40 ° C, chills. Dysuric disorders, often – acute urinary retention. Sharp, throbbing pain in the perineum. Difficulty in the act of defecation.
Chronic prostatitis
In rare cases, chronic prostatitis becomes the outcome of an acute process, however, as a rule, a primary chronic course is observed. The temperature occasionally rises to subfebrile values. The patient notes a slight pain in the perineum, unpleasant sensations during the act of urination and defecation. The most characteristic symptom is scanty discharge from the urethra during the act of defecation. The primary chronic form of the disease develops over a considerable period of time. It is preceded by prostatosis (stagnation of blood in the capillaries), gradually turning into abacterial prostatitis.
Chronic prostatitis is often a complication of the inflammatory process caused by the causative agent of a specific infection (chlamydia, trichomonas, ureaplasma, gonococcus). The symptoms of a specific inflammatory process in many cases mask the manifestations of prostate damage. There may be a slight increase in pain during urination, mild pain in the perineum, scant discharge from the urethra during defecation. A slight change in the clinical picture often goes unnoticed by the patient.
Chronic inflammation of the prostate gland can be manifested by a burning sensation in the urethra and perineum, dysuria, sexual disorders, increased general fatigue. The consequence of potency disorders (or fear of these disorders) often becomes mental depression, anxiety and irritability. The clinical picture does not always include all the listed groups of symptoms, differs in different patients and changes over time. There are three main syndromes characteristic of chronic prostatitis:pain, dysuric, sexual disorders.
There are no pain receptors in the prostate tissue. The cause of pain in chronic prostatitis becomes almost inevitable due to the abundant innervation of the pelvic organs involvement in the inflammatory process of the nerve pathways. Patients complain of pain of varying intensity – from weak, aching to intense, disturbing sleep. There is a change in the nature of pain (strengthening or weakening) during ejaculation, excessive sexual activity or sexual abstinence. The pain radiates into the scrotum, sacrum, perineum, and sometimes into the lumbar region.
As a result of inflammation in chronic prostatitis, the volume of the prostate squeezing the urethra increases. The ureteral lumen decreases. The patient has frequent urge to urinate, a feeling of incomplete emptying of the bladder. As a rule, dysuric phenomena are expressed in the early stages. Then compensatory hypertrophy of the muscular layer of the bladder and ureters develops. Symptoms of dysuria weaken during this period, and then increase again with decompensation of adaptive mechanisms.
In the initial stages, dyspotence may develop, which manifests itself differently in different patients. Patients may complain of frequent nocturnal erections, erased orgasms or worsening erections. Accelerated ejaculation is associated with a decrease in the threshold level of arousal of the orgasmic center. Pain during ejaculation can cause rejection of sexual activity. In the future, sexual disorders become more pronounced. At the advanced stage, impotence develops.
The degree of sexual disorder is determined by many factors, including the sexual constitution and the psychological mood of the patient. Potency disorders and dysuria can be caused by both changes in the prostate gland and the suggestibility of the patient, who, if he has chronic prostatitis, expects the imminent development of sexual disorders and urination disorders. Especially often psychogenic dyspotence and dysuria develop in suggestible, anxious patients.
Impotence, and sometimes the very threat of possible sexual disorders, is hard to bear by patients. Often there is a change in character, irritability, peevishness, excessive concern for one’s own health and even “going into illness”.
Complications
In the absence of timely treatment of acute prostatitis, there is a significant risk of developing a prostate abscess. With the formation of a purulent focus, the patient’s body temperature rises to 39-40 °With and can acquire a hectic character. Periods of heat alternate with pronounced chills. Sharp pain in the perineum makes it difficult to urinate and makes defecation impossible.
The increase in swelling of the prostate gland leads to an acute delay in urination. In rare cases, an abscess spontaneously opens into the urethra or rectum. When opened, purulent cloudy urine with an unpleasant pungent odor appears in the urethra, when opened into the rectum, feces contain pus and mucus.
For chronic prostatitis, a wave-like course with periods of prolonged remissions is characteristic, during which inflammation in the prostate proceeds latently or manifests itself with extremely poor symptoms. Patients who are not bothered by anything often stop treatment, and turn only when complications develop.
The spread of infection through the urinary tract causes the occurrence of pyelonephritis and cystitis. The most common complication of the chronic process is inflammation of the testicles and appendages of the testicles (epdidymoorchitis) and inflammation of the seminal vesicles (vesiculitis). The outcome of these diseases is often infertility.
Diagnostics
The characteristic clinical picture simplifies the process of diagnosis in acute and chronic prostatitis. It is mandatory to perform:
- rectal examination of the prostate
- sampling of prostate secretions to determine the sensitivity of microflora (seeding of prostate secretions and urine back-seeding).
- ultrasound of the prostate to identify structural changes (tumors, cysts, adenoma) and differentiation of prostatitis from other diseases, a
- spermogram is performed to exclude or confirm the development of infertility.
Treatment of prostatitis
Treatment of acute prostatitis
Patients with uncomplicated acute process are treated by a urologist on an outpatient basis. With severe intoxication, suspicion of a purulent process, hospitalization is indicated. Antibacterial therapy is being carried out. The drugs are selected taking into account the sensitivity of the infectious agent. Antibiotics that can penetrate well into prostate tissues (ciprofloxacin, etc.) are widely used.
With the development of acute urinary retention on the fne of prostatitis, they resort to installing a cystostomy, and not a urethral catheter, because there is a danger of the formation of a prostate abscess. With the development of an abscess, an endoscopic transrectal or transurethral opening of the abscess is performed.
Treatment of chronic prostatitis
Treatment of chronic prostatitis should be comprehensive, including etiotropic therapy, physiotherapy, correction of immunity:
- Antibiotic therapy. The patient is prescribed long courses of antibacterial drugs (for 4-8 weeks). The selection of the type and dosage of antibacterial drugs, as well as the determination of the duration of the course of treatment is carried out individually. The drug is chosen based on the sensitivity of the microflora according to the results of urine culture and prostate secretion.
- Prostate massage. Massage of the gland has a complex effect on the affected organ. During the massage, the inflammatory secret accumulated in the prostate gland is squeezed out into the ducts, then enters the urethra and is removed from the body. The procedure improves blood circulation in the prostate, which minimizes congestion and ensures better penetration of antibacterial drugs into the tissue of the affected organ.
- Physical therapy. Laser exposure, ultrasonic waves and electromagnetic vibrations are used to improve blood circulation. If it is impossible to carry out physiotherapy procedures, the patient is prescribed warm medicinal microclysms.
In chronic, long-term inflammation, an immunologist’s consultation is indicated to choose the tactics of immunocorrective therapy. The patient is given recommendations on lifestyle changes. Making certain changes in the lifestyle of a patient with chronic prostatitis is both a therapeutic and preventive measure. The patient is recommended to normalize sleep and wakefulness, adjust the diet, conduct moderate physical activity.
Prognosis and prevention
Acute prostatitis is a disease that has a pronounced tendency to chronicity. Even with timely and adequate treatment, chronic prostatitis becomes the outcome in more than half of patients. Recovery is not always possible, however, with the correct sequential therapy and compliance with the doctor’s recommendations, it is possible to eliminate unpleasant symptoms and achieve a long-term stable remission in the chronic process.
Prevention consists in eliminating risk factors. It is necessary to avoid hypothermia, alternate sedentary work with periods of physical activity, eat regularly and fully. With constipation, laxatives should be used. One of the preventive measures is the normalization of sexual life, since both excessive sexual activity and sexual abstinence are risk factors in the development of prostatitis. If symptoms of a urological or venereal disease appear, you need to consult a doctor in a timely manner.