What is Prostatitis?This is the most common urological disease in men against the background of inflammation of the prostate caused by a pathogenic (certainly disease-causing) and conditionally pathogenic infection.
In most cases, it is a complication of low-symptom or asymptomatic sexually transmitted diseases in young, sexually active men.The cause of the development of prostatitis can be: Trichomonas, gonococci (causing gonorrhea), chlamydia, ureaplasma, mycoplasma.Among the organisms not related to sexually transmitted diseases, E. coli, fecal enterococci, etc. are of great importance.
According to modern classification there are:
- Acute prostatitis.
- Chronic bacterial prostatitis.
- Chronic prostatitis (chronic pelvic pain syndrome) with signs of inflammation.
- Chronic prostatitis (chronic pelvic pain syndrome) without signs of inflammation.
- Asymptomatic prostatitis (asymptomatic) chronic prostatitis.
Currently, in most cases we are dealing with the latter category of prostatitis in men, since in recent years trichomoniasis, chlamydia, ureaplasmosis and mycoplasmosis have taken a leading role in the structure of sexually transmitted diseases, which initially in the vast majority of cases do not have any manifestations, i.e. do not bother a person in any way.And only after a long time they manifest themselves as a complication – prostatitis.
It should be said that asymptomatic prostatitis is detected in the majority of patients who come only for examination for sexually transmitted diseases, in sexual partners of women with sexually transmitted diseases, as well as in patients with infertility.
Causes of Prostatitis
Typically, prostatitis is diagnosed when:
- reduced physical activity (sedentary lifestyle);
- Dysrhythmias of sexual life (prolonged sexual abstinence, which is often replaced by a hyperactive sexual life);
- alcohol abuse;
- chronic constipation;
- as a result of an infection with an STI – urethrogenic prostatitis, i.e.h.if infections enter the prostate via the urethra;
- due to the penetration of pathogens from chronic foci of infection (chronic tonsillitis, sinusitis, kidney disease, etc.);
- with diseases of the rectum (hemorrhoids, anal fissure, paraproctitis) - endogenous prostatitis.This explains the detection of E. coli in most cases of chronic prostatitis.
Symptoms of prostatitis in men
It begins with a rise in temperature to 39-40 ° C with fever and chills, difficulty urinating, pain and burning during urination;In severe cases, acute urinary retention occurs due to swelling of the glandular tissue - a condition that requires surgical intervention.
It passes without any manifestations.It is mainly detected in patients seeking testing for sexually transmitted diseases after casual sexual intercourse.It is also detected in patients who came to the examination as sexual partners of women with sexually transmitted diseases or in patients with sperm pathology.
Manifested:
- Discomfort and pain in the lower abdomen, perineum, sometimes patients note that the pain radiates to the glans or urethra.
- Urinary disorders.Frequent, painful urination, feeling of incomplete urination (often with hypothermia), urination one or more times at night, difficulty urinating and weakening of the urine stream.
- Disturbance of sexual function.Pain and discomfort during ejaculation, pain in the urethra and rectum, weakening or loss of the feeling of orgasm, etc.
- Changes in the ability of sperm to fertilize.
- The result is increased anxiety and nervousness in the patient, which is caused by excessive fixation of attention on his condition.
Complications of prostatitis
If prostatitis is not treated or is treated inadequately, the following complications can occur:
- Transition of acute prostatitis to chronic.
- Acute urinary retention (the patient cannot urinate for a long time) may require surgical intervention.
- Development of male infertility.
- Formation of scars and adhesions in the urethra with subsequent narrowing.
- Development of bladder infection (cystitis).
- Inflammatory kidney diseases (pyelonephritis, etc.).
- The occurrence of purulent inflammation of the prostate in men (prostate abscess), which requires surgical intervention.
- Sepsis (penetration of an infection into the bloodstream with subsequent damage to organs and systems of the entire body) is a serious, life-threatening complication.It is more common in patients with reduced immune system function, patients with diabetes mellitus, patients with chronic renal failure, patients with AIDS, etc.
Diagnosis of prostatitis
The diagnosis of prostatitis is made in patients with characteristic complaints, as well as in patients with established sexually transmitted diseases and established infertility.
Diagnostics includes:
- Digital examination of the prostate (through the rectum) with collection and examination of prostatic secretion (juice) if the presence of inflammation in the gland is detected.
- Urine tests: general analysis, 2 or 4 glasses of urine, bacteriological examination (detection of prostatitis pathogens), cytological examination (detection of cancer).
- Uroflowmetry: assessment of the characteristics of the urine stream, its quantity, flow rate, duration of urination.
- Ultrasound examinations to detect residual urine, organic lesions of the prostate and formal signs of prostatitis.
Sometimes to diagnose prostatitis and exclude cancer, the following are additionally prescribed:
- Semen studies.
- Prostate biopsy.
- PSA blood test (used to detect cancer).
- Computed tomography of the pelvic organs.
- Nuclear magnetic resonance examination of the pelvic organs etc.
Treatment of prostatitis
Treating bacterial prostatitis caused by an STI is not an easy task.Adequate and timely therapy leads to complete cure of this category of prostatitis in most patients after complete elimination (disappearance) of STI pathogens.It is worth noting that, despite the achievements of modern medicine, complete cure of prostatitis caused by a vulgar infection (not an STI) occurs in only 30% of cases.In these cases, the goal is a stable remission of the disease.
Modern treatment of prostatitis includes:
- Antibiotic therapy for at least 2 weeks, sometimes up to 1-2 months or longer.
- Treatment of pain syndrome (anti-inflammatory drugs in the form of suppositories, injections, tablets).
- Treatment of urinary tract diseases (α-1 blockers, 5-α-reductase blockers).
- Physiotherapeutic treatment methods (magnetic field therapy, laser therapy, etc.).
- Prostate massage.
Patients are also recommended to make lifestyle changes, namely:
- regular sex life without sexual excesses;
- abstinence from alcohol and a sedentary lifestyle;
- mandatory use of barrier contraceptives;
- Treatment of diseases of the digestive tract causing stool retention, etc.