Symptoms of prostatitis and prostate adenoma in men

prostatitisis an inflammatory disease of the prostate. Manifested by frequent urination, pain in the penis, scrotum, rectum, sexual disorders (erectile dysfunction, premature ejaculation, etc. ), sometimes urinary retention, blood in the urine. The diagnosis of prostatitis is made by a urologist or andrologist according to a typical clinical picture, the results of a rectal examination. In addition, an ultrasound of the prostate, bakposev of prostate secretion and urine is performed. Treatment is conservative - antibiotic therapy, immunotherapy, prostate massage, lifestyle correction.

general information

Prostatitis is inflammation of the seminal gland (prostate) - the prostate. It is the most common disease of the genitourinary system in men. Patients between the ages of 25 and 50 are most commonly affected. According to various reports, 30-85% of men over 30 suffer from prostatitis. Possible abscess formation of the prostate, inflammation of the testicles and appendages, which threatens infertility. The increase in infection leads to inflammation of the upper genitourinary system (cystitis, pyelonephritis).

The pathology develops with the penetration of an infectious agent that enters the prostate tissue from the organs of the genitourinary system (urethra, bladder) or from a distant focus of inflammation (in pneumonia, influenza, tonsillitis, furunculosis).

Prostate adenoma is a benign neoplasm of the paraurethral glands located around the urethra in its prostate portion. The main symptom of prostate adenoma is a violation of urination due to the gradual compression of the urethra by one or more growing nodules. The pathology is characterized by a benign course.

Only a small proportion of patients seek medical help, but a detailed examination reveals symptoms of the disease in one in four men aged 40-50 and in half of men aged 50-60. The disease is found in 65% of men aged 60-70, 80% of men aged 70-80 and more than 90% of men aged over 80. The severity of symptoms can vary widely. Studies in the field of clinical andrology suggest that about 40% of men with BPH experience urinary problems, but only one in five patients in this group seek medical help.

Causes of prostatitis

As infectious agents in an acute process, Staphylococcus aureus (Staphylococcus aureus), Enterococcus (Enterococcus), Enterobacter (Enterobacter), Pseudomonas (Pseudomonas), Proteus (Proteus), Klebsiella (Klebsiella) and Escherichia coli (E. Coli) can act . Most microorganisms belong to the conditionally pathogenic flora and cause prostatitis only in the presence of other predisposing factors. Chronic inflammation is usually due to polymicrobial associations.

The risk of developing the disease increases with hypothermia, a history of specific infections and conditions accompanied by congestion in the tissues of the prostate. There are the following predisposing factors:

• General hypothermia (single or permanent, associated with working conditions).
• A sedentary lifestyle, a specialty that forces a person to be in a sedentary position for a long time (computer operators, drivers, etc. ).
• Constant constipation.
• Violations of the normal rhythm of sexual activity (excessive sexual activity, prolonged abstinence, incomplete ejaculation during "habitual" intercourse without emotional coloring).
• The presence of chronic diseases (cholecystitis, bronchitis) or chronic foci of infection in the body (chronic osteomyelitis, untreated caries, tonsillitis, etc. ).
• Previous urological diseases (urethritis, cystitis, etc. ) and sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea).
• Conditions that lead to suppression of the immune system (chronic stress, irregular and improper diet, regular lack of sleep, overtraining in athletes).

It is believed that the risk of developing pathology increases with chronic intoxication (alcohol, nicotine, morphine). Some studies in the field of modern andrology prove that chronic perineal trauma (vibration, concussion) in car drivers, motorcyclists and cyclists is a provoking factor. However, the overwhelming majority of experts believe that all these circumstances are not the true causes of the disease, but only contribute to the exacerbation of the latent inflammatory process in the tissues of the prostate.

Congestion in the tissue of the prostate plays a decisive role in the development of prostatitis. Violation of capillary blood flow leads to an increase in lipid peroxidation, edema, exudation of prostate tissue and creates conditions for the development of an infectious process.

The mechanism of development of prostate adenoma is not yet fully understood. Despite the widespread belief that the pathology is associated with chronic prostatitis, there are no data that would confirm the connection between these two diseases. Researchers have found no association between the development of prostate adenoma and alcohol and tobacco use, sexual orientation, sexual activity, sexually transmitted diseases, and inflammatory diseases.

There is a pronounced dependence of the incidence of prostate adenoma on the age of the patient. Scientists believe that adenoma develops as a result of hormonal imbalance in men during andropause (male menopause). This theory is supported by the fact that men who are castrated before puberty never suffer from pathology, and extremely rarely - men who are castrated after it.

Symptoms of prostate inflammation

Acute prostatitis

There are three stages of acute prostatitis, characterized by the presence of a specific clinical picture and morphological changes:

• Acute catarrhal. Patients complain of frequent, often painful urination, pain in the sacrum and perineum.
• Acute follicles. The pain intensifies, sometimes radiating to the anus, and is aggravated by defecation. Difficult urination, urine flows in a thin stream. In some cases, urinary retention occurs. A subfebrile condition or moderate hyperthermia is typical.
• Acute parenchyma. Severe general intoxication, hyperthermia up to 38-40°C, chills. Dysuric disorders, often - acute urinary retention. Sharp, throbbing pains in perineum. Difficulty passing stool.

Chronic prostate inflammation

In rare cases, chronic prostatitis becomes the result of an acute process, but usually a primarily chronic course is observed. The temperature occasionally rises to subfebrile levels. The patient notes a slight pain in the perineum, discomfort when urinating and defecation. The most characteristic symptom is a scanty discharge from the urethra during defecation. The primary chronic form of the disease develops over a longer period of time. It is preceded by prostatosis (stasis of blood in the capillaries), which gradually turns into nonbacterial prostatitis.

Chronic prostatitis is often a complication of the inflammatory process caused by the causative agent of a particular infection (chlamydia, trichomonas, ureaplasma, gonococcus). Symptoms of a specific inflammatory process in many cases mask the manifestations of damage to the prostate. Perhaps a slight increase in pain when urinating, slight pain in the perineum, scanty discharge from the urethra with a bowel movement. A slight change in the clinical picture often goes unnoticed by the patient.

Chronic inflammation of the prostate can be manifested by a burning sensation in the urethra and perineum, dysuria, sexual dysfunction, increased general fatigue. Violations of potency (or fear of these violations) often result in mental depression, anxiety and irritability. The clinical picture does not always include all of the symptom groups listed, is different for different patients and changes over time. There are three main syndromes characteristic of chronic prostatitis: pain, dysuria, sexual dysfunction.

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 and involvement in the inflammatory process of the nerve pathways. Patients complain of pain of varying intensity - from weak, painful to intense, disturbing sleep. With ejaculation, excessive sexual activity or sexual abstinence, there is a change in the nature of the pain (intensification or weakening). The pain radiates to the scrotum, sacrum, perineum, sometimes to the lumbar region.

As a result of inflammation in chronic prostatitis, the volume of the prostate increases and compresses the urethra. The lumen of the ureter is reduced. The patient has frequent urges 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. The symptoms of dysuria during this period weaken, and then increase again with the decompensation of the adaptive mechanisms.

At the initial stage, dypotency can develop, which manifests itself differently in different patients. Patients may complain of frequent nocturnal erections, blurry orgasms, or worsening erections. Accelerated ejaculation is associated with a decrease in the threshold level of arousal of the orgasmic center. Painful sensations during ejaculation can cause rejection of sexual activity. In the future, sexual dysfunction will become more pronounced. In the advanced stage, impotence develops.

The degree of sexual dysfunction is determined by many factors, including the patient's sexual constitution and psychological mood. Potency disorders and dysuria can be due both to changes in the prostate and to the suggestibility of the patient, who, with chronic prostatitis, expects the inevitable development of sexual and urinary disorders. Psychogenic dypotences and dysuria develop particularly frequently in suggestible, anxious patients.

Impotence and sometimes the threat of possible sexual disorders are difficult for patients to endure. Often there is a change in character, irritability, obnoxiousness, excessive concern for one's health and even "care for the disease. "

There are two groups of symptoms of the disease: irritative and obstructive. The first group of symptoms includes increased urination, persistent (imperative) urge to urinate, nocturia, urinary incontinence. The group of obstructive symptoms includes difficulty in urinating, delayed onset and prolonged time of urination, a feeling of incomplete emptying, urination with an intermittent sluggish stream, the need to strain. There are three stages of prostate adenoma: compensated, subcompensated, and decompensated.

Compensated level

In the compensated phase, the dynamics of urination changes. It becomes more frequent, less intense and less free. You need to urinate 1-2 times at night. Usually, nocturia in stage I prostate adenoma is benign in a patient who associates frequent nocturnal awakenings with the development of age-related insomnia. During the day, the normal frequency of urination can be maintained, however, patients with stage I prostate adenoma notice a waiting period that is particularly pronounced after a night's rest.

Then the frequency of urination per day increases and the amount of urine released per urination decreases. There are compelling urges. The stream of urine, which previously formed a parabolic curve, is discharged slowly and falls almost vertically. Hypertrophy of the muscles of the bladder develops, as a result of which the efficiency of their emptying is maintained. At this stage there is little or no residual urine in the bladder (less than 50 ml). The functional status of the kidneys and the upper urinary tract is preserved.

Undercompensated stage

At stage II of prostate adenoma, the volume of the bladder increases, dystrophic changes develop in its walls. The amount of residual urine is more than 50 ml and continues to increase. During urination, the patient is forced to put a lot of strain on the abdominal muscles and diaphragm, which leads to an even greater increase in intravesical pressure.

The act of urination becomes multiphasic, intermittent, undulating. The passage of urine along the upper urinary tract is gradually disturbed. Muscle structures lose their elasticity, the urinary tract expands. Kidney function is impaired. Patients are concerned about thirst, polyuria and other symptoms of progressive chronic renal failure. If the compensation mechanisms fail, the third stage begins.

Decompensated stage

The bladder in patients with stage III prostate adenoma is distended, filled with urine, easily determined by palpation and visually. The upper edge of the bladder can reach the level of the navel and above. Emptying is not possible even with strong tension in the abdominal muscles. The desire to empty the bladder becomes continuous. There may be severe pain in the lower abdomen. Urine is passed frequently, in drops or in very small portions. In the future, the pain and the urge to urinate will gradually weaken.

A characteristic paradoxical urinary retention or paradoxical ischuria develops (the bladder is full, urine is constantly excreted drop by drop). The upper urinary tract is enlarged, the functions of the renal parenchyma are impaired due to the constant obstruction of the urinary tract, which leads to an increase in pressure in the pelvic floor system. The chronic kidney failure clinic is growing. Without medical care, patients die from progressive CKD.

complications

Without 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 ° C and can become frantic. Heat waves alternate with severe chills. Stabbing pain in the perineum makes it difficult to urinate and makes defecation impossible.

The increase in prostate edema leads to acute urinary retention. Rarely does an abscess burst spontaneously into the urethra or rectum. When opened, purulent cloudy urine with an unpleasant pungent odor appears in the urethra, when opened, the feces contain pus and mucus in the rectum.

Chronic prostatitis is characterized by an undulating course with periods of long-lasting remissions, during which the inflammation of the prostate is latent or manifests itself with extremely bad symptoms. Patients who are not bothered by anything often discontinue treatment and turn only when complications arise.

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 epididymis (epdidymo-orchitis) and inflammation of the seminal vesicles (vesiculitis). The result of these diseases is often infertility.

diagnosis

To assess the severity of prostate adenoma symptoms, the patient is asked to fill out a urine diary. During the consultation, the urologist performs a digital examination of the prostate. To rule out infectious complications, prostate secretion and swabs from the urethra are taken and examined. Additional tests include:

• echography.During the ultrasound examination of the prostate, the volume of the prostate is determined, stones and blocked areas are detected, the amount of residual urine, the condition of the kidneys and the urinary tract are assessed.
• Urodynamic study.Uroflowmetry allows you to reliably assess the degree of urinary retention (the timing of urination and the speed of urine flow are determined by a special device).
• Definition of tumor markers.In order to rule out prostate cancer, it is necessary to determine the level of PSA (prostate specific antigen), the value of which should not normally exceed 4 ng / ml. In controversial cases, a biopsy of the prostate is performed.

Cystography and excretory urography of prostate adenoma have been performed less frequently in recent years due to the advent of new, less invasive and safer methods of examination (ultrasound). Sometimes a cystoscopy is done to rule out diseases with similar symptoms or to prepare for surgical treatment.

treatment of prostatitis

Treatment of acute prostatitis

Patients with an uncomplicated acute course are treated on an outpatient basis by a urologist. In case of severe poisoning, suspected purulent process, hospitalization is indicated. Antibacterial therapy is carried out. Preparations are selected taking into account the sensitivity of the infectious agent. Antibiotics, which can easily penetrate the prostate tissue, are widespread.

With the development of acute urinary retention on the basis of prostatitis, they resort to the installation of a cystostomy, and not a urethral catheter, since there is a risk of forming an abscess of the prostate. 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 complex, including etiotropic therapy, physiotherapy, immunity correction:

• antibiotic therapy. The patient is prescribed antibacterial drugs for a long time (within 4-8 weeks). The selection of the type and dosage of antibacterial drugs, as well as determining the duration of treatment is carried out individually. The drug is selected 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 is pushed out into the ducts, then enters the urethra and is removed from the body. The procedure improves blood flow to the prostate, which minimizes congestion and ensures better penetration of antibacterial drugs into the tissues of the affected organ.
• Physical therapy.Laser irradiation, ultrasonic waves and electromagnetic vibrations are used to improve blood circulation. If physiotherapeutic procedures cannot be performed, the patient is prescribed warm medicinal microclysters.

With chronic, long-term inflammation, consultation with an immunologist is indicated in order to choose the tactics of immunocorrective therapy. The patient is advised about lifestyle changes. Certain changes in the lifestyle of a patient with chronic prostatitis are both a curative and a preventive measure. The patient is recommended to normalize sleep and wakefulness, introduce a diet and engage in moderate physical activity.

Conservative therapy

Conservative therapy is carried out in the early stages and in the case of absolute contraindications to surgery. To reduce the severity of the symptoms of the disease, alpha-blockers, 5-alpha-reductase inhibitors, herbal preparations (African plum bark extract or sabal fruit) are used.

Antibiotics are prescribed to fight the infection that often accompanies prostate adenoma. At the end of antibiotic therapy, probiotics are used to restore normal intestinal flora. Perform immunity correction. Atherosclerotic vascular changes that develop in most elderly patients prevent the flow of drugs to the prostate, so special drugs are prescribed to normalize blood circulation.

surgery

The following surgical methods are used to treat prostate adenoma:

1. TRIP(transurethral resection). Minimally invasive endoscopic technique. The operation is performed when the adenoma volume is less than 80 cm3. Not applicable in renal failure.
2. adenomectomy.It is carried out in case of complications, the mass of the adenoma is more than 80 cm3. Currently, laparoscopic adenomectomy is widely used.
3. Laser vaporization of the prostate.Allows operations to be performed with a tumor mass of less than 30-40 cm3. It is the method of choice for young patients with prostate adenoma because it allows them to preserve sexual function.
4. laser enucleation(Holmium - HoLEP, Thulium - ThuLEP). The method is considered the "gold standard" of surgical treatment of prostate adenoma. Allows the removal of an adenoma with a volume of more than 80 cm3 without open surgery.

There are a number of absolute contraindications to surgical treatment of prostate adenoma (decompensated diseases of the respiratory and cardiovascular systems, etc. ). If surgical treatment is not possible, bladder catheterization or palliative surgery is performed - cystostomy, installation of a urethral stent.

prognosis and prevention

Acute prostatitis is a disease with a pronounced tendency to become chronic. Even with timely adequate treatment, more than half of patients end up with chronic prostatitis. Recovery is far from always achieved, but with the right consistent therapy and according to the doctor's recommendation, it is possible to eliminate unpleasant symptoms and, in the case of a chronic course, to achieve long-term stable remission.

Prevention means eliminating risk factors. It is necessary to avoid hypothermia, alternate between sedentary work and periods of physical activity, eat regularly and fully. In case of constipation, laxatives should be used. One of the preventive measures is the normalization of sex life, since both excessive sexual activity and sexual abstinence are risk factors for the development of prostatitis. If symptoms of a urological or sexually transmitted disease appear, you should consult a doctor in good time.