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Prostatitis

Symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the prostate (prostate gland) in men that negatively affects sexual function and urination.Pain in the perineum, groin, lower back and pelvic area, as well as disturbances in urodynamics (urine outflow) may indicate the presence of prostatitis.Untreated prostatitis can lead to male infertility and prostate cancer.

This is one of the most common diseases in men and requires careful attention and competent systemic treatment.It is exactly this approach to solving the problem of prostatitis that you can find in the urological department of a specialized clinic.Highly qualified urologists-andrologists have been successfully treating acute and chronic prostatitis for many years.Complex therapy, careful care and an individual approach to each case inevitably lead to the patient's recovery and stable, long-term remission.

Prevalence

Prostatitis ranks fifth among the 20 main urological diagnoses.It is believed that by the age of 30, 30% of the male population suffers from prostatitis, by the age of 40-40% and after 50 years, almost all men bear the burden of this disease in one way or another.And if infectious prostatitis is predominantly diagnosed up to the age of 35, the non-infectious form predominates in older age and is generally diagnosed many times more frequently than bacterial inflammation of the prostate.

Anatomy and Physiology of the Prostate

The prostate (prostate) is located in the lower front part of the pelvis, below the bladder.It consists of glandular and smooth muscle tissue surrounded by a fibrous capsule.The urethra runs from the bladder through the body of the prostate, into which the ejaculatory ducts open.

The prostate is a hormone-dependent organ.It arises and functions under the influence of male hormones - androgens.Testosterone plays a leading role in this process.

The prostate is connected to the seminal tuberosity, which acts as a valve for the ejaculatory duct.As part of the male reproductive system, the prostate affects erection, ejaculation and orgasm.The nerves responsible for erection run through the gland.In the chronic course of the disease, they are involved in the inflammatory process and lead to erectile dysfunction.

The prostate produces a secretion that is part of semen.It creates favorable conditions for sperm activity.Therefore, with chronic dysfunction of the gland, male infertility can occur.

Pathogenesis

There are two main reasons for the development of prostatitis:

  • Stagnation of prostate secretion against the background of impaired blood circulation and lymphatic outflow in the gland itself and neighboring organs;
  • pathogenic and conditionally pathogenic microflora.

Acute prostatitis is usually accompanied by an infection of the prostate tissue.However, both factors are usually related and together form a vicious circle that makes treating prostatitis difficult.

The inflamed prostate becomes painful.Pain may occur in the perineum, groin, pelvis, and lower back.It increases sharply when palpated during a rectal digital examination or during bowel movements.

The prostate enlarges and pinches the urethra.This makes it difficult for urine to flow out of the bladder.The urine stream becomes weak.The patient must tense his abdominal muscles so that the urge to urinate can take place.In acute cases, urinary tract obstruction and acute urinary retention sometimes occur.

Inflammation leads to disruption of the outflow of prostate juice and its stagnation.The resulting swelling disrupts the processes of cell metabolism and respiration in the gland.This creates conditions for the process to become chronic.With prolonged prostatitis, neighboring organs can become inflamed: seminal tubercles, Cooper's glands, seminal vesicles.The chronic form of the disease is associated with the risk of developing male infertility, adenomas and prostate cancer.

In recent years, it has been found that in 70-80% of cases, prostatitis occurs due to stagnant processes in the gland.Venous diseases are less common, but also cause prostatitis, especially when accompanied by hemorrhoids and a left varicocele (enlargement of the testicular vein).

Classification

The American National Institute of Health identifies 4 categories of prostatitis:

  • Acute prostatitis (category I)
  • Chronic bacterial prostatitis (category II)
  • Chronic Prostatitis/Chronic Pelvic Pain Syndrome (Category III)
  • Asymptomatic chronic prostatitis (category IV)

Based on its occurrence, prostatitis is divided into two types:

  • Not contagious
  • Contagious

The inflammatory process can develop quickly, accompanied by vivid symptoms (acute stage), or slowly, with gradually increasing symptoms.

Non-infectious prostatitisIn most cases, it is accompanied by stagnation of prostate secretions and impaired blood circulation and lymphatic flow in the gland itself and neighboring organs.

Infectious prostatitisarises due to the penetration of pathogenic or opportunistic microflora into the prostate tissue: bacteria, viruses, fungi.There are several ways an infection can enter the prostate:

  • Urinogenic (ascending): The entry portal is the urethra.It should be noted that the infection can also occur in a descending route, for example in purulent pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphogenic: Infection of adjacent pelvic organs can reach the prostate via lymph due to inflammation of the rectum (proctitis) or bladder (cystitis), as well as through infected hemorrhoidal veins.
  • Hematogenous (through the blood): caused by the presence in the body of chronic foci of infection (tonsillitis, carious teeth) or complications of acute infections (flu, acute respiratory infections, tonsillitis, etc.).

The most common pathogens causing prostatitis are:

  • Bacteria: Escherichia coli, Proteus, Gardnerella (gram negative);staphylococci, streptococci (gram positive);
  • Viruses (influenza, herpes, cytomegalovirus, ARVI pathogens);
  • mycoplasma;
  • chlamydia;
  • specific flora (Gonococcus, Trichomonas, Mycobacterium tuberculosis).

Depending on the type of progression, prostatitis occurs:

  • Spicy
  • Chronic

Acute prostatitisusually occurs under the influence of pathogenic (opportunistic) microflora in the presence of predisposing factors.It has a rapid course and pronounced symptoms.If it is not treated in a timely manner, a purulent process may develop, leading to the melting of prostate tissue.If treated incorrectly, acute prostatitis often becomes chronic.

Chronic prostatitishas a milder course and the symptoms disappear.However, it can worsen from time to time and the symptoms then correspond to an acute process.However, complete remission does not always occur between exacerbations, and the patient may feel constant discomfort.Chronic prostatitis can cause impotence, male infertility, adenomas or prostate cancer.

There is a chronic asymptomatic form of the disease, in which the patient has no symptoms, but the prostate secretion contains an increased number of purulent elements (leukocytes).

Complications

Without appropriate therapy, the inflammatory process can lead to a purulent fusion of the prostate tissue.In addition, the inflammation can spread to neighboring organs: seminal tubercles, Cooper's glands, seminal vesicles, urethra.Accordingly, the following complications can occur:

  • Prostate abscess
  • Sclerosis/fibrosis of the prostate (functional glandular tissue is replaced by connective tissue)
  • Prostate cysts
  • Prostate stones
  • Vesiculitis (inflammation of the seminal vesicles)
  • Colliculitis (inflammation of the seminiferous tubercle)
  • Epididymoorchitis (inflammation of the testicles and their appendages)
  • Posterior urethritis
  • Erectile dysfunction/impotence
  • Ejaculation disorder
  • infertility
  • Prostate adenoma
  • Prostate cancer

Symptoms

Different forms of prostatitis have their own characteristics and severity of symptoms.In general, the following manifestations are characteristic of prostatitis:

  • Pain in the groin, lower back and perineum (may radiate along the spermatic cords).
  • Pain increases during bowel movements and digital rectal examination.
  • Urodynamic disorders (frequent urination, urinary retention, difficulty urinating, weak stream, incomplete bladder emptying).
  • Prostatorrhea (involuntary release of prostate juice, especially in the morning and during bowel movements).
  • Disorders of sexual function (decreased libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • The temperature rises to 39-40 degrees
  • Acute urinary retention
  • General intoxication
  • Leukocyturia, protein and mucus in the urine
  • Blood in urine and semen
  • Leukocytosis in prostate secretion
  • Hypoechogenicity and enlargement of the gland, increased blood flow according to ultrasound data

Symptoms of chronic prostatitis

  • Body temperature normally does not exceed 37°C
  • Pain sensations are dulled and smoothed
  • Discharge from the urethra during bowel movements
  • Urinary disorders
  • Decreased libido
  • Erectile dysfunction
  • Ejaculation disorders (premature or delayed ejaculation)

Reasons

The main reasons for the development of prostatitis are infections and stagnation of prostate secretions.The following factors contribute to the occurrence of prostatitis:

  • Infections and opportunistic flora with weakened immunity
  • Physical inactivity
  • “Sedentary” work
  • Long-term sexual abstinence
  • Coitus interruptus (with delayed ejaculation)
  • Excessive sexual activity leads to depletion of the gland
  • Alcohol abuse
  • Decreased local immunity (hypothermia, taking immunosuppressants, immunodeficiency, autoimmune diseases)
  • Injuries to the pelvic organs
  • Manipulations of the prostate and neighboring organs (prostate biopsy, surgery, catheterization, cystoscopy, etc.)
  • Chronic diarrhea or constipation

diagnosis

To detect prostatitis, many methods are used, which can be divided into three groups: digital rectal examination, laboratory tests and instrumental methods.

Digital rectal examinationcarried out by a urologist-andrologist after a conversation with the patient.This method allows you to assess the size, shape and some features of the structure of the prostate.If the prostate is enlarged and the procedure itself is painful for the patient, the doctor can diagnose prostatitis in advance.

If the case is not acute, the doctor may perform prostate massage during the examination to obtain prostatic secretion, the examination of which is an important link in the diagnosis of prostatitis.If acute bacterial prostatitis is suspected, prostate massage is contraindicated: such manipulation can lead to the spread of the pathogen and blood poisoning.

To clarify the diagnosis, the patient is asked to undergo an examinationInstrumental studies, like for example:

  • transrectal ultrasound examination of the prostate and pelvic organs (shows structural features, the presence of inflammation and purulent foci, stones, cysts and other neoplasms);
  • Dopplerography (characteristics of blood flow in the gland);
  • Uroflowmetry (determination of the speed and time of urination);
  • Magnetic resonance imaging of the pelvic organs (an extremely informative and safe study that allows differential diagnosis from other diseases).

If necessary, diagnostics of neighboring organs of the genitourinary system is carried out: urethroscopy, urethrography and urethrocystography.

Laboratory researchare a necessary part of the diagnosis of prostatitis:

  • General urinalysis (before and after prostate massage)
  • General blood test
  • Blood test for proteins of the acute inflammatory phase (C-reactive protein etc.)
  • Microscopic examination of prostate secretion after finger massage
  • Microscopic examination of an abrasion from the urethra
  • Spermogram (cytology and biochemistry of sperm)
  • Culture of urine, prostatic secretion and semen
  • Determination of prostate-specific antigen (PSA)
  • Needle biopsy of the prostate and histological examination of the glandular tissue

The last two studies are necessary to rule out prostate cancer or adenoma.

The modern system has an excellent, very meaningful diagnostic basis.Urologists have extensive experience in diagnosing and successfully treating various forms of prostatitis.The status of a multidisciplinary clinic allows you to use the services of specialists in related areas.The medical center has developed research packages that include all the necessary types of diagnostics at a very attractive price. 

Treatment

Treating prostatitis is not an easy task.It requires a thoughtful, integrated approach.The treatment protocol of this disease includes drug therapy and physiotherapeutic procedures, in some cases surgical intervention is required.

Drug therapy

Includes the use of the following drugs:

  • Antibiotics (after determining sensitivity to them)
  • Antiseptics (local)
  • Vascular medications (improving microcirculation in the prostate)
  • Nonsteroidal anti-inflammatory drugs
  • Alpha-1 blockers (for urinary problems)
  • Enzyme preparations (dilute the prostate secretion, stimulate the immune system, relieve inflammation)
  • Immunomodulators
  • Antidepressants

Physiotherapeutic treatment

  • Electrical stimulation of the prostate (electrophoresis, galvanization, pulsed effect)
  • Vibration massage
  • Laser therapy with a rectal sensor (for chronic prostatitis)

For chronic prostatitis, prostate massage can be used as a therapeutic procedure.In the acute stage of the disease, this manipulation is not carried out in order to avoid the spread of infection and sepsis.

Surgical treatment

Surgery for prostatitis is rarely performed.This need arises with severe suppuration of prostate tissue, lack of positive dynamics in drug treatment and pathological enlargement of the prostate blocking the urethra.

forecast

With early diagnosis and appropriate treatment, acute prostatitis can be overcome.However, even with correct and timely therapy, the process often becomes chronic.

If treated incorrectly and the treatment deadlines (several months) are not adhered to, the disease usually becomes chronic.Chronic prostatitis severely affects a man's quality of life, as not only urinary function is impaired, but also sexual function.Erectile dysfunction, loss of orgasm intensity, ejaculation problems and infertility are observed in 30% of cases.It is completely impossible to cure chronic prostatitis, but with the right approach, stable remission can be achieved.

Benefits of Visiting a Professional Clinic

  • Successful treatment of various forms of prostatitis
  • Experienced urologists-andrologists of the highest qualifications
  • Multidisciplinary, allowing you to involve specialists from related fields in the treatment
  • Highly precise modern diagnostic and treatment devices
  • Own European-class clinical diagnostic laboratory
  • Comfortable and high-tech hospitals
  • A package of urological diagnostic services at an attractive price

Prevention of prostatitis

  • Choose safe sex to avoid sexually transmitted infections (STIs).
  • Support the immune system (vitamins, healthy nutrition, prevention of dysbiosis, sensible antibiotic therapy, etc.)
  • Avoid hypothermia
  • Lead an active lifestyle
  • Have sex regularly, if possible, with a partner (to avoid prostate stagnation and sexually transmitted diseases)
  • Avoid interrupted sexual intercourse (this relieves sperm stagnation)
  • Visit your urologist once a year for prevention and twice a year if you are over 50 or have a history of prostate disease.

Frequently asked questions

How useful is the PSA test in diagnosing prostatitis?

Prostate-specific antigen (PSA) is a marker for prostate cancer.It is known that in some cases prostate cancer has a clinical picture similar to the manifestations of prostatitis.Therefore, the PSA test is used to differentiate between these two diseases.However, you should not rely on PPE.This antigen also multiplies in prostate adenoma, a benign growth of glandular tissue.In prostatitis, PSA levels can rise even during periods of active inflammation.It decreases during the remission phase.Therefore, PSA cannot be used as definitive evidence of prostate cancer or prostatitis.

Why is prostatitis difficult to treat?

Prostatic capillaries have a special structure that forms a hematoprostatic barrier.This makes it difficult for some antibiotics to penetrate the glandular tissue.In addition, microorganisms tend to form biofilms, which reliably protect them from the effects of antibacterial agents.Therefore, modern protocols for the treatment of prostatitis necessarily include proteolytic enzymes that can destroy biofilms.Bacteria become more susceptible and antibiotics work more effectively.The most persistent treatment is chronic prostatitis, the main feature of which is the large diversity of microflora in the culture.In about 50% of cases, Enterococcus faecalis is sown, which is resistant to all aminoglycosides and cephalosporins.This limits the list of effective antimicrobial agents, which also complicates treatment.