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prostatitis

Symptoms of Prostatitis in Men

Prostatitis is an inflammatory disease of the male prostate (prostate) that negatively affects both sexual function and the process of urination. Pain in the perineal, groin, lower back, and pelvic regions, and urodynamic disturbances (the flow of urine) may indicate prostatitis. Untreated prostatitis can lead to male infertility and prostate cancer.

It is one of the most common male disorders and requires careful attention and effective systemic treatment. You can find this solution to the problem of prostatitis in the urology department of a specialized clinic. Acute and chronic prostatitis have been successfully treated by highly qualified urologists and andrologists over the years. Sophisticated treatment, attentive attitude and individualized treatment of each case inevitably lead to patient recovery and stable long-term remission.

Prevalence

Prostatitis ranks 5th among the top 20 diagnoses in urology. It is thought that at age 30, 30% of the male population suffers from prostatitis, and at 40-40% and 50 years later, almost all men carry the burden of the disease in some way. If primary infectious prostatitis is documented for up to 35 years, then at more mature ages, the non-infectious form predominates and is usually diagnosed several times more frequently than bacterial inflammation of the prostate.

Anatomy and Physiology of the Prostate

The prostate is located in the front lower part of the small 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, and the ejaculatory ducts lead into the bladder.

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

The prostate is associated with semen nodules, which act as valves to the ejaculatory ducts. As part of the male reproductive system, the prostate affects erection, ejaculation, and orgasm. The nerves responsible for erection pass through the gland. During the chronic course of the disease, they are involved in inflammatory processes and develop erectile dysfunction.

The secret to what the prostate produces is part of semen. Create favorable conditions for the activity of sperm. Thus, with chronic dysfunction of the glands, male infertility can be observed.

onset

Prostatitis occurs mainly for two reasons:

  • stagnation of prostate secretion against the background of circulatory disturbances and lymphatic outflow in the gland itself and in adjacent organs;
  • Pathogenic and opportunistic pathogenic microbial communities.

Acute prostatitis is usually associated with an infection of the prostate tissue. But, as a rule, these two factors are interrelated and together create a vicious circle that makes prostatitis difficult to treat.

An inflamed prostate becomes painful. Pain in perineum, groin, pelvis, lower back. Increases sharply on palpation during digital rectal examination or defecation.

The prostate enlarges in size, constricting the urethra. As a result, it becomes difficult for urine to flow out of the bladder. Weak urine flow. Patients must tighten their abdominal muscles to urinate. Urinary tract obstruction and acute urinary retention sometimes occur in acute cases.

Inflammation leads to the outflow of prostatic fluid and its stagnation. The resulting edema disrupts cellular metabolism and respiration processes in the gland. This creates the conditions for synchronization of processes. In chronic prostatitis, adjacent organs are also inflamed: seminal vesicles, Cooper's glands, seminal vesicles. Chronic forms of the disease are associated with a 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 a stagnant process in the gland. Venous disorders are less common, but they can also cause prostatitis, especially if accompanied by hemorrhoids and varicocele (dilated testicular veins) on the left side.

Classification

The National Institutes of Health has identified 4 types of prostatitis:

  • Acute prostatitis (category I)
  • Chronic bacterial prostatitis (category II)
  • Chronic prostatitis/chronic pelvic pain syndrome (category III)
  • Asymptomatic chronic prostatitis (category IV)

There are two types of prostatitis:

  • non-infectious
  • contagious

The inflammatory process can develop rapidly, with marked symptoms (acute phase), or develop slowly, with gradual disappearance of symptoms.

non-infectious prostatitisIn most cases, it is associated with stagnant prostate secretion and impaired blood circulation and lymph flow in the gland itself and in nearby organs.

infectious prostatitisDeveloped as a result of the penetration of pathogenic or opportunistically pathogenic microflora into prostate tissue: bacteria, viruses, fungi. There are different ways an infection can enter the prostate:

  • Urinary (Ascent): The entrance is the urethra. It should be noted that infections can also spread downstream, such as in suppurative pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphatic: Due to inflammation of the rectum (proctitis) or bladder (cystitis) and infected hemorrhoidal veins, infection from adjacent pelvic organs can pass through the lymph to the prostate.
  • Hematogenous (through blood): due to the presence of chronic infectious foci (tonsillitis, dental caries) or acute infectious complications (flu, acute respiratory infection, tonsillitis, etc. ) in the body.

The most common pathogens of prostatitis are:

  • Bacteria: Escherichia coli, Proteus, Gardnerella (Gram-negative); Staphylococcus, Streptococcus (Gram-positive);
  • Viruses (influenza, herpes, cytomegalovirus, ARVI pathogens);
  • Mycoplasma;
  • Chlamydia;
  • Specific flora (Neisseria gonorrhoeae, Trichomonas, Mycobacterium tuberculosis).

Depending on the nature of the course, prostatitis can occur:

  • Spicy
  • chronic

acute prostatitisIt usually occurs under the influence of pathogenic (opportunistically pathogenic) microbial communities and there are predisposing factors. It has a quick course and obvious symptoms. If left untreated, a purulent process may occur, causing the prostate tissue to melt. Acute prostatitis often becomes chronic if not treated properly.

chronic prostatitisThe course of the disease was mild and the symptoms disappeared. However, it may worsen from time to time, and then the symptoms will correspond to an acute course. At the same time, complete remission between acute episodes does not always occur, and patients may experience constant discomfort. Chronic prostatitis can lead to impotence, male infertility, adenoma or prostate cancer.

The disease is a chronic asymptomatic form when the patient has no complaints but has an increased number of purulent components (leukocytes) in prostate secretions.

complication

Without proper treatment, the inflammatory process can lead to purulent fusion of prostate tissue. In addition, inflammation can spread to nearby organs: seminal vesicles, Cooper's glands, seminal vesicles, urethra. Therefore, the following complications may occur:

  • prostate abscess
  • Prostate sclerosis/fibrosis (the gland's functional tissue is replaced by connective tissue)
  • prostate cyst
  • Prostate stones
  • Seminal vesiculitis (inflammation of the seminal vesicles)
  • Colitis (inflammation of the seminal vesicles)
  • Epididymitis (inflammation of the testis and its appendages)
  • Posterior urethritis
  • Erectile Dysfunction / Impotence
  • Ejaculation disorder
  • infertility
  • prostate adenoma
  • prostate cancer

symptom

Different forms of prostatitis are characterized by their course and severity of symptoms. In general, prostatitis has the following symptoms:

  • Groin, lower back, perineal pain (may radiate along the spermatic cord).
  • Pain worsened during defecation and digital rectal examination.
  • Violation of urodynamics (frequency of urination, urinary retention, dysuria, weak urine flow, incomplete bladder emptying).
  • Enlarged prostate (involuntary secretion of prostate fluid, especially in the morning and during bowel movements).
  • Sexual dysfunction (decreased libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • Warm up to 39-40 degrees
  • acute urinary retention
  • general poisoning
  • Leukocyturia, protein, and mucus in urine
  • blood in urine and semen
  • Leukocytosis in prostate secretion
  • Hypoechoic and enlarged glands, increased blood flow based on ultrasound

Symptoms of chronic prostatitis

  • Body temperature usually not higher than 37C
  • Pain becomes dull and smooth
  • Excreted from the urethra during bowel movements
  • urination disorder
  • decreased libido
  • erectile dysfunction
  • Ejaculation disorders (premature or delayed ejaculation)

reason

The key reasons for the development of prostatitis are infection and stagnation of prostate secretion. The following factors can lead to the appearance of prostatitis:

  • Immunocompromised infections and opportunistic flora
  • Lack of motivation
  • "Sedentary work
  • long-term abstinence
  • Intercourse interruption (delayed ejaculation)
  • Excessive sexual activity leads to gland failure
  • alcohol abuse
  • Decreased local immunity (hypothermia, use of immunosuppressants, immunodeficiency, autoimmune disease)
  • pelvic organ injury
  • Manipulation of the prostate and nearby organs (prostate biopsy, surgery, catheterization, cystoscopy, etc. )
  • chronic diarrhea or constipation

diagnosis

There are many ways to detect prostatitis, which can be divided into 3 groups: digital rectal examination, laboratory tests, and instrumental methods.

digital rectal examinationIt is performed by a urologist-andrologist after talking to the patient. This method allows you to assess the size, shape, and some characteristics of the structures of the prostate. If the prostate is enlarged and the surgery itself is painful for the patient, a doctor may initially diagnose prostatitis.

If it is not an acute case, doctors can perform prostate massage during the examination to obtain prostate secretions. The study of prostate secretions is an important part of the diagnosis of prostatitis. Prostate massage is contraindicated if acute bacterial prostatitis is suspected: this procedure can lead to pathogen transmission and blood poisoning.

For a definitive diagnosis, the patient will be asked to receiveInstrument Research, like:

  • Transrectal ultrasonography of prostate and pelvic organs (revealing structural features, presence of inflammatory and purulent foci, stones, cysts, and other tumors);
  • Doppler angiography (characteristics of glandular blood flow);
  • uroflowmetry (measures the speed and time of urination);
  • Magnetic resonance imaging of pelvic organs (an informative and safe study that allows differential diagnosis from other disorders).

If necessary, diagnosis of nearby organs of the genitourinary system: ureteroscopy, urethrography, and urethrocystography.

laboratory researchIs an essential part of the diagnosis of prostatitis:

  • Urinalysis (before and after prostate massage)
  • General blood analysis
  • Blood tests for acute phase proteins of inflammation (C-reactive protein, etc. )
  • Microscopic examination of prostate secretion after finger massage
  • Microscopic examination of scrapes from the urethra
  • Spermatogram (cytology and biochemistry of sperm)
  • Cultures of urine, prostate secretions, and semen
  • Determination of Prostate Specific Antigen (PSA)
  • Prostate biopsy and histological examination of glandular tissue

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

Modern ones have a good and informative diagnostic base. Urologists have extensive experience in diagnosing and successfully treating various forms of prostatitis, and the status of a multidisciplinary clinic gives you access to the services of relevant specialists. The medical center has developed study kits that include all necessary types of diagnostics at attractive prices.

treat

The treatment of prostatitis is not an easy task. It requires a thoughtful and comprehensive approach. Treatment options for this condition include medication, physical therapy, and in some cases surgery.

medical treatement

It involves the use of the following drugs:

  • Antibiotics (after determining susceptibility to them)
  • Preservatives (local)
  • Vascular preparations (improve prostate microcirculation)
  • NSAIDs
  • Alpha-1-adrenergic blockers (violating urination)
  • Enzymes (diluting the secrets of the prostate, stimulates the immune system, relieves inflammation)
  • immunomodulator
  • Antidepressants

Physiotherapy

  • Prostate electrical stimulation (electrophoresis, electroplating, pulsed exposure)
  • vibration massage
  • Rectal Sensor Laser Therapy (Chronic Prostatitis)

In chronic prostatitis, prostate massage can be used as a treatment. In the acute phase of the disease, in order to avoid the spread of infection and sepsis, this procedure is not performed.

operation treatment

Surgery for prostatitis is rarely used. This need arises in the presence of severe purulent prostatic tissue, lack of positive dynamics of medical therapy, and pathological enlargement of the prostate that obstructs the urethra.

forecast

Acute prostatitis can be overcome through early diagnosis and adequate treatment. However, even with correct and timely treatment, synchronization of this process often occurs.

The disease often develops a chronic course due to inappropriate treatment and non-compliance with the terms of treatment (which is a few months). Chronic prostatitis greatly affects a man's quality of life because not only urinary but also sexual function is affected. In 30% of cases, erectile dysfunction, decreased orgasmic acuity, ejaculation problems, and infertility were observed. Chronic prostatitis is completely impossible to cure, but with proper methods, stable remission can be achieved.

Benefits of going to a specialist clinic

  • Successful treatment of various forms of prostatitis
  • Experienced Urology Surgeons - The Most Qualified Andrologists
  • Multidisciplinary, allowing specialists in related fields to participate in treatment
  • High-precision modern diagnosis and treatment equipment
  • Has a European-class clinical diagnostic laboratory
  • Comfortable high-tech hospital
  • A package of urology diagnostic services at an attractive price

Prevent prostatitis

  • Choose Safe Sex to Avoid Sexually Transmitted Infections (STIs)
  • Supports the immune system (vitamins, healthy nutrition, prevention of dysbiosis, appropriate antibiotic therapy, etc. )
  • Avoid hypothermia
  • lead an active lifestyle
  • If possible, regularly have sex with a partner (to avoid prostate congestion and STIs)
  • Avoid interruptions in intercourse (this will eliminate sperm stagnation)
  • Visit your urologist once a year for preventive purposes, or twice a year if you are over 50 or have a history of prostate disease.

Frequently Asked Questions

How informative is the PSA test in diagnosing prostatitis?

Prostate-specific antigen (PSA) is a marker for prostate cancer. It is known that, in some cases, the clinical presentation of prostate cancer resembles that of prostatitis. Therefore, PSA testing is used for the differential diagnosis of these two diseases. But don't bet on PSA. This antigen is also elevated with prostate adenomas (benign growths of glandular tissue). In prostatitis, PSA levels also increase during periods of active inflammation. During the remission phase, it decreases. Therefore, PSA cannot be used as unconditional evidence for prostate cancer or prostatitis.

Why is prostatitis difficult to treat?

Prostate capillaries have a special structure that can form the hematopoietic prostate barrier. This makes it difficult for some types of antibiotics to penetrate glandular tissue. Furthermore, microorganisms tend to form biofilms that can reliably protect them from antimicrobial agents. Therefore, modern regimens for the treatment of prostatitis necessarily include proteolytic enzymes that can disrupt biofilms. Bacteria become fragile and antibiotics work more effectively. A key feature of the treatment of the most recalcitrant chronic prostatitis is the diversity of microbial communities in crops. Enterococcus faecalis is sown in approximately 50% of cases, resistant to all aminoglycosides and cephalosporins. This narrows the range of effective antibacterial agents, which also complicates treatment.