Prostatitis

Prostatitis is a disease characterized by the presence of localized inflammation and / or infection in the prostate gland.

It can present with a wide range of clinical symptoms and complaints.

Anatomy

The prostate is a small gland that is part of the male reproductive system and a hormone-dependent organ. Its shape and size have been compared to a large walnut. A normal prostate gland weighs about 20 g, has a volume of 15-25 ml, and is 3 cm long, 4 cm wide, and 2 cm deep.

The prostate gland is located in the small pelvis, below the bladder, and above the rectum. The urethra, the urethra, goes through the thickness of the gland. The prostate is surrounded by a capsule composed of smooth muscle, collagen, and elastic fibers; covered with three layers of dense connective tissue (fascia) on the anterior, lateral and posterior surfaces. The posterior surface of the prostate is surrounded by the bleb of the rectum. They are separated by the retrovesical fascia or Denonville's fascia, which allows palpation of the posterior surface of the prostate gland.

The prostate gland is approximately 70% glandular tissue and 30% fibromuscular stroma. It is customary to divide the organ into 3 zones.

Transition zone.The transition zone represents 10% of the glandular tissue and 20% of the cases of malignant prostate tumors. In this area, one of the main age-related diseases in men is formed: benign prostatic hyperplasia, which can cause difficulty in urinating due to excessive tissue growth.

Central zone.The area around the ejaculatory ducts. It consists of glandular tissue, connective tissue, and muscle elements. Tumors in this area are extremely rare.

Peripheral area.It covers the posterior and lateral sides of the prostate gland and contains 70% of the glandular tissue. This is an area that is felt through the rectum and allows the urologist to assess the state of the prostate gland. Up to 70% of malignant tumors are located precisely in the peripheral area. Therefore, digital rectal examination is an important diagnostic method and should be performed in patients older than 45 years.

Functions of the prostate:

• production of prostate secretion, which is an integral part of sperm and intervenes in the liquefaction of the ejaculate, in addition to saturating it with nutrients such as various enzymes and vitamins, citric acid, zinc ions, which help improve sperm motility and activity;
• The prostate contains smooth muscle fibers that help release sperm from the urethra during ejaculation, prevent sperm from entering the bladder, and participate in the urinary retention mechanism.

Prostatitis, benign prostatic hyperplasia, and prostate cancer are the three main diseases of the prostate.

All three diseases can coexist in the same prostate at the same time. That is, the presence of prostatitis does not exclude the presence of prostate hyperplasia and prostate cancer in the patient and vice versa.

Causes of prostatitis

According to statistics, prostatitis is the most common urological disease, after hyperplasia and prostate cancer, in men under 50 years of age and the third most common in men over 50 years of age.

Prostatitis accounts for 6 to 8% of outpatient urology visits.

The most common causative agent of prostatitis are strains of E. coli, which are detected in 80% of cases. The rarest pathogens are Enterococci, Pseudomonas aeruginosa, Klebsiella, and other gram-negative bacteria. The role of sexually transmitted infections (such as chlamydia trachomatis) in inflammation of the prostate is not yet clearly established and is under study. In patients with HIV infection and other severe changes in the immune system, possible causative agents are cytomegalovirus, mycobacterium tuberculosis, fungi, and other rare pathogens. There are data that indicate the presence of microorganisms in the prostate gland that are not detected in standard studies, but that play a role in the appearance of inflammatory changes and the subsequent development of prostatitis symptoms.

Possible causes of prostatitis are:

• intraprostatic reflux of urine as a result of dysfunctional urination (urine, with certain predisposing factors, can enter the prostate gland through the prostate ducts, causing an inflammatory process);
• unprotected anal sex;
• narrowing of the foreskin (phimosis);
• Autoimmune diseases;
• functional and anatomical changes in the pelvic floor muscles;
• changes in the central nervous system, including functional and anatomical changes in the brain;
• traumatic and unusual sexual activity;
• Psychological factors (in several studies, the influence of psychological stress on the appearance of symptoms of chronic prostatitis has been shown; in some patients psychosomatic disorders were diagnosed, in whose treatment the symptoms of prostatitis were reduced and the probability of relapse were noted) .

Risk factors for prostatitis also include: abstinence or excessive sexual activity, habit of holding back ejaculation, smoking, working at night, a sedentary lifestyle, inadequate fluid intake, and poor diet.

Symptoms

• pain or burning when urinating (dysuria);
• urinary disorders;
• discoloration of urine;
• the appearance of blood in the urine;
• pain in the abdomen, groin, or lower back;
• pain in the perineum;
• pain or discomfort in the penis and testicles;
• pain with ejaculation;
• increased body temperature (with acute bacterial prostatitis).

Diagnostics

According to the generally recognized classification of prostatitis NIH (US National Institutes of Health), there are four categories of diseases, traditionally denoted by Roman numerals:

• I - acute bacterial prostatitis;
• II - chronic bacterial prostatitis;
• III - chronic abacterial prostatitis / chronic pelvic pain syndrome (CP / CPPS);
• IIIa - chronic prostatitis / chronic pelvic pain syndrome with signs of inflammation;
• IIIb - chronic prostatitis / chronic pelvic pain syndrome without signs of inflammation;
• IV - asymptomatic (asymptomatic) chronic prostatitis.

Despite the widespread prevalence of prostatitis, acute bacterial prostatitis is not common - 5% of all cases of the disease. But its diagnosis is quite simple, since the picture of the disease is most often pronounced: a man complains of frequent and painful urination, pain in the uterus and perineum. An increase in body temperature is characteristic, and often at high values, less than 39 ° C.

The diagnosis of acute bacterial prostatitis involves a digital rectal examination (digital rectal examination), which involves feeling (palpating) the prostate gland with the index finger through the anus (rectum).

Digital rectal examination (DRE) is an important diagnostic manipulation if a pathology of the prostate gland is suspected. Therefore, it is advisable that men do not refuse to perform it.

In acute bacterial prostatitis, the prostate is very painful, swollen, and most often enlarged. Ultrasound examination may show not only an increase in the size of the prostate gland, but also foci of purulent fusion of prostate tissue (abscesses), but this occurs infrequently and, as a rule, is a consequence of an ongoing process. .

Laboratory diagnosis, first of all, includes a general urine test, in which an increase in the number of leukocytes is observed. Bacteriological urine culture is recommended. Based on the results of the analysis, it is possible to determine the presence of bacteria and their sensitivity to the antibiotic and thus adjust the prescribed antibiotic therapy. A general blood test is also performed to assess the general condition of the body and its response to the inflammatory process.

The ingestion of prostate secretions for the diagnosis of acute prostatitis is contraindicated due to the increased risk of a life-threatening condition: bacteremia and sepsis. Determination of the oncomarker (PSA), its fractions are also not recommended, due to the low information content and the distortion of the data in the context of inflammation.

Treatment of prostatitis

Antibiotic therapy is the basic therapy for prostatitis patients of all categories.

Alpha blockers are also an effective group of drugs. As a result of its action, it decreases the tone of the smooth muscles of the prostate gland, the neck of the bladder and the prostate part of the urethra, which improves urination and reduces the possibility of urine entering the prostate gland ( intraprostatic reflux of urine), which is one of the causes of prostatitis. The most effective and popular drugs are tamsulosin and silodosin. They are also widely used to improve urination in patients with prostatic hyperplasia.

It is possible to use anti-inflammatory drugs (diclofenac), which effectively reduce pain and discomfort when urinating, reduce swelling of the prostate, and also contribute to improving the quality of urination.

Acute bacterial prostatitis is often a reason for hospitalization in a hospital, where antibiotic therapy is prescribed in the form of intravenous injections. After stabilization of the patient's condition, the patient continues to receive antibiotics in tablet form for 15 or more days to prevent the transition from acute prostatitis to chronic bacterial prostatitis.

According to statistics, 10% of patients with acute prostatitis develop chronic bacterial prostatitis. Another 10% of patients will develop chronic pelvic pain syndrome (chronic prostatitis IIIb) in the future.

How is the treatment of prostatitis in the clinic?

Urologists treat prostatitis and other diseases of the genitourinary system, according to international clinical guidelines. This means that they not only use their professional knowledge, but are also guided by scientifically proven and accepted methods of diagnosis and therapy around the world.

Our doctors do not prescribe ineffective drugs and tests "just in case", they do not treat non-existent diseases. When making a diagnosis, urologists rely on data obtained from the patient's examination, clinical picture, laboratory data, and instrumental studies. If surgical treatment is required, a surgical operation is performed on the territory of the clinic.