Chronic prostatitis is a serious problem. Even modern urology cannot answer many questions about this pathology. Experts believe that chronic prostatitis is a disease that is the result of a whole series of health problems, including tissue damage, as well as dysfunctions not only of the urinary tract and prostate gland, but also of other organs.
Pathology is diagnosed mainly in men of reproductive age. In older men, chronic prostatitis is often accompanied by benign neoplasms of the prostate.
Classification of diseases
The classification of prostatitis was developed by scientists at the US National Institutes of Health in 1995:
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- 1 type- acute bacterial prostatitis. It is diagnosed in 5% of cases of inflammation of the prostate gland.
- type 2- chronic bacterial prostatitis.
- 3 type- chronic bacterial prostatitis. This pathology has another name: chronic pelvic pain syndrome.
- type 3A- an inflammatory form of chronic prostatitis. It is diagnosed in 60% of cases of chronic prostatitis.
- type 3B- non-inflammatory form of chronic prostatitis. Diagnosed in 30% of cases.
- 4 type- asymptomatic prostatitis.
There is also a classification of chronic prostatitis, compiled in 1990.
Symptoms of chronic prostatitis
Feeling of discomfort and pain in the pelvic area that lasts more than 3 months are the main symptoms of chronic prostatitis.
In addition, urinary disorders and erectile dysfunction are observed:
- pain occurs in the perineum, may radiate to the anus, groin, inner thigh, sacrum, lower back, and scrotum. Pain, on the one hand, spreading to the testicle, is often not a symptom of chronic prostatitis;
- erection does not occur, despite the presence of adequate conditions, but complete impotence is not observed;
- in the early stages of the development of the disease, premature ejaculation is observed;
- frequent urination, urinary incontinence, pain and burning sensation in the process of emptying the bladder.
The clinical picture may differ depending on the type of chronic prostatitis.
infectious form:
- frequent urination at night;
- pain in the thighs, perineum, glans and rectum, aggravated by movement;
- pain when urinating;
- weak stream of urine
Specific infectious:
- mucous discharge from the urethra;
- the above symptoms.
Non-infectious prostatitis:
- sharp pain in the perineum;
- pain in the thighs and head of the penis;
- the pain intensifies with the forced interruption of sexual intercourse or a prolonged absence from intimate life.
Important!The disease progresses in waves. Symptoms may weaken or intensify, but their presence clearly indicates the presence of an inflammatory process.
Symptoms may vary depending on the stage of development of the pathology.
The following stages of development of pathology are distinguished:
- exudative.The patient experiences pain in the pubis, groin and scrotum. There is frequent urination and a feeling of discomfort after intercourse. An erection can hurt.
- Alternative.The pain intensifies, is localized in the groin, pubic part and goes to the sacrum. Urination is accelerated, but occurs without difficulty. The erection does not suffer.
- proliferative.During an exacerbation, urination becomes more frequent. The urine stream becomes weak.
- cicatricialSclerosis of the prostate tissue occurs. There is a feeling of heaviness in the sacrum and pubic region. Increased urination. The erection becomes weak. Ejaculation may be completely absent.
The symptoms may vary depending on the course of the disease, but in any case, they will gradually increase.
Causes of chronic prostatitis
There are many factors that lead to chronic prostatitis. The disease occurs under the influence of infectious agents. The patient presents hormonal, autonomic, immunological and hemodynamic alterations. Biochemical factors, the reflux of urine in the lobes of the prostate and the poor functioning of growth factors, which are responsible for the proliferation of living cells, affect.
Reasons affecting the formation of pathology:
- infections of the genitourinary system;
- hypodynamia;
- irregular sex life;
- continuous catheterization of the bladder;
- usual hypothermia.
Developingbacterial diseasespromotes intraprostatic urinary reflux.
Chronic abacterial prostatitisdevelops against the background of neurogenic disorders of the pelvic floor muscles, as well as elements responsible for the functioning of the bladder wall, prostate and urethra.
Trainingmyofascial trigger points, which are located near the organs of the genitourinary system and the prostate gland, can cause pelvic pain syndrome. Stitches resulting from certain diseases, surgeries, and injuries can cause pain in the pubic region, perineum, and surrounding areas.
Diagnosis of pathology
The presence of a symptom complex makes it possible to diagnose chronic prostatitis without much difficulty. However, in some cases, the pathology may be asymptomatic. In this case, in addition to the standard examination and questioning of the patient, additional investigative methods are required.Neurological examination and study of the patient's immune status is mandatory..
Important!Special questionnaires and questionnaires allow you to more accurately determine the patient's subjective feelings and get a complete picture of the state of health, pain intensity, ejaculation, erection and urination disorders.
laboratory diagnosis
Laboratory diagnosis makes it possible to distinguish between a bacterial and abacterial form of pathology, as well as determine the type of pathogen and make the most accurate diagnosis.Chronic inflammation of the prostate is confirmed when the fourth sample of urine or prostatic secretion contains more than 10 leukocytes in the PZ, or bacterial associations.When the number of leukocytes increases, but the bacteria do not seed, the material is examined for chlamydia or other STD pathogens.
- The discharge from the urethra is sent to the laboratory to detect viral, fungal and bacterial flora, leukocytes and mucus in it.
- The scraping from the urethra is examined by PCR. This allows you to identify pathological agents that are sexually transmitted.
- Perform a microscopic examination of the prostatic secretion to count the number of macrophages, leukocytes, amyloid, and Trousseau-Lallemand bodies. An immunological study and a bacteriological study are prescribed. Determine the level of non-specific antibodies.
- Blood sampling is performed ten days after a digital rectal examination to determine the concentration of PSA in it. At a rate greater than 4. 0 ng/ml, the patient undergoes a prostate biopsy to rule out oncology.
The diagnosis is stated on the basis of results of researches.
Instrumental diagnosis
To clarify the stage and form of the disease will help transrectal ultrasound of the gland.. Ultrasound allows you to exclude other diagnoses, monitor the effectiveness of treatment, as well as determine the size of the prostate, its echostructure, homogeneity and density of the seminal vesicles. Urodynamic studies and pelvic floor muscle myography will reveal infravesical obstruction and neurogenic disorders that often accompany the pathology.
Tomography and magnetic resonance imaging are used to make a differential diagnosis, in particular with prostate cancer. These methods will reveal violations in the pelvic organs and the spine.
differential diagnosis
Differential diagnosis is important, as there is a risk that the patient may have more severe disease.
Differential diagnosis is established with such diseases:
- pseudodysynergia, functional disorder of the detrusor-sphincter system, bladder dysfunction of neurogenic origin, complex regional pain syndrome;
- bladder stricture, hypertrophic changes in the bladder neck, prostate adenoma;
- osteitis of the pubic joint, cystitis;
- pathology of the rectum.
If symptoms occur, the prostate gland should be examined by a urologist or an andrologist.. Get an ultrasound. If necessary, a biopsy of the prostate is prescribed.
Pathology treatment methods
Chronic prostatitis is treated by a urologist or an andrologist. Therapy is carried out in a complex way. The correction is subject to the patient's lifestyle, the characteristics of his thinking and his habits. It is important to move more, minimize alcohol consumption, get rid of nicotine addiction, eat well and normalize your sex life. However, doing without a course of basic therapy will not work. Taking medication is the main condition for a full recovery.
Indications for hospitalization
Most often, treatment is carried out on an outpatient basis. But in cases where the disease cannot be corrected and is prone to relapse, the patient is referred to a hospital where treatment is more effective.
Medical method of treatment.
This method is aimed at eliminating the existing infection, normalizing blood circulation, improving the drainage of the prostate lobes, correcting the hormonal background and the immune status. Therefore, doctors prescribe antibiotics, vasodilators, immunomodulators, anticholinergics and anti-inflammatory drugs.
If the pathology is of a bacterial nature, then antibiotics are definitely recommended. The agent is prescribed based on the results of bacterial culture of prostatic secretion.This will make it possible to isolate the pathogen with subsequent determination of its sensitivity to a particular drug. With a well-designed scheme, the effectiveness of treatment reaches more than 90%.
In the abacterial form, a short course of antibiotics is prescribed. It is continued only if the scheme gives a positive result. The effectiveness of therapy is about 40%
With chronic pelvic pain, the duration of the course of antibiotics is no more than a month. With positive dynamics, treatment continues for another month. If there is no effect, the drug is replaced by another, which may be more effective.
Antibacterial agents from the group of fluoroquinolones are the main drugs for the treatment of pathology.They have high bioavailability, are active against most gram-negative bacteria, ureaplasmas and chlamydiae, accumulate in the tissues of the prostate gland.
When treatment with fluoroquinolones is not effective, penicillins may be prescribed.
Antibacterial drugs are used for preventive purposes.
After antibiotic treatment, therapy with the use of alpha-blockers is prescribed.This treatment strategy is effective for patients who have persistent obstructive and irritative symptoms.
If urination disorders and pain persist, tricyclic antidepressants may be prescribed, which have an analgesic effect.
With severe violations of urination, before starting therapy, a urodynamic study is performed and action is taken on the basis of the results obtained.
non-pharmacological therapy
Non-drug methods of therapy make it possible to increase the concentration of antibacterial drugs in the tissues of the gland, but exceeding the dose is not recommended.
For this purpose, the following methods are used:
- electrophoresis;
- laser therapy;
- phonophoresis;
- Microwave hyperthermia (applied transrectally).
When applying the last method, the temperature is selected individually. The temperature, set in the range of 39-40 degrees, allows you to increase the concentration of the drug in the body, activates the immune system at the cellular level, kills bacteria and relieves congestion. Increasing the range to 40-45 degrees allows you to achieve a sclerosing and analgesic effect.
Laser and magnetic therapy are used in combination. The effect is similar to the effect of the previous methods, but it also has a biostimulating effect on the organ.
Transrectal massage is performed only in the absence of contraindications.
surgical method
Chronic prostatitis does not usually require surgery. The exception is complications that pose a threat to the patient's health and life. Modern surgical treatment allows the use of endoscopic surgery. It is minimally invasive. Rehabilitation is faster and the damage done to the body is minimal.
The surgical method is prescribed for:
- sclerosis of the prostate;
- prostate adenoma;
- seed tuber sclerosis;
- calcification in the prostate.
Important!Surgery is contraindicated in the acute stage. Surgical treatment is prescribed by the surgeon based on the results of the study and the general clinical picture.
Prognosis of chronic prostatitis
Physicians are wary of predicting the outcome of the disease. Full recovery is rare. Basically, chronic prostatitis enters a stage of long-term remission. Symptoms disappear, urine and blood counts return to normal. So that chronic prostatitis does not become more active and does not cause complications, it is necessary to follow all the recommendations of a specialist.