Prostatitisis an inflammatory disease of the prostate gland. Manifestations are frequent urination, pain in the penis, scrotum, rectum, sexual disorders (erectile dysfunction, premature ejaculation, . . . ), sometimes urinary retention, blood in urine. The diagnosis of prostatitis is established by a urologist or a gynecologist based on a typical clinical picture, the results of a rectal examination. In addition, ultrasound of the prostate, bakposv of prostate secretion and urine is performed. Conservative treatment - antibiotic therapy, immunotherapy, prostate massage, lifestyle modification.
General information
Prostatitis is an inflammation of the prostate gland - the prostate gland. This is the most common disease of the genitourinary system in men. Most commonly affects patients aged 25-50 years. According to various data, 30-85% of men over 30 years old suffer from prostatitis. Prostate abscesses can form, inflammation of the testicles and appendages, threat of infertility. Upward infection leads to inflammation of the upper genitourinary system (cystitis, pyelonephritis).
Pathology develops with the penetration of an infectious agent that enters the prostate tissue from organs of the genitourinary system (urethra, bladder) or from a distant inflammatory focal point (with pneumonia, flu, tonsillitis, boils).
Prostate adenoma is a benign tumor of the paraurethral glands located around the urethra in its prostatic portion. The main symptom of a prostatic tumor is a violation of urination due to the gradual compression of the urethra by one or more growing nodules. Pathology is characterized by a benign course.
Only a small part of patients seek medical help, however, a detailed examination reveals symptoms of the disease in every fourth man aged 40-50 years and in half of men aged 50 years. -60 years old. The disease is detected in 65% of men 60-70 years old, 80% of men 70-80 years old, and more than 90% of men over 80 years old. The severity of symptoms can vary considerably. Studies in the field of men's clinical sciences show that urination problems occur in about 40% of men with BPH, but only one in five patients in this group seek medical help.
Causes of prostatitis
As an infectious agent during the acute course, Staphylococcus aureus (Staphylococcus aureus), Enterococcus (Enterococcus), Enterobacter (Enterobacter), Pseudomonas (Pseudomonas), Proteus (Proteus), Klebsiella (Klebsiella) and Escherichia coli (E. Coli)) may work. Most microorganisms belong to the conditionally pathogenic flora and cause prostatitis only in the presence of other causative factors. Chronic inflammation is often due to multi-bacterial associations.
The risk of developing the disease is increased with hypothermia, a history of specific infections, and conditions accompanied by blockages in the tissues of the prostate gland. There are the following predisposing factors:
- General hypothermia (once or permanently, related to working conditions).
- A sedentary lifestyle, a trait that forces a person to sit for a long time (computer operator, driver, etc. ).
- Continuous constipation.
- Violation of the normal rhythm of sexual activity (excessive sexual activity, prolonged abstinence, incomplete ejaculation during "routine" sex without emotional color).
- The presence of chronic diseases (cholecystitis, bronchitis) or chronic foci of infection in the body (chronic osteomyelitis, untreated caries, tonsillitis, etc. ).
- Past urinary diseases (urethritis, cystitis, etc. ) and sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea).
- Conditions that suppress the immune system (chronic stress, mood swings and malnutrition, frequent lack of sleep, overtraining in athletes).
It is thought that the risk of developing pathology increases with chronic intoxication (alcohol, nicotine, morphine). Several studies in the field of modern andrology demonstrate that chronic trauma to the perineum (vibration, concussion) in motorcyclists, motorcyclists and cyclists is a predisposing factor. However, the vast majority of experts believe that all these circumstances are not the actual cause of the disease, but only contribute to the exacerbation of the underlying inflammatory process in the tissues of the prostate gland.
A decisive role in the occurrence of prostatitis is due to a blockage in the tissues of the prostate gland. Violation of the outflow of capillary blood causes an increase in lipid peroxidation, which causes edema, exudation of prostate tissues and facilitates the development of infectious processes.
The development mechanism of prostate cancer is still not fully defined. Although there is widespread opinion linking pathology with chronic prostatitis, there are no data to confirm a link between the two diseases. Researchers did not find any relationship between prostate cancer development and alcohol and tobacco use, sexual orientation, sexual activity, and sexually transmitted diseases. and inflammation.
The incidence of prostate cancer depends on the age of the patient. Scientists believe that adenomas develop as a result of a hormonal imbalance in men during menopause (male menopause). This theory is supported by the fact that men who are castrated before puberty never develop pathology, and extremely rarely - men who are castrated afterwards.
Symptoms of Prostatitis
Acute prostatitis
There are three stages of acute prostatitis, which are characterized by the presence of a certain clinical picture and morphological changes:
- Acute Catarrhal. The patient complained of frequent urination, painful urination, and pain in the sacrum and perineum.
- Acute cyst. The pain becomes more intense, sometimes radiating to the anus, and worsens with defecation. Difficulty urinating, urine comes out in a thin stream. In some cases, there is urinary retention. Subcutaneous fever or moderate hyperthermia are typical.
- Acute parenchyma. Severe intoxication, hyperthermia up to 38-40 ° C, chills. Urinary retention disorder, often - acute urinary retention. Sharp, stabbing pain in the perineum. Difficulty defecating.
Chronic prostatitis
In rare cases, chronic prostatitis becomes the result of an acute process, however, as a rule, a primary chronic process is observed. Temperatures sometimes rise to subthreshold values. Patients noted mild pain in the perineum, discomfort when urinating, defecating. The most characteristic symptom is little discharge from the urethra during defecation. The main chronic form of the disease develops over a considerable period of time. It was preceded by prostatitis (stagnation of blood in the capillaries), which gradually turned into bacterial prostatitis.
Chronic prostatitis is often a complication of the inflammatory process caused by the causative agent of a specific infection (chlamydia, trichomonas, ureaplasma, gonococcus). Symptoms of a specific inflammatory process in many cases mask the manifestations of prostate damage. Perhaps slightly increased pain when urinating, mild pain in the perineum, little discharge from the urethra during defecation. A small change in the clinical picture usually goes unnoticed by the patient.
Chronic prostatitis can be manifested by burning sensation in the urethra and perineum, dysuria, sexual dysfunction, increased general fatigue. The consequences of potency violations (or fear of these violations) often turn into depression, anxiety, and irritability. The clinical picture does not always include all of the symptom groups listed, which vary in different patients and change over time. There are three main syndromes characteristic of chronic prostatitis: pain, dyspepsia, sexual dysfunction.
There are no pain receptors in prostate tissue. The cause of pain in chronic prostatitis is almost inevitable due to the numerous accumulations in the pelvic organs, which are involved in the inflammatory process of the nerve pathways. Patients complain of pain of varying intensity - from weak, aching to intense, disturbing sleep. There is a change in the nature of pain (intensification or weakness) with ejaculation, excessive sexual activity or sexual abstinence. Pain radiates down the scrotum, sacrum, perineum, sometimes to the lower back.
The consequence of inflammation in chronic prostatitis is an increase in the volume of the prostate gland, which puts pressure on the urethra. The lumen of the ureter is reduced. Patients often feel the need to urinate, the feeling that the bladder is not empty. As a rule, the phenomenon of dysfunction is manifested in the early stages. Thereafter, compensatory hypertrophy of the muscular layer of the bladder and ureters develops. The symptoms of dysuria during this period gradually weakened, then increased again according to a decompensated adaptive mechanism.
In the early stages, malaise may develop, which manifests itself differently in different patients. Patients may complain of frequent nocturnal erections, blurred orgasms, or worsening erections. Rapid ejaculation is associated with a decrease in the level of the central organ stimulation threshold. Pain during ejaculation can cause refusal of sexual activity. In the future, sexual dysfunction becomes more pronounced. In the severe stage, impotence develops.
The degree of sexual dysfunction is determined by many factors, including the patient's sexual status and mood. Violation of potency and dysuria can be caused by both prostate gland changes and the patient's suggestive ability, if chronic prostatitis the patient expects the inevitable development of the disordersexual and urinary disorders. In particular, psychosis and dysuria develop in dyspeptic, anxious patients.
The patient can hardly tolerate impotence, and sometimes the threat of possible sexual disorders. There are often mood swings, irritability, obnoxiousness, excessive concern for one's own health, even "disease concern".
There are two groups of symptoms of the disease: irritation and congestion. The first group of symptoms includes increased urination, constant (compulsive) urge to urinate, nocturia, urinary incontinence. The group of symptoms of obstruction includes dysuria, delayed onset and increased duration of urination, sensation of incomplete emptying, urinary interruption, and urge to strain. There are three stages of prostate cancer: compensated, compensated, and decompensated.
Compensation phase
In the compensatory stage, the dynamics of the urinating behavior change. It becomes more frequent, less intense, and less free. There is a need to urinate 1-2 times at night. As a rule, nocturia in stage I of prostate cancer is not cause for concern in a patient associated with persistent nighttime awakening with the development of age-related insomnia. During the day, a normal frequency of urination can be maintained, however, patients with stage I prostate cancer note a waiting period, which is particularly pronounced after a night's sleep.
After that, the frequency of daytime urination increases, the amount of urine produced per urination decreases. There are pressing urges. The urine stream, formerly forming a parabolic curve, is discharged slowly and falls almost vertically. Hypertrophy of the bladder muscles develops, so its effectiveness is maintained. There is little or no urine left in the bladder at this stage (less than 50 ml). The functional state of the kidneys and upper urinary tract is preserved.
Compensation period
In stage II of the prostate, the bladder increases in volume, dystrophic changes develop in its wall. The amount of residual urine is more than 50 ml and continues to increase. During urination, the patient is forced to forcefully stretch the abdominal muscles and diaphragm, resulting in an even greater increase in intra-abdominal pressure.
The act of urinating becomes frequent, intermittent, undulating. The circulation of urine in the upper urinary tract is gradually disrupted. Muscle structures lose their elasticity, the urinary tract dilates. Renal function is impaired. The patient is concerned about thirst, polyuria, and other symptoms of advanced CKD. When the compensation mechanisms fail, the third phase begins.
Compensation period
The bladder in patients with stage III prostate cancer is distended, filled with urine, easily identified by palpation and by the naked eye. The upper border of the bladder can be as high as the navel or higher. Emptying is not possible even when the abdominal muscles are intensely tense. The desire to empty the bladder becomes constant. There may be severe pain in the lower abdomen. Urine is excreted frequently, in drops or in very small portions. Later, the pain and the urge to urinate gradually weaken.
A characteristic paradoxical urinary retention develops, also known as dysuria (bladder full, urine is continuously excreted drop by drop). The upper urinary tract is dilated, the functions of the renal parenchyma are impaired due to the constant obstruction of the urinary tract, leading to increased pressure in the renal tubular system. Chronic kidney failure clinic is growing. Without medical care, the patient will die from progressive CRF.
Complications
Without prompt treatment of acute prostatitis, there is a significant risk of developing a prostate abscess. With the formation of a purulent foci, the patient's body temperature rises to 39-40 ° C and can become hot in nature. Periods of heat alternate with severe chills. Pain in the perineum makes it difficult to urinate and not able to defecate.
An increase in prostate edema leads to acute urinary retention. Rarely, an abscess spontaneously ruptures into the urethra or rectum. When opened, purulent, cloudy, pungent urine appears in the urethra, when opened, stools with pus and mucus are found in the rectum.
Chronic prostatitis is characterized by an undulating process with a long period of remission, in which inflammation in the prostate is latent or manifested by extremely bad symptoms. Patients who are not bothered by anything often stop treatment and just go into the complication stage.
The spread of urinary tract infection causes the appearance of pyelonephritis and cystitis. The most common complications of the chronic process are inflammation of the testicles and epididymis (orchitis) and inflammation of the seminal vesicles (inflammation of the seminal vesicles). The result of these diseases is often infertility.
Diagnose
To assess the severity of prostate cancer symptoms, patients were asked to fill out a urine diary. During the consultation, the urologist performs a digital examination of the prostate gland. To rule out infectious complications, sampling and examination of prostate secretions and smears from the urethra are performed. Additional testing includes:
- Echography.Prostate ultrasound will determine the volume of the prostate gland, detect stones and congested areas, urinary retention, and assess the condition of the kidneys and urinary tract.
- Urodynamic studies.Urine flow measurement allows you to reliably assess the degree of urinary retention (the time to urinate and the rate of urine flow are determined by a special device).
- Define tumor markers.To rule out prostate cancer, it is necessary to assess the level of PSA (prostate-specific antigen), which should usually not exceed 4 ng/ml. In controversial cases, a prostate biopsy is performed.
Computed tomography and ureteral tomography for prostate tumors have been performed less frequently in recent years due to the emergence of new, less invasive and safer research methods (ultrasound). Sometimes cystoscopy is done to rule out diseases with similar symptoms or to prepare for surgical treatment.
Prostatitis treatment
Treatment of acute prostatitis
Patients with an uncomplicated acute course are treated by a urologist on an outpatient basis. With severe intoxication, suspected pyogenic process, the patient was assigned to hospital. Antibacterial therapy is performed. Preparations are selected taking into account the sensitivity of the infectious agent. Widely used antibiotics can penetrate well into prostate tissue.
With the development of acute urinary retention due to prostatitis, they resort to cystectomy, and not urethral catheterization, since there is a risk of prostate abscess formation. With the development of an abscess, a transrectal or transoperative laparoscopic approach to opening the abscess is performed.
Treatment of chronic prostatitis
Treatment of chronic prostatitis should be complex, including drug therapy, physiotherapy, immunomodulatory:
- Antibiotic therapy. Patients are prescribed long courses of antibacterial drugs (within 4-8 weeks). The selection of the type and dosage of antibacterial drugs, as well as the determination of the duration of the course of treatment are 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.Gland massage has a complex effect on the affected organ. During the massage, inflammatory secretions accumulated in the prostate gland will be pushed out through the ducts, then into the urethra and out of the body. This procedure improves blood circulation in the prostate, which helps to minimize congestion and ensure better penetration of antibacterial drugs into the tissue of the affected organ.
- Physical therapy.To improve blood circulation, laser exposure, ultrasonic waves and electromagnetic oscillations are used. If physiotherapeutic procedures are not possible, the patient is prescribed microneedling warm medicine.
In the case of chronic, long-term inflammation, the immunologist consults the indication to select the tactics of immune-activating therapy. Patients are counseled on lifestyle changes. Making certain changes in the lifestyle of patients with chronic prostatitis is both a treatment and a preventive measure. Patients are recommended to normalize sleep and wake up, establish a diet, carry out moderate physical activity.
Conservative therapy
Conservative treatment is carried out in the early stages and has absolute contraindications to surgery. To reduce the severity of the symptoms of the disease, alpha blockers, 5-alpha reductase inhibitors, herbal preparations (extract of African plum peel or sabal berries) are used.
Antibiotics are prescribed to fight the infection that often accompanies prostate tumors. At the end of the course of antibiotic therapy, probiotics are used to restore normal intestinal microflora. Carry out immunity correction. The atherosclerotic vascular changes that develop in most elderly patients prevent the outflow of drugs into the prostate gland, so special drugs are prescribed to normalize blood circulation.
Surgery
The following surgical methods are available to treat prostate tumors:
- TOUR(Through surgery). Minimally invasive endoscopic technique. The surgery was performed with an adenoma volume less than 80 cm3. Not applicable to people with kidney failure.
- Remove foreign body.It is performed in case of complications, the volume of the adenoma is more than 80 cm3. Currently, laparoscopic glandectomy is widely used.
- Laser sauna of the prostate.Allows you to perform surgery with tumors smaller than 30-40 cm3. This is the method of choice for young patients with prostate tumors, as it allows you to save sexual function.
- Nuclear Reactions with Lasers(holmium - HoLEP, thulium - ThuLEP). The method is recognized as the "gold standard" of prostate surgery. Allows you to remove an adenoma with a volume of more than 80 cm3 without open intervention.
There are a number of contraindications for surgical treatment of prostate tumors (decompensated diseases of the respiratory and cardiovascular systems, etc. ). If surgical treatment is not possible, bladder catheterization or palliative surgery - cystectomy, stenting through the urethra.
Forecasting and prevention
Acute prostatitis is a disease that tends to turn chronic. Even with timely adequate treatment, more than half of patients will develop chronic prostatitis. However, recovery is not always achievable, however, with the correct therapy and following the doctor's recommendations, it is possible to eliminate unpleasant symptoms and achieve long-term stable remission. in a chronic process.
Prevention is about eliminating risk factors. It is necessary to avoid hypothermia, alternating between sedentary and physical activity, and eat in moderation and fullness. For constipation, laxatives should be used. One of the preventive measures is to normalize sex life, as both excessive sexual activity and sexual abstinence are risk factors for developing prostatitis. If you develop symptoms of a urinary tract disease or a sexually transmitted disease, you should see your doctor for prompt treatment.