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Prostatitis

symptoms of prostatitis in men

Prostatitis is an inflammation of the prostate (prostate) in men, causing negative effects on both sexual function and urination.Pain in the perineum, groin, lower back and pelvic area, hemodynamic disorders (urinary discharge) may indicate the presence of prostatitis.Untreated prostatitis can cause male infertility and prostate cancer.

This is one of the most common male diseases, requiring careful attention and effective systemic treatment.This is exactly the method of solving the problem of prostatitis that you will find in the urology department of a professional clinic.Highly qualified urologists-andrologists have been successfully treating acute and chronic prostatitis for many years.Complex therapy, careful attention and an individual approach to each case will certainly help the patient recover and achieve a long-term, stable remission.

Prevalence rate

Prostatitis ranks 5th among the 20 major urological diagnoses.It is believed that at the age of 30, 30% of men suffer from prostatitis, at the age of 40 - 40%, and after the age of 50, almost all men, one way or another, bear the burden of this disease.And if by the age of 35, infectious prostatitis is noted mainly, then at a more mature age the non-infectious form prevails, and in general it is diagnosed many times more often than bacterial prostatitis.

Anatomy and physiology of the prostate

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

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

The prostate is connected to the spermatic tube, 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 pass through the gland.In the chronic course of the disease, they participate in the inflammatory process and develop 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 may occur.

Pathogenesis

There are two main reasons for the development of prostatitis:

  • stagnation of prostatic secretion against the background of impaired blood circulation and lymph outflow in the gland and neighboring organs;
  • pathogenic and conditionally pathogenic microflora.

Acute prostatitis is often associated with infection of prostate tissue.However, as a rule, both of these factors are interconnected and together create a vicious cycle that complicates the treatment of prostatitis.

An inflamed prostate becomes painful.Pain may be felt in the perineum, groin, pelvis, and lower back.It is markedly enhanced by palpation during digital rectal or defecation examination.

The prostate increases in size, compressing the urethra.This makes it difficult for urine to flow out of the bladder.The urine stream becomes weaker.The patient must tense the abdominal muscles for urination to occur.In acute cases, urinary tract obstruction and acute urinary retention sometimes occur.

Inflammation leads to disruption of the flow of prostatic fluid and its stagnation.The resulting swelling disrupts the metabolism and respiration of cells in the gland.This facilitates the process becoming chronic.When prostatitis persists, neighboring organs may become inflamed: seminal tubers, Cooper's glands, and seminal vesicles.The chronic form of the disease is associated with a risk of developing male infertility, adenoma and prostate cancer.

In recent years, it has been discovered that in 70-80% of cases, prostatitis occurs due to stagnant processes in the gland.Venous disorders are less common but they also cause prostatitis, especially if accompanied by hemorrhoids and left testicular varicose veins (testicular varices).

Classify

The US National Institutes of Health identifies 4 types of prostatitis:

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

Due to its appearance, prostatitis is divided into two types:

  • Not contagious
  • infectious

The inflammatory process can develop rapidly, accompanied by obvious symptoms (acute phase), or slowly, with progressive resolution of symptoms.

Non-infectious prostatitisIn most cases, it is associated with stagnation of prostatic secretions and impaired blood circulation and lymph flow in the gland and adjacent organs.

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

  • Urinary (ascending): the port of entry is the urethra.It should be noted that infections can also enter the descending pathway, such as with purulent pyelonephritis (kidney disease) and other urinary tract inflammatory diseases.
  • Lymph: infection from neighboring pelvic organs can enter the prostate through lymph due to inflammation of the rectum (proctitis) or bladder (cystitis), as well as from infected hemorrhoidal veins.
  • Hematogenous (through the blood): caused by the presence in the body of chronic infections (tonsillitis, tooth decay) or complications of acute infections (flu, acute respiratory infections, tonsillitis, etc.).

The most common causes of prostatitis are:

  • Bacteria: Escherichia coli, Proteus, Gardnerella (gram negative);staphylococcus, streptococcus (gram positive);
  • viruses (influenza, herpes, cytomegalovirus, ARVI pathogens);
  • mycoplasmas;
  • chlamydia;
  • Specific flora (gonococcus, trichomonas, tuberculosis mycobacteria).

According to the nature of the process, 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 clear symptoms.If not treated promptly, a purulent process can develop, leading to dissolution of prostate tissue.If not treated properly, acute prostatitis often becomes chronic.

Chronic prostatitishas a milder course, symptoms are eliminated.However, sometimes it can become more severe and then the symptoms will correspond to an acute process.However, complete remission between exacerbations does not always occur, and the patient may continuously feel discomfort.Chronic prostatitis can cause impotence, infertility in men, adenoma or prostate cancer.

There is a chronic asymptomatic form of the disease, when the patient has no complaints, but prostatic secretions contain many purulent elements (leukocytes).

complications

Without appropriate therapy, the inflammatory process can lead to purulent dissolution of prostate tissue.Furthermore, inflammation can spread to neighboring organs: seminal tubers, Cooper's glands, seminal vesicles, and urethra.Accordingly, the following complications may occur:

  • Prostate abscess
  • Prostatic sclerosis/fibrosis (functional glandular tissue is replaced by connective tissue)
  • Prostate cyst
  • Prostate stones
  • Inflammation of the seminal vesicles (inflammation of the seminal vesicles)
  • Colliculitis (inflammation of the seminal tubercle)
  • Epididymitis (inflammation of the testicles and their appendages)
  • Posterior urethritis
  • Erectile dysfunction/impotence
  • Ejaculation disorders
  • Infertility
  • Prostate tumor
  • Prostate cancer

Symptom

Different types 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, perineum (can spread along the spermatic cord).
  • The pain increases with defecation and digital rectal examination.
  • Urinary disorders (frequent urination, urinary retention, difficulty urinating, weak urine stream, incomplete bladder emptying).
  • Prostatitis (involuntary prostatic secretion, especially in the morning and during bowel movements).
  • Sexual dysfunction (decreased sexual desire, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • The temperature rises to 39-40 degrees
  • Acute urinary retention
  • General poisoning
  • White blood cells, proteins and mucus in urine
  • Blood in urine and semen
  • Leukocytosis in prostatic secretions
  • Hypoplasia and hypertrophy of the gland, increased blood flow according to ultrasound data

Symptoms of chronic prostatitis

  • Body temperature is usually not higher than 37C
  • Pain is reduced and soothed
  • Discharge from the urethra during bowel movements
  • Urinary disorders
  • Reduced sexual desire
  • Erectile dysfunction
  • Ejaculation disorders (premature ejaculation or delayed ejaculation)

Reason

The main reasons for the development of prostatitis are infection and stagnation of prostatic secretions.The following factors contribute to the appearance of prostatitis:

  • Opportunistic infections and flora have weakened immunity
  • No physical activity
  • "Sedentary" work
  • Abstain from sex for a long time
  • Coitus interruption (delayed ejaculation)
  • Excessive sexual activity leads to glandular deterioration
  • Alcohol abuse
  • Decreased local immunity (hypothermia, use of immunosuppressive drugs, immunodeficiency, autoimmune diseases)
  • Pelvic organ injury
  • Manipulation of the prostate and adjacent organs (prostate biopsy, surgery, catheterization, cystoscopy, etc.)
  • Chronic diarrhea or constipation

Diagnose

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

Digital rectal examis carried out by a urologist-andrologist after a conversation with the patient.This method allows you to evaluate the size, shape and some structural features of the prostate.If the size of the prostate gland is enlarged and the procedure itself is painful for the patient, the doctor can pre-diagnose prostatitis.

If the case is not acute, the doctor can perform prostate massage during the examination to obtain prostatic secretions. The study of this substance is an important link in the diagnosis of prostatitis.If there is a suspicion of acute bacterial prostatitis, prostate massage is contraindicated: such manipulation can lead to the spread of pathogens and blood poisoning.

To clarify the diagnosis, the patient will be asked to undergo an examinationmusical instrument research, such as:

  • transrectal ultrasound examination of the prostate and pelvic organs (shows structural features, presence of inflammation and foci of pus, stones, cysts and other tumors);
  • Dopplerography (characteristics of blood flow in the gland);
  • measuring urine flow (determining the speed and duration of urination);
  • magnetic resonance imaging of the pelvic organs (a highly informative and safe study that allows differential diagnosis with other diseases).

If necessary, diagnosis of adjacent organs of the genitourinary system is performed: urethroscopy, urethrography and cystourethrography.

Laboratory researchis a necessary component in the diagnosis of prostatitis:

  • General urinalysis (before and after prostate massage)
  • General blood test
  • Blood test for acute inflammatory phase proteins (C-reactive protein, etc.)
  • Microscopic examination of prostatic secretions after finger massage
  • Microscopically examine scratches from the urethra
  • Spermatogram (cytology and biochemistry of sperm)
  • Cultures of urine, prostatic secretions, and sperm
  • Determination of prostate specific antigen (PSA)
  • Prostate needle biopsy and histological examination of glandular tissue

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

The modern one has excellent, informative diagnostic facilities.Urologists have extensive experience in diagnosing and successfully treating various forms of prostatitis, and their status as a multidisciplinary clinic allows you to utilize the services of specialists in related fields.The medical center has developed research packages that include all types of necessary diagnostics at very attractive prices. 

Treatment

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

Treatment with medication

Regarding the use of the following drugs:

  • Antibiotics (after determining sensitivity to them)
  • Antiseptic (topical)
  • Vascular drugs (improve microcirculation in the prostate)
  • Nonsteroidal anti-inflammatory drugs
  • Alpha-1 blockers (for urinary problems)
  • Enzyme preparations (thin the prostate, stimulate the immune system, reduce inflammation)
  • immune regulation
  • Antidepressants

Physical therapy treatment

  • Electrical stimulation of the prostate (electrophoresis, galvanization, pulsed operation)
  • Vibro Massage
  • Laser treatment with rectal sensors (for chronic prostatitis)

For chronic prostatitis, prostate massage can be used as a treatment.In the acute stage of the disease, this operation is not performed to avoid the spread of infection and sepsis.

Surgical treatment

Surgical treatment of prostatitis is rarely used.This need arises in cases of severe swelling of the prostate tissue, lack of active motivation for drug treatment and pathological enlargement of the prostate causing obstruction of the urethra.

Forecast

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

If treatment is not correct and the duration of treatment (several months) is not followed, the disease often becomes chronic.Chronic prostatitis greatly affects men's quality of life because not only urinary function but also sexual function is affected.In 30% of cases, erectile dysfunction, loss of orgasm intensity, ejaculation problems and infertility are observed.It is absolutely impossible to cure chronic prostatitis, but with the right approach, stable remission is possible.

Advantages of going to a professional clinic

  • Successful treatment of various forms of prostatitis
  • Experienced urologists-andrologists have the highest professional qualifications
  • Multidisciplinary, allowing you to attract experts in related fields to your treatment
  • Modern diagnostic and treatment equipment has high accuracy
  • Own European-class clinical diagnostic laboratory
  • Comfortable and high-tech hospital
  • Urology diagnostic service package at attractive prices

Prevention of prostatitis

  • Choose protected sex to avoid sexually transmitted infections (STIs)
  • Immune system support (vitamins, healthy diet, prevention of physiological disorders, appropriate antibiotic treatment, etc.)
  • Avoid hypothermia
  • Have an active lifestyle
  • Have sex regularly, if possible, with one partner (to avoid prostatic congestion and sexually transmitted diseases)
  • Avoid interrupted sexual intercourse (this will reduce sperm stagnation)
  • See a urologist once a year for preventive purposes 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 of prostate cancer.It is known that in some cases prostate cancer has a clinical picture similar to the manifestation of prostatitis.Therefore, the PSA test is used to differentiate these two diseases.However, you should not bet on PSA.This antigen is also increased in prostate adenoma, a benign growth of glandular tissue.With prostatitis, PSA levels may also increase during periods of active inflammation.During the remission period it decreases.Therefore, PSA cannot be used as definitive evidence of prostate cancer or prostatitis.

Why is prostatitis difficult to treat?

Prostate capillaries have a special structure that creates the prostate hematopoietic barrier.This makes it difficult for some antibiotics to penetrate glandular tissue.In addition, microorganisms tend to form biofilms, which reliably protect them from the effects of antibacterial substances.Therefore, modern regimens for the treatment of prostatitis necessarily include proteolytic enzymes that can destroy biofilms.Bacteria become vulnerable and antibiotics work more effectively.Chronic prostatitis is the most long-term treated disease, the main characteristic of which is the diversity of the microflora in the culture medium.In about 50% of cases, cultivated Enterococcus faecalis is resistant to all aminoglycosides and cephalosporins.This narrows the list of effective antimicrobial agents, which also complicates treatment.