Chronic (bacterial) prostatitis is characterized by persistent or recurrent symptoms with confirmed bacterial infection of the prostate.
Prostatitis of this type occurs infrequently, accounting for about 10% of all cases of prostatitis.The question of whether atypical pathogens, such as ureaplasma urealiticum, can cause prostatitis is under discussion.They can be present in a man's body without any signs of inflammation or complaints.
Causes of chronic prostatitis
The causes of chronic prostatitis are essentially the same as the causes of acute bacterial prostatitis.Penetration of microorganisms into the prostate in most cases occurs through the urethra - due to urine reflux into the ducts of the prostate.
Chronic bacterial prostatitis develops as a result of inadequate treatment or short-term treatment of acute bacterial prostatitis.
Symptom
- Discomfort or pain - in the perineum, lower abdomen, groin, scrotum, penis, during ejaculation
- Changes in urination - difficulty urinating, frequent urination in small amounts, feeling of incomplete bladder emptying.
Patients may complain of several symptoms or any individual symptom.Increased body temperature is not normal (or insignificant).
Important:
Many men associate erectile dysfunction with prostatitis.This is often facilitated by unprofessional publications in the media and advertising of dubious drugs.The fact that erections can persist even after complete prostatectomy (due to the presence of malignant tumors in this organ) suggests that it itself plays no role in maintaining erections.
According to many reputable urologists, erectile dysfunction in patients with chronic prostatitis is due to psychological and neurological problems.
Diagnose
For initial assessment, a questionnaire is used - index of symptoms of chronic prostatitis.It can be used to objectify patient complaints.
The standard method for diagnosing prostatitis is to perform testing.This was a bacteriological and bacteriological study of urine samples obtained from different parts of the genital tract and prostatic secretions.However, the sampling method is quite laborious and sample modification is now more commonly used.A possible alternative is to submit ejaculated semen (sperm) for microscopic and bacteriological examination, as a portion of the ejaculate (at least 1/3) consists of prostatic secretions.This method is more comfortable for the patient, especially if they refuse a rectal examination or diagnostic prostate massage to obtain prostatic secretions.However, ejaculation has lower information content and reliability than the sample.
Sending ejaculate for bacteriological examination is included in the diagnostic algorithm for infections of the male genital organs and when examining infertility in men.
The results of laboratory tests (general urine test, general blood test, biochemical blood test, sperm count and other general clinical tests) in cases of chronic prostatitis are not very informative.Most likely, these tests will give “normal” results.
During rectal examination, changes indicating an inflammatory process in the prostate are not always observed in patients with chronic prostatitis.This means that you cannot rely on the results of a rectal examination to diagnose chronic prostatitis.
The same is true for ultrasound diagnosis: the diagnosis of chronic prostatitis based solely on ultrasound data is inaccurate.The European and American Urological Associations do not recommend ultrasound for diagnosing prostatitis.The type of execution in this case is not important through the anterior abdominal wall - lower abdomen or TRUS - through the rectum.Writing "chronic prostatitis", "ultrasound signs of chronic prostatitis", "signs of prostatitis" in the ultrasound conclusion is incorrect.Only a urologist has the privilege of determining this diagnosis, who determines it based on the complaint, history, tests and - only later - ultrasound.
The most common ultrasound finding for the diagnosis of chronic prostatitis is called diffuse changes in the prostate related to the inflammatory process or other changes in the prostate parenchyma.This is a type of fibrotic process that replaces normal prostate parenchyma with scar tissue.However, there is no correlation between the amount of fibrotic changes in the prostate and the presence of complaints.With age, the likelihood of such "scars" appearing in the organ increases, but a man can live his whole life without feeling discomfort in the perineum or pubic area.However, as soon as these changes are detected on ultrasound, some “experts” will diagnose prostatitis.And some men will have the feeling that they are really seriously ill, they will begin to listen to themselves, they will feel all the symptoms described on the Internet.
In many men over 30 years of age, ultrasound can show diffuse changes in the prostate.However, fibrosis does not indicate the presence of prostatitis.
The diagnosis of chronic prostatitis is established based on the exclusion of other diseases of the genitourinary system - mainly urethritis, prostatic hyperplasia, urethral stricture, neurogenic urinary disorders, prostate cancer, bladder cancer.
There is no specific picture of chronic prostatitis based on routine examination results.
Treatment of chronic prostatitis
Fluoroquinolone antibiotics are the optimal antibacterial drugs to treat chronic bacterial prostatitis.The recommended course of antibiotic treatment is 4 to 6 weeks.Such a long course is supported by scientific data that shows a reduced likelihood of disease recurrence.
For detected sexually transmitted infections (STIs), such as chlamydia, a macrolide antibiotic is prescribed.
There is evidence of decreased relaxation of the bladder neck in patients with chronic prostatitis, leading to reflux of urine into the urethral ducts and causing prostatic tissue inflammation and pain.For such patients, alpha blockers are recommended.
When treating chronic prostatitis, patients should limit offers to use herbal medicines.A characteristic of dietary supplements and herbal supplements is the instability of the plant components in one portion of the substance;they can differ even in preparation by the same manufacturer.Additionally, from the perspective of evidence-based medicine, the benefits of herbal medicine are unquestionable.
Prostate massage, used as a therapeutic basis in the mid-20th century, today, thanks to new scientific methods and classifications, remains an important tool for diagnosing prostatitis, but not for treatment.There is no need to use prostate massage as a treatment (effectiveness unproven).It has been suggested that frequent ejaculation has similar properties to therapeutic prostate massage sessions.
Other methods that have been shown to be effective in just one or a few studies or are still being studied include:
- pelvic floor muscle training - some evidence shows the effectiveness of specific exercises in reducing symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- acupuncture - a small number of studies show a benefit of acupuncture compared with placebo in patients with chronic prostatitis;
- Extracorporeal shock wave therapy - based on the impact of acoustic pulses of significant amplitude on connective tissue and bones, widely used in the treatment of diseases of the musculoskeletal system, recently used in urology, its effectiveness is being studied;
- behavioral therapy and psychological support - since chronic prostatitis is associated with low quality of life and the development of depression, these methods can improve the patient's psychological state and help reduce some of the symptoms of the disease.
Worth mentioning separatelychronic asymptomatic prostatitis (no symptoms).Diagnosis is usually made based on the results of the histology report - after a prostate biopsy or after surgical treatment of the prostate.The frequency of detecting inflammation in prostate tissue varies from 44% (during prostate biopsy) to 98-100% (after surgical treatment of the prostate).Scientists suggest that the inflammatory changes identified in this way are nothing more than an age-related physiological feature.No one specifically diagnoses this type of prostatitis;It was a kind of accidental discovery.It requires no treatment and does not require any further action on the part of the doctor or patient.