Chronic prostatitis is a serious problem. Even modern urology is not able to answer many questions about this pathology. Experts believe that chronic prostatitis is a disease that comes as a result of a number of health problems, including tissue damage, as well as dysfunction not only of the urinary tract and prostate gland, but also of other organs.
The pathology is diagnosed mainly in men of reproductive age. In older men, chronic prostatitis is often associated with benign prostate neoplasms.
Classification of the disease
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 with inflammation of the prostate gland.
- type 2- chronic bacterial prostatitis.
- 3 types- 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 with chronic prostate.
- Type 3B- non-inflammatory form of chronic prostatitis. It is 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 lasting more than 3 months are the main symptoms of chronic prostatitis.
In addition, urinary disorders and erectile dysfunction are observed:
- The pain appears in the perineum, may radiate to the anus, groin, inner thighs, sacrum, lower back and scrotum. Pain on one side, extending 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 disease development premature ejaculation is observed;
- frequent urination, urinary incontinence, pain and burning sensation in the process of emptying the bladder.
The clinical picture may vary depending on the type of chronic prostatitis.
infectious form:
- frequent urination at night;
- pain in the thigh, perineum, penis and rectum, aggravated by movement;
- painful urination;
- poor urine flow.
Specific infectious:
- mucous discharge from the urethra;
- the above symptoms.
Non-infectious prostates:
- acute pain in the perineum;
- pain in the thighs and head of the penis;
- the pain intensifies with forced cessation of sexual intercourse or prolonged absence of intimate life.
Important!The disease progresses in waves. Symptoms may be weakened or intensified, 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 pathology development 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, in the pubic part and gives to the sacrum. Urination accelerates, but occurs without difficulty. The erection does not suffer.
- Proliferative.During an irritation, urination becomes more frequent. Urine flow becomes poor.
- Scars.Prostate tissue sclerosis occurs. There is a feeling of heaviness in the sacrum and in the pubic region. Increased urination. The erection becomes weak. Ejaculation may be completely absent.
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 has hormonal, neurovegetative, immunological and hemodynamic disorders. Influenced by biochemical factors, urine reflux into the prostate lobes and impaired functioning of growth factors, which are responsible for the proliferation of living cells.
Reasons affecting the formation of pathology:
- genitourinary system infections;
- hypodynamics;
- irregular sex life;
- continuous bladder catheterization;
- regular hypothermia.
dEVELOPMENTdiseases of bacterial natureinduces intraprostatic urinary reflux.
Chronic bacterial prostatitisdevelops against the background of neurogenic disorders of the pelvic floor muscles, as well as the elements responsible for the functioning of the bladder wall, prostate and urethra.
TRAININGmyofascial stimuli, which are located near the organs of the genitourinary system and the prostate gland, can provoke pelvic pain syndrome. Drops that are the result of certain diseases, surgical interventions and injuries can provoke pain in the pubic region, perineum and adjacent areas.
Diagnosis of pathology
The presence of a complex of symptoms 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 search methods are required.Neurological examination and study of the patient's immunological 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 urinary disorders.
Laboratory diagnosis
Laboratory diagnosis makes it possible to distinguish between bacterial and bacterial form of pathology, as well as determine the type of pathogen and establish the most accurate diagnosis.Chronic inflammation of the prostate is confirmed when the fourth urine sample or prostate secretion contains more than 10 leukocytes in the PZ, or bacterial association.When the leukocyte count increases but the bacteria are not cultured, the material is examined for the detection of chlamydia or other STD pathogens.
- Discharges from the urethra are sent to the laboratory to detect viral, fungal and bacterial flora, leukocytes and mucosa in it.
- Scrape from the urethra is examined by PCR. This allows you to identify sexually transmitted pathological agents.
- Perform a microscopic examination of prostate secretion to count the number of macrophages, leukocytes, amyloid and Trousseau-Lalemand bodies. An immunological study and a bacteriological study are described. Determine the level of nonspecific antibodies.
- Blood sampling is performed ten days after a digital rectal examination to determine the concentration of PSA in it. At a rate above 4. 0 ng / ml, the patient undergoes a prostate biopsy to rule out oncology.
Diagnosis is made based on research results.
Instrumental diagnostics
To clarify the stage and form of the disease will help transrectal ultrasound of the gland. Ultrasound allows you to rule out other diagnoses, monitor the effectiveness of treatment, as well as determine the size of the prostate, its ecostructure, homogeneity and density of seminal vesicles. Urodynamic studies and myography of the pelvic floor muscles will allow the detection of infravesical obstruction and neurogenic disorders that often accompany the pathology.
Tomography and MRI are used to make a differential diagnosis, in particular, with prostate cancer. These methods will detect violations in the pelvic organs and spine.
Differential diagnosis
Differential diagnosis is important, as there is a risk that the patient will have a more serious illness.
Differential diagnosis is established with such diseases:
- pseudodyssinergia, functional disorder of the detrusor-sphincter system, bladder dysfunction of neurogenic origin, complex regional pain syndrome;
- bladder narrowing, hypertrophic changes in the bladder neck, prostate adenoma;
- pubic joint osteitis, cystitis;
- pathology of the rectum.
If symptoms occur, the prostate gland should be examined by a urologist or andrologist. Get an ultrasound scan. If necessary, a prostate biopsy is prescribed.
Pathology treatment methods
Chronic prostatitis is treated by a urologist or andrologist. Therapy is performed in a complex way. Correction is subject to the patient's lifestyle, peculiarities of thinking and his habits. It is important to move more, minimize alcohol intake, get rid of nicotine addiction, eat properly and normalize your sex life. However, doing without a course of basic therapy will not work. Taking medication is the main condition for a complete recovery.
Indications for hospitalization
Most often, treatment is performed on an outpatient basis. But in cases where the disease is not corrected and has a tendency to recur, the patient is sent to a hospital where treatment is most effective.
Medical method of treatment
This method aims to eliminate the existing infection, normalize blood circulation, improve drainage of the prostate lobules, correct the hormonal background and immune status. Therefore, doctors prescribe antibiotics, vasodilators, immunomodulators, anticholinergics and anti-inflammatory drugs.
If the pathology is bacterial, antibiotics are definitely recommended. The agent is prescribed based on the results of bacterial culture of prostate secretion.This will make it possible to isolate the pathogen by subsequently determining its susceptibility to a particular drug. With a well-designed scheme, the effectiveness of the treatment reaches more than 90%.
In the bacterial form, a short course of antibiotics is prescribed. Only continue if the scheme gives a positive result. The effectiveness of therapy is approximately 40%
With chronic pelvic pain, the duration of the course of antibiotics is not more than one month. With positive dynamics the treatment continues for another month. If there is no effect, the drug is replaced with 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 chlamydia, accumulated in the tissues of the prostate gland.
When fluoroquinolone treatment is not effective, penicillins may be prescribed.
Antibacterial drugs are used for preventive purposes.
After treatment with antibiotics, therapy with the use of a-blockers is prescribed.This treatment strategy is effective for patients who have persistent obstructive and irritating symptoms.
If urinary disorders and pain persist, tricyclic antidepressants may be prescribed, which have analgesic effect.
With severe urinary disorders, before starting therapy, a urodynamic study is performed and acts on the basis of the results obtained.
Non-drug therapy
Methods of drug-free therapy make it possible to increase the concentration of antibacterial drugs in the glandular tissue, but overdose is not recommended.
The following methods are used for this purpose:
- electrophoresis;
- Laser therapy;
- Phonophoresis;
- Microwave hyperthermia (applied transrectally).
When applying the latter 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, eliminates bacteria, facilitates 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 above methods, but also has a biostimulatory effect on the body.
Transrectal massage is performed only in the absence of contraindications.
Surgical method
Chronic prostatitis generally does not require surgery. Exceptions are complications that pose a threat to the health and life of the patient. Modern surgical treatment allows the use of endoscopic surgery. It is minimally invasive. Rehabilitation is faster, and minimal damage is done to the body.
The surgical method is prescribed for:
- prostate sclerosis;
- prostate adenoma;
- seminal tuberculosis sclerosis;
- prostate calcification.
Important!Surgery is contraindicated in the acute phase. Surgical treatment is prescribed by the surgeon based on the results of the study and the overall clinical picture.
Prognosis for chronic prostatitis
Doctors are careful in predicting the outcome of the disease. Complete recovery is rare. Basically, chronic prostatitis passes into a phase of long-term remission. The symptoms disappear, urine and blood counts return to normal. In order for chronic prostatitis not to become more active and cause complications, it is necessary to follow all the recommendations of a specialist.