About 40-60% of clinic urological patients are patients with chronic prostatitis.The symptoms of prostatitis in men are often the cause of depressive conditions and changes in the psyche.
The disease that every third man suffers over 25-30 years does not threaten life, but the difficulties of his diagnosis and treatment determine a long chronic course and often lead to disability.
The idea of the functions of the prostate, the mechanisms and causes of the development of inflammation allow us to correctly understand the symptoms and the need for timely treatment.
The functional value of the prostate gland
Its main function is the secretion of a specific fluid (secret) 40 - 50 glands that form the entire glandular tissue of the organ.The secret of 90 - 95% consist of water and the main elements of trace, phospholipids, amino acids of sperm, which gives sperm a specific smell, enzymes, proteins, citric acid and fructose.All components have their purpose and are severely balanced.
The secret of the prostate provides:
- The formation and maintenance of a neutral or slightly alkaline environment in the urethra and sperm.This environment provides sperm for the life of sperm.
- Spermatozoa thinning, necessary to prevent the bond of the spermatozoa and guarantee promotion.In the sexual intercourse process, the sperm mixed with prostate juice.
- The vitality of spermatozoa: the substances contained in the secret are a nourishing means for germ cells, thanks to which they can be located for several days in the female genital organs up to the fertilization of the egg.
- Protection of the parental system from infection by zinc, sperm, polymines and immunoglobulin A. The zinc concentration in the prostate is 100 times higher than other organs.It has a pronounced antimicrobial activity, accumulates in iron in the form of protein complexes and is in sperm in a free state;Spermina and polymines also have a high anti -Bacterial activity and the immunoglobulins are involved in the immune protection of the prostate and urethra.
Prostate iron also participates:
- In hormonal metabolism through the transformation of testosterone from blood, into active dihydrotestosterone;The latter regulates the secretory activity of the gland;This process proceeds with the participation of the same zinc;
- in the deed of urination using smooth muscle fibers contained in the capsule of the gland;
- In the process of ejaculation together with the muscles of the bottom of the pelvis and the part of the urethra that passes through the prostate;
- In the formation of the sensation of orgasm due to the vamento of the ducts that pass along the lateral surface of the seed tubercle;Contains receptors that transmit brain impulses during ejaculation.
Therefore, the prostate, together with the participation in the general hormonal state of a man and guaranteeing its possibility of reproduction, protects the urogenital organs from the aggression of conditions conditioned pathogenic and pathogens.
Causes and factors that contribute
The main cause of the inflammation of the prostate is to enter pathogenic microbes and conditioned pathogens.In 60%, this is an E. coli.In recent studies, the role of the participation of gonococcus and tricomonna infections in inflammation is confirmed.In case of violation of the protective barrier of the gland and a decrease in local immune defense, the penetration of such an infection such as yeast, mycoplasma and ureapaplasma, the herpes virus and the cytomegalinyrus, the microorganisms that cause respiratory diseases (with the oral-genital contact method), the intestinal microflora (in case of sexanal.
For tuberculosis diseases, the spread of mycobacteria through blood flow in the prostate is possible.There are isolated cases of tuberculosis prostatitis, but rarely.
Ways to penetrate the infection in the gland:
- Hematogen - with blood from other outbreaks of infection;This occurs through the venous vases of the prostate, communicating with the veins of the penis, the testicle, the rectum, the bladder and the kidneys (included with the injury of the tuberculosis)
- lymphogen - through the lymphatic vessels
- urethrogen - through the urethra
Factors that contribute:
- The violation of the hormonal background, in particular, a decrease in the level of testosterone, following which the antimicrobial prostate barrier is reduced.
- Varicocele (expansion of the veins of the seed), hemorrhoids, varicose veins of the lower limbs.These diseases are the result of a genetic defect in the venous valves, which leads to the ailments of the microcirculation of the blood in the organs located in the basin, an increase in the local temperature, reduced in normal (compared to total body temperature) and the creation of favorable conditions for the vital activity of microorganisms.
- Osteocondrosis, Hernia of the lumbar column and other innervation disorders, a sedentary lifestyle.They can lead to prolonged spasm (narrowing) of the prostate vessels or, on the contrary, to their long -term expansion.The first leads to the compromised blood intake, the second - to stagnant blood phenomena.
- The intoxication is alcohol, which leads to the paralysis of small vessels and nicotine, which contributes to their prolonged spasm.
- Various infectious diseases, diabetes mellitus, frequent mental effects and long negative, stress states, sleep disorders - all this helps to reduce general immunity.
Types of prostatitis
Basically, the first symptoms of prostatitis are explained by the deterioration of the blood supply to the gland following inflammation or vascular spasm that leads to the lack of oxygen, compromises metabolic processes with the formation of underestimated decay products.They cause a powerful irritation of a large number of nerve receptors associated with the ends of the nerves of the testicles, bladder, rectum, penalties, muscles of the bottom of the pelvis.
In accordance with the classification proposed by the National Institute of Health (depending on the course of the inflammatory process), acute bacterial prostatitis is distinguished, which is rare (about 5% of all cases) and chronic prostatitis.The latter can develop after acute, but in 90% - 98% of cases it is primary.It is assumed that it leads to sexual disorders and infertility.
The chronic form is divided into:
- Bacterial.
- Abacterial or chronic pelvic pain (in the absence of bacteria in studies).In turn, it is divided into inflammatory and non -inflammatory.
- Inflammatory asymptomatic (in the absence of evident symptoms).
Clinical events
Acute prostatitis
The acute path is caused by any microorganism and is characterized by almost simultaneous damage to all glandular lobules.The most common cause is gonococcus.The inflammatory process can be in the form of abscess or widespread non -inflammation.The most characteristic symptoms of acute prostatitis are as follows:
- Chills and high body temperature (up to 38.5OR and above).
- Serious intoxication: weakness, pains in the joints, headache, increase in the frequency of the impulse, lack of appetite, etc.
- Severe pain in the perineum, in the inguinal and lumbar areas.
- MINION Disorders - I urge frequent and false, pain and difficulty in urination, acute urinary retention.
- Belovoy or transparent exhaust from the urethra.
An examination of the fingers of the prostate through the rectum is impossible due to severe pain.In addition, it is contraindicated due to the possibility of spreading (diffusion) of infection in the blood and the development of a septic state.
Chronic prostatitis
The recommended classification reflects the fact that the signs of chronic prostatitis in men are very different and the opinions of doctors on the causes and mechanisms of the development of the disease are largely different.The diagnosis is based on the patient complaints, the clinical examination on an examination of the fingers of the gland through the rectal (rectal) and the ultrasound examination.At the same time, the degree of pain, dimensions and volume, contours, uniformity of consistency and presence of softening or sealing areas are assessed.
In part the functional capacity of the organ and, above all, the presence or absence of processes of inflammation, as well as the form of the disease, allows to evaluate the study of prostate secretion.It is obtained following a massage with the fingers of a prostate with subsequent bacteriological analysis of the material (secret), the pcr conduct (polymerase chain reaction) to detect conditionally and pathogens of sexual infections and an analysis of the spermogram.
General symptoms of various forms of chronic prostatitis:
- Discomfort or/and moderate pains in the form of "pain" and gravity in the perineum, which occur or intensify after drinking alcoholic beverages, physical activity, sexual contact.Sometimes they are passing a paroxysmal nature.
- A sense of discomfort and crusia in the urethra during urination or sexual contact, minor unloading with serous grace from the urethra (mainly after a long -term delay in the urine).
- Simpro frequent impulse to urinate (sometimes up to 3 times within 1 hour) and an insufficient feeling of bladder emptying, which is explained by a violation of the nervous regulation of the prostate, its muscle fibers and the bladder.
- Reduce the ability to fertilize, which is caused by an increase in the acidity of the secret, a decrease or the absence of mobility of the spermatozoa, their agglutination (gluing) with the heads.
- Pain for orgasm or canceled sensations of orgasm, ejaculation disorders, expressed in its premature or, on the contrary, in the excessive duration of sexual intercourse.These phenomena are associated with the inflammatory process in the field of seminal tubercle or its scars due to inflammation.
The information presented allows us to understand the need and importance of the timely appeal to a qualified specialist in the event of some symptoms and to abandon various cars -non -traditional car methods.The treatment is prescribed only after a complete and complete examination in order to establish the cause and shape of the disease.
Differential diagnosis
Differential diagnosis of acute prostatitis and distinctive signs of chronic prostatitis in men are reflected in the table:
| The form of prostatitis | The main symptoms | Laboratory data |
| Acute bacterial |
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| Chronic bacterial |
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| Chronic abotic (chronic pelvic pain syndrome): |
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| inflammatory |
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| Non -inflammatory or stagnant (40% of patients with prostatitis) |
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| Asymptomatic inflammatory prostatitis |
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