prostatitis

Prostatitis is a disease characterized by the presence of localized inflammation and / or infection in the prostate gland.

It can present with a wide range of clinical signs and disorders.

Anatomy

The prostate is a small gland that is part of the male reproductive system and a hormone-dependent organ. Its shape and size have been compared to a large walnut. A normal prostate gland weighs about 20g, has a volume of 15-25ml and measures 3cm in length, 4cm in width and 2cm in depth.

The prostate gland is located in the small pelvis, below the bladder and above the rectum. The urethra, the urethra, passes through the thickness of the gland. The prostate is surrounded by a capsule made up of smooth muscle, collagen and elastic fibers; covered with three layers of dense connective tissue (fascia) on the anterior, lateral and posterior surfaces. The posterior surface of the prostate is bounded by the ampulla of the rectum. They are separated by the retrovesical fascia or Denonville fascia, which allows palpation of the posterior surface of the prostate gland.

About 70% of the prostate gland is made up of glandular tissue and 30% of fibromuscular stroma. It is customary to divide the organ into 3 zones.

Transition zone.The transition zone accounts for 10% of glandular tissue and 20% of cases of malignant prostate tumors. In this area, one of the main age-related diseases in men is formed - benign prostatic hyperplasia, which can lead to difficulty urinating due to tissue overgrowth.

Central area.The area surrounding the ejaculatory ducts. It consists of glandular tissue, connective tissue and muscle elements. Tumors in this area are extremely rare.

Suburb.It covers the posterior and lateral sides of the prostate gland and contains 70% of the glandular tissue. This is a palpable area across the rectum and allows the urologist to assess the condition of the prostate gland. Up to 70% of malignant tumors are located in the peripheral area. Therefore, digital rectal examination is an important diagnostic method and should be performed in patients over the age of 45.

Functions of the prostate:

• production of prostate secretion, which is an integral part of sperm and is involved in the liquefaction of the ejaculate, as well as saturating it with nutrients such as various enzymes and vitamins, citric acid, zinc ions, which help to improve sperm motility and activity ;
• The prostate contains smooth muscle fibers that help release sperm from the urethra during ejaculation, prevent sperm from entering the bladder, and are involved in the urinary retention mechanism.

Prostatitis, benign prostatic hyperplasia and prostate cancer are the three main diseases of the prostate.

All three diseases can coexist simultaneously in the same prostate. That is, the presence of prostatitis does not exclude the presence of prostatic hyperplasia and prostate cancer in the patient and vice versa.

Causes of prostatitis

According to statistics, prostatitis is the most common urological disease - after prostatic hyperplasia and prostate cancer - in men under 50 and the third most common in men over 50.

Prostatitis accounts for 6 to 8% of outpatient urological visits.

The most common causative agent of prostatitis are E. coli strains, which are detected in 80% of cases. The rarest pathogens are enterococci, Pseudomonas aeruginosa, Klebsiella and other gram-negative bacteria. The role of sexually transmitted infections (such as chlamydia trachomatis) in inflammation of the prostate is not yet clearly established and is being studied. In patients with HIV infection and other severe changes in the immune system, possible causative agents are cytomegalovirus, mycobacterium tuberculosis, fungi and other rare pathogens. There are data indicating the presence of microorganisms in the prostate gland that are not detected in standard studies, but play a role in the appearance of inflammatory changes and the subsequent development of symptoms of prostatitis.

Possible causes of prostatitis are:

• intraprostatic reflux of urine as a result of dysfunctional urination (urine, with some predisposing factors, can enter the prostate gland through the ducts of the prostate, causing an inflammatory process);
• unprotected anal sex;
• narrowing of the foreskin (phimosis);
• Autoimmune diseases;
• functional and anatomical changes in the pelvic floor muscles;
• changes in the central nervous system, including functional and anatomical changes in the brain;
• traumatic and unusual sexual activity;
• psychological factors (the influence of psychological stress on the onset of symptoms of chronic prostatitis was shown in a number of studies - psychosomatic disorders were diagnosed in some patients, in the treatment of which a decrease in symptoms of prostatitis and the likelihood of its relapse have been noted).

Risk factors for prostatitis also include: abstinence or excessive sexual activity, habit of limiting ejaculation, smoking, night work, sedentary lifestyle, inadequate fluid intake and improper diet.

Symptoms

• pain or burning when urinating (dysuria);
• urinary disorders;
• urine discoloration;
• the appearance of blood in the urine;
• pain in the abdomen, groin or lower back;
• pain in the perineum;
• pain or discomfort in the penis and testicles;
• pain with ejaculation;
• increased body temperature (with acute bacterial prostatitis).

Diagnostics

According to the generally recognized classification of prostatitis NIH (US National Institutes of Health), there are four categories of diseases, traditionally indicated with Roman numerals:

• I - acute bacterial prostatitis;
• II - chronic bacterial prostatitis;
• III - chronic abacterial prostatitis / chronic pelvic pain syndrome (CP / CPPS);
• IIIa - chronic prostatitis / chronic pelvic pain syndrome with signs of inflammation;
• IIIb - chronic prostatitis / chronic pelvic pain syndrome without signs of inflammation;
• IV - chronic asymptomatic prostatitis (asymptomatic).

Despite the widespread prevalence of prostatitis, acute bacterial prostatitis is not common - 5% of all cases of the disease. But its diagnosis is quite simple, since the picture of the disease is most often pronounced: a man complains of frequent and painful urination, pain in the uterus and perineum. An increase in body temperature is characteristic and often to high values - below 39 ° C.

Diagnosis of acute bacterial prostatitis involves a digital rectal examination (rectal examination), which involves feeling (palpating) the prostate gland with the index finger through the anus (rectum).

Digital rectal examination (DRE) is an important diagnostic manipulation if any pathology of the prostate gland is suspected. Therefore, it is advisable that men do not refuse to lead it.

In acute bacterial prostatitis, the prostate on palpation is acutely painful, edematous, most often enlarged. Ultrasound examination can show not only an increase in the size of the prostate gland, but also foci of purulent fusion of the prostate tissue (abscesses) - but this happens rarely and, as a rule, is a consequence of an ongoing process.

Laboratory diagnostics, first of all, includes a general urine test, in which an increase in the number of leukocytes is noted. Bacteriological urine culture is recommended. Based on the results of the analysis, it is possible to determine the presence of bacteria and their sensitivity to the antibiotic, and thus, to adjust the prescribed antibiotic therapy. A general blood test is also performed to assess the general condition of the body and its response to the inflammatory process.

Taking prostatic secretions for diagnosis in acute prostatitis is contraindicated due to the increased risk of a life-threatening condition: bacteremia and sepsis. Determination of the oncomarker (PSA), its fractions is also not recommended, due to the low information content and distortion of data against the background of inflammation.

Treatment of prostatitis

Antibiotic therapy is the basic therapy for patients with prostatitis of all categories.

Alpha blockers are also an effective group of drugs. As a result of their action, the tone of the smooth muscle of the prostate gland, bladder neck and prostatic part of the urethra decreases, thereby improving urination and reducing the possibility of urine entering the prostate gland (intraprostatic reflux of urine) , which is one of the causes of prostatitis. The most effective and popular drugs are Tamsulosin and Silodosin. They are also widely used to improve urination in patients with prostatic hyperplasia.

It is possible to use anti-inflammatory drugs (Diclofenac), which effectively reduce pain and discomfort when urinating, reduce swelling of the prostate, and also help improve the quality of urination.

Acute bacterial prostatitis is often a reason for hospitalization, where antibiotic therapy in the form of intravenous injections is prescribed. After stabilization of the patient's condition, the patient continues to receive antibiotics in the form of tablets for 15 or more days in order to prevent the transition from acute prostatitis to chronic bacterial prostatitis.

According to statistics, 10% of patients with acute prostatitis develop chronic bacterial prostatitis. Another 10% of patients will develop chronic pelvic pain syndrome (chronic prostatitis IIIb) in the future.

How is the treatment of prostatitis in the clinic

Urologists treat prostatitis and other diseases of the genitourinary system, based on international clinical guidelines. This means that they not only use their professional knowledge, but are also guided by scientifically proven and globally accepted methods of diagnosis and therapy.

Our doctors do not prescribe ineffective drugs and tests "just in case", they do not treat non-existent diseases. When making a diagnosis, urologists rely on the data obtained from the examination of the patient, the clinical picture, the data of laboratory and instrumental studies. If surgical treatment is required, a surgical operation is performed on the territory of the clinic.