Chronic prostatitis is a serious problem. Modern urology is also unable to answer many questions about this pathology. Experts believe that chronic prostatitis is a disease that is the result of a whole range of health problems, which include 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 accompanied by benign neoplasms of the prostate.
Disease classification
The classification of prostatitis was developed by scientists from the National Institutes of Health of the United States in 1995:
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- 1 type- acute bacterial prostatitis. It is diagnosed in 5% of cases of inflammation of the prostate gland.
- type 2- chronic bacterial prostatitis.
- 3 type- 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 chronic prostatitis cases.
- type 3B- non-inflammatory form of chronic prostatitis. 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:
- pain occurs in the perineum, can radiate to the anus, groin, inner thigh, sacrum, lower back, and scrotum. Pain on the one hand, extending into 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 the development of the disease, premature ejaculation is observed;
- frequent urination, urinary incontinence, pain and burning sensation when emptying the bladder.
The clinical picture may differ depending on the type of chronic prostatitis.
infectious form:
- frequent urination at night;
- pain in the thighs, perineum, glans and rectum, aggravated by movement;
- painful urination;
- weak urine stream.
Specific infectious:
- mucous discharge from the urethra;
- the above symptoms.
Non-infectious prostatitis:
- sharp pain in the perineum;
- pain in the thighs and head of the penis;
- the pain intensifies with the forced interruption of sexual intercourse or a prolonged absence of intimate life.
Important!The disease progresses in waves. Symptoms may weaken or intensify, but their presence clearly indicates the presence of an inflammatory process.
Symptoms can vary depending on the stage of development of the disease.
The following stages of development of the pathology are distinguished:
- exudative.The patient feels 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, localizes in the groin, pubic part and moves to the sacrum. Urination is accelerated, but occurs without difficulty. The erection does not suffer.
- Proliferative.During an exacerbation, urination becomes more frequent. The urine stream becomes weak.
- scarring.Prostate tissue sclerosis occurs. There is a feeling of heaviness in the sacrum and pubic region. Increased urination. The erection becomes weak. Ejaculation can be completely absent.
Symptoms may vary depending on the course of the disease, but will gradually increase in each case.
Causes of chronic prostatitis
There are many factors that lead to chronic prostatitis. The disease occurs under the influence of infectious agents. The patient presents with hormonal, autonomic, immunological and haemodynamic disorders. Biochemical factors affect the reflux of urine into the lobes of the prostate and impaired functioning of growth factors, which are responsible for the proliferation of living cells.
Reasons affecting the formation of pathology:
- infections of the genitourinary system;
- hypodynamy;
- irregular sex life;
- continuous catheterization of the bladder;
- regular hypothermia.
Developmentdiseases of a bacterial naturepromotes intraprostatic urinary reflux.
Chronic bacterial prostatitisdevelops against the background of neurogenic disorders of the pelvic floor muscles, as well as elements responsible for the functioning of the bladder wall, prostate and urethra.
Trainingmyofascial trigger points, which are located near the organs of the genitourinary system and the prostate gland, can provoke pelvic pain syndrome. Stitches that are the result of certain diseases, surgeries and injuries can cause pain in the pubic region, perineum and adjacent areas.
Pathology Diagnosis
The presence of a symptom complex allows you to diagnose chronic prostatitis without much difficulty. However, in some cases, the pathology can be asymptomatic. In this case, in addition to the standard examination and questioning of the patient, additional research methods are required.A neurological examination and a 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, intensity of pain, disorders of ejaculation, erection and urination.
Laboratory diagnostics
Laboratory diagnostics allows you to distinguish between a form of bacterial and bacterial pathology, as well as to determine the type of pathogen and make the most accurate diagnosis.Chronic inflammation of the prostate is confirmed when the fourth urine or prostate secretion specimen contains more than 10 white blood cells in the PZ, or bacterial associations.When the number of leukocytes increases, but the bacteria are not seeded, the material is examined for chlamydia or other STD pathogens.
- Discharge from the urethra is sent to the laboratory to detect viral, fungal and bacterial flora, leukocytes and mucus contained in it.
- Curettage from the urethra is examined by PCR. This allows you to identify pathological agents that are sexually transmitted.
- Perform a microscopic examination of the prostate secretion to count the number of macrophages, leukocytes, amyloid and Trousseau-Lallemand bodies. An immunological study and a bacteriological study are prescribed. Determine the level of non-specific antibodies.
- Blood is drawn ten days after a digital rectal examination to determine the PSA concentration in it. At a rate greater than 4. 0 ng / mL, the patient undergoes a prostate biopsy to rule out oncology.
The diagnosis is displayed on the basis of results of researches.
Instrumental diagnostics
To clarify the stage and form of the disease will help transrectal ultrasound of the gland. Ultrasound allows you to exclude other diagnoses, monitor the effectiveness of treatment, as well as determine the size of the prostate, its echo structure, homogeneity and density of seminal vesicles. Urodynamic studies and myography of the pelvic floor muscles will reveal the infravesical obstruction and neurogenic disorders that often accompany the pathology.
Tomography and magnetic resonance imaging are used to make a differential diagnosis, in particular, with prostate cancer. These methods will reveal violations in the pelvic organs and the spine.
Differential diagnosis
Differential diagnosis is important, as there is a risk that the patient has a more severe disease.
Differential diagnosis is established with such diseases:
- pseudodysynergy, functional disorder of the detrusor-sphincter system, bladder dysfunction of neurogenic origin, complex regional pain syndrome;
- stenosis of the bladder, hypertrophic changes in the bladder neck, prostate adenoma;
- osteitis of the pubic joint, cystitis;
- pathology of the rectum.
If symptoms occur, the prostate gland should be examined by a urologist or andrologist. Get an ultrasound. If necessary, a biopsy of the prostate gland is prescribed.
Pathology treatment methods
Chronic prostatitis is treated by a urologist or andrologist. The therapy takes place in a complex way. Correction is subject to the patient's lifestyle, characteristics of thinking and habits of her. It is important to move more, minimize alcohol intake, get rid of nicotine addiction, eat right and normalize your sex life. However, doing without a basic therapy course will not work. Taking medications is the main condition for a complete recovery.
Indications for hospitalization
Most often, the treatment is carried out on an outpatient basis. But in cases where the disease cannot be corrected and tends to relapse, the patient is referred to a hospital where the treatment is more effective.
Medical method of treatment
This method is aimed at eliminating the existing infection, normalizing blood circulation, improving the drainage of the prostatic lobules, correcting the hormonal background and immune status. Therefore, doctors prescribe antibiotics, vasodilators, immunomodulators, anticholinergics, and anti-inflammatory drugs.
If the disease is bacterial in nature, antibiotics are highly recommended. The agent is prescribed based on the results of bacterial culture of prostatic secretion.This will allow to isolate the pathogen with the subsequent determination of its sensitivity to a particular drug. With a well-designed scheme, the effectiveness of the treatment reaches over 90%.
In the abacterial form, a short course of antibiotics is prescribed. It continues only if the scheme gives a positive result. The effectiveness of the therapy is about 40%
With chronic pelvic pain, the duration of the course of antibiotics does not exceed a month. With positive dynamics, the treatment is continued for another month. If there is no effect, the drug is replaced by another, which may be more effective.
Antibacterial agents from the group of fluoroquinolones are the main drugs for the treatment of pathology.They have a high bioavailability, are active against most gram-negative bacteria, ureaplasm and chlamydia, accumulate 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 with persistent obstructive and irritative symptoms.
If urination disturbances and pain persist, tricyclic antidepressants can be prescribed, which have an analgesic effect.
With severe violations of urination, before starting therapy, a urodynamic study is performed and act on the basis of the results obtained.
Non-drug therapy
Non-drug methods of therapy allow you to increase the concentration of antibacterial drugs in the tissues of the gland, but it is not recommended to exceed the dose.
For this purpose, the following methods are used:
- 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, relieves congestion. Increasing the interval to 40-45 degrees allows you to achieve a sclerosing and analgesic effect.
Laser and magnetotherapy are used in combination. The effect is similar to the effect of the above methods, but also has a biostimulating effect on the organ.
Transrectal massage is carried out only in the absence of contraindications.
Surgical method
Chronic prostatitis generally does not require surgery. The exception is complications that pose a threat to the patient's health and life. Modern surgical treatment allows the use of endoscopic surgery. It is minimally invasive. Rehabilitation is faster and the body suffers minimal damage.
The surgical method is prescribed for:
- prostate sclerosis;
- prostate adenoma;
- seed tubercle sclerosis;
- calcification in the prostate.
Important!Surgery is contraindicated in the acute phase. Surgical treatment is prescribed by the surgeon on the basis of the results of the study and the general clinical picture.
Prognosis for chronic prostatitis
Doctors are wary of predicting the outcome of the disease. Full recovery is rare. Basically, chronic prostatitis goes into a long-term remission phase. Symptoms disappear, urine and blood counts return to normal. In order for chronic prostatitis not to become more active and not cause complications, it is necessary to follow all the recommendations of a specialist.