Chronic prostatitis is a serious problem. Even modern urology is not able to answer many questions regarding this pathology. Experts believe that chronic prostatitis is a disease resulting from a whole range of health problems, including tissue damage, as well as dysfunctions not only of the urinary tract and the prostate, but also of other organs.
Pathology is diagnosed mainly in men of childbearing age. In older men, chronic prostatitis is often accompanied by benign prostate tumors.
Classification of diseases
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 of inflammation of the prostate.
- 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 of chronic prostatitis.
- Type 3B- non-inflammatory form of chronic prostatitis. Diagnosed in 30% of cases.
- 4 types- asymptomatic prostatitis.
There is also a classification of chronic prostatitis, compiled in 1990.
Symptoms of chronic prostatitis
A feeling of discomfort and pain in the pelvic region that lasts for 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, may 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 thighs, perineum, glans and rectum, worse on movement;
- painful urination;
- weak stream of urine.
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 may vary depending on the stage of development of the pathology.
The following stages of the development of pathology are distinguished:
- Exudative.The patient feels pain in the pubis, groin and scrotum. There are frequent urination and a feeling of discomfort after intercourse. An erection can hurt.
- Alternative.The pain intensifies, localizes in the groin, pubic part and gives 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.
- Cicatric.Sclerosis of prostate tissue occurs. There is a feeling of heaviness in the sacrum and 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. Biochemical factors, reflux of urine in the lobes of the prostate and impaired functioning of growth factors, responsible for the proliferation of living cells, affect.
Reasons that affect the formation of pathology:
- infections of the genitourinary system;
- hypodynamia;
- irregular sex life;
- continuous bladder catheterization;
- regular hypothermia.
Developmentbacterial diseasespromotes intraprostatic urinary reflux.
Abacterial chronic prostatitisdevelops against the background of neurogenic disorders of the muscles of the pelvic floor, as well as elements responsible for the functioning of the wall of the bladder, prostate and urethra.
Trainingmyofascial trigger points, which are located near the organs of the genitourinary system and the prostate, can cause pelvic pain syndrome. Stitches resulting from certain diseases, surgeries and injuries can cause pain in the pubic region, perineum and adjacent areas.
Pathology diagnosis
The presence of a symptom complex makes it possible 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 are mandatory..
Important!Special questionnaires and questionnaires allow you to more accurately determine the patient's subjective feelings and get a full picture of the state of health, pain intensity, ejaculation disorders, erectionand urination.
Laboratory diagnosis
Laboratory diagnostics allows you to distinguish between a bacterial and abacterial form of 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 sample of urine or prostatic secretion contains more than 10 leukocytes in the ZP, or bacterial associations.When the number of leukocytes is increased, but bacteria are not sown, the material is examined for the detection of chlamydia or other pathogens of STDs.
- The discharge from the urethra is sent to the laboratory for the detection of viral, fungal and bacterial flora, leukocytes and mucus in it.
- Urethral scraping is examined by PCR. This allows you to identify sexually transmitted pathological agents.
- Perform microscopic examination of prostate secretion to count the number of macrophages, leukocytes, amyloids, and Trousseau-Lallemand bodies. An immunological study and a bacteriological study are prescribed. Determine the level of non-specific antibodies.
- A blood sample is taken ten days after a digital rectal examination to determine the concentration of PSA in it. At a level above 4. 0 ng/ml, the patient undergoes prostate biopsy to exclude oncology.
The diagnosis is stated on the basis of the results of the studies.
Instrumental diagnosis
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 echostructure, homogeneity and density of seminal vesicles. Urodynamic studies and myography of the pelvic floor muscles will reveal subvesical obstruction and neurogenic disorders that often accompany the pathology.
Computed tomography and MRI are used to establish a differential diagnosis, especially with prostate cancer. These methods will reveal violations of the pelvic organs and spine.
Differential diagnosis
Differential diagnosis is important, as there is a risk that the patient has more serious disease.
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 neck of the bladder, prostate adenoma;
- osteitis of the pubic joint, cystitis;
- pathology of the rectum.
If symptoms appear, the prostate should be examined by a urologist or andrologist. Have an ultrasound. If necessary, a prostate biopsy is prescribed.
Pathology treatment methods
Chronic prostatitis is treated by a urologist or andrologist. Therapy is carried out in a complex way. Correction is subject to the patient's lifestyle, thinking characteristics and habits. It is important to move more, minimize alcohol consumption, get rid of nicotine addiction, eat right and normalize your sex life. However, doing without a basic therapy course will not work. Taking medication is the main condition for complete recovery.
Indications for hospitalization
Most often, 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 drainage of the lobules of the prostate, correcting the hormonal background and immune status. Therefore, doctors prescribe antibiotics, vasodilators, immunomodulators, anticholinergics and anti-inflammatory drugs.
If the pathology is bacterial in nature, antibiotics are definitely recommended. The agent is prescribed based on the results of bacterial culture of prostate secretion.This will allow isolation of the pathogen with subsequent determination of its susceptibility to a particular drug. With a well-designed scheme, the effectiveness of treatment reaches more than 90%.
In the abacterial form, a short course of antibiotics is prescribed. It is continued only if the scheme gives a positive result. The effectiveness of therapy is about 40%
With chronic pelvic pain, the duration of antibiotic therapy does not exceed a month. With positive dynamics, treatment is continued 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, accumulate in prostate tissues.
When treatment with fluoroquinolones is not effective, penicillins may be prescribed.
Antibacterial drugs are used for preventive purposes.
After treatment with antibiotics, treatment with the use of a-blockers is prescribed.This treatment strategy is effective for patients with persistent obstructive and irritative symptoms.
If urination disorders and pain persist, tricyclic antidepressants can be prescribed, which have an analgesic effect.
With severe violations of urination, before starting treatment, a urodynamic study is carried out and acts on the basis of the results obtained.
Non-drug therapy
Non-drug methods of therapy allow 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 transrecally).
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 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 it also has a biostimulating effect on the organ.
Transrectal massage is performed only in the absence of contraindications.
Surgical method
Chronic prostatitis usually does not require surgery. The exception is complications that threaten 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 caused to the body.
The surgical method is prescribed for:
- prostate sclerosis;
- prostate adenoma;
- seed tuber sclerosis;
- calcification in the prostate.
Important!Surgery is contraindicated in the acute stage. Surgical treatment is prescribed by the surgeon based on the results of the study and the overall clinical picture.
Prognosis of chronic prostatitis
Doctors are reluctant to predict the outcome of the disease. Complete recovery is rare. Basically, chronic prostatitis goes into a long-term remission phase. Symptoms resolve, urine and blood counts return to normal. So that chronic prostatitis does not become more active and does not cause complications, it is necessary to follow all the recommendations of a specialist.