Prostatitis

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

May present with various signs and clinical complaints.

Anatomy

The prostate is a small gland that is part of the male reproductive system and a hormone -dependent organ. Its shape and size are compared to large walnuts. The normal prostate gland weighs about 20 g, has a volume of 15-25 ml, and is 3 cm long, 4 cm wide and 2 cm deep.

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 composed 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 prostate surface is bordered by the rectal ampulla. They are separated by the retrovesical fascia or Deniaville's fascia, which allows palpation of the posterior surface of the prostate gland.

The prostate gland is about 70% glandular tissue and 30% fibromuscular stroma. It has become customary to divide the organ into 3 zones.

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

Middle zone.The area around the ejaculatory canal. Consists of glandular tissue, connective tissue and muscle elements. Tumors in this area are very rare.

Peripheral zone.Covers the posterior and lateral sides of the prostate gland and contains 70% glandular tissue. This is an area that can be felt through the rectum and allows the urologist to assess the condition of the prostate gland. Up to 70% of malignant tumors are localized precisely in the peripheral zone. Therefore, digital rectal examination is an important diagnostic method and should be performed in patients over 45 years of age.

Prostate function:

• production of prostate secretions, which are an integral part of sperm and are involved in diluting ejaculation, as well as regulating it with nutrients such as various enzymes and vitamins, citric acid, zinc ions, which help increase 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 mechanism of urinary retention.

Prostatitis, benign prostate hyperplasia and prostate cancer are the three major prostate diseases.

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

Causes of prostatitis

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

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

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

Possible causes of prostatitis are:

• intraprostatic urinary reflux as a result of dysfunctional urination (urine, with certain predisposing factors, can enter the prostate gland through the prostate duct, 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 (in a number of studies, the influence of psychological stress on the occurrence of symptoms of chronic prostatitis has been demonstrated - in some patients, psychosomatic disorders are diagnosed, in its treatment a decrease in symptoms of prostatitis and the possibility of its recurrence is observed).

Risk factors for prostatitis also include: abstinence or excessive sexual activity, habit of withholding ejaculation, smoking, working at night, inactive lifestyle, inadequate fluid intake, and poor diet.

Symptoms

• pain or burning when urinating (dysuria);
• urinary disorders;
• discoloration of urine;
• appearance of blood in 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 NIH (US National Institutes of Health) classification of prostatitis, there are four categories of the disease, traditionally denoted by Roman numerals:

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

Despite the spread of prostatitis, acute bacterial prostatitis is uncommon - 5% of all cases of the disease. But the diagnosis is quite simple, because the picture of the disease is most often expressed: a man complains of frequent, painful urination, pain in the uterus and perineum. Rise in body temperature is characteristic, and often to high values - less than 39 ° C.

The 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 prostate gland pathology is suspected. Therefore, it is desirable for men not to refuse to do so.

In acute bacterial prostatitis, the prostate on palpation is very painful, edematous, most often enlarged. Ultrasound examination can show not only an increase in the size of the prostate gland, but also a focal fusion of purulent prostate tissue (abscess) - but this is rare and, as a rule, is a result of the running process.

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

Taking prostate secretions for the diagnosis of acute prostatitis is contraindicated because of the increased risk of life -threatening conditions: bacteremia and sepsis. Determination of oncomarker (PSA), its fractionation is also not recommended - due to the low information content and data deviation 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 smooth muscle tone of the prostate gland, bladder neck and prostate portion of the urethra decreases, thus increasing urination and reducing the likelihood of urine entering the prostate gland (intraprostatic urine reflux), which is one of the causes of prostatitis. The most effective and popular drugs are Tamsulosin and Silodosin. They are also widely used to increase urination in patients with prostate hyperplasia.

You can use an anti-inflammatory drug (Diclofenac), which effectively reduces pain and discomfort during urination, reduces prostate swelling, and also contributes to improved urine quality.

Acute bacterial prostatitis is often a reason for hospitalization in hospitals, where antibiotic therapy in the form of intravenous injections is prescribed. After stabilizing the patient’s condition, the patient continues to receive antibiotics in tablet form for 15 or more days to prevent the transition of 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 to treat 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 apply their professional knowledge, but are also guided by scientifically proven and accepted methods of diagnosis and therapy around the world.

Our doctors do not prescribe medications and ineffective examinations "just in case", do not treat diseases that do not exist. When making a diagnosis, the urologist relies on data obtained from the patient’s examination, clinical picture, laboratory and instrumental study data. If surgical treatment is required, surgical operations are performed on the territory of the clinic.