Chronic prostatitis is a serious problem. Even modern urology cannot answer many questions about this pathology. Experts believe that chronic prostatitis is a disease caused by a variety of health problems, including tissue damage, as well as dysfunction of not only the urinary tract and prostate gland, but also other organs.
Pathology is diagnosed mainly in men of reproductive age. In older men, chronic prostatitis is often accompanied by benign neoplasms of the prostate.
Classification of diseases
The classification of prostatitis was developed by scientists at the US National Institutes of Health in 1995:
%20and%20chronic%20inflamed%20prostatitis%20(right).webp)
- 1 type- Acute bacterial prostatitis. It is diagnosed in 5% of cases of inflammation of the prostate gland.
- type 2- chronic bacterial prostatitis.
- 3 types- chronic bacterial prostatitis. This pathology has another name - chronic pelvic pain syndrome.
- Type 3A- inflammatory forms of chronic prostatitis. It is diagnosed in 60% of cases of chronic prostatitis.
- type 3B- non -inflammatory form of chronic prostatitis. Diagnosis in 30% of cases.
- 4 types- asymptomatic prostatitis.
There is also a classification of chronic prostatitis, compiled in 1990.
Symptoms of chronic prostatitis
Discomfort and pain in the pelvic area that lasts more than 3 months are the main symptoms of chronic prostatitis.
In addition, urinary disorders and erectile dysfunction are noted:
- pain occurs in the perineum, can spread to the anus, groin, inner thighs, sacrum, lower back and scrotum. Pain on one side, extending into the testicles, is often not a symptom of chronic prostatitis;
- erection does not occur, although there are adequate conditions, but complete impotence is not observed;
- in the early stages of disease development, premature ejaculation is observed;
- frequent urination, urinary incontinence, pain and burning sensation in the process of 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 penis and rectum, aggravated by movement;
- painful urination;
- poor urine flow.
Specially contagious:
- mucus discharge from the urethra;
- the above symptoms.
Non -communicable prostatitis:
- acute pain in the perineum;
- pain in the thighs and head of the penis;
- the pain is aggravated by the forced interruption of sexual intercourse or the prolonged absence of intimate life.
Important!The disease develops in waves. Symptoms may either weaken or intensify, but their presence clearly indicates the presence of an inflammatory process.
Symptoms may vary depending on the stage of pathological development.
The following stages of pathological development are distinguished:
- Exudative.The patient experienced pain in the pubis, groin and scrotum. There is frequent urination and discomfort after intercourse. Erections can be painful.
- Alternative.The pain is increasing, localized in the groin, genitals and giving to the sacrum. Urination is accelerated, but occurs without difficulty. Erections do not suffer.
- Proliferative.During exacerbations, urination becomes more frequent. Urine flow becomes weak.
- Cicatricial.Sclerosis of prostate tissue occurs. There is a feeling of heaviness in the sacrum and genital area. Increased urination. Erections become weak. Ejaculation may be completely absent.
Symptoms may vary depending on the course of the disease, but in any case, they will increase gradually.
Causes of chronic prostatitis
There are many factors that lead to chronic prostatitis. The disease occurs under the influence of infectious agents. Patients have hormonal, neurovegetative, immunological and hemodynamic disorders. Biochemical factors, reflux of urine into the prostate lobe and impaired function of growth factors, which are responsible for the proliferation of living cells, affect.
Causes influencing the formation of pathology:
- infections of the genitourinary system;
- hypodynamics;
- irregular sex life;
- continuous catheterization of the bladder;
- normal hypothermia.
Developmentdiseases of a bacterial naturepromotes intraprostatic urinary reflux.
Chronic abacterial prostatitisdeveloped against the background of neurogenic disorders of the pelvic floor muscles, as well as the elements responsible for the function of the walls of the bladder, prostate and urethra.
Formationmyofascial trigger point, located near the organs of the genitourinary system and the prostate gland, can trigger pelvic pain syndrome. Points caused by certain diseases, surgical interventions and injuries can trigger pain in the genital area, perineum and adjacent areas.
Pathological diagnosis
The presence of a complex of symptoms makes it possible to diagnose chronic prostatitis without much difficulty. However, in some cases, the pathology may be asymptomatic. In this case, in addition to standard examination and questioning of the patient, additional research methods are required.Neurological examination and study of the patient’s immunological status are mandatory..
Important!Questionnaires and special questionnaires allow you to more accurately determine the subjective feelings of the patient and get a complete picture of the state of health, intensity of pain, ejaculation, erectile dysfunction and urination.
Laboratory diagnostics
Laboratory diagnostics makes it possible to distinguish between bacterial and abacterial forms 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 a fourth sample of urine or prostate secretions contains more than 10 leukocytes in the PZ, or bacterial association.When the number of leukocytes increases, but the bacteria are not inoculated, the material is examined for detection of chlamydia or other STD pathogens.
- The discharge from the urethra is sent to the laboratory to detect the viral, fungal and bacterial flora, leukocytes and mucus in it.
- Scraping of the urethra is examined by PCR. This allows you to identify sexually transmitted pathological agents.
- Perform microscopic examination of prostate secretions to count the number of macrophages, leukocytes, amyloid and Trousseau-Lallemand body. Immunological studies and bacteriological studies were prescribed. Determine non -specific antibody levels.
- Blood sampling was performed ten days after digital rectal examination to determine the concentration of PSA in it. At rates in excess of 4. 0 ng / ml, patients underwent prostate biopsy to rule out oncology.
Diagnosis is revealed based on research results.
Instrumental diagnostics
To clarify the stage and form of the disease will help transrectal ultrasound of the glands. 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 and myographic studies of the pelvic floor muscles will make it possible to reveal infravesical obstruction and neurogenic disorders that often accompany pathology.
Tomography and MRI are used to make a differential diagnosis, in particular, with prostate cancer. This method will reveal violations in the pelvic organs and spine.
Differential diagnosis
Differential diagnosis is important, as there is a risk that the patient has a more serious illness.
Differential diagnosis is established with diseases such as:
- pseudodyssinergia, dysfunction of the detrusor-sphincter system, bladder dysfunction of neurogenic origin, complex regional pain syndrome;
- narrowing of the bladder, hypertrophic changes in the neck of the bladder, prostate adenoma;
- osteitis of the genital joints, cystitis;
- rectal pathology.
If symptoms occur, the prostate gland should be examined by a urologist or andrologist. Get an ultrasound scan. If necessary, a prostate gland biopsy is prescribed.
Methods of pathological treatment
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 intake, get rid of nicotine addiction, eat properly and normalize your sex life. However, to do without a course of basic therapy will not work. Medication intake is a key condition for full recovery.
Indications for hospitalization
Often, treatment is carried out on an outpatient basis. But in cases where the disease is incurable and has a tendency to recur, the patient is referred to a hospital where the treatment is more effective.
Methods of medical treatment
This method aims to eliminate existing infections, normalize blood circulation, improve drainage of the prostate lobules, correct 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 cultures of prostate secretion.This will make it possible to isolate the pathogen by determining its sensitivity to a particular drug. With a well -designed scheme, the effectiveness of treatment reaches more than 90%.
In 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 the course of antibiotics is not more than a month. With positive dynamics, treatment was 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 high bioavailability, are active against most gram-negative bacteria, ureaplasma and chlamydia, accumulated in prostate gland tissue.
When treatment with fluoroquinolones is ineffective, penicillin may be prescribed.
Antibacterial drugs are used for preventive purposes.
After treatment with antibiotics, therapy with the use of a blocker is prescribed.This treatment strategy is effective for patients with persistent obstructive and irritating symptoms.
If urinary disturbances and pain persist, tricyclic antidepressants may be prescribed, which have analgesic effects.
With severe urinary incontinence, before starting therapy, urodynamic studies are performed and act on the basis of the results obtained.
Non -drug therapy
Non -drug therapy methods make it possible to increase the concentration of antibacterial drugs in the glandular tissue, but it is not recommended to exceed the dose.
For this purpose, the following methods are used:
- electrophoresis;
- Laser therapy;
- Phonophoresis;
- Microwave hyperthermia (used transrectally).
When using 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, activate the immune system at the cellular level, eliminate bacteria, relieve congestion. Increasing the range to 40-45 degrees allows you to achieve sclerosing and analgesic effects.
Laser and magnetic therapy are used in combination. The effect is similar to the effect of the above method, but it also has a biostimulatory effect on the organs.
Transrectal massage is performed only if there are no contraindications.
Surgical methods
Chronic prostatitis usually does not require surgery. Exceptions are complications that pose a threat to the health and life of the patient. Modern surgical treatment allows the use of endoscopic surgery. It is minimally invasive. Recovery is faster, and minimal damage is caused by the body.
Surgical methods are prescribed for:
- prostate sclerosis;
- prostate adenoma;
- seed tubercle 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 for chronic prostatitis
Doctors carefully predict the consequences of the disease. It is rare to achieve full recovery. Essentially, chronic prostatitis enters a long -term remission stage. Symptoms disappeared, urine and blood counts returned 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 specialists.