About 40-60% of urological patients in the clinic are patients with chronic prostatitis.Symptoms of prostatitis in men are often the cause of depressive conditions and changes in the psyche.
The disease that every third man has undergone over 25-30 years does not threaten life, but difficulties in diagnosis and treatment determine a long chronic course and often lead to damage.
The idea of prostate functions, mechanisms and causes of the development of inflammation allow us to properly understand the symptoms and the need for timely treatment.
The functional value of the prostate gland
Its main function is the secretion of a specific fluid (secret) 40 - 50 glands that form all the glandular tissue of the organ.The secret of 90 - 95% consists of water and the main trace elements, phospholipids, sperm amino acids, which gives the sperm a specific odor, enzymes, proteins, citric acid and fructose.All components have their own purpose and are strictly balanced.
Prostate secret provides:
- The formation and maintenance of a neutral or slightly alkaline environment in the urethra and semen.This environment provides sperm for semen life.
- Thinning the sperm required to prevent sperm binding to each other and ensure their encouragement.In the process of sexual intercourse, the semen mixed with prostate juice.
- The viability of sperm: Substances contained in the secret are a germ cell nutrient medium, which can be located for several days in the female genital organs until the fertilization of the egg.
- Protection of the genital system from infection with the help of zinc, semen, polyamines and immunoglobulin A. The concentration of zinc in the prostate is 100 times higher than in other organs.It has pronounced antimicrobial activity, accumulates in iron in the form of protein complexes and is in sperm in free state;Spermine and polyamines also have high antibacterial activity, and immunoglobulins participate in the immune protection of the prostate and urethra.
Prostate iron also participates:
- In hormonal metabolism by transformation of testosterone coming from the blood into active dihydrotestosterone;The latter regulates the secretory activity of the gland;This process continues with the participation of the same zinc;
- In the act of urination using smooth muscle fibers contained in the gland capsule;
- In the process of ejaculation together with the muscles of the bottom of the pelvis and the part of the urethra passing through the prostate;
- in the formation of the sensation of orgasm due to the impression of the ducts passing along the lateral surface of the seed tuberculus;It contains receptors that transmit impulses to the brain during ejaculation.
In this way, the prostate, together with the participation in the general hormonal status of a person and guarantees the possibility of reproduction, protects the urogenital organs from aggression of conditionally pathogenic and pathogenic microorganisms.
Causes and contributing factors
The main cause of prostate inflammation is to enter IT pathogenic and conditionally pathogenic microbes.At 60%this is E. coli.Recent studies confirm the role of participation of gonococcal and trichomone infections in inflammation.In the case of disruption of the protective barrier of the gland and reduction of the local immune defenses, the penetration of such infection such as yeast, mycoplasma and uraaplasma, herpes virus and cytomegalirinrus, microorganisms that cause respiratory diseases (with oral-germs), the retinue-ghosts.
For diseases of tuberculosis, mycobacteria may spread through the blood in the prostate.Isolated cases of tuberculosis are detected, but rarely.
Ways to penetrate infection into the gland:
- Hematogenous - with blood from other foci of infection;This happens through the venous vessels of the prostate, communicating with the veins of the penis, testis, rectum, bladder and kidneys (including with tuberculosis lesion)
- lymphogenic - through lymph vessels
- Urethrogenic - by urethra
Contributing factors:
- Disruption of the hormonal background, more special, a decrease in testosterone levels, resulting in a decreased antimicrobial prostatic barrier.
- Varicocele (enlargement of the veins of the seed), hemorrhoids, varicose veins of the lower limbs.These diseases are the result of a genetic defect in the venous valves, leading to disorders of the blood microcirculation in organs located in the pelvis, an increase in local temperature, decreased in normal (compared to the total body temperature) and the creation of favorable conditions for the vital activity of the microorganisms.
- Osteochondrosis, lumbar spine hernia and other disorders of innervation, sedentary lifestyles.They can lead to prolonged spasm (narrowing) of the vessels of the prostate or, conversely, to their long -term expansion.The former leads to impaired blood supply, the second to stagnant blood phenomena.
- Intoxication is alcohol, which leads to paralysis of small vessels and nicotine, contributing to their prolonged spasm.
- Various infectious diseases, diabetes mellitus, frequent and long negative mental effects, conditions of stress, sleep disorders - all this helps to reduce overall immunity.
Types of prostatitis
In general, the first symptoms of prostatitis are explained by the worsening of the blood supply of the gland as a result of inflammation or vascular spasm, leading to oxygen deficiency, impaired metabolic processes with the formation of undervalued decay products.They cause powerful irritation of a large number of nerve receptors associated with the ends of the nerves of the testes, bladder, rectum, penis, muscles of the bottom of the pelvis.
In accordance with the classification proposed by the National Institute of Health (depending on the course of the inflammatory process), an acute bacterial prostatitis is distinguished, which is rare (about 5% of all cases) and chronic prostatitis.The latter may develop after acute, but in 90% - 98% of cases is primary.It is supposed to lead to sexual disorders and infertility.
The chronic form is divided into:
- Bacterial.
- Abacterial or chronic pelvic pain (in the absence of bacteria in studies).It, in turn, is divided into inflammatory and non -inflammatory.
- Asymptomatic inflammation (in the absence of obvious symptoms).
Clinical manifestations
Acute prostatitis
The acute course is provoked by all microorganisms and is characterized by almost concomitant damage to all glandular lobules.The most common cause is gonococcus.The inflammatory process can be in the form of an abscess or diffuse, not inflammation.The most characteristic symptoms of acute prostatitis are as follows:
- Chills and high body temperature (up to 38.5O and above).
- Severe intoxication - weakness, joint pain, headache, increase in heart rate, lack of appetite, etc.
- Severe pain in the perineum, in the area of inguinal and lumbar.
- Urination disorders - frequent and false impulses, soreness and difficulty in urinating, acute urinary retention.
- Belov or transparent disposal from the urethra.
Examination of the prostate finger through the rectum is impossible due to severe pain.In addition, it is contraindicated due to the possibility of spreading (spread) of infection in the blood and the development of a septic condition.
Chronic prostatitis
The recommended classification reflects the fact that the signs of chronic prostatitis in men are very diverse and the views of doctors about the causes and mechanisms of the development of the disease are largely different.The diagnosis is based on the patient's complaints, a clinical examination when examined the finger of the gland through the rectal (rectal) and an ultrasound examination.At the same time, the degree of pain, size and volume, contours, uniformity of the consistency and the presence of softening or sealing areas are evaluated.
In part, the functional capacity of the organ and most importantly - the presence or absence of inflammatory processes, as well as the shape of the disease, allows you to evaluate the study of prostatic secretion.It results from a prostate finger massage with subsequent bacteriological analysis of the material (secret), PCR behavior (polymerase chain reaction) to detect conditionally pathogenic microorganisms and pathogens of sexual infections and sperm analysis.
General symptoms of different forms of chronic prostatitis:
- Discomfort or/and moderate pain in the form of "pain" and severity in the perineum, which occur or are enhanced after drinking alcoholic beverages, physical activity, sexual contact.Sometimes they pass paroxysmal by nature.
- Feeling discomfort and cruise in the urethra during urination or sexual contact, slight discharge of a serous border from the urethra (mainly after long -term slowing of urine).
- The sudden frequent desire for urination (sometimes up to 3 times within 1 hour) and a feeling of insufficient emptying of the bladder, which is explained by a violation of nervous regulation of the prostate, muscle fibers and bladder.
- Reducing the ability to fertilize, which is caused by an increase in the acidity of the secret, a decrease or absence of sperm mobility, their agglutination (sticking) with heads.
- Orgasm pain or deleted orgasm sensations, ejaculation disorders, expressed in its premature or, conversely, in the excessive duration of sexual contact.These phenomena are related to the inflammatory process in the area of the seminal tube or its scars as a result of inflammation.
The information presented allows us to understand the need and importance of the timely appeal of a qualified specialist in the case of certain symptoms and abandonment of various unconventional methods of self -self -esteem.Treatment is prescribed only after a thorough and thorough examination to determine the cause and shape of the disease.
Differential diagnosis
The differential diagnosis of acute prostatitis and distinctive signs of chronic prostatitis in men are reflected in the table:
| Prostatitis | The main symptoms | Laboratory |
| Acute bacterial |
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| Chronic bacterial |
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| Chronic abacus (chronic pelvic pain syndrome): |
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| inflammatory |
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| Non -inflammatory or stagnant (40% of patients with prostatitis) |
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| Asymptomatic inflammatory prostatitis |
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