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Prostatitis

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

It can present with a wide range of clinical signs and complaints.

Anatomy

healthy and inflamed prostate

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 a large walnut. 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 surface of the prostate borders the rectal ampoule. They are separated by the retrovesical fascia or Denonville fascia, which allows palpation of the posterior surface of the prostate gland.

The prostate gland is approximately 70% glandular tissue and 30% fibromuscular stroma. It is accepted to divide the body into 3 zones.

Transition zone.The transition zone represents 10% of the glandular tissue and 20% of the cases of malignant tumors of the prostate. In this area, one of the main age-related diseases in men is formed - benign prostatic hyperplasia, which can lead to difficulty urinating due to tissue overgrowth.

Central area.The area surrounding the ejaculatory ducts. It consists of glandular tissue, connective tissue and muscle elements. Tumors in this area are extremely rare.

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

Prostate functions:

  • production of prostate secretion, which is an integral part of semen and participates in liquefaction of ejaculate, as well as its saturation with nutrients such as various enzymes and vitamins, citric acid, zinc ions, which help improve 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 participate in the mechanism of urine retention.

Prostatitis, benign prostatic hyperplasia and prostate cancer are the three main diseases of the prostate.

All three diseases can coexist in the same prostate. That is, the presence of prostatitis does not exclude the presence of prostate hyperplasia and prostate cancer in the patient 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.

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

The most common cause of prostatitis is E. coli strains, which are found in 80% of cases. Less common pathogens are enterococci, Pseudomonas aeruginosa, Klebsiella and other gram-negative bacteria. The role of sexually transmitted infections (such as chlamydia trachomatis) in inflammation of the prostate has not yet been clearly established and is being studied. In patients with HIV infection and other severe changes in the immune system, possible causes are cytomegalovirus, Mycobacterium tuberculosis, fungi and other rare pathogens. There are data showing the presence of microorganisms in the prostate gland, which are not detected in standard studies, but play a role in the appearance of inflammatory changes and the subsequent development of symptoms of prostatitis.

Possible causes of prostatitis are:

  • intraprostatic reflux of urine as a result of dysfunctional urination (urine with certain predisposing factors can enter the prostate gland through the ducts of the prostate, 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 (a number of studies have shown the effect of psychological stress on the onset of symptoms of chronic prostatitis - some patients have been diagnosed with psychosomatic disorders, the treatment of which reduces the symptoms of prostatitis and the likelihood of recurrence has been noted).

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

Symptoms

  • pain or burning when urinating (dysuria);
  • urinary disorders;
  • discoloration of urine;
  • the appearance of blood in the urine;
  • pain in the abdomen, groin or lower back;
  • pain in the perineum;
  • pain or discomfort in the penis and testicles;
  • pain with ejaculation;
  • fever (with acute bacterial prostatitis).

Diagnosis

According to the generally accepted classification of prostatitis, the NIH (US National Institutes of Health) has four categories of diseases, 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 / chronic pelvic pain syndrome with signs of inflammation;
  • IIIb - chronic prostatitis / chronic pelvic pain syndrome without signs of inflammation;
  • IV - asymptomatic (asymptomatic) chronic prostatitis.

Despite the widespread prevalence of prostatitis, acute bacterial prostatitis is not common - 5% of all cases of the disease. But his diagnosis is quite simple, as the picture of the disease is most often expressed: the man complains of frequent painful urination, pain in the womb and perineum. The increase in body temperature is characteristic, and often to high values - below 39 ° C.

The diagnosis of acute bacterial prostatitis involves a digital rectal examination (rectal examination), which involves palpation (palpation) of the prostate gland with the index finger through the anus (rectum).

Digital rectal examination (DRE) is an important diagnostic manipulation in case of suspicion of any pathology of the prostate gland. It is therefore advisable for men not to refuse to do so.

In acute bacterial prostatitis, the prostate on palpation is sharply painful, swollen, most often enlarged. Ultrasound may show not only an increase in the size of the prostate gland, but also foci of purulent fusion of prostate tissue (abscesses) - but this is rare and usually a consequence of an ongoing process.

Laboratory diagnosis, in the first place, includes a general urine test, which shows an increase in the number of leukocytes. Bacteriological culture of urine is recommended. Based on the results of the analysis, it is possible to determine the presence of bacteria and their sensitivity to the antibiotic and thus to adjust the prescribed antibiotic therapy. A general blood test is also performed to assess the general condition of the body and its response to the inflammatory process.

The use of prostate secretion for the diagnosis of acute prostatitis is contraindicated due to the increased risk of a life-threatening condition: bacteremia and sepsis. Determination of the tumor marker (PSA), its fractions is also not recommended - due to the low information content and the distortion of the data against the background of inflammation.

Treatment of prostatitis

Antibiotic therapy is the main therapy for patients with prostatitis of all categories.

Alpha-blockers are also an effective group of drugs. As a result of their action, the tone of the smooth muscles of the prostate gland, the bladder neck and the prostate part of the urethra decreases, thus improving urination and reducing the possibility of urine entering the prostate gland (intraprostatic reflux of urine), which isone of the causes of prostatitis. The most effective and popular drugs are Tamsulosin and Silodosin. They are also widely used to improve urination in patients with prostate hyperplasia.

It is possible to use anti-inflammatory drugs (diclofenac), which effectively reduce pain and discomfort during urination, reduce prostate swelling and also contribute to improving the quality of urination.

Acute bacterial prostatitis is often the reason for hospitalization, where antibiotic therapy is prescribed in the form of intravenous injections. After stabilization of the patient's condition, the patient continues to take antibiotics in tablet form for 15 or more days to prevent the transition from 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 is the treatment of prostatitis in the clinic

Urologists treat prostatitis and other diseases of the genitourinary system based on international clinical guidelines. This means that they use not only their professional knowledge, but are also guided by scientifically proven and globally accepted methods of diagnosis and therapy.

Our doctors do not prescribe ineffective drugs and examinations "just in case", do not treat non-existent diseases. When making a diagnosis, urologists rely on the data obtained from the patient's examination, clinical picture, data from laboratory and instrumental examinations. a surgical operation is performed on the territory of the clinic.