Chronic prostatitis is a serious problem. Even modern urology is not able to answer many questions about this pathology. Experts believe that chronic prostatitis is a disease that results from a range of health problems, which include tissue damage as well as dysfunction not only of the urinary tract and prostate gland, but also of other organs.
The 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 the disease
The classification of prostatitis was developed by scientists from the US National Institutes of Health in 1995:
%20and%20inflamed%20chronic%20prostatitis%20(right).webp)
- 1 type- acute bacterial prostatitis. It is diagnosed in 5% of cases of inflammation of the prostate gland.
- type 2- bacterial chronic prostatitis.
- 3 type- chronic bacterial prostatitis. This pathology has another name - chronic pelvic pain syndrome.
- type 3A- inflammatory form of chronic prostatitis. It is diagnosed in 60% of cases of chronic prostatitis.
- type 3B- non-inflammatory form of chronic prostatitis. It is diagnosed in 30% of cases.
- 4 type- asymptomatic prostatitis.
There is also a classification of chronic prostatitis, compiled in 1990.
Symptoms of chronic prostatitis
The feeling of discomfort and pain in the pelvic area, which lasts 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, can radiate to the anus, groin, inner thigh, sacrum, lower back and scrotum. Pain on one side extending into the testis 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 disease, premature ejaculation is observed;
- frequent urination, urinary incontinence, pain and burning sensation in the process of emptying the bladder.
The clinical picture may vary depending on the type of chronic prostatitis.
infectious form:
- frequent urination at night;
- pain in the thighs, perineum, glans penis and rectum, aggravated by movement;
- painful urination;
- weak stream of urine.
Specific infectious:
- mucous discharge from the urethra;
- the above symptoms.
Non-infectious prostatitis:
- acute pain in the perineum;
- pain in the thighs and head of the penis;
- the pain is exacerbated by forced interruption of sexual intercourse or prolonged absence of intimate life.
Important!The disease progresses in waves. Symptoms may either weaken or worsen, but their presence clearly indicates the presence of an inflammatory process.
Symptoms can vary depending on the stage of development of the pathology.
The following stages of pathology development are distinguished:
- Exudative.The patient experiences pain in the pubis, groin and scrotum. After intercourse there is frequent urination and discomfort. An erection can be harmful.
- Alternative.The pain intensifies, is localized in the groin, pubic area and attaches to the sacrum. Urination is accelerated, but proceeds without difficulty. Erection does not suffer.
- Proliferative.During exacerbations, urination becomes more frequent. Urine flow becomes weak.
- scarring.Sclerosis of the prostate tissue occurs. There is a feeling of heaviness in the sacrum and pubic area. Increased urination. The erection becomes weak. Ejaculation may be completely absent.
Symptoms may vary depending on the course of the disease, but in each case 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. It is influenced by biochemical factors, urine reflux in the lobes of the prostate and dysfunction of growth factors that are responsible for the proliferation of living cells.
Causes that affect the formation of pathology:
- urogenital infections;
- hypodynamia;
- irregular sex life;
- continuous catheterization of the bladder;
- regular hypothermia.
Developmentdiseases of bacterial naturepromotes intraprostatic urinary reflux.
Chronic abacterial prostatitisdevelops against the background of neurogenic disorders of the pelvic floor muscles, as well as elements responsible for the functioning of the wall of the bladder, prostate and urethra.
Formationmyofascial trigger points, which are located near the organs of the genitourinary system and prostate gland, can provoke pelvic pain syndrome. The spots that result from certain diseases, surgeries and injuries can provoke pain in the pubic area, perineum and adjacent areas.
Diagnosis of pathology
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 the standard examination and questioning of the patient, additional examination methods are needed.A neurological examination and examination of the patient's immunological status is mandatory..
Important!Special questionnaires and questionnaires allow you to more accurately determine the patient's subjective feelings and get a complete picture of health, pain intensity, ejaculation disorders, erection and urination.
Laboratory diagnostics
Laboratory diagnosis makes it possible to distinguish between bacterial and abacterial forms of pathology, as well as to determine the type of pathogen and to make the most accurate diagnosis.Chronic inflammation of the prostate is confirmed when the fourth sample of urine or prostate secretion contains more than 10 leukocytes in PZ or bacterial associations.When the white blood cell count is increased but the bacteria are not inoculated, the material is tested for chlamydia or other pathogens of sexually transmitted diseases.
- The discharge from the urethra is sent to the laboratory to detect viral, fungal and bacterial flora, leukocytes and mucus in it.
- Urethral scraping was examined by PCR. This allows you to identify pathological agents that are sexually transmitted.
- Perform a microscopic examination of the prostate secretion to count the number of macrophages, leukocytes, amyloid and Trusso-Laleman bodies. Immunological examination and bacteriological examination are prescribed. Determine the level of non-specific antibodies.
- Blood sampling is performed ten days after a digital rectal examination to determine the concentration of PSA in it. At a rate above 4. 0 ng / ml, the patient undergoes a prostate biopsy to rule out oncology.
The diagnosis is made on the basis of test results.
Instrumental diagnostics
Transrectal ultrasound of the gland will help to clarify the stage and form of the disease. Ultrasound allows you to rule out 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 examinations and myography of the pelvic floor muscles will reveal infravesical obstruction and neurogenic disorders that often accompany the pathology.
Tomography and MRI are used for differential diagnosis, especially with prostate cancer. These methods will reveal disorders in the pelvic organs and spine.
Differential diagnosis
The differential diagnosis is important because there is a risk that the patient will have a more serious illness.
The differential diagnosis is established with the following diseases:
- pseudodisynergy, functional disorder of the detrusor-sphincter system, bladder dysfunction of neurogenic origin, complex regional pain syndrome;
- bladder stricture, hypertrophic changes in the bladder neck, prostate adenoma;
- pubic osteitis, cystitis;
- pathology of the rectum.
If symptoms occur, the prostate gland should be examined by a urologist or andrologist. Take an ultrasound scan. If necessary, a prostate biopsy is prescribed.
Methods of treating pathology
Chronic prostatitis is treated by a urologist or andrologist. The therapy is complex. The correction depends on the patient's lifestyle, peculiarities of thinking and his habits. It is important to move more, to minimize alcohol intake, to get rid of nicotine addiction, to eat properly and to normalize your sex life. However, to do without a course of basic therapy will not work. Taking medication is the main condition for full recovery.
Indications for hospitalization
Most often the treatment is performed on an outpatient basis. But in cases where the disease cannot be corrected and there is a tendency for recurrence, the patient is referred to a hospital where treatment is more effective.
Medical method of treatment
This method is aimed at eliminating the existing infection, normalizing blood circulation, improving the drainage of the prostate lobules, 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 a bacterial culture of prostate secretion.This will make it possible to isolate the pathogen by subsequently determining its susceptibility to a particular drug. With a well-developed scheme, the effectiveness of the treatment reaches more than 90%.
In the abacterial form, a short course of antibiotics is prescribed. Continues only if the scheme gives a positive result. The effectiveness of the therapy is approximately 40%
In chronic pelvic pain, the duration of the course of antibiotics is not more than a month. In case of positive dynamics, the treatment continues for another month. If there is no effect, the drug is replaced with another that may be more effective.
Antibacterial agents from the group of fluoroquinolones are the main drugs for the treatment of pathology.They have a high bioavailability, are active against most gram-negative bacteria, ureaplasmas and chlamydia, accumulate in the tissues of the prostate gland.
When treatment with fluoroquinolones is not effective, penicillins may be prescribed.
Antibacterial drugs are used for preventive purposes.
After treatment with antibiotics, therapy with the use of α-blockers is prescribed.This treatment strategy is effective in patients who have persistent obstructive and irritating symptoms.
If urinary incontinence and pain persist, tricyclic antidepressants that have an analgesic effect may be prescribed.
In case of severe urinary disorders, a urodynamic examination is performed before starting the therapy and the results are based on the obtained results.
Non-drug therapy
Non-drug therapies allow to increase the concentration of antibacterial drugs in the tissues of the gland, but it is not recommended to exceed the dose.
The following methods are used for this purpose:
- electrophoresis;
- Laser therapy;
- phonophoresis;
- Microwave hyperthermia (applied transrectally).
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 also has a biostimulating effect on the body.
Transrectal massage is performed only in the absence of contraindications.
Surgical method
Chronic prostatitis usually does not require surgery. Exceptions are complications that pose a threat to the patient's health and life. Modern surgical treatment allows the use of endoscopic surgery. It is minimally invasive. Rehabilitation is faster and causes minimal damage to the body.
The surgical method is prescribed for:
- prostate sclerosis;
- prostate adenoma;
- sclerosis of the seminal tubercle;
- 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 examination and the overall clinical picture.
Prognosis for chronic prostatitis
Doctors are cautious in predicting the outcome of the disease. Rarely is a complete recovery achieved. In general, chronic prostatitis goes into a stage of long-term remission. The symptoms disappear, the urine and blood picture return to normal. In order not to activate chronic prostatitis and not to cause complications, it is necessary to follow all the recommendations of a specialist.