Prostatitis - symptoms and treatment

What is prostatitis? We will analyze the causes, diagnosis and treatment methods in an article by a doctor, urologist with 28 years of experience.

Definition of disease. Causes of disease

ProstatitisIs an inflammatory process of prostate tissue, accompanied by pain in the lower back, perineum or pelvic area, as well as disorders of the lower urinary tract.

The prostate gland (prostate) refers to the male reproductive system. It is located in front of the rectum, below the bladder, and surrounds the urethra (urethra). Therefore, when the prostate becomes inflamed, it compresses the urethra, which further leads to various problems with urination. The main function of the prostate is to produce secretions (fluid), which is part of the semen and liquefies it to ensure normal sperm motility.

Pathological conditions of the prostate, such as cancer or benign hyperplasia, are more common in elderly patients. Prostatitis differs in that it affects men of all ages, but the disease most often occurs in men of reproductive age (8 to 35% of cases).

Prostatitis most often occurs in the practice of urologists. It can occur suddenly (acute) or gradually, and its manifestations are permanent and long-term (chronic). The chronic form is much more common than the acute one. Chronic prostatitis ranks fifth among the twenty major urological diagnoses.

Prostatitis can be an independent disease or combined with benign prostatic hyperplasia and prostate cancer. In recent years, there has been a decline in the incidence of prostatitis in the male population: if in 2012 the incidence was 275 per 100 thousand population, then in 2017 the primary incidence was 203 per 100 thousand population.

Reasons for the development of prostatitisare bacterial (infectious) and nonbacterial (non-infectious).Infectious prostatitismost common in men younger than 35 years. This form of the disease is most often caused by gram-negative microorganisms, especially enterobacter, E. coli, dentition, pseudomonas and proteus, as well as sexually transmitted infections, such as gonococci, chlamydia, etc. Very rarely prostatitis can result from mycobacterium tuberculosis as a result. In chronic bacterial prostatitis, the spectrum of pathogens is wider and may include atypical pathogens. It should be borne in mind that chronic bacterial prostatitis is a polyetiological disease, ie it can have several causes.

Factors contributing to the development of inflammationin the prostate:

• fully communicable infections;
• immunodeficiency states;
• prostate biopsy;
• invasive manipulations and surgeries;
• Lifestyle;
• diarrhea, constipation;
• homosexual contacts;
• frequent change of sexual partners;
• sedentary lifestyle etc.

Chronic nonbacterial prostatitisit is diagnosed in patients who complain of chronic pain in the prostate area, while no infectious (bacterial) pathogen has been found in them. Despite numerous studies, the cause of this type of chronic prostatitis is not fully understood, however, there are some factors that can cause its development:

• increased prostatic pressure;
• muscle pain in the pelvic region;
• emotional disorders;
• Autoimmune disorders (antibodies that are supposed to fight infection, sometimes for some reason attack prostate cells);
• physical activity;
• irregular sex life;
• weightlifting, etc.

In some cases, prostatitis may occur after performing transurethral procedures such as urethral catheterization or cystoscopy, as well as after transrectal prostate biopsy.

Although the true incidence of different types of prostatitis has not been definitively established, the following data are provided:

• acute bacterial prostatitis accounts for approximately 5-10% of all cases of prostatitis;
• chronic bacterial prostatitis - 6-10%;
• chronic nonbacterial prostatitis - 80-90%;
• prostatitis, including prostatodynia (neurovegetative disorders of the prostate) - 20-30%.

If you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of prostatitis

All forms of inflammationprostate, in addition to asymptomatic, unites the presence of the following symptoms:

• pain in the lumbar region;
• feeling of discomfort with intestinal peristalsis;
• pain in the perineum or pelvic region;
• disorders of the lower urinary tract.

The main symptoms of the lower urinary tract in the presence of prostatitis:

• frequent urge to urinate;
• difficulty urinating, i. e. weak current and need for "strain";
• burning pain or its intensification when urinating.

In men with a diagnosisacute bacterial prostatitisPelvic pain and urinary symptoms, such as increased urination and urinary retention, occur. This can lead to the development of systemic manifestations such as fever, chills, nausea, vomiting and malaise. Acute bacterial prostatitis is characterized by a sharp onset of the disease with a vivid clinical picture. This is a serious disease.

Men with a diagnosischronic bacterial prostatitisnotice symptoms of a periodic nature, which increase and decrease. With exacerbation, pain and discomfort are noticed. Feelings of pain are localized mainly at the base of the penis, around or above the anus. Also, pain can occur just above the pubic bone or in the lower back, spreading to the penis and testicles. Defecation also becomes painful. Sometimes signs of lower urinary tract infection develop: burning pain and frequent urination, frequent urge. These symptoms can be confused with the manifestations of acute bacterial prostatitis, but usually have a sudden onset, cold, fever, weakness, pain throughout the body, lower back, as well as in the genitals, frequent and painful urination, pain with ejaculation. If you discover such symptoms, you need to see a doctor immediately.

If the standard modern examination has not established that chronic pain is caused by a pathological process in the prostate, then we are dealing with chronic nonbacterial prostatitis, which is also calledchronic pelvic pain syndrome(term used since 2003). In the presence of chronic pelvic pain syndrome, a man's quality of life is significantly reduced, because this syndrome sometimes leads to various psychological and sexual disorders:

• increased fatigue;
• feeling helpless;
• erectile dysfunction;
• painful ejaculation;
• pain after intercourse, etc.

In chronic nonbacterial prostatitis / chronic pelvic pain syndrome, there is a feeling of permanent discomfort or pain in the lower back, more often in the bottom of the penis and around the anus, for at least 3 months. Painful sensations are localized in one "target organ" or in several pelvic organs. Most often in this form of prostatitis, the pain is localized in the prostate (46%).

In chronic prostatitis, sexual disorders have a number of characteristics. First, all components of a man's copulatory (sexual) function are disturbed to varying degrees: libido, erection, ejaculation. Second, sexual dysfunction mainly occurs in people with a long (more than 5 years) history of the disease. Third, sexual dysfunction is often the main reason for seeking medical help.

Erectile dysfunction is noticed by 30% of patients suffering from chronic prostatitis, mainly due to a psychogenic factor - catastrophic perception of the disease.

Symptoms of prostatitis occur at least once in a lifetime in 50% of men.

Pathogenesis of prostatitis

The mechanism of development of prostatitis is ambiguous and very complex. Many factors are involved in its development. Most cases of acute bacterial prostatitis are caused by a cascade of processes triggered by ascending urethral infection or intraprostatic reflux (backflow of urine).

The penetration of microorganisms into the prostate is possible by ascending (through the urethra) or transrectally by lymphatic. Diarrhea and constipation associated with impaired rectal barrier function are considered to be a provocative factor in chronic prostatitis. However, the mechanism of penetration of microorganisms into the prostate has not yet been clearly established.

Urinary tract disorders with prostatitis can be due to:

• increase in the tone of the smooth muscles of the urethra of the prostate by increasing the activity of adrenergic receptors;
• enlargement of the prostate or narrowing of the urethra, resulting in turbulent urine flow, obstruction of the bladder outlet, and intraprostatic reflux.

In the future, there will be a violation of the drainage of the prostate canal, stagnation of the prostate secretion, edema, activation of the arachidonic acid cascade, inflammation and ischemia. A vicious circle of pathological changes is created.

Classification and stages of development of prostatitis

There are 4 main categories (types) of prostatitis.

1. Acute bacterial prostatitis(category I).
2. Chronic bacterial prostatitis(category II).
3. Chronic nonbacterial prostatitis / syndromechronic pelvic pain (category III). It can be inflammatory (category III A) or non-inflammatory (category III B).
4. Asymptomatic inflammatory prostatitis.Histological prostatitis identified by prostate biopsy (category IV).

Chronic bacterial prostatitisUnlikespicyit manifests as recurrent episodes of exacerbation with the presence or absence of complete remissions between them. The symptoms are usually less pronounced than the symptoms of acute prostatitis.

Classification of the National American Institutes of Health. . .

• Type I(acute bacterial prostatitis) - acute infection of the prostate: the symptoms of the disease appear suddenly. Shivering, fever, pain throughout the body, weakness, pain in the lower back and genital area, frequent, painful urination, pain during ejaculation. Potential symptoms of acute bacterial prostatitis include blood in urine and / or semen. It is rare. It is effectively treated with antibiotics.
• Type II(chronic bacterial prostatitis) - chronic or recurrent prostate infection: the symptoms are the same as in acute prostatitis, but they occur gradually and are less pronounced. Several courses of antibiotic therapy may be needed.
• Type III(chronic nonbacterial prostatitis and chronic pelvic pain syndrome): no evidence of infection.
• III A type: presence of leukocytes in ejaculate / prostate secretion / third part of urine obtained after prostate massage.
• III B type: absence of leukocytes in ejaculate / prostate secretion / third part of urine obtained after prostate massage. Pain in the lower back and genital area, frequent urges to urinate, difficulty urinating (often at night), burning or painful urination, and ejaculation. It accounts for about 90% of all cases of prostatitis. There are no known causes or clinically proven treatments.
• Type IV(asymptomatic inflammatory prostatitis): Sometimes an increased number of white blood cells. No treatment is required. Detected on prostate biopsy.

The boundaries between the different forms of prostatitis are blurred.

Complications of prostatitis

With inflammatory lesions of the prostate, nearby organs are involved in the pathological process: seminal tubercle, Cooper’s glands, seminal vesicles, and posterior urethra. The infection can penetrate the prostate and surrounding organs at the same time.

Vesiculitis- inflammation of the seminal vesicles. The pain is localized in the groin area and deep in the pelvis, radiating to the sacrum. The pain is usually unilateral because both seminal vesicles are affected to varying degrees. Vesiculitis may be asymptomatic. The only complaint of the patient may be the presence of blood in the semen. Periodic pyuria (pus in the urine) and pyospermia (pus in the ejaculate) have also been reported.

Posterior urethritis, coliculitis (inflammation of the seminal tubercle). . . In prostatitis, the infection penetrates the seminal tubercle, this is due to the proximity of the prostate to the excretory ducts.

Prostate abscess.Pathogens that cause prostatitis can also cause prostate abscess. This is a severe septic (bacterial) disease, accompanied by weakness, fever, chills and sweating. In some cases, impaired consciousness and delirium are observed. The patient needs hospitalization.

Prostate sclerosis (fibrosis). This is a late complication of prostatitis based on the replacement of prostate tissue with scars (connective tissue degeneration, or sclerosis), which leads to the gland shrinking, shrinking in size and completely losing its function. Sclerotic symptoms usually develop long after the onset of the inflammatory process in the prostate.

Prostate cysts.These formations can contribute to the formation of stones in the prostate. The presence of an infection in the cyst can lead to a prostate abscess. Ultrasound is not difficult to diagnose a prostate cyst. They can also be detected by digital rectal examination.

Prostate stones.They are quite common. The causes of the disease are not completely known, but most experts agree that they occur as a result of a long-term inflammatory process in the prostate. The stones are single and multiple, 1 to 4 mm in diameter. Large stones are rare. The stones clog the gland, causing the secretion in it to stagnate, the gland to become overstretched, and separate cysts to form into which the infection enters. Patients with prostate stones must deal with constant dull pain in the perineum. Painful sensations spread to the glans penis and cause frequent urges to urinate, which becomes difficult and painful.

Infertility.Chronic long-term prostatitis primarily reduces the motor function of sperm, making it completely immobile. One of the consequences is a violation of their production, the formation of immature sperm that have an abnormally altered shape (and fewer of them than before).

Ejaculation disorder.Prostatitis of all forms causes sexual dysfunction. Initially, patients are faced with premature ejaculation, which has a normal erection, which then weakens, and the degree of orgasm decreases. Prolonged existence of chronic prostatitis contributes to a decrease in the production of male sex hormones and a weakening of libido.

Erectile dysfunction.A link between chronic prostatitis / chronic pelvic pain syndrome and erectile dysfunction has been described. This disorder is especially painful for men.

Diagnosis of prostatitis

The appearance of the first signs of prostate inflammation requires urgent medical attention. The urologist will rule out many diseases that have similar manifestations and determine which category (type) the disease belongs to. Before choosing a treatment, the specialist will perform the necessary examinations and offer to undergo an evaluation test.

What questions can the doctor ask

At the meeting, the doctor will definitely determine: the duration of the clinical manifestations of the disease, the location and nature of the pain, for example, in the perineum, scrotum, penis and inner thigh; changes in the nature of the seed (presence of pus and blood).

At the reception, the urologist will offer to fill out special questionnaires, one of which is the index of symptoms of chronic prostatitis.

The patient should ask the doctor questionsabout what tests and studies need to be done, how to prepare for them, what treatment you plan to prescribe, and where you can get more information about the disease.

Chronic bacterial prostatitis is diagnosed when symptoms last for at least three months.

The research will include:

• Digital rectal examination of the gland to determine the extent of prostate enlargement and its consistency.

• Prostate, urine and / or ejaculate secretion tests.
• Identification of urogenital infection.
• Ultrasound examination of the urinary system (kidneys, prostate, bladder with determination of residual urine).

• Urodynamic study.

In the case of acute bacterial prostatitis, a swollen and painful prostate can be found by digital rectal examination. Prostate massage is contraindicated because it can lead to bacteremia and sepsis.

The most important study in examining patients with acute bacterial prostatitis is a culture of prostate secretions. In order to categorize chronic prostatitis, quantitative culture and microscopy of urine samples and prostate secretions obtained after prostate massage are still important methods.

Androflor - a comprehensive study of the microbiocenosis of the urogenital tract in men using PCR. It allows you to determine the qualitative and quantitative composition of the microflora. It is used to diagnose and control the treatment of inflammatory infectious diseases of the genitourinary system.

After determining the cause of the disease, the doctor will recommend a course of treatment. We must keep in mind that standard methods can detect infection only in 5-10% of cases, which ultimately leads to prostatitis.

What is the connection between prostatitis, prostate-specific antigen (PSA) and prostate cancer

Measurement of total PSA levels and free PSA in prostatitis does not provide additional diagnostic information. It is known that in 60 and 20% of patients with acute and chronic bacterial prostatitis, the level of prostate-specific antigen (PSA) increases. Upon completion of treatment, PSA levels decline in 40% of patients. PSA is not considered a specific marker for prostate cancer, because PSA levels may be elevated in benign prostatic hyperplasia and prostatitis.

Treatment of prostatitis

The leading role in the treatment of pathology is assigned to drug therapy.

Alpha1-blocker treatment

Alpha-blockers are prescribed for patients who complain of difficulty urinating. These medications help facilitate urination and relax the muscles of the prostate and bladder. Some patients are prescribed medications to lower hormone levels, which can shrink the gland and reduce discomfort. Muscle relaxants can help relieve pain caused by an edematous prostate that puts pressure on nearby muscles. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help if pain is present.

Standard antibiotic therapy in most cases does not reduce the number of disease recurrences, so an integrated approach is often used, which is prescribedauxiliary drugs: biostimulants, extracts of various plants and insects and their biological components, which may be in the formrectal suppositories. . . Despite the large arsenal of drugs, the efficiency of their use is still insufficient.

Physiotherapy in the treatment of prostatitis

For chronic prostatitis categories II, III A and III B, physiotherapeutic methods can be additionally used:

• prostate massage (prostate);
• laser therapy;
• microwave hyperthermia and thermotherapy;
• electrical stimulation by modulated currents of skin or rectal electrodes;
• acupuncture (acupuncture).

The effectiveness and safety of these treatments are still being studied. It is also used to treat prostatitisfolk methods, e. g.hirudotherapy.The effectiveness and safety of this method for the treatment of prostatitis has not been proven.

Stem cell injection

Cell therapy (stem cell injections) in the treatment of prostatitis is currently a promising technique in the early stages of development. Currently, regarding the injection of stem cells into the prostate, we can only have hypotheses about its mechanisms, as well as empirical data obtained by certain groups of researchers.

Surgical treatment of prostatitis

Surgical methods are used only to treat complications of prostatitis - abscesses and suppuration of seminal vesicles.

Treatment of chronic pelvic pain syndrome requires special consideration. Asymptomatic inflammatory prostatitis (category IV) should not be treated unless the patient is planning prostate surgery. In this case, the patient is given a prophylactic course of antibiotic therapy.

Diet and lifestyle for prostatitis

A special diet for prostatitis is not necessary, but eating lots of vegetables, lean meats and dairy products will improve bowel function. It is important to eat enough fiber, foods rich in vitamin E (wheat germ, corn oil, etc. ), sugar should be replaced with natural honey. Proper nutrition for prostatitis can improve bowel function and reduce the likelihood of recurrence or speed recovery. It is recommended to adhere to a healthy lifestyle, drink more fluids and limit caffeine and alcohol.

Forecast. Prophylaxis

Acute prostatitis often becomes chronic, even with timely and adequate treatment.

Complete recovery is not always possible, however, with proper consistent therapy and following the doctor's recommendations it is possible to remove the discomfort and pain. Independenthome treatment of prostatitiscan be dangerous and lead to complications.

Not all cases of prostatitis can be identified as the cause, but there are a number of steps you can take to prevent the onset of prostatitis. The same steps can help control existing symptoms:

1. Drink plenty of fluids. Drinking a lot of fluids leads to frequent urination, thus facilitating the flushing of infectious agents from the urethra of the prostate.
2. Empty your bladder regularly.
3. Avoid urethral irritation. Limit your intake of caffeine, spicy foods and alcohol.
4. Reduce the pressure on the prostate. Men who ride a bike often need to use a split seat to relieve pressure on the prostate area.
5. Stay sexually active.