Prostatitis

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

May come with a wide variety of clinical symptoms and ailments.

anatomy

The prostate is a small gland that is part of the male reproductive system and a hormone-dependent organ. Its shape and size have been compared to a large walnut. A normal prostate 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 is located in the pelvis, under the bladder, and above the rectum. The urethra, or urethra, runs through the thickness of the gland. The prostate is surrounded by a capsule made up of smooth muscle, collagen, and elastic fibers; covered with three layers of dense connective tissue (fascia) on the front, side and back surfaces. The posterior surface of the prostate is bounded by the ampulla of the rectum. They are separated by the retrovesical fascia, or Denonville fascia, which allows the posterior surface of the prostate to be palpated.

The prostate consists of about 70% glandular tissue and 30% fibromuscular stroma. It is customary to divide the organ into 3 zones.

Transition zone.The transition zone accounts for 10% of glandular tissue and 20% of cases of malignant prostate tumors. It is in this zone that one of the most important age-related diseases in men forms - benign prostatic hyperplasia, which can lead to difficulty urinating due to tissue overgrowth.

Central zone.The environment of the ejaculatory ducts. Consists of glandular tissue, connective tissue and muscle elements. Tumors in this area are extremely rare.

Edge zone.Covers the back and sides of the prostate and contains 70% of the glandular tissue. This is an area that can be palpated through the rectum and allows the urologist to assess the condition of the prostate. Up to 70% of malignant tumors are precisely located in the peripheral zone. Therefore, the digital rectal exam is an important diagnostic method and should be performed on patients over 45 years of age.

Prostate functions:

• Production of prostatic secretion, which is an integral part of sperm and is involved in the 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 are involved in the mechanism of urinary retention.

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

All three diseases can occur in the same prostate at the same time. That is, the presence of prostatitis does not rule out the presence of prostatic hyperplasia and prostate cancer in the patient, and vice versa.

Causes of Prostatitis

According to statistics, prostatitis is the most common urological disease - after prostatic 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 pathogen causing prostatitis are E. coli strains, which are detected in 80% of cases. Rarer 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 is not yet fully understood and is currently being investigated. In patients with HIV infection and other severe changes in the immune system, possible pathogens include cytomegalovirus, Mycobacterium tuberculosis, fungi, and other rare pathogens. There are data suggesting the presence of microorganisms in the prostate, 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 impaired urination (urine, with certain predisposing factors, can get into the prostate through the ducts of the prostate and cause 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 demonstrated the influence of psychological stress on the appearance of symptoms of chronic prostatitis - some patients have been diagnosed with psychosomatic disorders, the treatment of which was noted for a decrease in prostatitis symptoms and the likelihood of their relapse)

Risk factors for prostatitis include abstinence or excessive sexual activity, the habit of suppressing ejaculation, smoking, night work, a sedentary lifestyle, inadequate fluid intake, and poor diet.

Symptoms

• Pain or burning sensation when urinating (dysuria);
• Urinary tract disease;
• 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 when ejaculating;
• increased body temperature (in acute bacterial prostatitis).

diagnosis

According to the generally accepted classification of prostatitis NIH (US National Institutes of Health), there are four disease categories, which are traditionally denoted with 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. However, its diagnosis is quite simple, since the clinical picture is most often pronounced: a man complains of frequent, painful urination, pain in the uterus and perineum. An increase in body temperature is characteristic and often too high - less than 39 ° C.

The diagnosis of acute bacterial prostatitis involves a digital rectal examination (rectal examination) in which the prostate is felt (palpated) with the index finger through the anus (rectum).

The digital rectal examination (DRE) is an important diagnostic manipulation when a pathology of the prostate is suspected. Therefore, it is advisable for men not to refuse to perform.

With acute bacterial prostatitis, the prostate is severely painful, edematous, most often enlarged when palpating. Ultrasound examination can show not only enlargement of the prostate, but also foci of purulent fusion of prostate tissue (abscesses) - but this happens rarely and is usually a result of an ongoing process.

Laboratory diagnostics initially include a general urine test that shows an increase in the number of white blood cells. A bacteriological urine culture 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 done to assess the general condition of the body and its response to the inflammatory process.

Taking prostate secretions for the diagnosis of acute prostatitis is contraindicated due to the increased risk of life-threatening disease: bacteremia and sepsis. The determination of the oncomarker (PSA), its fractions, is also not recommended - because of the low information content and the data distortion against the background of inflammation.

Treatment of prostatitis

Antibiotic therapy is the basic 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, bladder neck and prostate part of the urethra decreases, which improves urination and reduces the possibility of urine entering the prostate (intraprostatic urinary reflux), which is one of the causes of prostatitis. The most effective and popular drugs are tamsulosin and silodosin. They are also commonly used to improve urination in patients with prostatic hyperplasia.

It is possible to use anti-inflammatory drugs (diclofenac) that are effective in relieving pain and discomfort when urinating, reducing prostate swelling, and also helping to improve the quality of urination to some extent.

Acute bacterial prostatitis is often a reason for hospitalization in a hospital where antibiotic therapy in the form of intravenous injections is prescribed. After the patient's condition has stabilized, the patient is given antibiotics in tablet form for 15 days or more 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 according to international clinical guidelines. In doing so, they not only use their specialist knowledge, but also orientate themselves on scientifically proven and globally recognized diagnostic and therapeutic methods.

Our doctors do not prescribe ineffective drugs and "just in case" tests, do not treat non-existent diseases. When making a diagnosis, urologists rely on the data from the examination of the patient, the clinical picture, the data from laboratory and instrument studies. If surgical treatment is required, surgical operation is carried out on the territory of the clinic.