Chronic prostatitis is a serious problem. Even modern urology cannot answer many questions about this pathology. Experts believe that chronic prostatitis is a disease that is the result of a whole range of health problems, which include tissue damage and dysfunction not only of the urinary tract and prostate, but also other organs.
The pathology is diagnosed mainly in men of childbearing age. In older men, chronic prostatitis is often accompanied by benign prostate growth.
classification of the disease
The classification of prostatitis was developed by scientists at the US National Institutes of Health in 1995:
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- 1 type- acute bacterial prostatitis. It is diagnosed in 5% of cases of prostate inflammation.
- type 2- bacterial chronic prostatitis.
- 3 type- chronic bacterial prostatitis. This pathology has another name - chronic pelvic pain syndrome.
- 3A type- an inflammatory form of chronic prostatitis. It is diagnosed in 60% of cases of chronic prostatitis.
- 3B type- non-inflammatory form of chronic prostatitis. Diagnosed in 30% of cases.
- 4 type- asymptomatic prostatitis.
There is also a classification of chronic prostatitis compiled in 1990.
Symptoms of chronic prostatitis
Pelvic discomfort and pain lasting more than 3 months are the main symptoms of chronic prostatitis.
In addition, urinary tract diseases and erectile dysfunction are observed:
- Pain occurs in the perineum and may radiate to the anus, groin, inner thigh, sacrum, lower back, and scrotum. On the one hand, pain that extends into the testicles is often not a symptom of chronic prostatitis;
- despite adequate conditions, an erection does not occur, but complete impotence is not observed;
- in the early stages of the development of the disease, premature ejaculation is observed;
- frequent urination, urinary incontinence, pain and burning when emptying the bladder.
The clinical picture can vary depending on the type of chronic prostatitis.
infectious form:
- frequent nighttime urination;
- pain in 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 thighs and head of penis;
- The pain intensifies with the forced cessation of sexual intercourse or a prolonged absence of intimate life.
Important!The disease comes in waves. Symptoms can either weaken or increase, but their presence clearly indicates the presence of an inflammatory process.
Symptoms may vary depending on the stage of development of the pathology.
The following stages of the development of pathology are distinguished:
- exudative.The patient has pain in the pubic bone, groin and scrotum. There is frequent urination and an uncomfortable feeling after intercourse. An erection can hurt.
- Alternative.The pain intensifies, is localized in the groin, pubic area, and gives way to the sacrum. Urination is accelerated, but occurs without problems. The erection does not suffer.
- proliferative.During an exacerbation, urination becomes more frequent. The stream of urine becomes weak.
- scarring.Prostate tissue sclerosis occurs. There is a feeling of heaviness in the sacrum and pubic region. Increased urination. The erection becomes weak. Ejaculation can be completely absent.
The symptoms may vary depending on the course of the disease, but in any case they 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. Biochemical factors, reflux of urine into the lobes of the prostate and dysfunction of growth factors responsible for the proliferation of living cells have an effect.
Reasons affecting the development of pathology:
- infections of the urogenital system;
- hypodynamia;
- irregular sex life;
- continuous catheterization of the bladder;
- regular hypothermia.
developmentDiseases of a bacterial naturepromotes intraprostatic urinary reflux.
Chronic abacterial prostatitisdevelops against the background of neurogenic diseases of the pelvic floor muscles, as well as elements responsible for the functioning of the bladder wall, prostate and urethra.
formationmyofascial trigger points, which are located near the organs of the genitourinary system and the prostate can provoke pelvic pain syndrome. Points that are the result of certain diseases, surgical procedures and injuries can cause 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 can be asymptomatic. In this case, in addition to the standard examination and questioning of the patient, additional research methods are required.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 sensations and get a complete picture of the state of health, pain intensity, ejaculation, erectile and urinary disorders.
laboratory diagnostics
Laboratory diagnostics makes it possible to distinguish between a bacterial and non-bacterial form of pathology, determine the type of pathogen and make the most accurate diagnosis.Chronic inflammation of the prostate is confirmed when the fourth sample of urine or prostatic fluid contains more than 10 leukocytes in the PZ or bacterial associations.If the number of leukocytes is increased, but the bacteria are not seeded, the material is examined for evidence of chlamydia or other STD pathogens.
- The discharge from the urethra is sent to the laboratory to detect viral, fungal and bacterial flora, leukocytes and mucus in it.
- Scraping from the urethra is examined using PCR. This allows you to identify pathogens that are sexually transmitted.
- Perform a microscopic examination of the prostatic fluid to count the number of macrophages, leukocytes, amyloid and Trousseau-Lallemand bodies. An immunological study and a bacteriological study are prescribed. Determine the level of non-specific antibodies.
- Ten days after a digital rectal examination, a blood sample is taken to determine the concentration of PSA in it. If the rate is above 4. 0 ng/mL, the patient will undergo a prostate biopsy to rule out oncology.
The diagnosis is made based on the results of the research.
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 echo structure, homogeneity and density of the seminal vesicles. Urodynamic studies and myography of the pelvic floor muscles allow the detection of infravesical obstruction and neurogenic disorders often associated with the pathology.
In the case of prostate cancer in particular, tomography and MRI are used for differential diagnosis. These methods will reveal injuries in the pelvic organs and spine.
differential diagnosis
The differential diagnosis is important because there is a risk that the patient has a more serious condition.
With such diseases, a differential diagnosis is made:
- pseudodyssinergia, dysfunction of the detrusor-sphincter system, bladder dysfunction of neurogenic origin, complex regional pain syndrome;
- stricture of the bladder, hypertrophic changes in the bladder neck, prostate adenoma;
- osteitis of the pubic bone, cystitis;
- pathology of the rectum.
If symptoms occur, the prostate should be examined by a urologist or andrologist. Get an ultrasound scan. If necessary, a biopsy of the prostate is prescribed.
Pathological treatment methods
Chronic prostatitis is treated by a urologist or andrologist. Therapy is carried out in a complex way. Correction depends on the patient's lifestyle, thinking characteristics and habits. It is important to exercise more, minimize alcohol consumption, get rid of nicotine addiction, eat right and normalize your sex life. However, doing without basic therapy will not work. Taking medication is the most important condition for a full recovery.
Indications for hospitalization
Most often, the treatment is carried out on an outpatient basis. But in cases where the disease cannot be corrected and is prone to recurrence, the patient is referred to a hospital, where treatment is more effective.
Medical treatment method
This method is aimed at eliminating the existing infection, normalizing blood circulation, improving drainage of the prostate lobules, correcting the hormonal background and immune status. Therefore, doctors prescribe antibiotics, vasodilators, immunomodulators, anticholinergic and anti-inflammatory drugs.
If the pathology is bacterial in nature, then antibiotics are definitely recommended. The remedy is prescribed based on the results of bacterial culture of prostate secretion.This allows isolating the pathogen with subsequent determination of its sensitivity to a particular drug. With a well-designed scheme, the effectiveness of treatment reaches more than 90%.
In the abacterial form, a short course of antibiotics is prescribed. It continues only if the scheme gives a positive result. The effectiveness of the therapy is about 40%
With chronic pelvic pain, the course of antibiotics does not last more than a month. With positive dynamics, treatment is continued 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 used in the treatment of pathologies.They have a high bioavailability, are effective against most gram-negative bacteria, ureaplasma and chlamydia and accumulate in the tissue of the prostate.
If treatment with fluoroquinolones is not effective, penicillins may be prescribed.
Antibacterial drugs are used for preventive purposes.
After treatment with antibiotics, therapy with a-blockers is prescribed.This treatment strategy is effective in patients with persistent obstructive and irritant symptoms.
For persistent voiding dysfunction and pain, tricyclic antidepressants may be prescribed, which have an analgesic effect.
With severe violations of urination, before starting therapy, a urodynamic study is carried out and action is taken on the basis of the results obtained.
Non-drug therapy
Non-drug methods of therapy make it possible to increase the concentration of antibacterial drugs in the tissues of the gland, but exceeding the dose is not recommended.
The following methods are used for this:
- electrophoresis;
- laser therapy;
- phonophoresis;
- Microwave hyperthermia (applied transrectally).
With the latter method, the temperature is selected individually. The temperature in the range of 39-40 degrees allows you to increase the concentration of the drug in the body, activate the immune system at the cellular level, eliminate bacteria and relieve congestion. Increasing the range to 40-45 degrees, you can get a sclerosing and analgesic effect.
Laser and magnetic therapy are used in combination. The effect is similar to the action of the above methods, but also has a biostimulating effect on the organ.
Transrectal massage is performed only without contraindications.
surgical method
Chronic prostatitis generally does not require surgery. Excluded are complications that endanger the health and life of the patient. Modern surgical treatment allows the use of endoscopic surgery. It's minimally invasive. Rehabilitation is faster and there is minimal damage to the body.
The surgical method is prescribed for:
- sclerosis of the prostate;
- prostate adenoma;
- sclerosis of the seminal tubercle;
- Calcification in the prostate.
Important!In the acute stage, surgery is contraindicated. Surgical treatment is prescribed by the surgeon based on the results of the study and the overall clinical picture.
Prognosis for chronic prostatitis
Doctors are cautious in predicting the outcome of the disease. It's rare to achieve a full recovery. Basically, chronic prostatitis goes into a stage of long-term remission. The symptoms disappear, urine and blood values return to normal. In order for chronic prostatitis not to become more active and not cause complications, it is necessary to follow all the recommendations of a specialist.