Symptoms of prostatitis and prostate adenoma in men

Prostatitisinflammatory disease of the prostate. Frequent urination, pain in the penis, scrotum, rectum, sexual disorders (erectile disorders, premature ejaculation, etc. ), sometimes urinary retention, blood in the urine. The diagnosis of prostatitis is established by a urologist or andrologist based on a typical clinical picture and the results of a rectal examination. In addition, they perform an ultrasound of the prostate, prostate secretions and urine. The treatment is conservative - antibiotic therapy, immunotherapy, prostate massage, lifestyle correction.

general information

Prostatitis is inflammation of the seminal (prostate) gland - the prostate. It is the most common disease of the urinary system in men. It most often affects patients aged 25-50. According to various data, 30-85% of men over the age of 30 suffer from prostatitis. It is possible to develop a prostate abscess, inflammation of the testicles and appendages, which threatens infertility. The rise of the infection leads to inflammation of the upper urinary tract (cystitis, pyelonephritis).

The pathology develops when an infectious agent enters the prostate tissue from the organs of the urogenital system (urethra, bladder) or from a distant inflammatory focus (pneumonia, influenza, tonsillitis, furunculosis).

Prostate adenoma is a benign tumor of the paraurethral glands located around the urethra in the prostate. The main symptom of prostate adenoma is a violation of urination due to gradual compression of the urethra by one or more growing nodules. The pathology is characterized by a benign course.

Only a small number of patients consult a doctor, however, a detailed examination reveals the symptoms of the disease in every fourth man aged 40-50, and in half of men aged 50-60. The disease is detected in 65% of men aged 60-70, 80% of men aged 70-80 and more than 90% of men over 80. The severity of symptoms can vary significantly. Studies in the field of clinical andrology suggest that about 40% of men with BPH have urinary problems, but only one in five of this group seek medical help.

Causes of prostatitis

As infectious agents in the acute process, Staphylococcus aureus (Staphylococcus aureus), Enterococcus (Enterococcus), Enterobacter (Enterobacter), Pseudomonas (Pseudomonas), Proteus (Proteus), Klebsiella (Klebsiella) and Escherichia coli (E. . Amost microorganisms belong to conditionally pathogenic flora and cause prostatitis only in the presence of other predisposing factors. Chronic inflammation is usually caused by polymicrobial associations.

The risk of developing the disease increases with hypothermia, specific infections in the anamnesis, and conditions accompanied by congestion of prostate tissue. There are the following predisposing factors:

• General hypothermia (one-time or permanent, related to working conditions).
• Sedentary lifestyle, a specialty that forces a person to sit for a long time (computer operator, driver, etc. ).
• Constant constipation.
• Violation of the normal rhythm of sexual activity (excessive sexual activity, prolonged abstinence, incomplete ejaculation during "usual" sexual intercourse, without emotional coloring).
• Chronic diseases (cholecystitis, bronchitis) or the presence of chronic infectious foci in the body (chronic osteomyelitis, untreated caries, tonsillitis, etc. ).
• Previous urological diseases (urethritis, cystitis, etc. ) and sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea).
• Conditions that suppress the immune system (chronic stress, irregular and undernourished, regular lack of sleep, overtraining of athletes).

It can be assumed that the risk of developing pathology increases with chronic intoxication (alcohol, nicotine, morphine). In the field of modern andrology, some studies prove that chronic perineal trauma (vibration, concussion) of motorists, motorcyclists and cyclists is a provoking factor. However, the vast majority of experts believe that all these conditions are not the real causes of the disease, but only contribute to the aggravation of the latent inflammatory process in the tissues of the prostate.

Congestion of prostate tissues plays a decisive role in the occurrence of prostatitis. Violation of capillary blood flow increases lipid peroxidation, edema, secretion of prostate tissues and creates conditions for the development of an infectious process.

The mechanism of prostate adenoma formation has not yet been fully defined. Despite the widespread opinion linking the pathology with chronic prostatitis, there is no data to confirm the relationship between the two diseases. The researchers found no correlation between the development of prostate adenoma and alcohol and smoking, sexual orientation, sexual activity, sexually transmitted and inflammatory diseases.

The incidence of prostate adenoma depends on the patient's age. Scientists believe that adenomas develop as a result of hormonal imbalance in men during andropause (male menopause). This theory is supported by the fact that men castrated before puberty never suffer from pathology, and extremely rarely - those who were castrated after.

Symptoms of prostatitis

Acute prostatitis

There are three stages of acute prostatitis, which are characterized by certain clinical picture and morphological changes:

• Acute catarrhal. Patients complain of frequent, often painful urination, pain in the sacrum and perineum.
• Acute follicular. The pain becomes more intense, sometimes radiating to the anus, which is aggravated by defecation. Urination is difficult, urine comes out in a thin stream. In some cases, there is urinary retention. A typical subfebrile state or moderate hyperthermia.
• Acutely parenchymal. Severe general poisoning, hyperthermia up to 38-40°C, chills. Dysuric disorders, often - acute urinary retention. Sharp, throbbing pains in the perineum. Difficulty passing stool.

Chronic prostatitis

In rare cases, chronic prostatitis will be the result of an acute process, but usually a primary chronic course is observed. The temperature sometimes rises to subfebrile values. The patient notices slight pain in the perineum, discomfort during urination and defecation. The most characteristic symptom is a slight discharge from the urethra during defecation. The primary chronic form of the disease develops over a considerable period of time. It is preceded by prostosis (stagnation of blood in the capillaries), which gradually turns into abacterial prostatitis.

Chronic prostatitis is often a complication of an inflammatory process caused by the causative agent of a particular infection (chlamydia, trichomonas, ureaplasma, gonococcus). In many cases, the symptoms of a specific inflammatory process mask the manifestations of prostate damage. Perhaps a slight increase in pain during urination, a slight pain in the perineum, a slight discharge from the urethra during defecation. A slight change in the clinical picture often goes unnoticed by the patient.

Chronic inflammation of the prostate can manifest itself in a burning sensation in the urethra and perineum, dysuria, sexual disorders, and increased general fatigue. Violation of potency (or fear of it) often results in mental depression, anxiety and irritability. The clinical picture does not always include all the listed symptom groups, it is different in different patients and changes over time. Chronic prostatitis is characterized by three main syndromes: pain, dysuria, and sexual disorders.

There are no pain receptors in prostate tissue. The cause of pain in chronic prostatitis becomes almost inevitable due to the abundant innervation of the pelvic organs and the involvement of nerve pathways in the inflammatory process. Patients complain of pain of varying intensity - from weak, aching to intense, disturbing sleep. The nature of the pain changes (increases or weakens) due to ejaculation, excessive sexual activity or sexual abstinence. Pain radiates to the scrotum, sacrum, perineum, and sometimes to the lumbar region.

As a result of the inflammation that occurs in chronic prostatitis, the volume of the prostate increases, compressing the urethra. The lumen of the ureter decreases. The patient has a frequent urge to urinate, a feeling of incomplete emptying of the bladder. Usually, dysuric phenomena are expressed in the early stages. Then compensatory hypertrophy of the muscle layer of the bladder and ureters develops. The symptoms of dysuria weaken during this period, and then increase again with the decompensation of adaptive mechanisms.

In the initial stage, dyspotency may develop, which manifests itself differently in different patients. Patients may complain of frequent nocturnal erections, blurred orgasms, or worsening erections. Accelerated ejaculation is associated with a decrease in the excitation threshold level of the orgasmic center. Painful sensations during ejaculation can cause refusal of sexual activity. In the future, sexual dysfunctions will become more and more prominent. In an advanced stage, impotence develops.

The degree of sexual dysfunction is determined by many factors, including the sexual constitution and psychological mood of the patient. Violation of potency and dysuria can be caused both by changes in the prostate and by the suggestibility of the patient, who expects the inevitable development of sexual disorders and urinary disorders in the case of chronic prostatitis. Especially often, psychogenic dyspotency and dysuria develop in suggestive, anxious patients.

Impotence and sometimes the threat of possible sexual disorders are difficult for patients to tolerate. Often there is a change in character, irritability, discomfort, excessive concern for one's own health, even "taking care of the disease".

There are two groups of symptoms of the disease: irritative and obstructive. The first group of symptoms includes increased urination, persistent (urgent) urge to urinate, nocturia, urinary incontinence. The group of obstructive symptoms includes difficulty urinating, delayed appearance and increased time to urinate, a feeling of incomplete emptying, intermittent, slow-flowing urination, and the need to strain. There are three stages of prostate adenoma: compensated, subcompensated and decompensated.

Compensated section

In the compensated stage, the dynamics of the act of urination changes. It becomes more frequent, less intense and less free. You have to urinate 1-2 times at night. In stage I prostate adenoma, nocturia is usually not a cause for concern in patients who associate constant night awakenings with the development of age-related insomnia. During the day, the normal frequency of urination can be maintained, however, patients with stage I prostate adenoma notice a waiting period, especially after a night's sleep.

Then the frequency of daytime urination increases and the amount of urine released during one urination decreases. There are compulsions. The stream of urine, which previously formed a parabolic curve, slowly leaves and falls almost vertically. Hypertrophy of the bladder muscles develops, thanks to which the efficiency of emptying remains. At this stage, there is little or no residual urine in the bladder (less than 50 ml). The functional state of the kidneys and upper urinary tract is preserved.

Subcompensated stage

Prostate adenoma II. stage, the volume of the bladder increases, and dystrophic changes develop in its wall. The amount of residual urine exceeds 50 ml and is constantly increasing. During urination, the patient is forced to intensively strain the abdominal muscles and the diaphragm, which leads to an even greater increase in intravesical pressure.

Urination becomes multiphasic, intermittent, and wavy. The passage of urine along the upper urinary tract is gradually disturbed. The muscle structures lose their flexibility, the urinary tract expands. Kidney function is impaired. Patients are concerned about thirst, polyuria, and other symptoms of progressive chronic renal failure. When compensatory mechanisms fail, the third stage begins.

Decompensated stage

The III. The bladder of patients with stage 1 prostate adenoma is elongated, full of urine, and can be easily determined by touch and visually. The upper edge of the bladder can reach the level of the navel and above. Emptying is not possible even with intense tension of the abdominal muscles. The desire to empty the bladder becomes continuous. Severe pain may occur in the lower abdomen. Urine is passed often, in drops or in very small amounts. In the future, the pain and the urge to urinate gradually weaken.

Characteristic paradoxical urinary retention, or paradoxical ischuria, develops (the bladder is full, urine is continuously discharged drop by drop). The upper urinary tract enlarges, the functions of the renal parenchyma are impaired due to the permanent obstruction of the urinary tract, which leads to an increase in pressure in the pelvic system. The clinic of chronic kidney failure is growing. Without medical care, patients die from progressive CRF.

Complications

In the absence of timely treatment of acute prostatitis, there is a significant risk of developing a prostate abscess. With the development of a purulent focus, the patient's body temperature rises to 39-40 ° C and can become hectic. Periods of heat alternate with strong chills. Sharp pains in the perineum make urination difficult and defecation impossible.

An increase in prostatic edema leads to acute urinary retention. Rarely, the abscess ruptures spontaneously into the urethra or rectum. When opened, purulent, cloudy urine with an unpleasant pungent odor appears in the urethra, and when opened, the stool contains pus and mucus in the rectum.

Chronic prostatitis is characterized by an undulating course, with long periods of remission, during which prostatitis manifests itself with latent or extremely weak symptoms. Patients who are not bothered by anything often stop treatment and come back only if complications develop.

The spread of the infection through the urinary tract causes the occurrence of pyelonephritis and cystitis. The most common complication of the chronic process is inflammation of the testes and epididymis (epdidymo-orchitis) and inflammation of the seminal vesicles (vesiculitis). The consequence of these diseases is often infertility.

Diagnostics

In order to assess the severity of the symptoms of prostate adenoma, the patient is asked to fill out a urine diary. During the consultation, the urologist performs a digital examination of the prostate. In order to rule out infectious complications, sampling and examination of prostate secretions and smears from the urethra are performed. Further tests include:

• Echography.During an ultrasound examination of the prostate, the volume of the prostate gland is determined, stones and congested areas are detected, the amount of residual urine, and the state of the kidneys and urinary tract are assessed.
• Urodynamic examination.Uroflowmetry enables a reliable assessment of the degree of urinary retention (the time of urination and the speed of urine flow are determined by a special device).
• Determination of tumor markers.To rule out prostate cancer, the level of PSA (prostate-specific antigen) should be assessed, the value of which should not normally exceed 4 ng / ml. In controversial cases, a biopsy of the prostate is performed.

Cystography and excretory urography of prostate adenoma have been performed less frequently in recent years due to the appearance of new, less invasive and safer research methods (ultrasound). Cystoscopy is sometimes performed to rule out diseases with similar symptoms or to prepare for surgical treatment.

Treatment of prostatitis

Treatment of acute prostatitis

Patients with an uncomplicated acute process are treated by a urologist on an outpatient basis. Hospital treatment is required in case of suspicion of severe poisoning or purulent process. Antibacterial therapy is performed. The preparations are selected taking into account the sensitivity of the infectious agent. Antibiotics, which penetrate well into the prostate tissue, are widely used.

With the development of acute urinary retention due to prostatitis, a cystostomy is not installed with a urethral catheter, as there is a risk of prostate abscess formation. With the formation of an abscess, an endoscopic transrectal or transurethral opening of the abscess is performed.

Treatment of chronic prostatitis

Treatment of chronic prostatitis should be complex, including etiotropic therapy, physiotherapy, correction of immunity:

• Antibiotic therapy. The patient is prescribed long antibacterial drugs (within 4-8 weeks). The type and dose of antibacterial drugs and the duration of treatment are determined individually. The drug is selected based on the sensitivity of the microflora according to the results of urine culture and prostate secretion.
• Prostate massage.Massage of the gland has a complex effect on the affected organ. During the massage, the inflammatory secretion accumulated in the prostate gland is squeezed out into the channels, and then, reaching the urethra, it is emptied from the body. The procedure improves blood circulation in the prostate, which minimizes congestion and ensures better penetration of antibacterial drugs into the tissue of the affected organ.
• Physiotherapy.Laser exposure, ultrasound waves and electromagnetic vibrations are used to improve blood circulation. If it is impossible to carry out physiotherapy procedures, the patient is prescribed warm medical microclysters.

In the case of chronic, long-lasting inflammation, a consultation with an immunologist is justified to choose the tactics of immune correction therapy. The patient gives advice on lifestyle changes. Certain changes in the lifestyle of patients with chronic prostatitis are both curative and preventive measures. The patient is recommended to normalize sleep and wakefulness, establish a diet, and moderate physical activity.

Conservative therapy

Conservative therapy is performed in the early stages of surgery and in the presence of absolute contraindications. Alpha-blockers, 5-alpha-reductase inhibitors, herbal preparations (African plum bark extract or sabaal fruit) are used to reduce the severity of the symptoms of the disease.

Antibiotics are prescribed to fight the infection that often accompanies prostate adenoma. At the end of antibiotic therapy, probiotics are used to restore normal intestinal microflora. Do the immunity correction. The atherosclerotic vascular changes that develop in most elderly patients prevent the flow of drugs to the prostate gland, so special drugs are prescribed to normalize blood circulation.

Surgery

The following surgical methods are available for the treatment of prostate adenoma:

1. TOUR(transurethral resection). Minimally invasive endoscopic technique. The operation is performed with an adenoma volume of less than 80 cm3. It cannot be used in case of kidney failure.
2. Adenomectomy.It is performed in the presence of complications, the mass of the adenoma exceeds 80 cm3. Currently, laparoscopic adenomectomy is widely used.
3. Laser vaporization of the prostate.It makes it possible to perform surgery with a tumor mass smaller than 30-40 cm3. For young patients with prostate adenoma, this is the method of choice because it allows the preservation of sexual function.
4. Laser enucleation(holmium - HoLEP, thulium - ThuLEP). The method is recognized as the "gold standard" for surgical treatment of prostate adenoma. It enables the removal of an adenoma with a volume greater than 80 cm3 without open intervention.

Surgical treatment of prostate adenoma has many absolute contraindications (decompensated diseases of the respiratory system and cardiovascular system, etc. ). If surgical treatment is not possible, bladder catheterization or palliative surgery is performed - cystostomy, urethral stent installation.

Prediction and prevention

Acute prostatitis is a disease that tends to become chronic. Even with timely and appropriate treatment, more than half of patients suffer from chronic prostatitis. Recovery is by no means always successful, however, with correct and consistent therapy and adherence to medical recommendations, it is possible to eliminate unpleasant symptoms and achieve long-term stable remission in the chronic process.

The purpose of prevention is to eliminate risk factors. Avoid hypothermia, alternate between periods of sedentary work and physical activity, eat regularly and fully. In case of constipation, a laxative should be used. One of the preventive measures is the normalization of sexual life, since both excessive sexual activity and sexual abstinence are risk factors for the development of prostatitis. If symptoms of a urological or sexually transmitted disease appear, you should consult a doctor in a timely manner.