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Prostatitis

symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the prostate (prostate) in men, which has a negative effect on both sexual function and the urination process.Pain in the perineum, groin, lower back and pelvic area, disturbances in urodynamics (urine outflow) may indicate the presence of prostatitis.Untreated prostatitis can cause male infertility and prostate cancer.

This is one of the most common male diseases that requires careful attention and competent systemic treatment.This is exactly the approach to solving the problem of prostatitis that you will find in the urology department of a professional clinic.Highly qualified urologists and andrologists have been successfully treating acute and chronic prostatitis for years.Complex therapy, careful attention and an individual approach to each case will inevitably result in patients' recovery and stable, long-term remission.

Prevalence

Prostatitis ranks 5th among the 20 main urological diagnoses.It is believed that at the age of 30, 30% of the male population suffers from prostatitis, at the age of 40, 40%, and after the age of 50, almost all men bear the burden of the disease.And if by the age of 35 predominantly infectious prostatitis is registered, then at a more mature age the non-infectious form predominates and is usually diagnosed several times more often than bacterial inflammation of the prostate.

Anatomy and physiology of the prostate

The prostate gland (prostate) is located in the lower front part of the pelvis, below the bladder.It consists of glandular and smooth muscle tissue, surrounded by a fibrous capsule.The urethra passes from the bladder through the body of the prostate, into which the ejaculatory ducts open.

The prostate is a hormone-dependent organ.It develops and works under the influence of male hormones - androgens.Testosterone plays a leading role in this process.

The prostate gland is connected to the seminal tubercle, which acts as a valve for the ejaculatory duct.As part of the male reproductive system, the prostate affects erection, ejaculation and orgasm.The nerves responsible for erection pass through the gland.During the chronic course of the disease, they participate in the inflammatory process, erectile dysfunction develops.

The prostate produces a secretion that is part of the semen.It creates favorable conditions for sperm activity.Therefore, in case of chronic dysfunction of the gland, male infertility may occur.

Pathogenesis

There are two main reasons for the development of prostatitis:

  • stagnation of prostate secretion against the background of impaired blood circulation and lymph outflow in the gland itself and neighboring organs;
  • pathogenic and conditionally pathogenic microflora.

Acute prostatitis is usually associated with an infection of the prostate tissue.But usually both factors are related to each other and together they create a vicious circle that makes prostatitis difficult to treat.

An inflamed prostate becomes painful.Pain is felt in the perineum, groin, pelvis and lower back.During digital rectal examination or defecation, it increases sharply to palpation.

The prostate enlarges, the urethra pinches.This makes it difficult for urine to flow out of the bladder.The flow of urine weakens.The patient must strain his abdominal muscles to urinate.Urinary tract obstruction and acute urinary retention sometimes occur in acute cases.

Inflammation leads to disruption of the outflow of prostate juice and its stagnation.The resulting swelling disrupts the processes of cellular metabolism and respiration in the gland.This creates the conditions for the process to become chronic.In the case of long-lasting prostatitis, neighboring organs can become inflamed: the seminal tubercle, Cooper's glands, seminal vesicles.The chronic form of the disease is associated with the risk of male infertility, adenoma and prostate cancer.

In recent years, it has been found that in 70-80% of cases, prostatitis occurs due to stagnant processes in the gland.Venous disorders are less common, but they also cause prostatitis, especially when accompanied by hemorrhoids and varicocele (dilation of the testicular vein) on the left side.

Classification

The US National Institutes of Health identifies 4 categories of prostatitis:

  • Acute prostatitis (category I)
  • Chronic bacterial prostatitis (category II)
  • Chronic prostatitis / Chronic pelvic pain syndrome (category III)
  • Asymptomatic chronic prostatitis (category IV)

Due to its occurrence, prostatitis is divided into two types:

  • It is not contagious
  • Infectious

The inflammatory process can develop quickly with vivid symptoms (acute stage) or slowly with gradually increasing symptoms.

Non-infectious prostatitisin most cases, it is associated with stagnation of prostate secretions, as well as violations of blood circulation and lymph flow in the gland itself and nearby organs.

Infectious prostatitisit develops due to the penetration of pathogenic or opportunistic microflora into the prostate tissue: bacteria, viruses, fungi.The infection can enter the prostate in different ways:

  • Urinogenic (ascending): the entrance gate is the urethra.It should be noted that the infection can also enter the descending route, for example, in the case of purulent pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphogenous: infection of the adjacent pelvic organs can enter the prostate through the lymph from prostatitis (proctitis) or cystitis, as well as from infected hemorrhoidal veins.
  • Hematogenous (through the blood): the presence of foci in the body caused by chronic infection (tonsillitis, carious teeth) or complications of acute infections (influenza, acute respiratory infections, tonsillitis, etc.).

The most common causes of prostatitis are:

  • bacteria: Escherichia coli, Proteus, Gardnerella (gram-negative);staphylococci, streptococci (gram-positive);
  • viruses (influenza, herpes, cytomegalovirus, ARVI pathogens);
  • mycoplasma;
  • chlamydia;
  • specific flora (gonococcus, trichomonas, mycobacterium tuberculosis).

Depending on the nature of the course, prostatitis occurs:

  • Spicy
  • Chronic

Acute prostatitisit usually occurs under the influence of pathogenic (opportunistic) microflora, in the presence of predisposing factors.It has a rapid course and pronounced symptoms.If it is not treated in time, a purulent process can develop, which can lead to the melting of the prostate tissue.If not treated properly, acute prostatitis often becomes chronic.

Chronic prostatitisit has a milder course, the symptoms have disappeared.However, it can worsen from time to time, and then the symptoms correspond to an acute process.However, complete remission between exacerbations does not always occur, and the patient may feel constant discomfort.Chronic prostatitis can cause impotence, male infertility, adenoma or prostate cancer.

There is a chronic asymptomatic form of the disease, when the patient has no complaints, but there is an increased number of purulent elements (leukocytes) in the secretion of the prostate.

Complications

Without proper therapy, the inflammatory process can lead to purulent melting of prostate tissue.In addition, inflammation can spread to nearby organs: seminal tubercle, Cooper's gland, seminal vesicle, urethra.Accordingly, the following complications may occur:

  • Prostate abscess
  • Sclerosis/fibrosis of the prostate (functional glandular tissue is replaced by connective tissue)
  • Prostate cysts
  • Prostate stones
  • Vesiculitis (inflammation of the seminal vesicles)
  • Colliculitis (inflammation of the testicles)
  • Epididymo-orchitis (inflammation of the testes and their appendages)
  • Posterior urethritis
  • Erectile dysfunction/impotence
  • Ejaculation disorder
  • Infertility
  • Prostate adenoma
  • Prostate cancer

Symptoms

Different forms of prostatitis have their own characteristics and severity of symptoms.In general, the following manifestations are characteristic of prostatitis:

  • Pain in the groin, lower back, perineum (can radiate along the spermatic cords).
  • Pain increases with bowel movements and digital rectal examination.
  • Urodynamic disorders (frequent urination, urinary retention, difficulty urinating, weak flow, incomplete emptying of the bladder).
  • Prostatorrhea (involuntary discharge of prostate juice, especially in the morning and during bowel movements).
  • Disorders of sexual functions (reduced libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • The temperature rises to 39-40 degrees
  • Acute urinary retention
  • General poisoning
  • Leukocyturia, protein and mucus in the urine
  • Blood in urine and semen
  • Leukocytosis in prostatic secretions
  • Hypoechogenicity and enlargement of the gland, increased blood flow according to ultrasound data

Symptoms of chronic prostatitis

  • Body temperature usually does not exceed 37 degrees
  • The feeling of pain dulls and smoothes out
  • Discharge from the urethra during defecation
  • Urinary tract disorders
  • Decreased libido
  • Erectile dysfunction
  • Ejaculation disorders (early or delayed ejaculation)

Reasons

The main causes of prostatitis are infections and stagnation of prostate secretions.The following factors contribute to the appearance of prostatitis:

  • Infections and opportunistic flora with weakened immunity
  • Physical inactivity
  • "Sedentary" work
  • Long-term sexual abstinence
  • Coitus interruptus (with delayed ejaculation)
  • Excessive sexual activity, which leads to exhaustion of the gland
  • Alcohol abuse
  • Reduced local immunity (hypothermia, use of immunosuppressants, immunodeficiency, autoimmune diseases)
  • Injuries of pelvic organs
  • Manipulations on the prostate and nearby organs (prostate biopsy, surgery, catheterization, cystoscopy, etc.)
  • Chronic diarrhea or constipation

Diagnostics

Many methods are used to detect prostatitis, which can be divided into 3 groups: digital rectal examination, laboratory tests and instrumental methods.

Digital rectal examinationperformed by a urologist-andrologist after a conversation with the patient.This method makes it possible to evaluate the size, shape and some characteristics of the prostate.If the size of the prostate increases and the procedure itself is painful for the patient, the doctor can pre-diagnose prostatitis.

If the case is not acute, the doctor can perform a prostate massage during the examination in order to determine the secretion of the prostate, the examination of which is an important link in the diagnosis of prostatitis.If acute bacterial prostatitis is suspected, prostate massage is contraindicated: such manipulation can lead to the spread of the pathogen and blood poisoning.

In order to clarify the diagnosis, the patient is invited to the examinationinstrumental studies, such as:

  • transrectal ultrasound examination of the prostate and pelvic organs (reveals the presence of structural features, inflammation and purulent foci, stones, cysts and other tumors);
  • Dopplerography (characteristics of blood flow in the gland);
  • uroflowmetry (determining the speed and time of urination);
  • magnetic resonance imaging of the pelvic organs (a very informative and safe examination that allows differential diagnosis with other diseases).

If necessary, diagnostics of the nearby organs of the urogenital system are carried out: urethroscopy, urethrography and urethrocystography.

Laboratory researchthe necessary components for the diagnosis of prostatitis:

  • General urine test (before and after prostate massage)
  • General blood test
  • Blood test for proteins of the acute phase of inflammation (C-reactive protein, etc.)
  • Microscopic examination of prostate secretion after finger massage
  • Microscopic examination of a scraping from the urethra
  • Spermogram (sperm cytology and biochemistry)
  • Culture of urine, prostatic secretions and sperm
  • Determination of prostate specific antigen (PSA).
  • Needle biopsy of the prostate and histological examination of glandular tissue

The last two tests are necessary to rule out prostate cancer or adenoma.

The modern has an excellent, extremely informative diagnostic base.Urologists have extensive experience in the diagnosis and successful treatment of various forms of prostatitis, and the status of the multidisciplinary clinic enables the use of the services of specialists working in related fields.The medical center has developed research packages that include all the necessary types of diagnostics at extremely attractive prices. 

Treatment

Treating prostatitis is not an easy task.It requires a thoughtful, integrated approach.The treatment protocol for this disease includes drug therapy and physiotherapy procedures, in some cases surgical intervention is required.

Drug therapy

It includes the use of the following drugs:

  • Antibiotics (after determination of sensitivity to them)
  • Antiseptics (topical)
  • Vascular drugs (improve microcirculation of the prostate)
  • Nonsteroidal anti-inflammatory drugs
  • Alpha-1 blockers (for urinary problems)
  • Enzyme preparations (dilute prostate secretions, stimulate the immune system, relieve inflammation)
  • Immunomodulators
  • Antidepressants

Physiotherapy treatment

  • Electrical stimulation of the prostate (electrophoresis, galvanization, pulsating effect)
  • Vibro massage
  • Laser therapy with a rectal sensor (for chronic prostatitis)

In case of chronic prostatitis, prostate massage can be used as a therapeutic procedure.In the acute stage of the disease, this manipulation is not performed to avoid the spread of infection and sepsis.

Surgical treatment

Surgery for prostatitis is rarely used.This need arises in case of severe swelling of the prostate tissue, lack of positive dynamics of drug treatment and pathological enlargement of the prostate blocking the urethra.

Forecast

Acute prostatitis can be overcome with early diagnosis and appropriate treatment.However, the process often becomes chronic even with correct and timely therapy.

If the treatment is incorrect and the treatment deadlines are not observed (several months), the disease usually has a chronic course.Chronic prostatitis greatly affects men's quality of life, because it affects not only urine but also sexual function.Erectile dysfunction, loss of orgasmic intensity, ejaculation problems and infertility are observed in 30% of cases.It is completely impossible to cure chronic prostatitis, but a stable remission can be achieved with the right approach.

Advantages of visiting a professional clinic

  • Successful treatment of various forms of prostatitis
  • Experienced urologist-andrologist with the highest qualifications
  • It is multidisciplinary, which allows the involvement of specialists from related fields in the treatment
  • High-precision modern diagnostic and treatment equipment
  • Our own European-class clinical diagnostic laboratory
  • Comfortable and high-tech hospitals
  • Urological diagnostic service package at an attractive price

Prevention of prostatitis

  • Choose protected sex to avoid sexually transmitted infections (STIs).
  • Support of the immune system (vitamins, healthy diet, prevention of dysbiosis, reasonable antibiotic therapy, etc.)
  • Avoid hypothermia
  • Lead an active lifestyle
  • If possible, have regular sex with a partner (to avoid prostate stagnation and STDs)
  • Avoid interrupted sexual intercourse (this relieves sperm stagnation)
  • See your urologist once a year for prevention, and twice a year if you are over 50 or have previously had prostate disease.

Frequently Asked Questions

How informative is the PSA test in diagnosing prostatitis?

Prostate-specific antigen (PSA) is a marker for prostate cancer.It is known that in some cases the clinical picture of prostate cancer is similar to the manifestations of prostatitis.Therefore, the PSA test is used to distinguish between these two diseases.However, you should not bet on PSA.This antigen is also increased in the case of prostate adenoma, a benign growth of glandular tissue.In the case of prostatitis, the PSA level can also rise during periods of active inflammation.It decreases during the remission phase.Therefore, PSA cannot be used as definitive evidence of prostate cancer or prostatitis.

Why is prostatitis difficult to treat?

The capillaries of the prostate have a special structure that creates a hematoprostatic barrier.This makes it difficult for certain types of antibiotics to penetrate the glandular tissue.In addition, microorganisms tend to form biofilms, which reliably protect them from the effects of antibacterial agents.Therefore, modern prostatitis treatment protocols necessarily include proteolytic enzymes that can destroy biofilms.Bacteria become vulnerable and antibiotics work more effectively.Chronic prostatitis is the most persistently treated disease, the most important feature of which is the diversity of the microflora found in the culture.In approximately 50% of cases, Enterococcus faecalis is resistant to all aminoglycosides and cephalosporins.This narrows the list of effective antimicrobial agents, which also complicates the treatment.