Chronic (bacterial) prostatitis is characterized by persistent or recurring symptoms with confirmed bacterial infection in the prostate gland.
Prostatitis in this category is rare, occurring in about 10% of all prostatitis.The question of whether atypical pathogens such as ureaplasma urealyticum can trigger prostatitis is debated.They can be present in a man's body without any signs of inflammation or complaints.
Causes of chronic prostatitis
The causes of chronic prostatitis are basically similar to the causes of acute bacterial prostatitis.Microorganisms enter the prostate in most cases through the urethra - due to the backflow of urine into the ducts of the prostate gland.
Chronic bacterial prostatitis develops as a result of inadequate treatment or short treatment of acute bacterial prostatitis.
Symptoms
- Discomfort or pain - in the perineum, lower abdomen, groin, scrotum, penis, during ejaculation
- Changes in urination - difficulty urinating, frequent urination in small amounts, a feeling of incomplete emptying of the bladder.
The patient may complain of several symptoms or any individual symptom.An increase in body temperature is not typical (or insignificant).
Important:
Many men associate erectile dysfunction with prostatitis.This is often facilitated by unprofessional publications in the media and the advertising of dubious drugs.The fact that an erection can persist despite the complete removal of the prostate (due to a malignant tumor of the organ) suggests that it itself does not play a role in maintaining an erection.
According to many respected urologists, erectile dysfunction in patients with chronic prostatitis is caused by psychogenic and neurotic problems.
Diagnostics
For the initial assessment, a questionnaire is used - the index of symptoms of chronic prostatitis.It can be used to objectify the patient's complaints.
The standard way to diagnose prostatitis is to perform a test.This is a microscopic and bacteriological examination of urine samples obtained from different parts of the urogenital tract and prostate secretions.However, the sampling method is quite labor-intensive, and modifications of the samples are now more often used.A possible alternative is to submit the ejaculate (sperm) for microscopic and bacteriological examination, since the ejaculate is partially (at least 1/3) prostate secretion.This method is more convenient for patients, especially if they categorically refuse rectal examination of the prostate gland or diagnostic massage to obtain prostatic secretions.However, ejaculate donation has a lower information content and reliability compared to a sample.
The submission of the ejaculate for bacteriological examination is included in the diagnostic algorithm for infections of the male genital organs and in the examination of male infertility.
The results of laboratory tests (general urine test, general blood test, biochemical blood test, spermogram and other general clinical tests) are not informative in the case of chronic prostatitis.Most likely these tests will show 'normal'.
During the rectal examination, changes indicative of the inflammatory process of the prostate are not always observed in patients with chronic prostatitis.In other words, it is impossible to rely on the results of a rectal examination to diagnose chronic prostatitis.
The same is true for ultrasound diagnostics: it is incorrect to diagnose chronic prostatitis based on ultrasound data alone.The European and American Urological Association does not recommend ultrasound for the diagnosis of prostatitis.The type of execution in this case is not important through the anterior abdominal wall - through the lower abdomen or through TRUS - through the rectum.It is incorrect to write the words "chronic prostatitis", "ultrasound signs of chronic prostatitis", "signs of prostatitis" at the end of the ultrasound examination.Only a urologist has the right to make this diagnosis, who makes the diagnosis based on complaints, anamnesis, laboratory tests and - only afterwards - an ultrasound.
The most common ultrasound sign used to diagnose chronic prostatitis is the so-called diffuse changes in the prostate gland, which are associated with an inflammatory process or other changes in the prostate parenchyma.It is a type of fibrotic process, the replacement of normal prostate parenchyma with scar tissue.However, there is no correlation between the number of fibrous changes in the prostate and the presence of complaints.With age, the chance of such "scars" appearing on the organ increases, but a person can live his whole life without feeling any discomfort in the perineum or pubic area.However, as soon as these changes are detected on ultrasound, some "experts" diagnose prostatitis.And some men have the feeling that they are really seriously ill, they will start listening to themselves, they will feel all the symptoms described on the Internet.
In many men over the age of 30, ultrasound can show diffuse changes in the prostate gland.However, the fibrotic process does not indicate the presence of prostatitis.
The diagnosis of chronic prostatitis is established based on the exclusion of other diseases of the urogenital system - mainly urethritis, prostatic hyperplasia, urethral stricture, neurogenic urinary disorders, prostate cancer, bladder cancer.
Based on the results of the routine examination, there is no specific picture of chronic prostatitis.
Treatment of chronic prostatitis
Antibiotics belonging to the group of fluoroquinolones are the optimal antimicrobial drugs for the treatment of chronic bacterial prostatitis.The recommended antibiotic therapy is 4-6 weeks.Such a long course is justified by scientific data, which indicate a decrease in the probability of relapse of the disease.
A macrolide antibiotic is prescribed for detected sexually transmitted infections (STIs), such as chlamydia.
It has been shown that in patients with chronic prostatitis, the relaxation of the bladder neck is reduced, which leads to the backflow of urine into the urethral channels and causes inflammation and pain in the prostate tissue.Alpha-blockers are recommended for such patients.
In the treatment of chronic prostatitis, patients are advised to refrain from tempting offers to use herbs.Dietary supplements and herbal supplements are characterized by the instability of herbal ingredients in a part of the substance;they may differ even in the product of the same manufacturer.In addition, from the point of view of evidence-based medicine, the benefits of herbal medicine are beyond criticism.
Thanks to new scientific approaches and classifications, prostate massage, which was the basis of therapy in the middle of the 20th century, is still an important tool for diagnosing prostatitis, but not for its treatment.There is no need for prostate massage as a therapeutic procedure (the effect is not proven).There are suggestions that frequent ejaculation is similar in properties to therapeutic prostate massage.
Other methods that have been shown to be effective in only one or a few studies or are still being investigated include:
- pelvic floor muscle training - some evidence suggests that specific exercises are effective in reducing symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- acupuncture - some studies indicate that acupuncture is beneficial compared to placebo in patients with chronic prostatitis;
- extracorporeal shock wave therapy - based on the effect of significant amplitude acoustic pulses on connective and bone tissue, widely used in the treatment of musculoskeletal diseases, recently used in urology, its effectiveness is being studied;
- behavioral therapy and psychological support - since chronic prostatitis is associated with a low quality of life and the development of depression, these methods can improve the patient's psychological state and help reduce some symptoms of the disease.
It is worth mentioning separatelyasymptomatic (asymptomatic) chronic prostatitis.The diagnosis is most often made based on the results of the histological report - after a biopsy of the prostate or surgical treatment of the prostate.The frequency of detection of inflammation in prostate tissue varies from 44% (with prostate biopsy) to 98-100% (after surgical treatment of the prostate).The scientists suggested that the inflammatory changes identified in this way are nothing more than age-related physiological characteristics.No one specifically diagnoses this category of prostatitis;it's kind of an accidental discovery.It does not require treatment and requires no further action by either the doctor or the patient.