Symptoms of prostatitis and prostate adenoma in men

Prostatitisis an inflammatory disease of the prostate gland. It is manifested by frequent urination, pain in the penis, testicles, rectum, sexual disorders (erection disorder, premature ejaculation, etc. ), sometimes retention of urine, blood in the urine. The diagnosis of prostatitis is made by a urologist or andrologist based on a typical clinical picture and the results of a rectal examination. In addition, ultrasound of the prostate gland, bakposev and urine examination of prostate secretion are performed. Treatment is conservative - antibiotic therapy, immunotherapy, prostate massage, lifestyle correction.

General Information

Prostatitis is an inflammation of the seminal (prostate) gland - the prostate. It is the most common disease of the genitourinary system in men. It mostly affects patients aged 25-50. According to various reports, 30-85% of men over the age of 30 suffer from prostatitis. Possible abscess of the prostate gland, inflammation of the testicles and appendages, which threatens infertility. The rise of infection causes inflammation of the upper genitourinary system (cystitis, pyelonephritis).

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

Prostate adenoma is a benign neoplasm of the paraurethral glands located in the prostate gland around the urethra. The main symptom of prostate adenoma is urinary incontinence due to gradual compression of the urethra by one or more growing nodes. It is characterized by a pathologically benign course.

Only a small number of patients seek medical help, but a detailed examination reveals symptoms of the disease in every fourth man aged 40-50 and in half of men aged 50-60. The disease is found 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 clinical andrology show that urinary problems occur in about 40% of men with BPH, but only one in five patients in this group seek medical help.

Causes of prostatitis

Staphylococcus aureus, Enterococcus, Enterobacter, Pseudomonas, Proteus, Klebsiella and Escherichia coli can act as an infectious agent in an acute process. . Most microorganisms conditionally belong to the pathogenic flora and cause prostatitis only in the presence of other predisposing factors. Chronic inflammation is usually due to polymicrobial associations.

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

• General hypothermia (one-time or permanent, related to work conditions).
• Sedentary lifestyle, profession that forces a person to be in a sedentary position for a long time (computer operator, driver, etc. ).
• Constant constipation.
• Violation of the normal rhythm of sexual activity (excessive sexual activity, long-term abstinence, incomplete ejaculation during "ordinary" sexual intercourse devoid of emotional color).
• Presence of chronic diseases (cholecystitis, bronchitis) or chronic infectious foci (chronic osteomyelitis, untreated caries, tonsillitis, etc. ) in the body.
• Past urological diseases (urethritis, cystitis, etc. ) and sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea).
• Conditions that cause suppression of the immune system (chronic stress, disordered nutrition, lack of regular sleep, excessive training in athletes).

It is believed that the risk of developing pathology increases with chronic intoxication (alcohol, nicotine, morphine). Some studies in the field of modern andrology prove that chronic perineal trauma (vibration, shock) in motorcyclists, motorcyclists and cyclists is an inciting factor. However, the vast majority of experts believe that all these cases are not the real causes of the disease, but only contribute to the exacerbation of the latent inflammatory process in the tissues of the prostate gland.

A decisive role in the formation of prostatitis is played by blockage in the tissues of the prostate gland. Violation of capillary blood flow causes lipid peroxidation, edema, increased exudation of prostate tissues and creates conditions for the development of an infectious process.

The mechanism of development of prostate adenoma has not yet been fully determined. Despite widespread opinions linking the pathology with chronic prostatitis, there is no data confirming the relationship between these two diseases. The researchers found no relationship between the development of prostate adenoma and alcohol and tobacco use, sexual orientation, sexual activity, sexually transmitted and inflammatory diseases.

There is a clear dependence of the frequency of prostate adenoma on the age of the patient. Scientists believe that adenoma develops in men during andropause (male menopause) as a result of hormonal imbalance. This theory is confirmed by the fact that men castrated before puberty never suffer from pathology, and very rarely - men castrated after that.

Symptoms of prostatitis

Acute prostatitis

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

• Acute catarrh. Patients often complain of painful urination, pain in the sacrum and perineum.
• Acute follicular. The pain becomes stronger, sometimes spreads to the anus, worsens with defecation. It is difficult to urinate, urine flows in a thin stream. In some cases, there is urinary retention. A subfebrile state or moderate hyperthermia is typical.
• Acute parenchymal. Severe general intoxication, hyperthermia up to 38-40°C, shivering. Dysuric disorders, often - acute urinary retention. Sharp, throbbing pains in the perineum. Difficulty in defecation.

Chronic prostatitis

In rare cases, chronic prostatitis is the result of an acute process, but as a rule, an initial chronic course is observed. The temperature sometimes rises to subfebrile values. The patient feels a slight pain in the perineum, discomfort during urination and defecation. The most characteristic symptom is a small amount of discharge from the urethra during defecation. The initial chronic form of the disease develops over a long period of time. Before that, prostatosis (blood stagnation in capillaries) gradually turns into abacterial prostatitis.

Chronic prostatitis is often a complication of the inflammatory process caused by a specific infection (chlamydia, trichomonas, ureaplasma, gonococcus). Symptoms of a specific inflammatory process in many cases hide the manifestations of prostate damage. Perhaps a slight increase in pain during urination, slight pain in the perineum, a small amount of discharge from the urethra during defecation. A slight change in the clinical picture often does not go unnoticed by the patient.

Chronic inflammation of the prostate gland can be manifested by a burning sensation in the urethra and perineum, dysuria, sexual disorders, and increased general fatigue. The result of potency violations (or the fear of these violations) is often mental depression, anxiety, and irritability. The clinical picture does not always include all groups of listed symptoms, it differs in different patients and changes over time. There are three main syndromes characteristic of chronic prostatitis: pain, dysuric, sexual disorders.

There are no pain receptors in prostate tissue. The cause of pain in chronic prostatitis is almost inevitable due to the abundant innervation of pelvic organs, involvement in the inflammatory process of nerve pathways. Patients complain of pain of varying intensity - from weak, aching to intense, restless sleep. There is a change in the nature of pain (intensification or weakening) with ejaculation, excessive sexual activity or sexual abstinence. The pain spreads to the scrotum, sacrum, perineum, sometimes the lumbar region.

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

In the initial stages, different patients may develop dyspotency, which manifests itself differently. Patients may often complain of nocturnal erections, blurred orgasms, or worsening erections. Accelerated discharge is associated with a decrease in the threshold level of excitation of the orgastic center. Painful sensations during ejaculation can lead to refusal of sexual activity. In the future, sexual dysfunctions manifest themselves more prominently. In the advanced stage, impotence develops.

The degree of sexual dysfunction is determined by many factors, including the sexual constitution and psychological state of the patient. Violation of potency and dysuria can be related to both changes in the prostate gland and, if there is chronic prostatitis, the suggestion of the patient who expects the inevitable development of sexual disorders and urinary disorders. Psychogenic dyspotency and dysuria develop in anxious patients, who are especially often offered.

The threat of impotence and sometimes possible sexual disorders is difficult for patients to tolerate. Often there is a change of character, irritability, disgust, excessive concern for one's health and even "care for the disease".

There are two groups of symptoms of the disease: irritative and obstructive. The first group of symptoms includes increased urination, constant urge to urinate (imperative), nocturia, urinary incontinence. The group of obstructive symptoms includes difficulty urinating, delayed onset and increased time to urinate, feeling of incomplete emptying, urinating with intermittent slow flow, urge to urinate. There are three stages of prostate adenoma: compensation, subcompensation and decompensation.

Compensated stage

During the compensated stage, the dynamics of urinary movement changes. It is more frequent, less intense and less free. Need to urinate 1-2 times a night. As a rule, nocturia in stage I of prostate adenoma does not cause concern in a patient who associates constant night awakenings with the development of age-related insomnia. During the day, normal urination frequency can be maintained, but in patients with stage I prostate adenoma, a noticeable waiting period is noted, especially after a night's sleep.

Then the frequency of urination during the day increases and the volume of urine released during one urination decreases. There are imperative calls. The urine stream, which previously formed a parabolic curve, slowly empties and falls almost vertically. Bladder muscle hypertrophy develops, thanks to which the efficiency of its emptying is maintained. 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.

Subcompensation stage

In the II stage of prostate adenoma, the volume of the bladder increases, dystrophic changes develop in its walls. The amount of residual urine is above 50 ml and continues to increase. During urination, the patient is forced to intensively strain the abdominal muscles and the diaphragm, which further increases the intravesical pressure.

The act of urination is multiphasic, intermittent, and wavy. The passage of urine along the upper urinary tract is gradually impaired. Muscle structures lose their elasticity, 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.

Decompensation stage

In patients with stage III prostate adenoma, the bladder is elongated, filled with urine, easily identified by palpation and visual inspection. The upper edge of the bladder can reach the level of the navel and above. Ejaculation is impossible even with the tight tension of the abdominal muscles. The urge to empty the bladder is persistent. There may be severe pain in the lower abdomen. Urine is excreted frequently, in drops or in very small portions. In the future, the pain and the urge to urinate gradually weaken.

Characteristic paradoxical urinary retention develops or paradoxical ischuria (bladder is full, urine is constantly released drop by drop). The upper urinary tract expands, the functions of the kidney parenchyma are disturbed due to the permanent obstruction of the urinary tract, causing an increase in pressure in the pelvicalyceal 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, the risk of developing prostate abscess increases significantly. With the formation of a purulent focus, the patient's body temperature rises to 39-40 ° C and can be hectic in nature. Periods of heat alternate with severe cold. Sharp pains in the perineum make urination difficult and defecation impossible.

Increased edema of the prostate gland causes acute urinary retention. Rarely, an abscess spontaneously reaches 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 inflammation in the prostate is hidden or manifests itself with very weak symptoms. Patients who are not worried about anything often stop treatment and turn away only when complications develop.

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

Diagnostics

To assess the severity of symptoms of prostate adenoma, the patient is asked to fill in a urine diary. During the consultation, the urologist performs a digital examination of the prostate. To exclude infectious complications, a sample and examination of prostate secretion and smear from the urethra is performed. Additional tests include:

• Echography.In the process of ultrasound examination of the prostate gland, the volume of the prostate gland is determined, areas with stones and blockages are detected, the amount of urine remains, and the condition of the kidneys and urinary tract are evaluated.
• Urodynamic study.Uroflowmetry allows you to reliably judge the degree of urinary retention (the time of urination and the speed of urine flow are determined by a special apparatus).
• Definition of tumor markers.To exclude prostate cancer, it is necessary to evaluate the level of PSA (prostate-specific antigen), the value of which normally does not exceed 4 ng / ml. In controversial cases, a biopsy of the prostate is performed.

In recent years, due to the emergence of new, less invasive and safe research methods (ultrasound), cystography and excretory urography are performed less frequently for prostate adenoma. 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. Severe intoxication, suspicion of a purulent process, hospitalization is indicated. Antibacterial therapy is carried out. Preparations are selected taking into account the sensitivity of the infectious agent. Antibiotics that can penetrate prostate tissue well are widely used.

With the development of acute urinary retention in prostatitis, they resort to the installation of a cystostomy, not a urethral catheter, because of the danger of the formation of an abscess of the prostate gland. With the development of an abscess, 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 courses of antibacterial drugs (within 4-8 weeks). Selection of the type and dose of antibacterial drugs, as well as determining the duration of the treatment course, is carried out 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 into the channels, then enters the urethra and is removed 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 not possible to carry out physiotherapeutic procedures, the patient is prescribed warm drug microclysters.

In chronic, long-term inflammation, consultation of an immunologist is indicated to choose the tactics of immunocorrective therapy. The patient is given advice on lifestyle changes. Making certain changes in the lifestyle of a patient with chronic prostatitis is both a curative and preventive measure. The patient is recommended to normalize sleep and wakefulness, diet, moderate physical activity.

Conservative therapy

Conservative therapy is carried out in the early stages and when there are absolute contraindications to surgical intervention. To reduce the severity of the symptoms of the disease, alpha-blockers, 5-alpha reductase inhibitors, herbal preparations (African plum bark extract or sabal fruit) are used.

Antibiotics are often prescribed to fight the infection that accompanies prostate adenoma. At the end of the course of antibiotic therapy, probiotics are used to restore normal intestinal microflora. Correct the immunity. Atherosclerotic vascular changes that develop in the majority of 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. Not applicable for kidney failure.
2. Adenomectomy.It is performed in the presence of complications, the mass of the adenoma is more than 80 cm3. Currently, laparoscopic adenomectomy is widely used.
3. Laser vaporization of the prostate.It allows surgery with a tumor mass of less than 30-40 cm3. It is the method of choice for young patients with prostate adenoma, as it allows to save sexual function.
4. Laser enucleation(holmium - HoLEP, thulium - ThuLEP). The method is known as the "gold standard" of surgical treatment of prostate adenoma. Allows removal of adenoma with a volume of more than 80 cm3 without open intervention.

There are a number of absolute contraindications to the surgical treatment of prostate adenoma (decompensated diseases of the respiratory and cardiovascular systems, etc. ). If surgical treatment is not possible, bladder catheterization or palliative surgery is performed - cystostomy, urethral stenting.

Prognosis and prevention

Acute prostatitis is a disease that tends to become chronic. Even with timely and adequate treatment, more than half of patients end up with chronic prostatitis. Recovery is not always achieved, but with the correct consistent therapy and following the doctor's recommendations, it is possible to eliminate unpleasant symptoms in a chronic process and achieve long-term stable remission.

Prevention is the elimination of risk factors. It is necessary to avoid hypothermia, to alternate between periods of sedentary work and physical activity, and to eat regularly and fully. Laxatives should be used for constipation. One of the preventive measures is the normalization of sexual life, because both excessive sexual activity and abstinence from sexual intercourse are risk factors for the development of prostatitis. If symptoms of a urological or sexually transmitted disease appear, you should consult a doctor in time.