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Prostatitis

symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the prostate gland (prostate gland) in men, which negatively affects both sexual function and urination.Pains in the perineum, groin, back and pelvis, disturbances in urodynamics (urine flow) may indicate the presence of prostatitis.Untreated prostatitis can lead to male infertility and prostate cancer.

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

Don't spread

Prostatitis ranks 5th among 20 main urological diagnoses.It is estimated that at the age of 30, 40-40% of the male population suffers from prostatitis, and after 50 years, almost all men bear the burden of this disease in one way or another.And if until the age of 35, mainly infectious prostatitis is recorded, at a more mature age, the non-infectious form prevails and is generally diagnosed several times more often than bacterial inflammation of the prostate.

Anatomy and physiology of the prostate gland

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 through the body of the prostate from the bladder, where the ejaculatory ducts open.

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

The prostate gland is attached 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.Nerves responsible for erection pass through the gland.In the chronic course of the disease, they participate in the inflammatory process and develop erectile dysfunction.

The prostate produces a secretion that is part of the sperm.Creates favorable conditions for sperm activity.Therefore, male infertility can occur with chronic dysfunction of the gland.

Pathogenesis

There are two main reasons for the development of prostatitis:

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

Acute prostatitis is usually associated with an infection of the prostate tissue.However, as a rule, both factors are related to each other, and together they create a vicious circle that complicates the treatment of prostatitis.

An inflamed prostate gland becomes painful.Pain can be felt in the perineum, groin, pelvis and lower back.Rectal digital examination or palpation during defecation sharply increases.

Prostate increases in size, compresses the urethra.This makes it difficult for urine to leave the bladder.The flow of urine weakens.In order for urination to occur, the patient must tense the abdominal muscles.Urinary tract obstruction and acute urinary retention sometimes occur in acute cases.

Inflammation leads to violation of the flow of prostate juice and its stagnation.The resulting swelling disrupts cellular metabolism and respiratory processes in the gland.This allows the process to become chronic.With prolonged prostatitis, neighboring organs can become inflamed: seminal tubercle, Cooper's glands, seminal vesicles.The chronic form of the disease is associated with the risk of developing male infertility, adenoma and prostate cancer.

In recent years, it has been known that in 70-80% of cases, prostatitis occurs as a result of the stagnation of processes in the gland.Venous disorders are less common, but they also cause prostatitis, especially if accompanied by hemorrhoids and varicocele (enlargement of the testicular vein) on the left.

Classification

The American National Institutes of Health defines 4 categories of prostatitis:

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

According to the occurrence, prostatitis is divided into two types:

  • Non-infectious
  • Infectious

The inflammatory process can develop rapidly, accompanied by bright symptoms (acute phase) or gradually increasing symptoms that disappear slowly.

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

Infectious prostatitisdevelops due to the penetration of pathogenic or opportunistic microflora into the prostate tissue: bacteria, viruses, fungi.There are different ways that the infection can enter the prostate:

  • Urinogenic (upward): the portal of entry is the urethra.It should be noted that the infection can enter in a descending way, for example, with purulent pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphogenic: infection from neighboring pelvic organs can enter the prostate through lymph due to inflammation of the rectum (proctitis) or bladder (cystitis), as well as infected hemorrhoidal vessels.
  • Hematogenous (through the blood): presence of chronic infection centers in the body (tonsillitis, rotten teeth) or complications of acute infections (flu, 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).

According to the nature of the course, prostatitis occurs:

  • spicy
  • Chronic

Acute prostatitisusually occurs under the influence of pathogenic (opportunistic) microflora in the presence of predisposing factors.It has a rapid course and clear symptoms.If not treated in time, a purulent process may develop, which leads to the dissolution of prostate tissue.If treated incorrectly, acute prostatitis often becomes chronic.

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

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

Complications

Without appropriate therapy, the inflammatory process can lead to purulent dissolution of the prostate tissue.Moreover, inflammation can spread to nearby organs: seminal tubercle, Cooper's glands, seminal vesicles, 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 tubercle of the sperm)
  • Epididymo-orchitis (inflammation of the testicles and their appendages)
  • Posterior urethritis
  • Erectile dysfunction/impotence
  • Ejaculation disorder
  • Infinity
  • 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 spread along the spermatic cords).
  • Pain worsens with defecation and digital rectal examination.
  • Urodynamic disorders (frequent urination, urinary retention, difficulty urinating, weak flow, incomplete emptying of the bladder).
  • Prostatorrhea (involuntary release of prostate juice, especially in the morning and during bowel movements).
  • Sexual dysfunction (decrease in libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • The temperature rises to 39-40 degrees
  • Urinary incontinence
  • General intoxication
  • Leukocyturia, protein and mucus in the urine
  • Blood in urine and semen
  • Leukocytosis in prostate secretion
  • Hypoechogenicity and enlargement of the gland, increased blood flow according to ultrasound data

Symptoms of chronic prostatitis

  • Body temperature is usually not higher than 37C
  • Pain sensations are dulled and smoothed
  • Urethral discharge during bowel movements
  • Urinary tract disorders
  • Decreased libido
  • Erectile dysfunction
  • Ejaculation disorders (early or delayed ejaculation)

Reasons

The main reasons for the development of prostatitis are infections and stagnation of prostate secretion.The following factors contribute to the appearance of prostatitis:

  • Infections and opportunistic flora with weakened immunity
  • Physical inactivity
  • "Sitting" work
  • Prolonged sexual abstinence
  • Coitus interruptus (with delayed ejaculation)
  • Excessive sexual activity that leads to exhaustion of the gland
  • Alcohol abuse
  • Reduction of local immunity (hypothermia, use of immunosuppressants, immunodeficiency, autoimmune diseases)
  • Damage to the pelvic organs
  • Manipulations to the prostate gland and nearby organs (biopsy of the prostate gland, 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 examinationit is carried out by a urologist-andrologist after a conversation with the patient.This method allows to evaluate the size, shape and some features of the structure of the prostate gland.If the size of the prostate increases and the procedure itself is painful for the patient, the doctor can make a preliminary diagnosis of prostatitis.

If the condition is not acute, during the examination, the doctor can massage the prostate to obtain prostate secretions, the study 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.

Examination of the patient will be required to clarify the diagnosisinstrumental studies, for example:

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

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

Laboratory researchis a necessary component of the diagnosis of prostatitis:

  • General urinalysis (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 scrap from the urethra
  • Spermogram (cytology and biochemistry of sperm)
  • Urine, prostatic secretion and sperm culture
  • Determination of prostate specific antigen (PSA).
  • Needle biopsy of the prostate and histological examination of the gland tissue

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

It has an excellent modern, highly informative diagnostic database.Urologists have extensive experience in diagnosing and successfully treating various forms of prostatitis, and the status of a multidisciplinary clinic allows you to use the services of specialists in related fields.The medical center has developed research packages that include all necessary types of diagnostics at a very attractive price. 

Treatment

Treatment of prostatitis is not an easy task.This requires a thoughtful, integrated approach.The treatment protocol for this disease includes drug treatment and physiotherapeutic procedures, in some cases surgical intervention is required.

Drug therapy

It involves the use of the following drugs:

  • Antibiotics (after determining sensitivity to them)
  • Antiseptics (local)
  • Vascular drugs (improving microcirculation in the prostate)
  • Nonsteroidal anti-inflammatory drugs
  • Alpha-1 blockers (for urinary problems)
  • Enzyme preparations (reduces prostate secretion, stimulates the immune system, relieves inflammation)
  • Immunomodulators
  • Antidepressants

Physiotherapy treatment

  • Electrical stimulation of the prostate (electrophoresis, galvanization, impulse movement)
  • Vibro massage
  • Rectal sensor laser therapy (for chronic prostatitis)

Prostate massage can be used as a therapeutic procedure for chronic prostatitis.In the acute stage of the disease, this manipulation is not carried out to prevent the spread of infection and sepsis.

Surgical treatment

Surgery is rarely used for prostatitis.This need arises in the case of serious suppuration of the prostate tissue, lack of positive dynamics of drug treatment, and pathological growth of the prostate gland blocking the urethra.

Forecast

Acute prostatitis can be overcome with early diagnosis and adequate treatment.However, even with proper and timely therapy, this process often becomes chronic.

If the treatment is not carried out correctly and treatment periods are not observed (several months), the disease usually takes a chronic course.Chronic prostatitis greatly affects a person's quality of life, because not only urinary function, but also sexual function suffers.Erectile dysfunction, loss of orgasm intensity, ejaculation problems, infertility are observed in 30% of cases.Chronic prostatitis cannot be completely cured, but with the right approach, stable remission can be achieved.

Advantages of visiting a professional clinic

  • Successful treatment of various forms of prostatitis
  • The most highly qualified experienced urologists and andrologists
  • Multidisciplinary allows to involve specialists in related fields to the treatment
  • High-precision modern diagnostic and treatment equipment
  • Own clinical diagnostic laboratory of European level
  • Comfortable and high-tech hospitals
  • A package of urological diagnostic services at an affordable price

Prevention of prostatitis

  • Choose protected sex to avoid sexually transmitted infections (STIs).
  • Support the immune system (vitamins, healthy diet, prevention of dysbiosis, reasonable antibiotic therapy, etc.)
  • Avoid hypothermia
  • Live an active lifestyle
  • If possible, have regular sex with a partner (to avoid prostate stasis and STIs)
  • Avoid having sex (this will relieve sperm stasis)
  • See your urologist once a year for preventive purposes, twice a year if you are over 50 or have prostate disease.

Frequently asked questions

How informative is the PSA test in the diagnosis of prostatitis?

Prostate-specific antigen (PSA) is a marker for prostate cancer.It is known that in some cases, prostate cancer has a clinical picture 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 prostate adenoma, a benign growth of glandular tissue.With prostatitis, PSA levels can also increase 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?

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