What is prostatitis?This is the most common urological disease in men against the background of inflammation of the prostate gland, caused by a pathogenic (definitely causing the disease) and conditionally pathogenic infection.
In most cases, in young, sexually active men, it is a complication of sexually transmitted diseases with little or no symptoms.The cause of the development of prostatitis can be: Trichomonas, gonococci (causing gonorrhea), chlamydia, ureaplasma, mycoplasma.Among organisms not related to sexually transmitted diseases, E.coli, fecal enterococcus, etc.
According to the modern classification there are:
- Acute prostatitis.
- Chronic bacterial prostatitis.
- Chronic prostatitis (chronic pelvic pain syndrome) with signs of inflammation.
- Chronic prostatitis (chronic pelvic pain syndrome) without signs of inflammation.
- Asymptomatic prostatitis (asymptomatic) chronic prostatitis.
Currently, in most cases, we have to deal with the latter category of prostatitis in men, since in recent years trichomoniasis, chlamydia, ureaplasmosis and mycoplasmosis have acquired a leading role in the structure of sexually transmitted diseases, which initially, in the vast majority of cases, do not present any manifestations, that is, they do not bother a person in any way.And only after a long time do they manifest themselves as a complication - prostatitis.
It should be said that asymptomatic prostatitis is detected in most patients who simply come for examination for sexually transmitted diseases, in sexual partners of women with sexually transmitted diseases, as well as in patients with infertility.
Causes of prostatitis
As a rule, prostatitis is diagnosed when:
- decrease in physical activity (sedentary lifestyle);
- arrhythmias of sexual life (prolonged sexual abstinence, often replaced by a hyperactive sexual life);
- alcohol abuse;
- chronic constipation;
- following an infection with an STI - urethrogen prostatitis, that is, which occurs when infections enter the prostate from the urethra;
- due to the penetration of pathogens from foci of chronic infection (chronic tonsillitis, sinusitis, kidney disease, etc.);
- for diseases of the rectum (hemorrhoids, anal fissure, paraproctitis) - endogenous prostatitis.This explains the detection of E. coli in most cases of chronic prostatitis.
Symptoms of prostatitis in men
It begins with a rise in temperature up to 39-40°C with fever and chills, difficulty urinating, pain and burning during urination;in more severe cases, due to swelling of the glandular tissue, acute urinary retention occurs, a condition that requires surgical intervention.
It proceeds without manifestations.It is mainly detected in patients who seek testing for sexually transmitted diseases after casual sexual intercourse.It is also detected in patients who came for examination as sexual partners of women with sexually transmitted diseases or in patients with sperm pathology.
Manifests:
- Discomfort and pain in the lower abdomen, perineum, sometimes patients note that the pain radiates to the head of the penis or urethra.
- Urinary disorders.Frequent and painful urination, sensation of not having finished urinating (often with hypothermia), urination one to several times during the night, difficulty urinating and weakening of urine flow.
- Sexual function disorder.Pain and discomfort during ejaculation, pain in the urethra and rectum, weakening or loss of sensation of orgasm, etc.
- Changes in the fertilizing capacity of spermatozoa.
- As a result, the patient increases anxiety and nervousness, caused by hyper-fixation of attention on his condition.
Complications of prostatitis
In the absence or inadequate treatment of prostatitis, the following complications may occur:
- Transition of acute to chronic prostatitis.
- Acute urinary retention (the patient cannot urinate for a long time) may require surgery.
- Development of male infertility.
- Formation of scars and adhesions in the urethra with subsequent narrowing.
- Development of inflammation of the bladder (cystitis).
- Inflammatory kidney diseases (pyelonephritis, etc.).
- The appearance of purulent inflammation of the prostate in men (prostate abscess), which requires surgical intervention.
- Sepsis (penetration of the infection into the bloodstream resulting in damage to the organs and systems of the entire body) is a formidable and life-threatening complication.It develops more often in patients with reduced function of the immune system, in patients with diabetes mellitus, in patients with chronic renal failure, in patients with AIDS, etc.
Diagnosis of prostatitis
The diagnosis of prostatitis is made in patients with characteristic disorders, as well as in patients with identified sexually transmitted diseases and identified infertility.
Diagnostics include:
- Digital examination of the prostate (through the rectum) with collection and examination of prostatic secretion (juice), when the presence of inflammation in the gland is detected.
- Urinalysis: general analysis, 2 or 4 glasses of urine, bacteriological examination (detection of prostatitis pathogens), cytological examination (detection of cancer).
- Uroflowmetry: evaluation of the characteristics of the urine flow, its quantity, flow rate, duration of urination.
- Ultrasound tests to identify urinary residues, organic lesions of the prostate, formal signs of prostatitis.
Sometimes, to diagnose prostatitis and exclude cancer, the following are also prescribed:
- Sperm studies.
- Prostate biopsy.
- PSA blood test (to detect cancer).
- Computed tomography of the pelvic organs.
- Nuclear magnetic resonance examination of the pelvic organs, etc.
Treatment of prostatitis
Treating bacterial prostatitis caused by an STI is no easy task.Adequate and timely therapy leads to complete healing of this category of prostatitis after complete elimination (disappearance) of STI pathogens in the majority of patients.It is worth saying that complete healing of prostatitis caused by a vulgar infection (not an STI) occurs only in 30% of cases, despite the achievements of modern medicine.In these cases the goal is to achieve a stable remission of the disease.
Modern treatment of prostatitis includes:
- Antibacterial therapy for at least 2 weeks, sometimes up to 1-2 months or longer.
- Treatment of pain syndrome (anti-inflammatory drugs in the form of suppositories, injections, tablets).
- Treatment of urinary disorders (α-1-blockers, 5-α-reductase blockers).
- Physiotherapy treatment methods (magnetotherapy, laser therapy, etc.).
- Prostate massage.
Patients are also recommended to make lifestyle changes, namely:
- regular sexual life without sexual excesses;
- give up alcohol and a sedentary lifestyle;
- mandatory use of barrier contraception;
- treatment of digestive tract diseases causing stool retention, etc.