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Prostatitis

symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the prostate gland (prostate) in men, which has a negative impact on both sexual function and the process of urination.Pain in the perineum, groin, lower back and pelvic area, urodynamic disorders (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 disorders, which 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-andrologists have been successfully treating acute and chronic prostatitis for many years.Complex therapy, careful attention and an individual approach to each case inevitably lead patients to recovery and stable, long-term remission.

Prevalence

Prostatitis is in 5th place among the 20 main urological diagnoses.It is believed that by the age of 30, 30% of the male population suffers from prostatitis, by the age of 40-40% and after 50 years almost all men in one way or another bear the brunt of this disease.And if up to 35 years of age predominantly infectious prostatitis is recorded, at a more mature age the non-infectious form prevails and in general it is diagnosed many 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, under 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, into which 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 major role in this process.

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

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

Pathogenesis

There are two main reasons for the development of prostatitis:

  • stagnation of prostatic secretion against the background of reduced blood circulation and lymphatic outflow in the gland itself and nearby organs;
  • pathogenic and conditionally pathogenic microflora.

Acute prostatitis is usually associated with infection of the prostate tissue.But, as a rule, both factors are interrelated and together create a vicious circle that complicates the treatment of prostatitis.

The inflamed prostate gland becomes painful.Pain may be felt in the perineum, groin, pelvis, and lower back.It sharply intensifies upon palpation during a digital rectal examination or defecation.

The prostate increases in size, pinching the urethra.This makes it difficult for urine to flow out of the bladder.Urine flow becomes weak.The patient must strain the abdominal muscles so that the act of urination can occur.In acute cases, urinary tract obstruction and acute urinary retention sometimes occur.

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.With prolonged prostatitis, nearby organs can become inflamed: the 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 found that in 70-80% of cases prostatitis occurs due to stagnant processes in the gland.Venous disorders are less frequent, but they also cause prostatitis, especially if accompanied by hemorrhoids and varicocele on the left (dilation of the testicular vein).

Classification

The American National Institute 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 onset, prostatitis is divided into two types:

  • Non-infectious
  • Infectious

The inflammatory process can develop rapidly, accompanied by vivid symptoms (acute phase), or slowly with gradually increasing symptoms.

Non-infectious prostatitisin most cases, it is associated with stagnation of prostatic secretions and reduced blood and lymphatic circulation in the gland itself and nearby organs.

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

  • Urinogen (ascending): the gateway is the urethra.It should be noted that the infection can also enter via descending route, for example, in purulent pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphogenic: Infection of adjacent pelvic organs can enter the prostate through the lymph due to inflammation of the rectum (proctitis) or bladder (cystitis), as well as from infected hemorrhoidal veins.
  • Hematogenous (through blood): caused by the presence in the body of foci of chronic infection (tonsillitis, decayed teeth) or complications of acute infections (flu, acute respiratory infections, tonsillitis, etc.).

The most common causative agents of prostatitis are:

  • bacteria: Escherichia coli, Proteus, Gardnerella (gram-negative);staphylococci, streptococci (gram-positive);
  • viruses (flu, 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 pronounced symptoms.If it is not treated in time, a purulent process can develop which leads to fusion of the prostate tissue.If treated incorrectly, acute prostatitis often becomes chronic.

Chronic prostatitisit has a milder course, symptoms disappear.However, it can worsen from time to time and therefore the symptoms correspond to an acute process.However, complete remission does not always occur between flare-ups and the patient may constantly feel 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 the prostatic secretion contains a greater number of purulent elements (leukocytes).

Complications

Without adequate therapy, the inflammatory process can lead to purulent dissolution of the prostate tissue.Also, inflammation can spread to nearby organs: seminal tubercle, Cooper's glands, seminal vesicles, urethra.As a result, the following complications may occur:

  • Prostate abscess
  • Sclerosis/fibrosis of the prostate (the functional tissue of the gland is replaced by connective tissue)
  • Prostate cyst
  • Prostate stones
  • Vesiculitis (inflammation of the seminal vesicles)
  • Colliculitis (inflammation of the seminal tubercle)
  • Epididymo-orchitis (inflammation of the testicles 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 (may radiate along the spermatic cords).
  • The pain intensifies with defecation and rectal examination.
  • Urodynamic disorders (frequent urination, urinary retention, difficulty urinating, weak flow, incomplete emptying of the bladder).
  • Prostatorrhea (involuntary release of prostatic juice, especially in the morning and during bowel movements).
  • Sexual function disorders (decreased libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • The temperature rises to 39-40 degrees
  • Acute urinary retention
  • General intoxication
  • Leukocyturia, proteins 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 is usually no higher than 37°C
  • Pain sensations are dulled and dulled
  • Discharge from the urethra during bowel movements
  • Urinary disorders
  • Decreased libido
  • Erectile dysfunction
  • Ejaculation disorders (premature or delayed ejaculation)

Reasons

The main reasons for the development of prostatitis are infections and stagnation of prostatic 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 leading to depletion of the gland
  • Alcohol abuse
  • Decreased local immunity (hypothermia, use of immunosuppressants, immunodeficiency, autoimmune diseases)
  • Lesions of the pelvic organs
  • Manipulations on the prostate and nearby organs (prostate biopsy, surgery, catheterization, cystoscopy, etc.)
  • Chronic diarrhea or constipation

Diagnostics

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

Digital rectal examcarried out by a urologist-andrologist after an interview with the patient.This method allows you to evaluate the size, shape and some features of the structure of the prostate gland.If the size of the prostate is enlarged 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 to obtain prostatic secretion, the study of which represents 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.

To clarify the diagnosis, the patient will be asked to undergoinstrumental studies, such as:

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

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

Laboratory researchare a necessary component of the diagnosis of prostatitis:

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

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

The modern one has an excellent and highly informative diagnostic base.Urologists have extensive experience in successfully diagnosing and 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 types of necessary diagnoses at a very attractive price. 

Treatment

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

Drug therapy

It involves the use of the following drugs:

  • Antibiotics (after determining sensitivity to them)
  • Antiseptics (local)
  • Vascular drugs (improve microcirculation in the prostate)
  • Non-steroidal anti-inflammatory drugs
  • Alpha blockers (for urinary problems)
  • Enzyme preparations (thin prostatic secretion, stimulate the immune system, relieve inflammation)
  • Immunomodulators
  • Antidepressants

Physiotherapy treatment

  • Electrical stimulation of the prostate (electrophoresis, galvanization, pulsed action)
  • Vibromassage
  • Laser therapy with rectal sensor (for chronic prostatitis)

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

Surgical treatment

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

Forecast

With early diagnosis and adequate treatment, acute prostatitis can be overcome.However, very often the process becomes chronic even with correct and timely therapy.

If the treatment is not correct and the terms of treatment are not respected (several months), the disease usually takes a chronic course.Chronic prostatitis significantly affects the quality of a man's life, because not only urinary function suffers, but also sexual function.In 30% of cases, erectile dysfunction, loss of orgasmic intensity, ejaculation problems and infertility are observed.It is completely impossible to cure chronic prostatitis, but with the right approach it is possible to achieve a stable remission.

Advantages of visiting a professional clinic

  • Effective treatment of various forms of prostatitis
  • Expert urologists-andrologists of the highest qualification
  • Multidisciplinary, allowing specialists in related fields to be involved in the treatment
  • Modern, high-precision diagnostic and therapeutic equipment
  • Own European-class clinical diagnostic laboratory
  • Comfortable and highly technological hospitals
  • A package of urological diagnostic services at an attractive price

Prevention of prostatitis

  • Choose safe sex to avoid sexually transmitted infections (STIs)
  • Support the immune system (vitamins, healthy diet, prevention of dysbiosis, reasonable antibiotic therapy, etc.)
  • Avoid hypothermia
  • Lead an active lifestyle
  • Have sex regularly, if possible, with a partner (to avoid stagnation of the prostate and sexually transmitted diseases)
  • Avoid interrupted sexual intercourse (this will alleviate sperm stagnation)
  • Visit your urologist once a year for preventive purposes and twice a year if you are over 50 or have a history of prostate disease.

Frequently asked questions

How informative is the PSA test in diagnosing prostatitis?

Prostate specific antigen (PSA) is a marker of prostate cancer.It is known that in some cases prostate cancer presents 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 also increases in prostatic adenoma, a benign growth of glandular tissue.With prostatitis, PSA levels may also rise during periods of active inflammation.During the remission phase it decreases.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 blood-prostatic barrier.This makes it difficult for some types of antibiotics to penetrate glandular tissue.In addition, microorganisms tend to form biofilms that reliably protect them from the action of antibacterial agents.Therefore, modern protocols for the treatment of prostatitis necessarily include proteolytic enzymes that can destroy biofilms.The bacteria become vulnerable and the antibiotics work more effectively.Chronic prostatitis is the most persistent treated one, the main feature of which is the wide variety of microflora in the culture.In approximately 50% of cases, Enterococcus faecalis, resistant to all aminoglycosides and cephalosporins, is sown.This narrows the list of effective antimicrobial agents, also complicating treatment.