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).
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.
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 the pelvic organs, involvement in the inflammatory process of the 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 the 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".
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
The characteristic clinical picture facilitates the diagnosis process in acute and chronic prostatitis. It is mandatory:
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 tissues well are widely used.
With the development of acute urinary retention against the background of prostatitis, since there is a danger of the formation of an abscess of the prostate, they resort to the installation of a cystostomy, not a urethral catheter. 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 case of 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.
Antibiotic therapy is most effective for the treatment of prostatitis. Phytotherapy, immunocorrectors and hormonal preparations can also be used as prescribed by the doctor.
In the absence of acute symptoms, prostatitis can be treated with physiotherapy methods. In case of abscess and suppuration, surgical intervention is recommended.
Treatment with drugs
Treatment of prostatitis through antibiotic therapy should begin with bakposev, the purpose of which is to assess the sensitivity of the body to this type of antibiotics. A good result with urinary disorders is the use of anti-inflammatory drugs.
Medicines are taken in tablets, in acute cases - in the form of drops or intramuscularly. Rectal suppositories are effective for the treatment of chronic forms of prostatitis: with their help, drugs reach their goals faster and have a minimal effect on other organs.
Blood thinners and anti-inflammatory drugs have also proven themselves well.
Antibacterial therapy
Antibiotics are an effective tool in the fight against bacterial prostatitis. In order to achieve the desired effect and not harm the body, the choice of medicine, dosage and treatment regimen should be carried out by a doctor. For the correct selection of the most effective drugs, he should find out what kind of pathogen causes prostatitis, and also check the patient's tolerance to a certain group of antibiotics.
For the effective treatment of chronic prostatitis, antibiotics of the fluoroquinolone group have proven themselves well. Their action is aimed at preventing bacterial infection and strengthening the body's own immunity. In addition, a bacteriostatic antibiotic is recommended for the prevention and treatment of concomitant diseases of the genitourinary system.
Prostatitis caused by mycoplasma and chlamydia can be additionally treated with macrolide and tetracycline drugs that slow down the spread of infection.
The duration of taking antibacterial drugs is from 2 to 4 weeks. In case of positive dynamics, the course can be extended.
Physiotherapy
Physiotherapy methods in the treatment of prostatitis are aimed at activating blood circulation in the pelvis, improving metabolic processes in the prostate gland, and cleaning channels. If physiotherapy is combined with taking antibiotics, the effect of the latter is strengthened.
The main methods include:
- magnetotherapy;
- laser therapy;
- electrophoresis;
- warming up;
- ultrasound;
- mud treatment;
- high frequency radiation;
- physiotherapy.
One of the oldest methods - transrectal prostate massage, according to modern research, has no proven effectiveness.
Non-specific treatments
Non-specific treatment of prostatitis includes:
- hirudotherapy;
- therapeutic fasting;
- acupuncture;
- Diet according to Ostrovsky's method;
- Alkalization of the body by the Neumyvakin method.
All non-traditional methods of prostatitis treatment should be agreed with your doctor.
Surgery
In complex and emergency cases, surgical methods are used:
- for drainage of purulent abscesses removed by laparoscopic methods through puncture;
- in urinary disorders due to damage to the urinary tract;
- with a large volume of the affected area;
- with a significant number of stones in the body of the gland.
Stones and sclerosed tissues are removed endoscopically. With a large area of damage or many stones, resection of the prostate is indicated.
Transurethral resection is also effective in bacterial prostatitis. Thus, it is possible to reduce the risk of relapse.
Folk treatment
Treatment of prostatitis with folk remedies is unlikely to be effective on its own, but it can be applied in combination with medical and physiotherapeutic methods. These include: beekeeping products, decoctions of herbs and seeds, garlic, ginger, beaver flow, fresh vegetables, pumpkin seeds.
In acute cases of the course of the disease, you must consult a doctor and in no case do not self-medicate! A fatal outcome is possible in case of rupture of a purulent abscess.
Candles for prostatitis
Treatment of prostatitis with rectal suppositories is much more effective than tablets, if the rectum is closer to the prostate, it means that the medicine will work faster.
The composition of drugs for the treatment of prostatitis can be completely different, they are prescribed to solve a specific problem.
- Antibacterial agents are particularly effective for prostatitis caused by chlamydia.
- Painkillers are used for symptomatic treatment, they relieve pain well.
- Immunostimulants improve blood circulation, eliminate swelling and are used in complex therapy.
- Phytopreparations have a mild effect. They are used in addition to the main treatment, like candles on bee products.
- Compositions based on ichthyol promote blood flow in the region of the intestinal mucosa, which accelerates the weakening of inflammatory processes and slightly improves immunity.
- Enzyme-based products prevent the formation of scar tissue. It is recommended to take it as part of complex therapy with antibiotics, anti-inflammatory and analgesics.
Auxiliary drugs
For the symptomatic treatment of prostatitis in men, for example, to relieve pain during urination, in addition, you can take antispasmodics that relax smooth muscles and thereby quickly relieve pain.
Blood thinning and anti-inflammatory dietary supplements based on bee products, pumpkin seed oil, and palm fruit extracts help overall recovery.
Diet and lifestyle
A proper, balanced diet and a healthy lifestyle are very important for the treatment of prostatitis. The food should not contain spicy, fried, salty or acidic foods. Alcohol in acute form is strictly prohibited.
Food should have enough fiber to prevent constipation. The amount of protein should be reduced. It is desirable to supplement the diet with herbs, ginger, pumpkin seeds.
Non-drug treatment
Non-drug methods of therapy allow to act directly on the prostate, increase the drug concentration in its tissues, help to eliminate the blockage.
Microwave hyperthermia is performed using a rectal probe inserted into the patient's anus. You can set the required temperature for a certain type of exposure on the device. To increase the concentration of the drug in the prostate, it is necessary to warm it to 38-40 ° C. To achieve an antibacterial effect - 40-45 ° C.
Today, non-drug treatment focuses on laser therapy. The possibilities of this technique are wide. Under the influence of the laser, the following processes occur in the prostate gland:
- activation of redox reactions;
- improves blood microcirculation;
- new capillaries are formed;
- pathogenic microflora is suppressed;
- the process of cell division is activated, which helps tissue regeneration.
During studies on the effect of laser therapy on patients with prostatitis, side effects, but positive for therapeutic purposes, were noted. In those who finished the course, potency increased, erectile dysfunction was eliminated, vitality was restored. To achieve this result, it is necessary to use a beam with a certain wavelength. In general, low-intensity laser radiation is used in the treatment of chronic prostatitis.
Patients can undergo a course of laser therapy on their own initiative, if not prescribed by the attending physician.
Surgical treatment of chronic prostatitis
Chronic prostatitis does not threaten the patient's life, but it can significantly reduce its quality. The most serious complication of this disease is the formation of stones in the tissues of the gland. Transurethral resection is used to free it from prostatitis.
The operation is carried out under the supervision of TRUS.
If complications such as sclerosis of the prostate gland occur, transurethral electrosurgery is performed. If sclerosis of the bladder neck is observed along with this pathology, a partial resection of the prostate is performed.
Endoscopic operations are indicated to eliminate the violation of the openness of the secret due to the blockage of the seminal and excretory ducts. For this purpose, an incision is made in the seminal vesicles and excretory ducts. With an abscess, it is possible to completely remove the gland.
Consequences of untreated prostatitis
Even if the symptoms of prostatitis do not appear for a long time, it is necessary to undergo regular examination by a urologist. Untreated prostatitis can be accompanied by the formation of calcifications, which must be removed together with the gland. Experts are sure that there are no other methods to remove or dissolve stones.
In addition, pathogenic microorganisms can migrate to neighboring organs, causing inflammation. Running can lead to the development of prostatitis adenoma and prostate cancer.
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 sexual abstinence 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.