Prostatitis - symptoms and treatment

What is prostatitis? We will analyze the causes of occurrence, diagnosis and treatment methods in the article of a doctor, urologist with 28 years of experience.

Definition of disease. Causes of the disease

ProstatitisIs an inflammatory process of the prostate tissue, accompanied by pain in the lower back, perineum or pelvic region, as well as disturbances in the work of the lower urinary tract.

The prostate gland (prostate) refers to the male reproductive system. It sits in front of the rectum, below the bladder, and surrounds the urethra (urethra). That is why, when the prostate gland becomes inflamed, it compresses the urethra, which further leads to various problems with urination. The main function of the prostate is the production of secretion (fluid), which is part of the semen and liquefies it to ensure normal sperm motility.

Pathological conditions of the prostate gland, such as cancer or benign hyperplasia, are more common in older patients. Prostatitis differs in that it affects men of all age groups, but most often the disease occurs in men of reproductive age (from 8 to 35% of cases).

Prostatitis occurs most often in the practice of a urologist. It can occur suddenly (acutely) or gradually, and its manifestations are constant and long-term (chronic). The chronic form is much more common than the acute one. Chronic prostatitis ranks fifth among the twenty major urological diagnoses.

Prostatitis can be either an independent disease or be combined with benign prostatic hyperplasia and prostate cancer. In recent years, there has been a decrease in the incidence of prostatitis in the male population: if in 2012 the incidence was 275 per 100 thousand of the population, then in 2017 the primary incidence was 203 per 100 thousand of the population.

The reasons for the development of prostatitisare bacterial (infectious) and non-bacterial (non-infectious).Infectious prostatitismost common in males under the age of 35. Most often, this form of the disease is caused by gram-negative microorganisms, especially enterobacter, E. coli, serration, pseudomonas and proteus, as well as sexually transmitted infections, such as gonococcus, chlamydia, etc. Very rarely, prostatitis can occur due to mycobacterium tuberculosis. In chronic bacterial prostatitis, the spectrum of pathogens is broader and may include atypical pathogens. It should be remembered that chronic bacterial prostatitis is a polyetiological disease, that is, it can have several causes.

Factors contributing to the development of inflammationin the prostate gland:

• sexually transmitted infections;
• immunodeficiency states;
• biopsy of the prostate;
• invasive manipulations and operations;
• Lifestyle;
• diarrhea, constipation;
• homosexual contacts;
• frequent change of sexual partners;
• sedentary lifestyle, etc.

Chronic nonbacterial prostatitisdiagnosed in patients who complain of chronic pain in the prostate area, while an infectious (bacterial) causative agent of the disease has not been found in them. Despite numerous studies, the cause of this type of chronic prostatitis is not fully understood, however, there are some factors that can cause its development:

• increased prostatic pressure;
• muscle pain in the pelvic region;
• emotional disorders;
• Autoimmune disorders (antibodies that are supposed to fight infection, sometimes for some reason attack the cells of the prostate gland);
• physical activity;
• irregular sex life;
• lifting weights, etc.

In some cases, prostatitis may occur after performing transurethral procedures such as urethral catheterization or cystoscopy, as well as after transrectal biopsy of the prostate.

Although the true incidence of various types of prostatitis has not been definitively established, the following data are provided:

• acute bacterial prostatitis accounts for approximately 5-10% of all cases of prostatitis;
• chronic bacterial prostatitis - 6-10%;
• chronic non-bacterial prostatitis - 80-90%;
• prostatitis, including prostatodynia (neurovegetative disorders of the prostate gland) - 20-30%.

If you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of prostatitis

All forms of inflammationthe prostate gland, in addition to the asymptomatic, is united by the presence of the following symptoms:

• pain in the lumbar region;
• feelings of discomfort with intestinal peristalsis;
• pain in the perineum or pelvic region;
• disturbances in the work of the lower urinary tract.

The main symptoms of the lower urinary tract in the presence of prostatitis:

• frequent urge to urinate;
• difficulty urinating, that is, a weak stream and the need for "straining";
• burning pain or its intensification when urinating.

In men with diagnosedacute bacterial prostatitisPelvic pain and urinary tract symptoms such as increased urination and urinary retention occur. This can lead to the development of systemic manifestations such as fever, chills, nausea, vomiting, and malaise. Acute bacterial prostatitis is characterized by a sharp onset of the disease with a vivid clinical picture. This is a serious illness.

Men with diagnosedchronic bacterial prostatitisnote symptoms of a periodic nature that increase and decrease. With an exacerbation, pain and discomfort are noted. Pain sensations are localized mostly at the base of the penis, around or above the anus. Also, pain can occur just above the pubic bone or in the lower back, spreading to the penis and testicles. Defecation also becomes painful. Sometimes signs of infection of the lower parts of the urinary system develop: burning pain and frequent urination, frequent urge. These symptoms can be confused with acute bacterial prostatitis, but it usually has a sudden onset, chills, fever, weakness, pain throughout the body, in the lower back, and in the genitals, frequent and painful urination, pain during ejaculation. If you find such symptoms, you need to urgently consult a doctor.

If the standard modern examination has not established that chronic pain is caused by a pathological process in the prostate gland, then we are dealing with chronic non-bacterial prostatitis, which is also calledchronic pelvic pain syndrome(the term has been used since 2003). In the presence of chronic pelvic pain syndrome, a man's quality of life is significantly reduced, since this syndrome sometimes leads to various psychological and sexual disorders:

• increased fatigue;
• feeling helpless;
• erectile dysfunction;
• painful ejaculation;
• pain after intercourse, etc.

In chronic nonbacterial prostatitis / chronic pelvic pain syndrome, there is a feeling of persistent discomfort or pain in the lower back, more often at the base of the penis and around the anus, for at least 3 months. Painful sensations are localized in one "target organ" or several pelvic organs. Most often, with this form of prostatitis, pain is localized in the prostate gland (46%).

In chronic prostatitis, sexual disorders have a number of features. First, all components of the copulative (sexual) function of a man are disturbed to varying degrees: libido, erection, ejaculation. Secondly, sexual dysfunction occurs mainly in persons with a long (more than 5 years) history of the disease. Thirdly, sexual dysfunction is often the main reason for seeking medical attention.

Erectile dysfunction is noted by 30% of patients suffering from chronic prostatitis, largely due to the psychogenic factor - a catastrophic perception of the disease.

Symptoms of prostatitis occur at least once in a lifetime in 50% of men.

Pathogenesis of prostatitis

The mechanism of development of prostatitis is multifaceted and very complex. Many factors are involved in its development. Most cases of acute bacterial prostatitis are caused by a cascade of processes triggered by an ascending urethral infection or intraprostatic reflux (backflow of urine).

The penetration of microorganisms into the prostate gland is possible by the ascending route (through the urethra) or transrectally by the lymphatic route. Diarrhea and constipation associated with impaired rectal barrier function are considered as a provoking factor in chronic prostatitis. However, the mechanism of penetration of microorganisms into the prostate is still not clearly established.

Urinary disorder with prostatitis may result from:

• increasing the tone of smooth muscles of the prostatic urethra by increasing the activity of adrenergic receptors;
• enlargement of the prostate or narrowing of the urethra, resulting in turbulent urine flow, bladder outlet obstruction, and intraprostatic reflux.

In the future, there is a violation of the drainage of the ducts of the prostate gland, stagnation of prostate secretions, edema, activation of the arachidonic acid cascade, inflammation and ischemia. A vicious circle of pathological changes is formed.

Classification and stages of development of prostatitis

There are 4 main categories (types) of prostatitis.

1. Acute bacterial prostatitis(category I).
2. Chronic bacterial prostatitis(category II).
3. Chronic nonbacterial prostatitis / syndromechronic pelvic pain (category III). May be inflammatory (category III A) or non-inflammatory (category III B).
4. Asymptomatic inflammatory prostatitis.Histological prostatitis detected by biopsy of the prostate (category IV).

Chronic bacterial prostatitisUnlikespicy,manifests itself as recurrent episodes of exacerbation with the presence or absence of complete remissions between them. Symptoms are usually less severe than those of acute prostatitis.

National American Institutes of Health classification. . .

• Type I(acute bacterial prostatitis) - acute infection of the prostate gland: symptoms of the disease come on suddenly. Chills, fever, pain throughout the body, weakness, pain in the lower back and genital area, frequent, painful urination, pain during ejaculation. Potential symptoms of acute bacterial prostatitis include blood in the urine and / or semen. It is rare. It is effectively treated with antibiotics.
• II type(chronic bacterial prostatitis) - a chronic or recurrent infection of the prostate gland: the symptoms are the same as in acute prostatitis, but appear gradually and are less pronounced. Several courses of antibiotic therapy may be required.
• III type(chronic nonbacterial prostatitis and chronic pelvic pain syndrome): no evidence of infection.
• III A type: presence of leukocytes in ejaculate / prostate secretion / third portion of urine obtained after prostate massage.
• III B type: absence of leukocytes in ejaculate / prostate secretion / third portion of urine obtained after prostate massage. Pain in the lower back and genital area, frequent urge to urinate, difficulty urinating (often at night), burning or painful urination and ejaculation. Represents about 90% of all cases of prostatitis. There are no known causes or clinically proven treatments.
• IV type(asymptomatic inflammatory prostatitis): Sometimes an increased white blood cell count. No treatment required. Detected on prostate biopsy.

The boundaries between the various forms of prostatitis are blurred.

Complications of prostatitis

With inflammatory lesions of the prostate gland, nearby organs are involved in the pathological process: seminal tubercle, Cooper glands, seminal vesicles, posterior urethra. The infection can penetrate simultaneously into the prostate gland and the surrounding organs.

Vesiculitis- inflammation of the seminal vesicles. The pains are localized in the groin area and deep in the pelvis, radiating to the sacrum. The pain is usually one-sided, since both seminal vesicles are affected to varying degrees. Vesiculitis may be asymptomatic. The only complaint of patients may be the presence of blood in the semen. Periodic pyuria (pus in the urine) and pyospermia (pus in the ejaculate) are also noted.

Posterior urethritis, colliculitis (inflammation of the seminal tubercle). . . With prostatitis, the infection penetrates into the seminal tubercle, this is due to the proximity of the prostate gland to the excretory ducts.

Abscess of the prostate gland.The pathogens that cause prostatitis can also provoke an abscess of the prostate gland. This is a severe septic (bacterial) disease, which is accompanied by weakness, fever, chills with pouring sweat. In some cases, impaired consciousness and delirium are observed. The patient needs hospitalization.

Sclerosis of the prostate (fibrosis).This is a late complication of prostatitis, which is based on the replacement of prostate tissue with scars (connective tissue degeneration, that is, sclerosis), which leads to the fact that the gland shrinks, decreases in size and completely loses its function. As a rule, sclerotic symptoms develop long after the onset of the inflammatory process in the prostate gland.

Prostate cysts.These formations can contribute to the formation of stones in the prostate gland. The presence of an infection in a cyst can lead to a prostate abscess. It is not difficult to diagnose a prostate cyst using ultrasonography. They can also be detected with a digital rectal examination.

Prostate stones.They are quite common. The causes of the disease are not fully understood, but most experts agree that they arise as a result of a prolonged inflammatory process in the prostate gland. Stones are single and multiple, with a diameter of 1 to 4 mm. Large stones are rare. The stones clog the gland, because of which the secret stagnates in it, the gland is overstretched, separate cysts are formed, into which the infection enters. Patients with stones in the prostate gland have to deal with constant dull pain in the perineum. Painful sensations spread to the glans penis and cause frequent urge to urinate, which becomes difficult and painful.

Infertility. Chronic long-term prostatitis primarily reduces the motor function of sperm, making them completely immobile. One of the consequences is a violation of their production, the formation of immature spermatozoa that have an abnormally altered shape (and a smaller number of them than before).

Disorder of ejaculation.Prostatitis of all forms causes sexual dysfunction. At first, patients are faced with premature ejaculation, having a normal erection, which then weakens, and the degree of orgasm decreases. The prolonged existence of chronic prostatitis contributes to a decrease in the production of male sex hormones and a weakening of libido.

Erectile dysfunction.The relationship between chronic prostatitis / chronic pelvic pain syndrome and erectile dysfunction has been described. This disorder is especially painful for men.

Diagnosis of prostatitis

The appearance of the first signs of inflammation of the prostate gland requires immediate medical attention. The urologist will exclude many diseases that have similar manifestations, and determine which category (type) the disease belongs to. Before choosing a treatment, a specialist will conduct the necessary examinations and offer to undergo an evaluation test.

What questions the doctor might ask

At the appointment, the doctor will definitely specify: the duration of the clinical manifestations of the disease, the location and nature of the pain, for example, in the perineum, scrotum, penis and inner thigh; changes in the nature of the semen (the presence of pus and blood).

At the reception, the urologist will offer to fill out special questionnaires, one of them is the index of symptoms of chronic prostatitis.

The patient should ask the doctor questionsabout what tests and studies will need to be done, how to prepare for them, what treatment he plans to prescribe and where I can get more information about the disease.

Chronic bacterial prostatitis is diagnosed when symptoms last for at least three months.

The survey will include:

• Digital rectal examination of the gland to determine the extent of prostate enlargement and its consistency.

• Tests of secretions of the prostate, urine and / or ejaculate.
• Identification of urogenital infection.
• Ultrasound examination of the urinary system (kidneys, prostate, bladder with determination of residual urine).

• Urodynamic study.

In the case of acute bacterial prostatitis, a swollen and painful prostate gland can be found with a digital rectal examination. Prostate massage is contraindicated as it can lead to bacteremia and sepsis.

The most important study in the examination of patients with acute bacterial prostatitis is the culture of prostate secretions. In order to categorize chronic prostatitis, quantitative culture and microscopy of urine samples and prostate secretions obtained after massage of the prostate are still important methods.

Androflor - a comprehensive study of the microbiocenosis of the urogenital tract in men by PCR. Allows you to determine the qualitative and quantitative composition of microflora. It is used to diagnose and control the treatment of inflammatory infectious diseases of the genitourinary system.

After identifying the cause of the disease, the doctor will recommend a course of treatment. It must be remembered that standard methods only in 5-10% of cases can detect an infection, which ultimately leads to prostatitis.

What is the relationship between prostatitis, prostate specific antigen (PSA) and prostate cancer

Measurement of total PSA and free PSA levels in prostatitis does not provide additional diagnostic information. It is known that in 60 and 20% of patients with acute and chronic bacterial prostatitis, the level of prostate-specific antigen (PSA), respectively, increases. After the end of treatment, the PSA level decreases in 40% of patients. PSA is not considered a specific marker for prostate cancer because PSA levels can be elevated in benign prostatic hyperplasia and prostatitis.

Treatment of prostatitis

The leading role in the treatment of pathology is assigned to drug therapy.

Treatment with alpha1-blockers

Alpha1-blockers are prescribed for patients who complain of difficulty urinating. These medicines help to ease urination and relax the muscles of the prostate gland and bladder. Some patients are prescribed drugs to lower hormone levels, which can help shrink the gland and reduce discomfort. Muscle relaxants can help relieve pain caused by an edematous prostate putting pressure on nearby muscles. Non-steroidal anti-inflammatory drugs (NSAIDs) may help if pain is present.

Standard antibiotic therapy in most cases does not lead to a decrease in the number of relapses of the disease, in connection with which an integrated approach is often used and is also prescribedauxiliary drugs: biostimulants, extracts of various plants and insects and their biological components, which can be in the formrectal suppositories. . . Despite the large arsenal of drugs, the effectiveness of their use remains insufficient.

Physiotherapy in the treatment of prostatitis

For chronic prostatitis of categories II, III A and III B, physiotherapeutic methods can be additionally used:

• massage of the prostate gland (prostate);
• laser therapy;
• microwave hyperthermia and thermotherapy;
• electrical stimulation with modulated currents of cutaneous or rectal electrodes;
• acupuncture (acupuncture).

The effectiveness and safety of these treatments are still under study. Also used for the treatment of prostatitisfolk methods, eghirudotherapy.The effectiveness and safety of this method for the treatment of prostatitis has not been proven.

Stem cell injection

Cell therapy (stem cell injections) in the treatment of prostatitis is currently a promising technique in the early stages of development. At the moment, regarding the injection of stem cells into the prostate, we can only have hypotheses about its mechanisms, as well as empirical data obtained by individual groups of researchers.

Surgical treatment of prostatitis

Surgical methods are used only to treat complications of prostatitis - abscess and suppuration of seminal vesicles.

The treatment of chronic pelvic pain syndrome requires separate consideration. Asymptomatic inflammatory prostatitis (category IV) should not be treated unless the patient plans to have prostate surgery. In this case, the patient is given a prophylactic course of antibiotic therapy.

Diet and lifestyle for prostatitis

A special diet for prostatitis is not required, but eating a lot of vegetables, lean meat and dairy products will improve bowel function. It is important to consume enough fiber, foods rich in vitamin E (wheat germ, corn oil, etc. ), sugar should be replaced with natural honey. Proper nutrition for prostatitis can improve bowel function and reduce the likelihood of relapse or speed recovery. It is recommended to adhere to a healthy lifestyle, drink more fluids, and limit caffeine and alcohol.

Forecast. Prevention

Acute prostatitis often becomes chronic, even with timely and adequate treatment.

Full recovery is not always possible to achieve, however, with correct consistent therapy and following the doctor's recommendations, it is possible to eliminate discomfort and pain. Independenthome prostatitis treatmentcan be dangerous and lead to complications.

Not in all cases of prostatitis it is possible to determine the cause, however, there are a number of steps you can take to try to prevent the occurrence of prostatitis. The same steps can help control the symptoms that are already present:

1. Drink plenty of fluids. Drinking plenty of fluids leads to frequent urination, thereby facilitating the flushing of infectious agents from the prostatic urethra.
2. Empty your bladder regularly.
3. Avoid irritation of the urethra. Limit your intake of caffeine, spicy foods, and alcohol.
4. Reduce pressure on the prostate. Men who ride a bike frequently need to use a split seat to relieve pressure on the prostate area.
5. Stay sexually active.