prostatitisis an inflammatory disease of the prostate gland. It manifests itself with frequent urination, pain in the penis, scrotum, rectum, sexual disorders (erection, early ejaculation, etc. ), sometimes retention of urine, blood in the urine. The diagnosis of prostatitis is established by a urologist or andrologist based on the typical clinical picture, the results of the rectal examination. In addition, an ultrasound of the prostate, back culture of prostate secretion and urine is performed. The treatment is conservative - antibiotic therapy, immunotherapy, prostate massage, lifestyle correction.
Main 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 most often affects patients aged 25-50 years. According to various data, 30-85% of men over the age of 30 suffer from prostatitis. Possible formation of an abscess of the prostate gland, inflammation of the testicles and appendages, which threatens infertility. The rise of the infection leads to inflammation of the upper genitourinary system (cystitis, pyelonephritis).
The pathology develops with the penetration of an infectious agent that enters the prostate tissue from the organs of the genitourinary system (urethra, bladder) or from a distant inflammatory focus (with pneumonia, influenza, tonsillitis, furunculosis)
Causes of prostatitis
Staphylococcus aureus (Staphylococcus aureus), Enterococcus (Enterococcus), Enterobacter (Enterobacter), Pseudomonas (Pseudomonas), Proteus (Proteus), Klebsiella (Klebsiella) and Escherichia coli (E. Coli) can act as an infectious agent in an acute process. . Most microorganisms belong to the conditionally 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 the tissues of the prostate. There are the following predisposing factors:
- General hypothermia (single or permanent, related to working conditions).
- Sedentary lifestyle, profession that forces a person to be in a sitting position for a long time (computer operator, driver, etc. ).
- Constant constipation.
- Violations of the normal rhythm of sexual activity (excessive sexual activity, prolonged abstinence, incomplete ejaculation during "usual" intercourse, devoid of emotional coloring).
- The presence of chronic diseases (cholecystitis, bronchitis) or chronic infectious foci in the body (chronic osteomyelitis, untreated caries, tonsillitis, etc. ).
- Past urological diseases (urethritis, cystitis, etc. ) and sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea).
- Conditions that cause suppression of the immune system (chronic stress, irregular and malnutrition, regular lack of sleep, overtraining in athletes).
It is assumed 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 motorists, motorcyclists and cyclists is a provoking factor. However, the majority of experts believe that all these circumstances 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.
Congestion in the tissues of the prostate plays a decisive role in the occurrence of prostatitis. Violation of capillary blood flow causes an increase in lipid peroxidation, edema, 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 catarrhal. Patients complain of frequent, often painful urination, pain in the sacrum and perineum.
- Acute follicular. The pain becomes more intense, sometimes radiates to the anus, intensifies during defecation. Urination is difficult, urine comes out in a thin stream. In some cases, there is retention of urine. A subfebrile state or moderate hyperthermia is characteristic.
- Acute parenchymal. Severe general intoxication, hyperthermia up to 38-40 ° C, chills. Dysuric disorders, often - acute retention of urine. Sharp, throbbing pain in perineum. Difficulty defecating.
Chronic prostatitis
In rare cases, chronic prostatitis becomes the result of an acute process, but as a rule, a primary chronic course is observed. Sometimes the temperature rises to subfebrile values. The patient notes slight pain in the perineum, discomfort during the act of urination and defecation. The most characteristic symptom is scanty discharge from the urethra during defecation. The primary chronic form of the disease develops over a considerable period of time. It is preceded by prostatosis (blood stagnation in the capillaries), gradually turning into abacterial prostatitis.
Chronic prostatitis is often a complication of the inflammatory process caused by the causative agent of a specific infection (chlamydia, trichomonas, ureaplasma, gonococcus). Symptoms of a specific inflammatory process in many cases mask the manifestations of prostate damage. Perhaps a slight increase in pain during urination, slight pain in the perineum, scanty discharge from the urethra during defecation. A slight change in the clinical picture often goes unnoticed by the patient.
Chronic inflammation of the prostate gland can manifest itself with a burning sensation in the urethra and perineum, dysuria, sexual disorders, increased general fatigue. The consequence of potency disorders (or fear of these disorders) often becomes mental depression, anxiety and irritability. The clinical picture does not always include all the listed groups of symptoms, it is different for 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 becomes almost inevitable due to the abundant innervation of the pelvic organs, the involvement of the nerve pathways in the inflammatory process. Patients complain of pain of varying intensity - from weak, aching to intense, disrupting sleep. There is a change in the nature of the pain (intensification or weakening) with ejaculation, excessive sexual activity or sexual abstinence. The pain spreads to the scrotum, sacrum, perineum, sometimes in the lumbar region.
As a result of inflammation in chronic prostatitis, the volume of the prostate increases, pressing the urethra. The lumen of the ureter is reduced. The patient has a frequent urge to urinate, a feeling of incomplete emptying of the bladder. As a rule, dysuric phenomena are manifested in the early stages. Compensatory hypertrophy of the muscle layer of the bladder and ureters then develops. Symptoms of dysuria during this period weaken and then increase again with decompensation of adaptive mechanisms.
In the initial stages, dyspotency may develop, which manifests itself differently in different patients. Patients may complain of frequent nocturnal erections, blurred orgasm or worsening erection. Accelerated ejaculation is associated with a decrease in the threshold level of arousal of the orgasmic center. Painful sensations during ejaculation can cause refusal of sexual activity. In the future, sexual dysfunctions become more pronounced. In an advanced stage, impotence develops.
The degree of sexual disorder is determined by many factors, including the sexual constitution and psychological mood of the patient. Violations of potency and dysuria can be due both to changes in the prostate gland and to the suggestibility of the patient, who, if he has chronic prostatitis, expects the inevitable development of sexual disorders and urination disorders. Psychogenic dyspotence and dysuria develop especially often in suggestible, anxious patients.
Impotence, and sometimes the very threat of possible sexual disorders, is difficult for patients to tolerate. Often there is a change in character, irritability, unpleasantness, excessive concern for one's own health and even "sickness care".
Complications
In the absence of timely treatment of acute prostatitis, there is a significant risk of developing a prostate abscess. With the formation of a purulent focus, the patient's body temperature rises to 39-40 ° C and can become hectic. Periods of heat alternate with severe chills. Sharp pains in the perineum make it difficult to urinate and make defecation impossible.
Increasing swelling of the prostate leads to acute urinary retention. Rarely, an abscess spontaneously ruptures into the urethra or rectum. When opened, purulent, cloudy urine with an unpleasant pungent odor appears in the urethra, when opened, feces contain pus and mucus in the rectum.
Chronic prostatitis is characterized by an undulating course with periods of prolonged remissions, during which the inflammation in the prostate is latent or manifests itself with extremely weak symptoms. Patients who are not worried about anything often stop treatment and return only when complications develop.
The spread of the infection through the urinary tract causes the appearance of pyelonephritis and cystitis. The most common complication of the chronic process is inflammation of the testicles and epididymis (epdidymorchitis) and inflammation of the seminal vesicles (vesiculitis). The result of these diseases is often infertility.
Diagnosis
The characteristic clinical picture facilitates the process of diagnosis in acute and chronic prostatitis. It is mandatory to:
Treatment of prostatitis
Treatment of acute prostatitis
Patients with an uncomplicated acute process are treated by a urologist on an outpatient basis. In case of severe intoxication, suspected purulent process, hospitalization is indicated. Antibacterial therapy is administered. Preparations are selected taking into account the sensitivity of the infectious agent. Antibiotics, which can penetrate well into the tissues of the prostate, are widely used.
With the development of acute urinary retention on the background of prostatitis, a cystostomy is resorted to, rather than a urethral catheter, because there is a danger of prostate abscess formation. 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). The choice of the type and dosage of antibacterial drugs, as well as the determination of the duration of the course of treatment, is made individually. The drug is selected based on the sensitivity of the microflora according to the results of the culture of urine 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 impossible to carry out physiotherapy procedures, the patient is prescribed warm medicinal microclysters.
In case of chronic, prolonged inflammation, a consultation with an immunologist is indicated for choosing the tactics of immunocorrective therapy. The patient is given advice on lifestyle changes. Changing the lifestyle of a patient with chronic prostatitis is both a curative and preventive measure. The patient is recommended to normalize sleep and wakefulness, establish a diet, conduct moderate physical activity.
For the treatment of prostatitis, antibiotic therapy is most effective. Phytotherapy, immunocorrectors and hormonal preparations can also be used according to a doctor's prescription.
In the absence of acute symptoms, prostatitis can be treated with physiotherapeutic methods. In case of abscesses and suppurations, surgical intervention is recommended.
Drug treatment
Treatment of prostatitis by antibiotic therapy should begin with bakposev, the purpose of which is to assess the body's sensitivity to this type of antibiotic. The use of anti-inflammatory drugs is a good result for urinary disorders.
Medicines are taken in tablets, in acute cases - in the form of a dropper or intramuscularly. For the treatment of chronic forms of prostatitis, rectal suppositories are effective: with their help, drugs reach their goal faster and have a minimal effect on other organs.
Blood thinners and anti-inflammatory drugs have also been shown to work well.
Antibacterial therapy
Antibiotics are an effective means of combating bacterial prostatitis. In order to achieve the desired effect and not to harm the body, the choice of the drug, the dosage and the treatment regimen should be carried out by a doctor. For the correct selection of the most effective drugs, he will need to find out which type of pathogen caused prostatitis, as well as check the patient for tolerance to antibiotics of a certain group.
For effective treatment of chronic prostatitis, antibiotics from the fluoroquinolone group have proven themselves well. Their action is aimed at suppressing 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.
Treatment of prostatitis caused by mycoplasma and chlamydia can be done additionally with macrolide and tetracycline drugs that slow the spread of the infection.
The duration of taking antibacterial drugs is from 2 to 4 weeks. With positive dynamics, the course can be extended.
Physiotherapy
Physiotherapy methods for the treatment of prostatitis are aimed at activating blood circulation in the pelvic area, improving metabolic processes in the prostate gland and cleaning the channels. If physiotherapy is combined with taking antibiotics, then the effect of the latter is enhanced.
The main methods include:
- magnetic therapy;
- laser therapy;
- electrophoresis;
- warm up;
- ultrasound;
- mud treatment;
- high frequency radiation;
- physiotherapy.
One of the oldest methods – transrectal massage of the prostate, according to modern research, has no proven effectiveness.
Non-specific treatments
Non-specific treatments for prostatitis include:
- hirudotherapy;
- therapeutic fasting;
- acupuncture;
- diet according to the Ostrovsky method;
- alkalinization of the body by the Neumyvakin method.
All non-traditional methods of prostatitis treatment are strongly recommended to be agreed with your doctor.
surgery
Surgical methods are used in complex and urgent cases:
- for draining purulent abscesses, which are removed laparoscopically by puncture;
- in case of urination disorder 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 by endoscopic methods. In case of a large area of damage or multiple stones, resection of the prostate is resorted to.
Transurethral resection is also effective in bacterial prostatitis. In this way, it is possible to reduce the risk of relapse.
People's funds
Treatment of prostatitis with folk remedies is unlikely to be effective by itself, but in combination with medical and physical therapy methods may be applicable. These include: bee products, decoctions of herbs and seeds, tinctures of garlic, ginger, beaver jet, fresh vegetables, pumpkin seeds.
In acute cases of the course of the disease, you should consult a doctor and in no case self-medicate! If a purulent abscess bursts, a fatal outcome is possible.
Candles for prostatitis
Treatment of prostatitis with rectal suppositories is much more effective than tablets, if only because the rectum is much closer to the prostate, which 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 in prostatitis caused by chlamydia.
- Painkillers are used for symptomatic treatment, they relieve pain well.
- Immunostimulants improve blood circulation, relieve swelling and are used in complex therapy.
- Phytopreparations have a mild effect. They, like candles on bee products, are used as an addition to the main treatment.
- Compositions based on ichthyol promote blood flow in the area of the intestinal mucosa, which accelerates the weakening of inflammatory processes and slightly improves immunity.
- Enzyme-based products prevent scarring. It is recommended to be taken as part of complex therapy with antibiotics, anti-inflammatory and analgesic drugs.
Auxiliary drugs
For symptomatic treatment of prostatitis in men, such as relieving pain during urination, you can additionally take antispasmodics that relax smooth muscles and thus quickly relieve pain.
Blood-thinning and anti-inflammatory nutritional supplements based on bee products, pumpkin seed oil, palm fruit extracts contribute to general recovery.
Diet and lifestyle
Proper, balanced nutrition and a healthy lifestyle are very important for the treatment of prostatitis. Food should not contain spicy, fried, salty, pickled foods. In the acute form, alcohol is strictly prohibited.
Food should contain enough fiber to prevent constipation. The protein content should be reduced. It is desirable to supplement the diet with herbs, ginger, pumpkin seeds.
Non-drug treatment
Non-drug methods of therapy allow you to act directly on the prostate, increase the concentration of drugs in its tissues, help to eliminate congestion.
Microwave hyperthermia is performed using a rectal probe that is inserted into the patient's anus. On the device, you can set the temperature required for a certain type of exposure. To increase the concentration of the drug in the prostate, heating to 38-40°C is required. 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 a laser in the prostate gland, the following processes take place:
- activation of redox reactions;
- improves blood microcirculation;
- new capillaries are formed;
- pathogenic microflora is suppressed;
- the process of cell division is activated, which contributes to tissue regeneration.
In the period of research on the effects of laser therapy in patients with prostatitis, a side effect was noted, but positive for the purposes of treatment. In those who have completed the course, potency increases, erectile dysfunction is eliminated and vitality is restored. To achieve this result, it is necessary to use a beam of a certain wavelength. Generally, low-intensity laser radiation is used to treat chronic prostatitis.
Patients can, on their own initiative, undergo a course of laser therapy if it is not prescribed by the attending physician.
Surgical treatment of chronic prostatitis
Chronic prostatitis does not pose a threat to 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. To get rid of prostatitis, transurethral resection is used.
Surgery is performed under TRUS guidance.
If complications such as prostatic sclerosis occur, transurethral electrosurgery is performed. If sclerosis of the bladder neck is observed in combination with this pathology, a partial resection of the prostate is performed.
In the case of obstruction of the seminal and excretory ducts, endoscopic operations are indicated to remove the disorders of secretion permeability. For this purpose, an incision is made on the seminal vesicles and excretory ducts. In the case of an abscess, complete removal of the gland is possible.
Consequences of untreated prostatitis
Even if the symptoms of prostatitis do not appear for a long time, it is necessary to regularly undergo an examination by a urologist. Incompletely cured prostatitis can be accompanied by the formation of calcifications, which must then be removed together with the gland. Experts are sure that there are no other ways to remove or dissolve stones.
In addition, pathogenic microorganisms can migrate to neighboring organs, causing inflammation. Flowing prostatitis can cause the development of prostate adenoma and cancer.
Prognosis and prevention
Acute prostatitis is a disease that has a pronounced tendency to chronicity. Even with timely and adequate treatment, more than half of patients end up with chronic prostatitis. Recovery is far from always achieved, but with proper consistent therapy and following the doctor's recommendations, it is possible to eliminate unpleasant symptoms and achieve long-term stable remission in a chronic process.
Prevention is the elimination of risk factors. It is necessary to avoid hypothermia, to alternate sedentary work and periods of physical activity, to eat regularly and wholesomely. Laxatives should be used for constipation. One of the preventive measures is the normalization of sexual life, since 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 promptly.