Symptoms of prostatitis and prostate adenoma in men

Prostatitisis an inflammatory disease of the prostate gland. Manifested by frequent urination, pain in the penis, scrotum, rectum, sexual disorders (erectile dysfunction, premature ejaculation, etc. ), sometimes urinary retention, blood in the urine. The diagnosis of prostatitis is established by a urologist or andrologist according to the usual clinical picture, the results of a rectal examination. In addition, ultrasound of the prostate, bakposev prostate secretion and urine are performed. Treatment is conservative - antibiotic therapy, immunotherapy, prostate massage, lifestyle correction.

General information

Prostatitis is an inflammation of the seminal gland (prostate) - the prostate. It is the most common disease of the genitourinary system in men. Often affects patients aged 25-50 years. According to various data, 30-85% of men over the age of 30 suffer from prostatitis. The possibility of the formation of an abscess of the prostate gland, inflammation of the testicles and appendages, which threatens infertility. Ascending infection leads to inflammation of the upper genitourinary system (cystitis, pyelonephritis).

Pathology develops with the penetration of infectious agents that enter the prostate tissue from organs of the genitourinary system (urethra, bladder) or from a distant inflammatory focus (with pneumonia, influenza, tonsillitis, furunculosis).

Prostate adenoma is a benign neoplasm of the paraurethral gland located around the urethra in the prostate. The main symptom of prostate adenoma is the violation of urination due to the gradual compression of the urethra by one or more growing nodules. Pathology is characterized by a benign course.

Only a small proportion of patients seek medical help, however, a detailed examination reveals symptoms of the disease in every fourth man aged 40-50 years and half of men aged 50-60 years. This disease is detected in 65% of men aged 60-70 years, 80% of men aged 70-80 and more than 90% of men aged 80 and above. The severity of symptoms can vary significantly. Studies in the field of clinical andrology suggest that problems with urination occur in about 40% of men with BPH, but only one in five patients in this group seek medical help.

Causes of prostatitis

As an infectious agent in the acute process, Staphylococcus aureus (Staphylococcus aureus), Enterococcus (Enterococcus), Enterobacter (Enterobacter), Pseudomonas (Pseudomonas), Proteus (Proteus), Klebsiella (Klebsiella) and Escherichia coli (E. Coli) can act. . Most microorganisms belong to the conditionally pathogenic flora and cause prostatitis only in the presence of other predisposing factors. Chronic inflammation is usually caused by a polymicrobial association.

The risk of developing this disease increases with hypothermia, a history of infection and certain conditions that are accompanied by congestion in the prostate tissue. There are the following predisposing factors:

• General hypothermia (one-time or permanent, associated with work conditions).
• Sedentary lifestyle, profession that forces a person to be in a sitting position for a long time (computer operator, driver, etc. ).
• Persistent constipation.
• Violation of the normal rhythm of sexual activity (excessive sexual activity, prolonged abstinence, incomplete ejaculation during "normal" sexual intercourse without emotional coloring).
• The presence of chronic diseases (cholecystitis, bronchitis) or chronic infectious focus 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 poor nutrition, frequent sleep deprivation, overtraining in athletes).

It is assumed that the risk of developing pathology increases with chronic intoxication (alcohol, nicotine, morphine). Several studies in the field of modern andrology prove that chronic perineal trauma (vibration, tremors) in drivers, motorcyclists and cyclists is a provoking factor. However, most experts believe that all these conditions are not the real cause of the disease, but only contribute to the worsening of the latent inflammatory process in the prostate tissue.

A decisive role in the occurrence of prostatitis is played by congestion in the prostate tissue. Violation of capillary blood flow causes increased lipid peroxidation, edema, exudation of prostate tissue and creates conditions for the development of infectious processes.

The mechanism of prostate adenoma development has not yet been fully determined. Despite the widespread opinion that links pathology with chronic prostatitis, there is no data that will confirm the relationship between these two diseases. Researchers did not find any relationship between the development of prostate adenoma and alcohol and tobacco use, sexual orientation, sexual activity, sexually transmitted diseases and inflammation.

There is a clear dependence of the occurrence of prostate adenoma on the age of the patient. Scientists believe that adenomas develop as a result of hormonal imbalance in men during andropause (male menopause). This theory is supported by the fact that men castrated before puberty never develop pathology, and very rarely - men castrated after it.

Symptoms of prostatitis

Acute prostatitis

There are three stages of acute prostatitis, which are characterized by the presence of certain clinical features and morphological changes:

• Acute catarrhal. Patients complain of frequent, often painful urination, pain in the sacrum and perineum.
• Acute follicles. The pain becomes stronger, sometimes radiating to the anus, aggravated by defecation. Urination is difficult, urine flows out in a thin stream. In some cases, there is urinary retention. A subfebrile state or moderate hyperthermia is typical.
• Acute parenchyma. Severe general poisoning, hyperthermia up to 38-40°C, chills. Screening disorders, often - acute urinary retention. Sharp, throbbing pain in the perineum. Difficulty defecating.

Chronic prostatitis

In rare cases, chronic prostatitis becomes the result of an acute process, however, as a rule, the main chronic course is observed. The temperature sometimes rises to subfebrile values. The patient noted some pain in the perineum, discomfort during urination and defecation. The most characteristic symptom is a slight discharge from the urethra during defecation. The main chronic form of the disease develops over a long 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 certain infectious agents (chlamydia, trichomonas, ureaplasma, gonococcus). Symptoms of certain inflammatory processes in many cases mask the manifestation of prostate damage. Perhaps a slight increase in pain during urination, mild pain in the perineum, a slight discharge from the urethra during defecation. Slight changes in the clinical picture are often not noticed by the patient.

Chronic inflammation of the prostate gland can be manifested by a burning sensation in the urethra and perineum, dysuria, sexual disturbances, increased general fatigue. The consequences of potential violations (or fear of these violations) are often mental depression, anxiety and irritability. The clinical picture does not always include all the groups of symptoms listed, differs in different patients and changes over time. There are three main syndrome characteristics of chronic prostatitis: pain, discharge, sexual dysfunction.

There are no pain receptors in prostate tissue. The cause of pain in chronic prostatitis becomes almost inevitable due to the abundant conservation of pelvic organs, involvement in the inflammatory process of nerve pathways. Patients complain of pain of varying intensity - from weak, aching to severe, disturbing sleep. There is a change in the nature of the pain (intensification or weakening) with ejaculation, excessive sexual activity or sexual abstinence. Pain radiates to the scrotum, sacrum, perineum, sometimes to the lumbar region.

As a result of inflammation in chronic prostatitis, the volume of the prostate increases, squeezing 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, the phenomenon is detected at an early stage. Then compensatory hypertrophy of the muscle layer of the bladder and ureter develops. Symptoms of dysuria during this period weaken, and then increase again with the decompensation of the adaptive mechanism.

In the early stages, dyspotency may develop, which manifests itself differently in different patients. Patients may complain of frequent nocturnal erections, blurred orgasms, or worsening erections. Accelerated ejaculation is associated with a decrease in the threshold level of orgasmic center excitation. Painful sensations during ejaculation can cause rejection of sexual activity. In the future, sexual dysfunction becomes more pronounced. In advanced stages, impotence develops.

The level of sexual disorders is determined by many factors, including the sexual constitution and psychological mood of the patient. Violation of potency and dysuria can be caused by both changes in the prostate gland and the suggestion of the patient, who, if he has chronic prostatitis, expects the inevitable development of sexual disorders and urinary disorders. Especially often psychogenic dyspotency and dysuria develop in suggested, anxious patients.

Impotence, and sometimes the threat of possible sexual harassment, is difficult for patients to accept. Often there are changes in character, irritability, resentment, excessive concern for one's own health, and even "care for the disease. "

There are two groups of disease symptoms: irritating and obstructive. The first group of symptoms includes increased urination, constant desire (imperative) to urinate, nocturia, urinary incontinence. The group of obstructive symptoms includes difficulty urinating, delayed onset and increased time to urinate, feeling of incomplete emptying, urination with intermittent slow flow, need to strain. There are three stages of prostate adenoma: compensated, subcompensated and decompensated.

Compensation level

At the compensation stage, the dynamics of urination change. It becomes more frequent, less intense and less free. There is a need to urinate 1-2 times at night. As a rule, nocturia in stage I prostate adenoma does not cause concern in patients who associate constant nocturnal awakenings with the development of age-related insomnia. During the day, the frequency of urination can be maintained, however, patients with stage I prostate adenoma noted a waiting period, especially pronounced after a night's sleep.

Then the frequency of daytime urination increases, and the amount of urine released per urination decreases. There is an imperative urge. The stream of urine, which previously formed a parabolic curve, is released slowly and falls almost vertically. Bladder muscle hypertrophy develops, whereby emptying efficiency is maintained. There is little or no residual urine in the bladder at this stage (less than 50 ml). The function of the kidneys and upper urinary tract is preserved.

Level of subcompensation

In stage II prostate adenoma, the bladder increases in volume, dystrophic changes develop in its walls. The amount of residual urine exceeds 50 ml and continues to increase. During the act of urinating, the patient has to tense the abdominal muscles and diaphragm strongly, which leads to a greater increase in intravesical pressure.

The act of urinating becomes multiphase, alternating, undulating. The passage of urine along the upper urinary tract is gradually disrupted. The muscle structure loses its elasticity, the urinary tract expands. Kidney function is affected. Patients are concerned about thirst, polyuria and other symptoms of progressive chronic renal failure. When the compensation mechanism fails, the third stage begins.

Decompensated level

The bladder in patients with stage III prostate adenoma is stretched, filled with urine, easily determined by palpation and visual. The upper edge of the bladder can reach the level of the navel and above. Emptying is impossible even with strong abdominal muscle tension. The urge to empty the bladder becomes constant. There may be severe pain in the lower abdomen. Urine is excreted frequently, in drops or very small portions. In the future, the pain and the urge to urinate gradually weaken.

A characteristic paradoxical urinary retention develops, or paradoxical ischuria (full bladder, urine is always excreted drop by drop). The upper urinary tract is enlarged, the function of the renal parenchyma is impaired due to the constant obstruction of the urinary tract, which leads to increased pressure in the pelvicallyceal system. The clinic of chronic kidney failure is growing. If medical treatment is not provided, the patient dies from progressive CRF.

Complications

In the absence of timely treatment of acute prostatitis, there is a high 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 busy in nature. Periods of heat alternate with severe chills. Sharp pain in the perineum makes it difficult to urinate and defecation becomes impossible.

Increased prostate edema 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, the stool contains pus and mucus in the rectum.

Chronic prostatitis is characterized by an undulating course with a long-term remission period, in which inflammation in the prostate is latent or manifests itself with very weak symptoms. Patients who are not bothered by anything often stop treatment and switch only when complications develop.

The spread of infection through the urinary tract causes pyelonephritis and cystitis. The most common complications in the chronic process are inflammation of the testicles and epididymis (epdidymo-orchitis) and inflammation of the seminal vesicles (vesiculitis). The consequence of this disease is often infertility.

Diagnostics

To assess the severity of prostate adenoma symptoms, patients are asked to fill in a urine diary. During the consultation, the urologist performs a digital examination of the prostate. To exclude infectious complications, sampling and examination of prostate secretions and smears from the urethra are performed. Additional tests include:

• Echography.In the prostate ultrasound process, the volume of the prostate gland is determined, stones and areas with congestion are detected, the amount of residual urine, the condition of the kidneys and urinary tract are evaluated.
• Urodynamic studies.Uroflowmetry allows you to accurately assess the level of urinary retention (the time of urination and the speed of urine flow are determined by a special device).
• Definition of tumor markers.To exclude prostate cancer, it is necessary to evaluate the level of PSA (prostate-specific antigen), a value that usually does not exceed 4 ng / ml. In controversial cases, a prostate biopsy is performed.

Cystography and excretory urography for prostate adenoma have been performed less frequently in recent years due to the emergence of new, less invasive and safer research methods (ultrasound). Sometimes cystoscopy is performed to exclude diseases with similar symptoms or in preparation for surgical treatment.

Treatment of prostatitis

Treatment of acute prostatitis

Patients with uncomplicated acute processes are treated by urologists on an outpatient basis. With severe intoxication, suspicion of a purulent process, hospitalization is indicated. Antibacterial therapy is carried out. Preparations are selected taking into account the sensitivity of infectious agents. Antibiotics are widely used that can penetrate well into prostate tissue.

With the development of acute urinary retention in fne prostatitis, they use a cystostomy installation, and not 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 a long course 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. This drug is selected based on the sensitivity of the microflora according to the results of urine cultures and prostate secretions.
• Prostate massage.Glandular massage has a complex effect on the affected organ. During the massage, the inflammatory secret accumulated in the prostate gland is squeezed out into the duct, then enters the urethra and is removed from the body. This 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.To improve blood circulation, laser exposure, ultrasonic waves and electromagnetic vibrations are used. If it is impossible to carry out physiotherapeutic procedures, the patient is prescribed warm medical microclysters.

In chronic, long-term inflammation, consultation of an immunologist is indicated to choose immunocorrective therapy tactics. Patients are advised about lifestyle changes. Making certain changes in the lifestyle of patients with chronic prostatitis is a curative and preventive measure. The patient is recommended to normalize sleep and wakefulness, prescribe a diet, carry out moderate physical activity.

Conservative therapy

Conservative therapy is carried out in the early stages and in the presence of absolute contraindications to surgery. To reduce the severity of disease symptoms, alpha blockers, 5-alpha reductase inhibitors, herbal preparations (African plum peel extract or sabal fruit) are used.

Antibiotics are prescribed to fight infections that often accompany prostate adenomas. At the end of the course of antibiotic therapy, probiotics are used to restore normal intestinal microflora. Carry out correction of immunity. Atherosclerotic vascular changes that develop in most elderly patients prevent the flow of drugs into the prostate gland, so special drugs are prescribed to normalize blood circulation.

Surgery

There are the following surgical methods for the treatment of prostate adenoma:

1. VISIT(transurethral removal). Minimally invasive endoscopic techniques. The operation is carried out with an adenoma volume of less than 80 cm3. Not applicable for renal failure.
2. Adenomectomy.It is carried out in the presence of complications, the mass of the adenoma is more than 80 cm3. Currently, laparoscopic adenomectomy is widely used.
3. Laser vaporization of the prostate.Allows you to perform surgery with a tumor mass less than 30-40 cm3. It is the preferred method for young patients with prostate adenoma, because it allows you to save sexual function.
4. Laser enucleation(holmium - HoLEP, thulium - ThuLEP). This method is recognized as the "gold standard" of surgical treatment of prostate adenoma. Allows you to remove adenomas with a volume of more than 80 cm3 without open intervention.

There are some absolute contraindications for surgical treatment of prostate adenoma (respiratory and cardiovascular system decompensation diseases, etc. ). If surgical treatment is not possible, bladder catheterization or palliative surgery is performed - cystostomy, urethral stent installation.

Prediction and prevention

Acute prostatitis is a disease that has a clear tendency to become chronic. Even with adequate timely treatment, more than half of patients end up with chronic prostatitis. Recovery is far from always achieved, however, with the correct consistent therapy and according to the doctor's recommendations, it is possible to eliminate unpleasant symptoms and achieve long-term stable remission in chronic processes.

Prevention is to eliminate risk factors. It is necessary to avoid hypothermia, alternate between sedentary work and periods of physical activity, eat regularly and fully. For constipation, laxatives should be used. One of the preventive measures is the normalization of sexual life, because both excessive sexual activity and sexual abstinence are risk factors in the development of prostatitis. If symptoms of urological or venereal diseases appear, you should see a doctor in time.