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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 effect on both sexual function and the urinary process.Pain in the perineum, groin, lower back and pelvic area, disturbances in urodynamics (outflow of urine) may indicate the presence of prostatitis.Untreated prostatitis can lead to male infertility and prostate cancer.

This is one of the most common male diseases, requiring careful attention and efficient 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 stable long-term recovery and remission.

Prevalence

Prostatitis ranks 5th among the top 20 urological diagnoses.It is believed that at the age of 30, 30% of the male population suffers from prostatitis, at the age of 40 - 40%, and after 50 years, almost all men in one way or another bear the burden of this disease.And if until the age of 35 mostly infectious prostatitis is recorded, then at a more mature age the non-infectious form predominates, and in general it is diagnosed several times more often than bacterial inflammation of the prostate.

Anatomy and physiology of the prostate gland

The prostate gland is located in the lower front of the pelvis, below 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, where the ejaculatory duct opens.

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 acts as a valve for the ejaculatory duct.As part of the male reproductive system, the prostate affects erection, ejaculation, and orgasm.The nerve responsible for erection passes through the gland.In the chronic course of this disease, they are involved in the inflammatory process, and erectile dysfunction develops.

The prostate produces a secretion that is part of semen.It 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 prostate secretion against the background of impaired blood circulation and lymph outflow in the gland itself and neighboring organs;
  • pathogenic and conditional microflora.

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

An inflamed prostate gland becomes painful.Pain can be felt in the perineum, groin, pelvis, and lower back.It increases sharply on palpation during digital examination of the rectum or defecation.

The prostate increases in size, pinching the urethra.This makes it difficult for urine to flow out of the bladder.The flow of urine becomes weak.The patient needs to tense his abdominal muscles in order for the act of urinating to 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 interferes with cellular metabolism and respiration in the gland.This creates conditions for the process to become chronic.With prolonged prostatitis, neighboring organs can become inflamed: seminal tubercles, Cooper's glands, seminal vesicles.The chronic form of this 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 the stagnant process in the gland.Venous disorders are less common, but they also cause prostatitis, especially if accompanied by hemorrhoids and varicocele on the left side (enlargement of the testicular veins).

Classification

The American National Institutes of Health identify 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 occurrence, prostatitis is divided into two types:

  • Not contagious
  • Contagious

The inflammatory process can develop quickly, accompanied by obvious symptoms (acute stage), or slowly with gradually increasing symptoms.

Prostatitis is not contagiousin most cases, it is associated with stagnation of prostate secretions and impaired blood circulation and lymph flow in the gland itself and nearby organs.

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

  • Urinogenic (ascending): the portal of entry is the urethra.It should be noted that infection can also enter through the descending route, for example, with purulent pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphogenous: infection from adjacent pelvic organs can enter the prostate through lymph due to inflammation of the rectum (proctitis) or bladder (cystitis), as well as from infected hemorrhoidal veins.
  • Hematogenous (through the blood): caused by the presence in the body of a focus of chronic infection (tonsillitis, dental caries) or complications of an acute infection (flu, acute respiratory infection, tonsillitis, etc.).

The most common causative agents of prostatitis are:

  • bacteria: Escherichia coli, Proteus, Gardnerella (gram-negative);staphylococci, streptococci (gram-positive);
  • viruses (influenza, herpes, cytomegalovirus, ARVI pathogens);
  • mycoplasma;
  • chlamydia;
  • certain flora (gonococcus, trichomonas, mycobacterium tuberculosis).

According to the nature of the course, prostatitis occurs:

  • spicy
  • Chronicle

Acute prostatitisusually occurs under the influence of pathogenic (opportunistic) microflora in the presence of predisposing factors.It has a fast course and clear symptoms.If it is not treated in time, the purulent process can develop, which leads to melting of the prostate tissue.If not treated properly, acute prostatitis often becomes chronic.

Chronic prostatitishave a milder course, erased symptoms.However, it can get worse over time, and then the symptoms will correspond to an acute process.However, complete remission between exacerbations does not always occur, and patients may always feel uncomfortable.Chronic prostatitis can cause impotence, male infertility, adenoma or prostate cancer.

There is a chronic asymptomatic form of this disease, when the patient has no complaints, but the prostate secretion contains an increased number of purulent elements (leukocytes).

Complications

Without proper therapy, the inflammatory process can cause purulent liquefaction of prostate tissue.Moreover, inflammation can spread to nearby organs: seminal tubercles, Cooper's glands, seminal vesicles, urethra.Therefore, the following complications may occur:

  • Prostatic abscess
  • Sclerosis/fibrosis of the prostate (functional glandular tissue is replaced by connective tissue)
  • Prostate cyst
  • Prostate stones
  • Vesiculitis (inflammation of the seminal vesicles)
  • Colliculitis (inflammation of the seminal tubercles)
  • Epididymo-orchitis (inflammation of the testicles and appendages)
  • Posterior urethritis
  • Erectile dysfunction/impotence
  • Ejaculatory disorders
  • 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 cord).
  • Pain increases with defecation and digital rectal examination.
  • Urodynamic disturbances (frequent urination, urinary retention, difficulty urinating, weak flow, incomplete emptying of the bladder).
  • Prostatorrhea (involuntary discharge of prostate juice, especially in the morning and during defecation).
  • Sexual dysfunction (decreased libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • The temperature rises to 39-40 degrees
  • Acute urinary retention
  • General poisoning
  • Leukocyturia, protein and mucus in the urine
  • Blood in urine and semen
  • Leukocytosis in prostatic secretions
  • Hypoechogenicity and gland enlargement, increased blood flow according to ultrasound data

Symptoms of chronic prostatitis

  • Body temperature is usually not higher than 37C
  • The sensation of pain becomes dull and smooth
  • Discharge from the urethra during defecation
  • Urinary disorders
  • Decreased libido
  • Erectile dysfunction
  • Ejaculatory disorders (premature or delayed ejaculation)

Reason

The main reason for the development of prostatitis is infection and stagnation of prostate secretions.The following factors contribute to the appearance of prostatitis:

  • Infections and opportunistic flora with weak immunity
  • Physical inactivity
  • "Sedentary" work.
  • Long-term sexual abstinence
  • Coitus interruptus (with delayed ejaculation)
  • Excessive sexual activity leads to thinning of the gland
  • Alcohol abuse
  • Decreased local immunity (hypothermia, use of immunosuppressants, immunodeficiency, autoimmune diseases)
  • Pelvic organ injury
  • Manipulation of the prostate and nearby organs (prostate biopsy, surgery, catheterization, cystoscopy, etc.)
  • Chronic diarrhea or constipation

Diagnostics

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

Digital rectal examinationconducted by a urologist-andrologist after a conversation with the patient.This method allows you to evaluate the size, shape and some structural features of the prostate gland.If the size of the prostate is enlarged and the procedure itself is painful for the patient, the doctor can diagnose prostatitis first.

If the case is not acute, the doctor can perform a prostate massage during the examination to obtain prostate secretion, a study that is an important link in the diagnosis of prostatitis.If there is a suspicion of acute bacterial prostatitis, prostate massage is contraindicated: such manipulations can cause the spread of pathogens and blood poisoning.

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

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

If necessary, diagnostics of organs near the genitourinary system are carried out: urethroscopy, urethrography and urethrocystography.

Laboratory researchis an important component in the diagnosis of prostatitis:

  • General urine analysis (before and after prostate massage)
  • General blood test
  • Blood test for inflammatory acute phase proteins (C-reactive protein, etc.)
  • Microscopic examination of prostate secretions after finger massage
  • Microscopic examination of scrapings from the urethra
  • Spermogram (sperm cytology and biochemistry)
  • Culture of urine, prostate secretions 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.

Modern ones have an excellent and informative diagnostic base.Urologists have extensive experience in diagnosing and successfully 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 a research package that includes all types of necessary diagnostics 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 surgical intervention is required.

Drug therapy

Involves the use of the following drugs:

  • Antibiotics (after determining sensitivity to them)
  • Antiseptic (local)
  • Vascular medicine (increases microcirculation in the prostate)
  • Nonsteroidal anti-inflammatory drugs
  • Alpha-1 blockers (for urinary problems)
  • Enzyme preparation (thins prostate secretions, stimulates the immune system, relieves inflammation)
  • Immunomodulators
  • Antidepressant

Physiotherapy treatment

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

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

Surgical treatment

Surgery for prostatitis is rarely performed.This need arises in cases of serious suppuration of prostate tissue, lack of positive dynamics in drug treatment and pathological enlargement of the prostate gland that blocks the urethra.

Forecast

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

If the treatment is not correct and the treatment conditions are not followed (several months), the disease usually takes a chronic course.Chronic prostatitis greatly affects a man's quality of 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 impossible to cure chronic prostatitis, but with the right approach, a stable remission can be achieved.

Advantages of visiting a professional clinic

  • Successful treatment for various forms of prostatitis
  • Experienced urologist-andrologist with the highest qualifications
  • Multidisciplinary, allowing you to involve experts in related fields in treatment
  • High-precision modern diagnostic and treatment equipment
  • Own European class clinical diagnostic laboratory
  • A comfortable and high-tech hospital
  • A package of urological diagnostic services at an attractive price

Prevention of prostatitis

  • Choose protected sex to avoid sexually transmitted infections (STIs)
  • Support the immune system (vitamins, healthy diet, prevention of dysbiosis, reasonable antibiotic therapy, etc.)
  • Avoid hypothermia
  • Live an active lifestyle
  • Have sex regularly, if possible, with one partner (to avoid prostate stagnation and STIs)
  • Avoid interrupted sexual intercourse (this will ease 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 for prostate cancer.It is known that in some cases prostate cancer has a clinical picture similar to the manifestations of prostatitis.Therefore, the PSA test is used to differentiate these two diseases.However, you should not bet on PSA.This antigen is also elevated in prostate adenoma, a benign growth of glandular tissue.With prostatitis, PSA levels can 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?

Prostate capillaries have a special structure that creates a hematoprostatic barrier.This makes it difficult for some antibiotics to penetrate the glandular tissue.In addition, microorganisms tend to form biofilms, which reliably protect them from the action of antibacterial agents.Therefore, modern protocols for the treatment of prostatitis necessarily include proteolytic enzymes that can destroy the biofilm.Bacteria become vulnerable, and antibiotics work more effectively.Chronic prostatitis is the most persistent treatment, the main feature of which is a variety of microflora in the culture.In about 50% of cases, Enterococcus faecalis is sown, resistant to all aminoglycosides and cephalosporins.This narrows the list of effective antimicrobial agents, which also complicates treatment.