Chronic (bacterial) prostatitis is characterized by persistent or recurring symptoms with a confirmed bacterial infection in the prostate gland.
Prostatitis of this category is rare, in about 10% of all cases of prostatitis.The question of whether atypical pathogens, such as ureaplasma urealyticum, can trigger prostate inflammation is being discussed.They can be present in the male body without any signs of inflammation or complaints.
Causes of chronic prostatitis
The causes of chronic prostatitis are basically the same as the causes of acute bacterial prostatitis.The entry of microorganisms into the prostate in most cases occurs through the urethra - as a result of urine reflux into the ducts of the prostate gland.
Chronic bacterial prostatitis develops as a result of insufficient treatment or short treatment for acute bacterial prostatitis.
symptoms
- Discomfort or pain - in the perineum, lower abdomen, groin, scrotum, penis, during ejaculation
- Changes in urination - difficulty urinating, frequent urination in small portions, incomplete emptying of the bladder.
Patients may complain of several symptoms, or any symptoms individually.An increase in body temperature is unusual (or not significant).
Important:
Many men associate erectile dysfunction with prostatitis.This is often facilitated by unprofessional publications in the media and dubious drug advertising.The fact that an erection can persist even with complete removal of the prostate (due to the presence of a malignant tumor of the organ) suggests that it itself does not play a role in maintaining an erection.
According to many competent urologists, erectile dysfunction in patients with chronic prostatitis is caused by psychogenic and neurotic problems.
Diagnostics
For the initial assessment, a questionnaire was used - the chronic prostatitis symptom index.It can be used to objectify patient complaints.
The standard method for diagnosing prostatitis is to perform a test.This is a microscopic and bacteriological study of urine samples obtained from different parts of the genitourinary tract and prostate secretions.However, the sample method is quite labor intensive, and sample modification is now more often used.A possible alternative is to submit the ejaculate (sperm) for microscopic and bacteriological examination, because the ejaculate is partially (at least 1/3) composed of prostate secretions.This method is more comfortable for patients, especially if they refuse a rectal examination or a diagnostic sequence of the prostate gland to obtain prostate secretions.However, donating ejaculate has lower information content and reliability compared to samples.
Submitting the ejaculate for bacteriological examination is included in the diagnostic algorithm for infections of the male genital organs and when examining a man for infertility.
The results of laboratory tests (general urine test, general blood test, biochemical blood test, spermogram and other general clinical tests) in the case of chronic prostatitis are not informative.Most likely, this test will show "normal".
During rectal examination, changes indicating an inflammatory process in the prostate are not always observed in patients with chronic prostatitis.That is, it is impossible to rely on the results of a rectal examination to diagnose chronic prostatitis.
The same applies to ultrasound diagnostics: it is incorrect to diagnose chronic prostatitis based only on ultrasound data.The European and American Urological Associations do not recommend ultrasound to diagnose prostatitis.The type of implementation in this case is not important through the anterior abdominal wall - the lower part of the abdomen or TRUS - through the rectum.It is incorrect to write "chronic prostatitis", "ultrasound signs of chronic prostatitis", "prostatitis signs" in the conclusion of the ultrasound examination.Only a urologist has the prerogative to establish this diagnosis, who determines it based on complaints, anamnesis, laboratory tests and - only after - ultrasound.
The most common ultrasound sign in which the diagnosis of chronic prostatitis is made is the so-called diffuse changes in the prostate gland associated with inflammatory processes or other changes in the prostate parenchyma.This is a type of fibrotic process, the replacement of normal prostate parenchyma with scar tissue.However, there is no correlation between the number of fibrous changes in the prostate and the presence of complaints.With age, the likelihood of such "scars" appearing on the organ increases, but a man can live his whole life without feeling any discomfort in the perineum or genital area.However, once these changes are detected on ultrasound, some "experts" will diagnose prostatitis.And some men will have the feeling that they are really sick, they will start listening to themselves, they will feel all the symptoms described on the Internet.
In most men over the age of 30, ultrasound may show diffuse changes in the prostate gland.However, the fibrotic process does not indicate the presence of prostatitis.
The diagnosis of chronic prostatitis is established based on the exclusion of other diseases of the genitourinary system - especially urethritis, prostatic hyperplasia, urethral stricture, neurogenic urinary disorders, prostate cancer, bladder cancer.
There is no specific picture for chronic prostatitis based on routine examination results.
Treatment of chronic prostatitis
Antibiotics of the fluoroquinolone group are optimal antimicrobial drugs for the treatment of chronic bacterial prostatitis.The recommended course of antibiotic therapy is 4 to 6 weeks.Such a long course is justified by scientific data that show a decrease in the likelihood of disease recurrence.
For detected sexually transmitted infections (STIs), such as chlamydia, macrolide antibiotics are prescribed.
There is evidence of decreased relaxation of the bladder neck in patients with chronic prostatitis, which leads to reflux of urine into the inner channel of the urethra and causes inflammation of the prostate tissue and pain.For such patients, alpha blockers are recommended.
When treating chronic prostatitis, patients are advised to refrain from tempting offers to use herbal remedies.A characteristic of dietary supplements and herbal supplements is the instability of the plant components in the ingredient section;they can be different even in the preparation of the same manufacturer.In addition, from the point of view of evidence-based medicine, the merits of herbal medicine do not stand up to criticism.
Prostate massage, which was used as the basis of therapy in the middle of the 20th century, today, thanks to new scientific approaches and classifications, remains an important tool for diagnosing prostatitis, but not for its treatment.It is not necessary to use prostate massage as a therapeutic procedure (its effect has not been proven).There is a suggestion that frequent ejaculation is similar in properties to a therapeutic prostate massage session.
Other methods that have been shown to be effective in only one or a few studies or are still being investigated include:
- pelvic floor muscle training - some evidence shows the effectiveness of special training to reduce the symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- acupuncture - a small number of studies show the benefits of acupuncture compared to placebo in patients with chronic prostatitis;
- extracorporeal shock wave therapy - based on the effect of significant amplitude acoustic pulses on connective tissue and bones, widely used in the treatment of diseases of the musculoskeletal system, recently used in urology, its effectiveness is being studied;
- behavioral therapy and psychological support - since chronic prostatitis is associated with a low quality of life and the development of depression, these methods can improve the psychological state of the patient and help reduce some symptoms of the disease.
Separately worth mentioningchronic prostatitis without symptoms (asymptomatic)..The diagnosis is most often made based on the results of histological reports - after biopsy of the prostate gland or after surgical treatment of the prostate.The frequency of detection of inflammation in prostate tissue varies from 44% (with prostate biopsy) to 98-100% (after prostate surgical treatment).Scientists have suggested that the inflammatory changes identified in this way are nothing more than age-related physiological features.No one specifically diagnoses this category of prostatitis;it was a kind of accidental discovery.It does not require treatment and does not require any further action from the doctor or the patient.