Prostatitis

One of the most common urological diseases in men is inflammation of the prostate gland (prostatitis). According to statistics, men under the age of 50 suffer from prostatitis. Most often, inflammation of the prostate gland is primarily chronic, that is, it appears without a visible acute onset.

Prostatitis is often characterized by severe pain symptoms, neuroticism of the patient, the development of persistent urination disorders, sexual disorders, and infertility. Therefore, it is extremely important to timely and reliable diagnosis, as well as a complete treatment of prostatitis. There are several types of this disease.

CLASSIFICATION AND CRITERIA FOR PROSTATITIS (NIDDK, 1995)

The main mechanism for the occurrence of prostatitis is recognized as the so-called reflux (throwing) of urine into the prostatic ducts. The ducts that drain the glands of the prostate enter the urethra horizontally or obliquely against the flow of urine. This feature can contribute to the reflux of urine into the ducts of the glands, impaired secretory function and infection. Urine causes increased mucus formation and sloughing of cells. Due to the strong irritant effect and the acidic reaction of urine, the viscosity of the prostatic secretion increases. Ultimately, “plugs” containing dead cells, fibrin, leukocytes, and urinary salts form in the prostate gland, which is accompanied by a violation of the drainage and secretory functions of the organ and the formation of closed microcavities, where conditions are created for the long-term existence of pathogenic and opportunistic microflora.

ACUTE BACTERIAL PROSTATITIS

Acute bacterial prostatitis is caused predominantly by aerobic Gram-negative bacteria. Most often – in 80% of cases – Escherichia coli is found. Pseudomonas aeruginosa, Serratia, Klebsiella and Proteus cause acute prostatitis in 10-15% of cases, in another 5-10% enterococci are isolated.

Clinical manifestations. Acute bacterial prostatitis is characterized by high fever and chills, severe pain in the rectum, perineum, lumbosacral region, severe urination disorders. Swelling of the prostate can lead to acute urinary retention. The disease occurs against the background of general malaise, pain in the joints and muscles.

Diagnostics. The diagnosis of acute prostatitis is often made on the basis of characteristic symptoms, as well as the results of clinical and instrumental examination. Any diagnostic manipulations that involve a mechanical effect on the prostate gland (four-cup test, secretion analysis) are contraindicated in order to avoid the spread of infection, and also because of severe pain.

Treatment. An acute inflammatory process dictates the need for immediate antibiotic therapy until the results of a bacteriological study are obtained. Antibiotics are prescribed empirically, often in combination, based on their effectiveness against gram-negative organisms and enterococci. As symptomatic agents, analgesics, antipyretics, laxatives, rehydrators are prescribed, bed rest is recommended. Antibacterial therapy should be intensive and long enough to avoid both suppuration and chronic infection.

CHRONIC BACTERIAL PROSTATITIS

In chronic prostatitis, Escherichia coli (56%), enterococci (26%), Klebsiella (20%) Pseudomonas aeruginosa (8%) Proteus mirabilis (8%) are most often found. Recently, however, there has been a growing interest in the so-called atypical pathogens – chlamydia, mycoplasmas, ureaplasmas, viruses, Trichomonas and fungi.

The penetration of microflora into the ducts of the prostate occurs mainly due to the above-mentioned urethro-prostatic reflux of urine. Routes of infection through the blood and lymphatic vessels are also not excluded. In a significant number of patients, the source of the constant presence of infection is microcalcifications and prostate stones, often detected by ultrasound.

Clinical manifestations. Typical for chronic bacterial prostatitis is a combination of pain and urinary disorders. Pain sensations are noted by patients in the supra- and subpubic region, in the perineum, sacrum, sometimes there is accelerated and painful ejaculation. Disorders of urination are manifested in its increase, urination at night, a feeling of incomplete emptying of the bladder, an intermittent stream of urine.

Diagnostics. The diagnosis of chronic bacterial prostatitis is based on the results of the examination of the patient, microscopic and bacteriological examination of the secretion of the prostate gland, ultrasound data.

Treatment. Chronic prostatitis is extremely difficult to treat. Antibacterial, anti-inflammatory, resolving and antispasmodic agents are prescribed. In addition, it is impossible to talk about the quality treatment of chronic bacterial prostatitis without special physiotherapy. This is, first of all, finger massage of the prostate gland, vibromassage, the use of external and rectal electro- and ultraphonophoresis of medicinal mixtures, centimeter, UHF and EHF therapy, sinusoidally modulated currents.

CHRONIC PELVIC PAIN SYNDROME

Chronic pelvic pain syndrome is one of the most common and least understood types of prostatitis. The causes of this disease have not yet been convincingly established. Much attention is paid to the possible etiological role of chlamydia, ureaplasmas and mycoplasmas, viruses of the herpetic group. Another likely cause of chronic pelvic pain syndrome is the persistent reflux of urine from the urethra into the prostate ducts. Another factor in the occurrence of chronic pelvic pain syndrome may be autoimmune processes. A sedentary lifestyle, irregular sex life, constant hypothermia, rare urination can contribute to the development of this form of prostatitis.

Clinical manifestations. Clinical symptoms in chronic pelvic pain syndrome are similar to those of chronic bacterial prostatitis. Pain in the perineum, testicles and penis predominates. There are urination disorders, manifested by frequent, sometimes imperative urges, weakening of the pressure of the urine stream. Often the disease is accompanied by sexual dysfunctions.

Diagnostics. When examining the secret of the prostate gland in patients with an inflammatory type of chronic pelvic pain syndrome, an increased content of leukocytes and macrophages is found. In the non-inflammatory type, pathological abnormalities are not detected. Bacteriological and molecular biological methods do not detect pathogenic microorganisms. Expressed changes in ultrasound are also not observed.

Treatment. Good results are obtained by a combination of antibiotics with non-steroidal anti-inflammatory drugs and uroselective alpha-blockers. The effectiveness of treatment is significantly increased through the use of physiotherapy techniques. These are physiotherapy exercises, electrotherapy, medicinal electro- and ultraphonophoresis, sedentary warm baths, microclysters, prostate massage. Electroneurostimulation, laser and magnetic therapy are increasingly being used to relieve pain.

If you are interested in the question of how to treat prostatitis, you can get qualified advice by contacting Androcenter.