ProstatitisIt is an inflammatory disease of the prostate gland. It is 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 an andrologist according to a typical clinical picture, the results of a rectal examination. In addition, an ultrasound of the prostate is performed, bakposev of prostatic discharge and urine. 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. It most frequently affects patients between the ages of 25 and 50. According to various data, 30-85% of men over the age of 30 suffer from prostatitis. Possible formation of abscesses 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).
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
As an infectious agent in an 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 generally due to polymicrobial associations.
The risk of developing the disease increases with hypothermia, a history of infections, and specific conditions accompanied by congestion in the prostate tissues. There are the following predisposing factors:
- General hypothermia (single or permanent, associated with working conditions).
- A sedentary lifestyle, a specialty 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" sexual intercourse without 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, irregular stress 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, concussion) in motorists, motorcyclists and cyclists is a provoking factor. However, the vast majority of experts believe that all these circumstances are not the true 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 appearance 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 radiating to the anus, aggravated by defecation. Urination is difficult, urine comes out in a thin stream. In some cases, there is urinary retention. Subfebrile condition or moderate hyperthermia is typical.
- acute parenchymal. Severe general intoxication, hyperthermia up to 38-40°C, chills. Dysuric disorders, often - acute urinary retention. Sharp, stabbing pains in the perineum. Difficulty in defecation.
chronic prostatitis
In rare cases, chronic prostatitis becomes the result of an acute process; however, as a rule, a primary chronic course is observed. The temperature occasionally rises to subfebrile values. The patient notes a slight pain in the perineum, discomfort during the act of urination and defecation. The most characteristic symptom is scant 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 when urinating, mild pain in the perineum, scanty discharge from the urethra during defecation. A slight change in the clinical picture usually goes unnoticed by the patient.
Chronic inflammation of the prostate gland can be manifested by a burning sensation in the urethra and perineum, dysuria, sexual disorders, increased general fatigue. The consequence of potency violations (or the fear of these violations) often becomes mental depression, anxiety and irritability. The clinical picture does not always include all the listed groups of symptoms, it differs in different patients and changes over time. There are three main syndromes characteristic of chronic prostatitis: pain, dysuria, sexual disorders.
There are no pain receptors in the prostate tissue. The cause of pain in chronic prostatitis becomes almost inevitable due to the abundant innervation of the pelvic organs, participation in the inflammatory process of the nerve pathways. Patients complain of pain of varying intensity, from weak painful sleep to intense disturbing sleep. There is a change in the nature of the pain (intensification or weakening) with ejaculation, excessive sexual activity, or sexual withdrawal. The 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, compressing 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 expressed in the early stages. Compensatory hypertrophy of the muscular layer of the bladder and ureters then develops. Dysuria symptoms 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 orgasms, or worsening erections. Accelerated ejaculation is associated with a decrease in the arousal threshold level of the orgasmic center. Painful sensations during ejaculation can lead to rejection of sexual activity. In the future, sexual dysfunctions become more pronounced. In the advanced stage, impotence develops.
The degree of sexual disorder is determined by many factors, including the sexual makeup and psychological mood of the patient. Violations of potency and dysuria can be due to both changes in the prostate gland and the suggestibility of the patient, who, if he has chronic prostatitis, expects the inevitable development of sexual disorders and urination disorders. Especially often psychogenic dyspotence and dysuria develop in anxious and suggestible patients.
Impotence, and sometimes the very threat of possible sexual disorders, is difficult for patients to tolerate. Often there is a change of character, irritability, hatred, excessive concern for one's own health and even "worry about the disease. "
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 he may become agitated in nature. Hot spells alternate with severe chills. Sharp pains in the perineum make urination difficult and make defecation impossible.
Increased prostatic edema leads to acute urinary retention. Rarely, an abscess spontaneously ruptures into the urethra or rectum. When it is opened, purulent, cloudy urine with an unpleasant pungent odor appears in the urethra; when it opens, the stool contains pus and mucus in the rectum.
Chronic prostatitis is characterized by an undulating course with periods of long-term remissions, during which inflammation in the prostate is latent or manifests itself with extremely poor symptoms. Patients who are bothered by nothing often stop treatment and recur 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 (epdidymo-orchitis) and inflammation of the seminal vesicles (vesiculitis). The result of these diseases is often infertility.
Diagnosis
The characteristic clinical picture simplifies the diagnostic process in acute and chronic prostatitis. It is mandatory:
Treatment of prostatitis
Treatment of acute prostatitis
Patients with an uncomplicated acute process are treated by a urologist 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 the infectious agent. Antibiotics are widely used that can penetrate well into the tissues of the prostate.
With the development of acute urinary retention against the background of prostatitis, they resort to installing a cystostomy, and not a urethral catheter, since there is a danger of an abscess forming in the prostate. With the development of an abscess, a transrectal or transurethral endoscopic opening of the abscess is performed.
Treatment of chronic prostatitis
Treatment of chronic prostatitis should be complex, including etiotropic therapy, physiotherapy, immunity correction:
- antibiotic therapy. The patient is prescribed long courses of antibacterial drugs (within 4-8 weeks). The selection of the type and dosage of antibacterial drugs, as well as the determination of the duration of the course of treatment, are carried out individually. The drug is chosen based on the sensitivity of the microflora based on the results of urine culture and prostate discharge.
- prostate massage.Gland 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 ducts, then it 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.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 medicinal microclysters.
In long-term chronic inflammation, the consultation of an immunologist is indicated to select the tactics of immunocorrective therapy. The patient receives advice on lifestyle changes. Making certain changes in 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, engage in moderate physical activity.
For the treatment of prostatitis, antibiotic therapy is most effective. Phytotherapy, immunocorrectors and hormonal preparations can also be used according to medical prescription.
In the absence of acute symptoms, prostatitis can be treated with physiotherapy methods. In case of abscesses and suppurations, surgical intervention is recommended.
drug treatment
Treatment of prostatitis through antibiotic therapy should begin with bakposev, the purpose of which is to assess the sensitivity of the body to this type of antibiotic. In violation of urination, a good result is the use of anti-inflammatory drugs.
The drugs 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 minimal effect on other organs.
Anticoagulant and anti-inflammatory drugs have also proven effective.
antibacterial therapy
Antibiotics are an effective remedy in the fight against bacterial prostatitis. In order to achieve the desired effect and not harm the body, the choice of the drug, dosage and treatment regimen should be carried out by a doctor. For the correct selection of the most effective drugs, you will need to find out what kind of pathogen caused prostatitis, and also check the patient's tolerance to antibiotics of a particular group.
For the effective treatment of chronic prostatitis, antibiotics from the fluoroquinolone group have proven their effectiveness. Its action is aimed at suppressing a bacterial infection and strengthening the body's immunity. Also, 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 additionally be carried out with macrolide and tetracycline drugs, which slow down the spread of infection.
The duration of taking antibacterial drugs is 2-4 weeks. In case of positive dynamics, the course can be extended.
Physiotherapy
Physiotherapeutic methods in the treatment of prostatitis are aimed at activating blood circulation in the pelvic area, improving metabolic processes in the prostate, cleaning the ducts. If physiotherapy is combined with taking antibiotics, the effect of the latter is enhanced.
The main methods include:
- magnetotherapy;
- laser therapy;
- electrophoresis;
- warming up;
- ultrasound;
- sludge treatment;
- high frequency irradiation;
- physiotherapy.
One of the oldest methods - transrectal prostate massage, according to modern research, has no proven effectiveness.
Non-specific treatments
Non-specific treatments for prostatitis include:
- hirudotherapy;
- healing fast;
- acupuncture;
- diet according to the Ostrovsky method;
- alkalization of the body according to the Neumyvakin method.
It is strongly recommended that all non-traditional methods of treating prostatitis be coordinated with your doctor.
Surgery
Surgical methods are used in complex and emergency cases:
- for drainage of purulent abscesses, which are removed by laparoscopic methods through a puncture;
- in violation of urination 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.
Calculi and sclerosed tissues are removed by endoscopic methods. With a large area of damage or multiple stones, resection of the prostate is resorted to.
Transurethral resection is also effective for bacterial prostatitis. Thus, it is possible to reduce the risk of relapse.
Home remedies
Treatment of prostatitis with folk remedies is unlikely to be effective on its own, but in combination with medical and physiotherapeutic methods it may be applicable. These include: beekeeping products, decoctions of herbs and seeds, tinctures of garlic, ginger, ordinary beaver, fresh greens, pumpkin seeds.
In acute cases of the course of the disease, you should consult a doctor and in no case should you self-medicate. In case of rupture of a purulent abscess, a lethal 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 drug will work faster.
The composition of drugs for the treatment of prostatitis can be completely different, they are prescribed to solve a particular problem.
- Antibacterial agents are especially effective for prostatitis caused by chlamydia.
- Analgesics are used for symptomatic treatment, they relieve pain well.
- Immunostimulants improve blood circulation, relieve swelling, and are used in complex therapy.
- Herbal preparations have a mild effect. They, like candles in bee products, are used as an addition to the main treatment.
- Ichthyol-based compositions promote blood flow in the area of the intestinal mucosa, which accelerates the attenuation of inflammatory processes and slightly improves immunity.
- Enzyme-based products prevent the formation of scar tissue. It is recommended to take as part of a complex therapy with antibiotics, anti-inflammatories and analgesics.
Auxiliary drugs
For symptomatic treatment of prostatitis in men, such as pain relief when urinating, you can also take antispasmodics that relax smooth muscles and thus quickly relieve pain.
Anticoagulant and anti-inflammatory dietary supplements based on bee products, pumpkin seed oil and palm fruit extracts contribute to general recovery.
diet and lifestyle
For the treatment of prostatitis, a correct and balanced diet and a healthy lifestyle are very important. The food should not contain spicy, fried, salty or pickled foods. In the acute form, alcohol is strictly prohibited.
Food must 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-pharmacological treatment
Non-drug methods of therapy allow you to act directly on the prostate, increase the concentration of drugs in its tissues and help 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 particular type of exposure. To increase the concentration of the drug in the prostate it is necessary to heat to 38-40°C. To obtain an antibacterial effect - 40-45 ° C.
Today, non-drug treatment focuses on laser therapy. The possibilities of this technique are vast. Under the influence of a laser, the following processes occur in the prostate gland:
- 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.
During the research period 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 completed the course, potency increased, erectile dysfunction was eliminated, and vitality was restored. To achieve this result, it is necessary to use a beam with a certain wavelength. In general, 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 can significantly reduce its quality. The most serious complication of this disease is the formation of stones in the tissues of the gland. To free it from prostoliths, transurethral resection is used.
The surgery is carried out under the control of TRUS.
If complications such as sclerosis of the prostate occur, transurethral electrosurgery is performed. If, in combination with this pathology, sclerosis of the bladder neck is observed, then a partial resection of the prostate is performed.
With blockage of the seminal and excretory ducts, endoscopic operations are indicated to eliminate violations of the patency of the secret. To do this, an incision is made in the seminal vesicles and excretory ducts. With 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. Not fully cured prostatitis may be accompanied by the formation of calcifications, which must then be removed along with the gland. Experts are sure that there are no other ways to remove or dissolve the stones.
Also, pathogenic microorganisms can migrate to neighboring organs and cause inflammation. Running prostatitis can cause the development of adenoma and prostate cancer.
Prognosis and prevention
Acute prostatitis is a disease that has a marked tendency to become chronic. Even with timely and proper treatment, more than half of patients end up with chronic prostatitis. Recovery is far from always achieved, however, with correct and 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 eliminating 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, since both excessive sexual activity and sexual abstinence are risk factors in the development of prostatitis. If symptoms of a urological or sexually transmitted disease appear, you should consult a doctor in a timely manner.