Acute prostatitis is an infectious inflammation of the prostate gland, accompanied by swelling and the formation of purulent foci in the prostate. Manifestations of acute prostatitis depends on the phase (catarrhal, follicular, parenchymatous, abscessed), and may include dysuric disorders, pain in the perineum, fever, purpura. Diagnosis is based on palpation of the prostate, ultrasound and Doppler studium of the prostate, a study of the discharge of the urethra and prostate secretion. Treatment of acute prostatitis includes the administration of antimicrobial therapy, nonsteroidal anti-inflammatory drugs, antispasmodics, analgesics, immunomodulators, physiotherapy.
Acute and chronic prostatitis, which are the most common and socially important diseases of the male. In clinical urology, prostatitis is diagnosed in 30-58% of men in the reproductive and working age (30-50 years). For acute prostatitis accompanied by disorders of sexual function and fertility, disorders of psychoemotional state and social disadaptation.
Causes of acute prostatitis
Causative agents of acute prostatitis are mainly non-specific infectious agents that penetrate into the tissue of the prostate, gram-negative (Escherichia coli, Klebsiella, Proteus) or gram-positive (staphylococci, enterococci, streptococci)
Often acute prostatitis can be caused by pathogens urogenital infections:
- chlamydia
- trichomoniasis,
- Ureaplasma,
- gonorrhea,
- mycoplasmosis,
- candidiasis etc
Most often, the invasion of microbial agents in the tissues of the prostate occurs, the transcanalicular way – through the excretory ducts of the glands in the wall of the posterior urethra. Therefore, the urethritis of any origin, are often complicated with acute prostatitis. Less microbial flora gets into the prostate from the bladder in acute cystitis. The introduction of pathogens in the gland is significantly facilitated by the increased intraurethral pressure (reprehenderat, the stones of the urethra), keeping the endourethral manipulation (bougienage of the urethra, urinary catheterization, ureteroscopy, cystoscopy, etc).
Additionally, acute prostatitis may be the result of hematogenous infections, has allowed the conditions of blood supply of the prostate with a well-developed system of arterial and venous anastomoses. When called hematogenous drift call can occur in the prostate tissue from distant foci in purulent tonsillitis, sinusitis, caries, cholecystitis, bronchitis, pyoderma, etc. Can be lymphogenous inflammation of the prostate of the bowel with anal fissures, proctitis, colitis.
Non-infectious factors that contribute to the development of acute prostatitis include the persistent congestion in the veins of the pelvis and disorders drainage acini of the prostate. The stagnation can be caused by disritmia sexuality and sexual infringement – a practice interrupted intercourse, lack of or unlawful sexual activity, excessive sexual activity, etc., the Pathological deposition of blood from the venous line of the pelvis, can be observed, when a sedentary lifestyle, frequent constipation, colds, chronic (especially of alcohol), poisoning, varicose veins of the pelvis.
Forms of acute prostatitis
In the development of acute prostatitis distinguish the following forms, which are its stages:
- catarrhal,
- follicular,
- parenchymal,
- abscessed.
Acute prostatitis begins with a catarrhal inflammation of the mucous and submucous layer of the excretory ducts of individual lobules of the gland. In a further swelling of the walls of water, which contributes to the stagnation of muco-purulent secret in the follicles of the prostate and progression of inflammation in connection with what may develop focal suppuration of lobules acute follicular prostatitis. When multiple lesions of lobules, and diffuse participation of the parenchyma and interstitial tissue of the prostate in suppurative inflammation, acute prostatitis goes to the next stage – parenchymal. In the case of the merger of small ulcers in the large hearth, forming an abscess of the prostate, which can be opened into the urethra, perineum, rectum or bladder.
Symptoms of acute prostatitis
Clinical manifestations of acute prostatitis correspond to the stages of the process. The common manifestations are pain, problems with urination and intoxication.
In the acute catarrhal stage of prostatitis a feeling of weight and pain in the perineum. Dysuric disorder is characterized by painful and frequent urination, especially at night. Body temperature is maintained within the normal range, may be slightly elevated; the poison is missing. Palpation examination of the prostate does not change or slightly increased, little painful. The study of prostate secretion to detect the increase of white blood cells, the accumulation of muco-purulent threads. In the urine during the emptying of the excretory ducts into the acini appear white blood cells. Massage of the Prostate is usually impossible due to pain. Treatment is begun in the catarrhal stage of acute prostatitis, leading to a recovery in 7-10 days.
In the follicular form of acute prostatitis occurs more bright, accompanied by a dull pain in the perineum, irradiating in the penis, rectum or sacrum. Against this background, urination, painful and difficult, until the development of acute retention of urine. The law on the tombs in acute follicular prostatitis is also difficult because the expressed pain. Due to the increase in body temperature, 38°C, impaired General condition. Palpation per rectum is determined is enlarged, dense, intense, asymmetric prostate gland, severely painful in some areas when a digital examination. The urine, collected after the palpation of the gland, contains a large number of leukocytes and purulent filaments, which are of the cloudy colour. Massage to obtain prostate secretion in the follicular phase of acute prostatitis is contraindicated. With a decisive treatment of acute follicular prostatitis can favorably be eliminated, otherwise it passes to the next, the parenchymal phase.
Clinic of acute parenchymatous prostatitis develops rapidly. Characterized by severe affordable by means of (up to 39-39,5°C and above) with chills, General weakness, depression of appetite, thirst. The first urination of the strong learning and complicated, then you can completely stop. Try to empty your bladder or bowel, which were accompanied by severe pain. The development of the painful tenesmus, constipation, flatulence. The pain extends to the rectum, the throbbing character, due to which the patient to take a forced position – lying down with crossed legs. With the development of reactive inflammation of the rectum from the anus of mucus.
Determined by palpation diffusely enlarged, with unclear contours of the gland, extremely painful to the slightest touch. Massage of the Prostate in the parenchymal phase of acute prostatitis is contraindicated strongly. Sometimes due to the pararectal tissues, swelling and soreness, rectal exam, which cannot be maintained. In the urine – marked album sanguinem cellam, pyuria. The result of acute parenchymatous prostatitis can serve as resolution of the disease, the formation of abscess of the prostate or chronic prostatitis.
The diagnosis of acute prostatitis
Recognition and identification of the stage of acute prostatitis is performed by a urologist and is based on a comprehensive physical examination, laboratory and instrumental examination. Examination of the prostate through the rectum allows it to determine the size, consistency, homogeneity, symmetry, cancer; pain, reaction, foci of destruction, the signs of purulent fusion of tissues. Palpation of the prostate in acute prostatitis is performed very carefully, without a grave, pressing and massaging motion. Obtained in the prostate secretion showed an increase in the number of leucocytes and amyloid Taurus, reducing the number of lecithin granules.
In acute prostatitis, there is a greater leukocyturia in the third part of the urine and urine collected after palpation of the prostate. For the allocation of the causative agent of acute prostatitis is necessary to conduct bacterial analysis of urine and urethral discharge with antibiotics, the PCR studies scrapings, blood cultures in the sanguinem cultura. The nature and severity dysuric disorders in acute prostatitis is estimated with the use of uroflowmetries.
An ultrasound of the prostate with moderate pain syndrome can be performed transrectal; in the case of pronounced pain reaction – transabdominal. Anoscopically it is estimated, form, extent of cancer, the presence of focal or diffuse changes, it provides a level of acute prostatitis. The use of Doppler studium allows a detailed and differentiated, to evaluate the vascularization of the prostate.
In the planning of surgical tactics in relation to the destructive forms of acute prostatitis is appropriate, CT or MRI of the pelvis.
Treatment of acute prostatitis
A leading role in the treatment of acute prostatitis belongs to the causal treatment. You need the first meeting of the antimicrobial (antibacterial, antiviral, antitrichomonal, antimycotic) drugs inhibit the reproduction of micro-organisms in the glands and tissues of the urethra. To reduce cramps and painful urination prescribed analgesics, spasmolytics, and rectal candles with Anaesthesinum or belladonna, heat microclysters. In the complex treatment of acute prostatitis are used nonsteroidal anti-inflammatory drugs, enzymes, immunomodulators, vitamins, infusion solutions.
Physical therapy in acute prostatitis is performed after decrease in acute symptoms. With a view to, anti-inflammatory, decongestant, analgesic activity, improve microcirculation and local immunity used rectal electrophoresis, UHF-therapy, microwave therapy, massage the prostate. In acute prostatitis is shown, in accordance with the bed rest, sparing diet, sexual peace.
When retention of urine, on the basis of acute prostatitis prevent the implementation of the catheterization of the bladder, prefer trocar cystostomy. When an abscess of the prostate occurs, which need surgery - opening and drainage of the abscess cavity.
To cure acute prostatitis is estimated to restore the structure of the tissue glands and its functions, the normalization of the composition of the juice, the prostate, the elimination of pathogens that cause inflammation of body fluids.
The prognosis and prevention
As a rule, in a timely and meaningful causal treatment leads to cupping the signs of acute prostatitis. On abscess of the prostate or chronic inflammation occurs in advanced cases.
Prevention of acute prostatitis should include debridement of infectious foci in the body, carrying and endourethral endovesical manipulations in accordance with the rules of asepsis, timely treatment of sexually transmitted diseases and urethritis, the normalization of sexual activity and physical activity.