Chronic prostatitis is long term inflammation of the prostate gland, leading to impaired morphology and functioning of the prostate. Chronic prostatitis is manifested prostatic triad of pain in the pelvic region and genitals, urinary disorders, sexual dysfunction. The diagnosis of chronic prostatitis includes palpation of the gland, study of prostate secretion, ultrasound, uroflowmetry, in, needle biopsy of the prostate. In chronic prostatitis shows complex medicine, physiotherapy, massage prostate, instillation posterior urethra. Surgical treatment it is recommended that in complex forms of chronic prostatitis.
Chronic prostatitis
Chronic prostatitis is the most common male disease: approximately 50% of men suffer from some type of inflammation of the prostate. Chronic prostatitis often affects men aged 20 to 40 years, in the period of maximum sexual and reproductive activity. In this context, the detection and treatment of chronic prostatitis in urology is becoming not only medical but also social aspect.
Classification of chronic prostatitis
According to the modern classification of prostatitis developed in 1995, we can distinguish 3 types of disease:
- I. Acute prostatitis.
- II. Chronic prostatitis of bacterial origin.
- III. Chronic nonbacterial prostatitis Genesis/chronic pelvic pain Syndrome – a syndrome that is not associated with obvious signs of infection and continued 3 months or more.
- III chronic prostatitis with an inflammatory component (detection in the prostate secretion white blood cells and infectious agents);
- III B chronic prostatitis without an inflammatory component (leukocytes and pathogens in the prostate secretion).
- IV. Asymptomatic chronic prostatitis (no complaints in the identification of leukocytes in prostatic secret).
In the presence of the infectious component we are talking about bacterial (infection) chronic prostatitis; in the absence of microbial pathogens – nonbacterial (non-contagione) of prostatitis. It is estimated that 90-95% of all cases there are non-bacterial chronic prostatitis, and only 10-5% of bacteria.
The causes of chronic prostatitis
In the etiology and pathogenesis of chronic bacterial prostatitis that are associated with any infection in the prostate following ways: upwards (through the urethra), down (when the reflux of infected urine from the bladder), hematogenous (blood highways) or lymphogenous (for lymphatic collectors). Most uropathogens are E. coli, Klebsiella, Proteus, Staphylococcus, Enterococcus, CORINE, fungal, parasitic, and viral pathogens. Coupled with the non-specific flora the development of chronic prostatitis can take part agents specific urethritis (chlamydia, Mycoplasma, gonococcus, Trichomonas, Gardnerella).
However, for the development of chronic prostatitis it is not so much the presence and activity of micro-organisms as the state of the pelvic organs and circulation in them, the presence of comorbidities, the level of protection mechanisms.
Therefore, the occurrence of chronic prostatitis can contribute to a number of factors. First, it is urological diseases, pyelonephritis, cystitis, urethritis, stricture of the urethra, increatos to the end of the acute prostatitis, orchitis, epididymitis etc Microbial etiologist can get into the prostate from distant foci of infection, such as sinusitis, tonsillitis, dental caries, chronic bronchitis, pneumonia, pyoderma, etc., Predispose to chronic inflammation, local and General hypothermia, overheating, stay in a humid environment, fatigue, malnutrition, rare urination, etc ..
Chronic non-bacterial prostatitis is usually associated with congestive (congestive) phenomena in the prostate caused by stasis in the venous circulation in the pelvic organs and impaired drainage acini of the prostate. Local obstructio causes the overflow of the blood vessels of the prostate with blood, swelling of incomplete emptying of secretions, breach the barrier, secretory, motor, contractile function of the gland.
Congestive changes generally caused by behavioral factors, long-term lack of sex, in practice, terminated or extended sexual activity, excessive sexual activity, lack of exercise, prolonged sitting, chronic intoxication (alcohol, nicotine, drugs), occupational risk (vibration). For the development of nonbacterial chronic prostatitis predisposing pathology of the pelvic organs and nerve structures of their innervation (e.g., injury of the spinal cord), adenoma of the prostate, hemorrhoids, constipation, androgenodeficiency, etc reasons.
Symptoms of chronic prostatitis
Chronic prostatitis is manifested by local and General symptoms. Local manifestations belongs prostatic triad, which is characterized by pain, dysuria and sexual dysfunction. Pain in chronic prostatitis are constant pain in nature, localized in the perineum, genitals, suprapubic, groin. Pain syndrome increases at the beginning and end of urination, pain radiating to the glans of the penis, testicles, sacrum, the rectum. Pain may increase after sexual intercourse or in connection with the long-term abstinence; weaken or strengthen after orgasm to become more intense in the moment of ejaculation.
The intensity of the pain syndrome in chronic prostatitis is different from discomfort, to express, to violate sleep, and performance events. Pain with restricted localization in the sacrum are often regarded as low back pain or sciatica, in connection with a patient long treated without the doctor for help.
Urination in chronic prostatitis and painful learning. While there may be a problem beginning miscet, weakening or interruption of the urine stream, feeling of incomplete emptying of the bladder, frequent nighttime urination, a burning sensation in the urethra. In the urine in chronic prostatitis can detect the presence of floating threads. After a bowel movement or physical exertion from the urethra shows the distribution due to a decrease in tone of the prostate. In chronic prostatitis can cause itching, feeling cold or excessive sweating in the crotch, a local discoloration of the skin, associated with the stagnation of blood circulation.
Chronic prostatitis accompanied by severe disorders of sexual function. Phenomena gipotenzia may be worsening, painful erections, prolonged, and frequent night-time erection problems or early ejaculation, loss of libido (reduced libido), deleted orgasms Hematospermias infertility. Sexual dysfunction, is always difficult for an experienced man, which leads to psycho-emotional disorders, to neurosis and depression, even more worsen sexual function.
Acute chronic prostatitis accompanied by a slight increase in body temperature and deterioration of health. The general status of the in chronic prostatitis is characterized by increased levels of irritability, lethargy, anxiety, fatigue, loss of appetite, sleep disorders, reduced work capacity, creativity and physical activity.
Nearly a quarter of patients with chronic prostatitis symptoms for a long time absent, resulting in late treatment for the urologist. Long duration of chronic prostatitis may be complicated by impotence, vesiculitis, epididymoorchitis, infertility, incontinence, stone formation, cysts of the prostate gland, sclerosis of the prostate, the development of adenoma and cancer of the prostate.
The diagnosis of chronic prostatitis
Necessary for the diagnosis of chronic prostatitis the information obtained through comprehensive laboratory and instrumental examination. Initial screening for suspected chronic prostatitis include the clarification of anamnesis and complaints, which carries out the external review of the genital area for discharge, lesions, irritation, and a digital rectal examination of the prostate with the aim of determining the shape, boundaries, consistency, sensitivity of the breast.
To determine the structural and functional changes of the prostate is shown holding ultrasound of the prostate (a CONSCIENCE). Important methods in the diagnosis of chronic prostatitis studies secret prostate, urinalysis, bacteriological review swab of the urethra and of urine, 3 cups of urine samples, PCR and RIDGE study scrape on pathogenic genital infections, the determination of prostate-specific antigen (PSA).
Clinically significant chronic prostatitis is the detection in the analysis of producer assets chlamydiosis, mycoplasmosis, herpes, cytomegalovirus, trichomoniasis, gonorrhea, candidiasis, and nonspecific bacterial flora. The fence prostate secretion, that studies carried out after urination and massage the prostate. Symptoms of chronic prostatitis increases the number of cells in the visual field, reduces the number of lecithin grains, the presence of pathogenic micro-organisms.
On the General analysis of urine in chronic prostatitis may show pyuria, pyuria, erythrocyturia. Bacteriological urine culture helps determine the level and nature of bacteriuria. With reproductive disorders, shows a study of the sperm and the MAR test.
Rate and causes voiding helps to determine, urodynamic studies (uroflowmetry, cystometry, profilometry, and electromyography). With the use of data from studies of chronic prostatitis may be different from the stress incontinence, neurogenic bladder, etc When the hematuria, Hematospermias, obstructive voiding is the endoscopic examination urethroscopy, and cystoscopy. To remove the adenoma and cancer of the prostate require the establishment of a DOG, in some cases, a biopsy of the prostate with the morphological study of tissues.
Treatment of chronic prostatitis
Chronic prostatitis cure difficult, but remember that recovery is still possible, and largely depends on the willpower of the patient, the timeliness of his appeal, the specialist for compliance with all the requirements of a urologist. The cornerstone of treatment of chronic bacterial prostatitis antimicrobial treatment is in accordance with antibiotics for at least 2 weeks. To reduce pain and inflammation nsaids are appointed ; to relax the muscles of the prostate, the restoration of urodynamics and outflow prostatic secretion shows, reception a-adrenoblokatorov.
With the aim of improving drainage of the prostate, of the local microcirculation and muscle tone is held between a therapeutic massage of the prostate. With massage of the prostate, would result in the allocation of not less than 4 drops for the prostate secretion. Massage of the Prostate is contraindicated in acute bacterial prostatitis, abscess of the prostate, hemorrhoids, stones, prostate, rectal fissures, hyperplasia and prostate cancer.
For the relief of the pain syndrome in chronic prostatitis can be recommended paraprostatic blockade, acupuncture. Important in the treatment of chronic prostatitis has a physiotherapy appointment of medicinal electrophoresis, ultrasound, phonophoresis, magnetic therapy, laser magneticam illic, inductometer, mud therapy, SMT, hot hip bath temperature 40 – 45°C, enemas with hydrogen sulphide and the mineral water, instillation into the urethra.
With the development of complications associated with chronic prostatitis surgical treatment: the removal of strictures of the urethra; the TURKEY of the prostate or prostatectomy when sclerosis prostate; transurethral resection of the bladder with multiple sclerosis on his neck, puncture and drainage of cysts and abscesses of the prostate; circumcisio with phimosis, caused by repeated urinary tract infections, etc
Prevention of chronic prostatitis
Prevention of chronic prostatitis, to require compliance with genital hygiene, timely treatment of urogenital and extragenital infections, the normalization of the regularity of the sexual life, sufficient physical activity, prevent constipation, timely emptying of the bladder.
To avoid recurrences of chronic prostatitis necessary dynamic checks andrologist (urologist); prevention programmes, physiotherapy, multivitamins, immunomodulators, with the exception of hypothermia, overheating, stress, bad habits.