Prostatitis is inflammation of the prostate and is one of the common problems among 40% of middle-aged and elderly men.This disease is not directly life-threatening, but it causes a significant decrease in the quality of life, affects performance, intimate areas, limits freedom and causes daily difficulties and psychological disturbances.
Prostatitis occurs in acute or chronic forms and can be of infectious or non-infectious origin.
Causes of prostatitis
The causes of prostatitis are diverse: acute prostatitis is related to bacterial infections that enter the prostate via ascending pathways during urinary tract diseases and infectious STDs, while 90% of cases of chronic prostatitis are not related to infection.Prostatic secretion stagnation is caused by infectious inflammation of the duct walls and systemic disease.
Causes of acute prostatitis
Acute bacterial prostatitis is caused by Enterobacteriaceae, Gram-negative and Gram-positive cocci, chlamydia, mycoplasma, and viruses.Risk factors for prostate infection are sexually transmitted diseases and invasive urological interventions (catheterization, urethral drip and shunt, urocystoscopy).
Factors that trigger infectious inflammation are often hypothermia, chronic constipation or diarrhea, sedentary work, excessive sexual activity or sexual abstinence, chronic sexually transmitted and urinary diseases, suppressed immune response, sleep deprivation, overtraining, and chronic stress.By worsening the blood supply to the pelvic organs, these factors themselves can cause sterile inflammation and promote the entry of pathogens into prostate tissue.
Acute bacterial inflammation can resolve without any consequences, but in some cases the following complications can occur:
- acute urinary retention;
- Chronic prostatitis (chronic inflammatory pelvic pain syndrome);
- epididymitis;
- Prostate abscess;
- Fibrosis of prostate tissue;
- Infertility.
Causes of chronic prostatitis
In 10% of cases, chronic prostatitis is a complication of acute inflammation of the prostate and urethritis, chlamydia, human papillomavirus, and other chronic infections.Approximately 90% are caused by nonbacterial chronic prostatitis or chronic pelvic pain syndrome (CPPS).This form of the disease is not related to infection, but is caused by a variety of causes, mainly stagnant processes in the pelvis.Urinary stagnation causes inflammation and develops in the context of urethritis, neurogenic bladder neck stenosis, urethral stricture, and autoimmune inflammation.Deterioration of the blood supply to the pelvic organs, which is caused by systemic cardiovascular disease (IHD, atherosclerosis).The common venous system of the small pelvis determines the connection between chronic prostatitis and anal fissure, hemorrhoids, proctitis, and fistulas.
Chronic pelvic pain in men is associated with:
- low physical activity;
- Low levels of testosterone in the blood;
- Changes in the microbial environment in the body;
- Genetic and phenotypic predispositions.
symptoms of prostatitis
- Fever (38-39 degrees Celsius for acute prostatitis and low fever for chronic prostatitis).
- Urinary dysfunction: Frequently wanting to urinate but not always having it, difficulty urinating, or increased frequency of urination, especially at night.When the urine is exhausted, there will always be some left in the bladder.
- Prostate damage: white blood cells and blood in semen, pain during urological examination.
- Fibromyalgia.
- Prostatic leakage is a small discharge from the urethra.
- Pain in the pelvis, perineum, testicles, suprapubic bone, penis, sacrum, bladder, and scrotum.
- Pain during urination and ejaculation.
- Spasmodic muscle spasm.
- Prostate stones.
- Psychological stress in the context of chronic fatigue, feelings of hopelessness, disaster, and chronic pain syndromes.
- Decreased performance (weakness, depressed mood, irritability).
- Sexual dysfunction – erectile dysfunction, premature ejaculation, lack of orgasm.
- Irritable bowel syndrome and proctitis may occur.
In the chronic course, the signs of prostatitis are vague (less distinct) but are accompanied by systemic, neurological, and psychiatric symptoms.
Diagnosis of prostatitis
The key to successful, timely treatment of prostatitis is accurate and comprehensive diagnosis.In most cases, the reason for the lower proportion of infectious prostatitis is that the pathogen was not detected.Chronic STIs may be asymptomatic, but their pathogens can penetrate prostate tissue and cause inflammation.Therefore, laboratory research methods play a leading role in the diagnostic process.
To determine the susceptibility of bacteria to antibiotics, it is necessary to inoculate biological fluids: urine, semen, prostate secretions.This approach allows you to select the drug that is most effective against a specific strain of pathogen and is able to penetrate directly into the site of inflammation.
The "classic" methods for laboratory diagnosis of prostatitis are considered cultural methods (urine culture, ejaculate, culture of urogenital smear contents).This method is very accurate but takes time.To detect bacteria, the smear needs to be stained with a Gram stain, but this is less likely to detect viruses, mycoplasmas, and Ureaplasmas.To increase the accuracy of the study, mass spectrometry and PCR (polymerase chain reaction) were used.Mass spectrometry is the ion analysis of a substance's structure and determination of each of its components.Polymerase chain reaction allows you to detect DNA or RNA fragments of infectious agents, including viruses and plasma.
Currently, for special examinations of urological patients, special comprehensive PCR studies of the genitourinary tract microbiota are used.The results are available within one day and reflect a complete picture of the proportion of microorganisms in the subject's body.
Testing for prostatitis includes collection of urine and ejaculate and a urinary smear.
The European Association of Urology recommends the following set of laboratory tests:
- General urinalysis;
- Bacterial culture of urine, semen, and semen;
- PCR diagnostics.
A general urine examination can determine signs of inflammation (number of microbial colony-forming units, number of white blood cells, red blood cells, urine clarity) and the presence of calcifications (prostate stones).General analysis is included in several methods for urinary system (glass or partial) samples.
Glass or partial sampling involves the sequential collection of urine or other biological fluids into separate containers.In this way, the localization of the infectious process was determined.Prostatitis is indicated by the detection of infectious agents, blood cells (white and red blood cells) in three cups of samples or in the last part of urine after urinary massage of the prostate
Two-Cup Test - Inoculation of the mid-urinary stream before and after uroprostatic massage.
Three Cup Samples – Collect the initial, middle and final portions of urine during the same urination.
Four-cup test - Culture and general analysis of the initial and middle portions of the urine stream, prostate secretions after uroprostatic massage, and a portion of the urine after this procedure.
They also perform culture or PCR diagnostics on semen and urogenital smear material.
To diagnose prostatitis, blood tests are also needed.General capillary blood tests can confirm or refute the presence of inflammation and rule out other diagnoses causing the same symptoms.
The diagnosis of non-inflammatory chronic pelvic pain syndrome is more difficult because it is based on clinical manifestations and indirect laboratory indicators (including general analysis of urine and blood).The intensity of the pain syndrome was determined using a visual analog pain scale, and the severity of psychological changes was determined using a scale assessing anxiety and depression.At the same time, because the range of pathogens can be so broad, research is needed to find the source of infection.Instrumental studies included urofluorometry to measure residual urine volume and transrectal ultrasonography (TRUS) of the prostate.
Asymptomatic prostatitis is detected by histological examination of a prostate biopsy specimen for suspected cancer.Start with a blood test for prostate-specific antigen (PSA).PSA in serum occurs with prostatic hypertrophy and inflammation, and normal standards change with age.This study also helps rule out suspicion of malignant prostate tumors.
Treatment and prevention of prostatitis
Acute prostatitis is treated with antibiotics (fluoroquinolines, cephalosporins, macrolides), α-blockers, nonsteroidal anti-inflammatory drugs, and neuromodulators.Few antibiotics penetrate the prostate; pathogens are immune to some drugs, so bacterial cultures are needed.
Conservative urological treatment may also include acupuncture, herbal medicine, remote shock wave therapy, thermal physical therapy procedures (after acute inflammation), massage.
Prevention of prostatitis includes medical procedures and the development of healthy habits:
- Use barrier contraceptives;
- Engage in regular sexual activities while minimizing the risk of infection;
- physical activity;
- Eliminate deficiencies - vitamin deficiencies and vitamin deficiencies, mineral deficiencies;
- Adhere to sterile conditions and careful technique when performing invasive urological interventions;
- Perform periodic preventive inspections using laboratory testing.