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Prostatitis

Prostatitis is a disease characterized by the presence of inflammation and / or infection located in the prostate.

It can present with a wide range of clinical signs and complaints.

Anatomy

healthy and inflamed prostate

The prostate is a small gland that is part of the male reproductive system and a hormone-dependent organ. Its shape and size were compared to a large walnut. A normal prostate weighs about 20 g, has a volume of 15-25 ml and is 3 cm long, 4 cm wide and 2 cm deep.

The prostate is located in the small pelvis, below the bladder and above the rectum. The urethra, the urethra, passes through the thickness of the gland. The prostate is surrounded by a capsule consisting of smooth muscle, collagen and elastic fibers. It is covered with three layers of dense connective tissue (fascia) on the anterior, lateral and posterior surface. The posterior surface of the prostate is bounded by the rectal ampulla. They are separated from the retrograde or Denonville fascia, which allows palpation of the posterior surface of the prostate gland.

The prostate gland is about 70% glandular tissue and 30% fibrous muscle layer. It is common to divide the instrument into 3 zones.

Transition zone.The transition zone accounts for 10% of glandular tissue and 20% of prostate malignancies. In this zone, one of the main age-related diseases in men is formed - benign prostatic hyperplasia, which can lead to difficulty urinating due to tissue overgrowth.

Central zone.The area surrounding the ejaculatory ducts. It consists of glandular tissues, connective tissue and muscle elements. Tumors in this area are extremely rare.

Peripheral zone.It covers the back and sides of the prostate and contains 70% of the glandular tissue. This is an area that is palpable through the rectum and allows the urologist to assess the condition of the prostate. Up to 70% of malignancies are located in the peripheral area. Therefore, digital rectal examination is an important diagnostic method and should be performed in patients over 45 years of age.

Prostate functions:

  • production of prostate secretion, which is an integral part of sperm and is involved in the liquefaction of ejaculate, as well as its saturation with nutrients such as various enzymes and vitamins, citric acid, zinc ions, which help improve motility and activity.
  • The prostate contains smooth muscle fibers that help release sperm from the urethra during ejaculation, prevent sperm from entering the bladder and are involved in the urinary retention mechanism.

Prostatitis, benign prostatic hyperplasia and prostate cancer are the three main diseases of the prostate.

All three diseases can coexist in the same prostate at the same time. That is, the presence of prostatitis does not rule out the presence of prostate hyperplasia and prostate cancer in the patient and vice versa.

Causes of prostatitis

According to statistics, prostatitis is the most common urological disease - after prostate hyperplasia and prostate cancer - in men under 50 and the third most common in men over 50.

Prostatitis accounts for 6 to 8% of outpatient visits.

The most common causative agent of prostatitis is E. coli strains, which are detected in 80% of cases. More rare pathogens are enterococci, Pseudomonas aeruginosa, Klebsiella and other gram-negative bacteria. The role of sexually transmitted infections (such as chlamydia trachomatis) in prostate inflammation has not yet been clearly established and is under study. In patients with HIV infection and other serious changes in the immune system, possible causative agents are cytomegalovirus, mycobacterium tuberculosis, fungi and other rare pathogens. There is evidence to suggest the presence of microorganisms in the prostate gland that are not detected in standard studies, but play a role in the development of inflammatory changes and the subsequent development of prostatitis symptoms.

Possible causes of prostatitis are:

  • endoprostatic reflux of urine as a result of dysfunctional urination (urine, with certain predisposing factors, can enter the prostate gland through the prostate ducts, causing an inflammatory process).
  • unprotected anal sex
  • foreskin narrowing (phimosis)
  • autoimmune disease;
  • functional and anatomical changes in the pelvic floor muscles.
  • changes in the central nervous system, including functional and anatomical changes in the brain.
  • traumatic and unusual sexual activity
  • psychological factors (in some studies, the effect of psychological stress on the onset of symptoms of chronic prostatitis has been demonstrated - some patients were diagnosed with psychosomatic disorders, in the treatment of which the symptoms of prostatitis decreased and the likelihood of recurrence) were noted).

Risk factors for prostatitis also include: abstinence or excessive sexual activity, the habit of limiting ejaculation, smoking, working at night, a sedentary lifestyle, inadequate fluid intake and poor nutrition.

Symptoms

  • pain or burning when urinating (dysuria)
  • urinary disorders
  • discoloration of urine
  • the appearance of blood in the urine.
  • pain in the abdomen, groin or back
  • pain in the perineum
  • pain or discomfort in the penis and testicles
  • pain with ejaculation
  • increased body temperature (with acute bacterial prostatitis).

Diagnostics

According to the generally recognized NIH (National Institutes of Health) prostatitis classification, there are four categories of diseases, traditionally denoted by Latin numerals:

  • I - acute bacterial prostatitis.
  • II - chronic bacterial prostatitis.
  • III - chronic bacterial prostatitis / chronic pelvic pain syndrome (CP / CPPS).
  • IIIa - chronic prostatitis / chronic pelvic pain syndrome with signs of inflammation.
  • IIIb - chronic prostatitis syndrome / chronic pelvic pain without signs of inflammation.
  • IV - asymptomatic (asymptomatic) chronic prostatitis.

Despite the widespread prevalence of prostatitis, acute bacterial prostatitis is uncommon - 5% of all cases of the disease. But the diagnosis is quite simple, as the picture of the disease is more pronounced: a man complains of frequent, painful urination, pain in the uterus and perineum. The increase in body temperature is characteristic and often at high values - below 39 ° C.

The diagnosis of acute bacterial prostatitis includes a digital rectal examination (rectal examination), which includes sensation (palpation) of the prostate with the index finger through the anus (rectum).

Digital rectal examination (DRE) is an important diagnostic procedure if any prostate pathology is suspected. Therefore, men are advised not to refuse to do so.

In acute bacterial prostatitis, the prostate is very painful to the touch, swollen, often swollen. Ultrasound examination may show not only an increase in prostate size, but also foci of purulent prostate tissue fusion (abscesses) - but this is rare and is usually the result of a running procedure.

Laboratory diagnostics, first of all, include a general urine test, in which an increase in the number of leukocytes is observed. Bacteriological culture of urine is recommended. Based on the results of the analysis, it is possible to determine the presence of bacteria and their sensitivity to the antibiotic and, therefore, to adjust the prescribed antibiotic treatment. A general blood test is also performed to assess the general condition of the body and its response to the inflammatory process.

Taking prostate secretions to diagnose acute prostatitis is contraindicated due to the increased risk of a life-threatening condition: bacteremia and sepsis. The identification of the oncomarker (PSA), its fractions - is also not specified - due to the low information content and the distortion of data in the context of inflammation.

Treatment of prostatitis

Antibiotic therapy is the basic treatment for patients with prostatitis of all categories.

Alpha-blockers are also an effective group of drugs. As a result of their action, the tone of the smooth muscles of the prostate, bladder neck and urethra prostate is reduced, thus improving urination and reducing the chance of urine entering the prostate gland (endoprostatic reflux), which is one ofthe causes of prostatitis. The most effective and popular drugs are Tamsulosin and Silodosin. They are also widely used to improve urination in patients with prostate hyperplasia.

It is possible to use anti-inflammatory drugs (Diclofenac), which effectively reduce pain and discomfort when urinating, reduce prostate swelling and also help to improve the quality of urination.

Acute bacterial prostatitis is often a reason for hospitalization, where antibiotic therapy is prescribed in the form of an intravenous injection. After the patient's condition has stabilized, the patient continues to take antibiotics in tablet form for 15 days or more to prevent the transition from acute prostatitis to chronic bacterial prostatitis.

According to statistics, 10% of patients with acute prostatitis develop chronic bacterial prostatitis. Another 10% of patients will develop chronic pelvic pain syndrome (chronic prostatitis IIIb) in the future.

How is prostatitis treated in the clinic

Urologists treat prostatitis and other diseases of the urinary system, based on international clinical guidelines. This means that they not only use their professional knowledge, but are also guided by scientifically proven and universally accepted methods of diagnosis and treatment.

Our doctors do not prescribe ineffective drugs and examinations "on a case by case" basis, they do not treat non-existent diseases. At diagnosis, urologists rely on data obtained from the patient examination, clinical picture, data from laboratory and organic studies. If surgery is required, surgery is performed on the clinic floor.