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Prostatitis

symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the prostate (prostate) in men, which has a negative impact on both sexual function and the urination process.Pain in the perineum, groin, lower back and pelvic region, urodynamic disorders (urine flow) may indicate the presence of prostatitis.Untreated prostatitis can cause male infertility and prostate cancer.

This is one of the most common male ailments, requiring special attention and competent systemic treatment.This is exactly the approach to solving the problem of prostatitis that you will find in the urology department of a professional clinic.Highly qualified urologists-andrologists have been successfully treating acute and chronic prostatitis for many years.Complex therapy, close attention and an individual approach to each case inevitably lead patients to stable and long-term recovery and remission.

Prevalence

Prostatitis ranks 5th among the top 20 urological diagnoses.It is believed that by the age of 30, 30% of the male population suffers from prostatitis, by the age of 40 – 40%, and after 50, almost all men in one way or another bear the burden of this disease.And if up to 35 years mainly infectious prostatitis is recorded, then at a later age the non-infectious form predominates and, in general, it is diagnosed several times more often than bacterial inflammation of the prostate.

Anatomy and physiology of the prostate

The prostate (prostate) is located in the lower front of the pelvis, below the bladder.It is made up of smooth glandular muscle tissue, surrounded by a fibrous capsule.The urethra passes through the body of the prostate from the bladder, into which the ejaculatory ducts open.

The prostate is a hormone-dependent organ.It is formed and functions under the influence of male hormones - androgens.Testosterone plays a leading role in this process.

The prostate is connected to the seminal tubercle, which acts as a valve for the ejaculatory duct.As part of the male reproductive system, the prostate affects erection, ejaculation and orgasm.The nerves responsible for erection pass through the gland.During the chronic course of the disease, they are involved in the inflammatory process and erectile dysfunction develops.

The prostate produces a secretion that is part of semen.This creates favorable conditions for sperm activity.Therefore, in cases of chronic dysfunction of the gland, male infertility may occur.

Pathogenesis

There are two main reasons for the development of prostatitis:

  • stagnation of prostate secretion against the background of impaired blood circulation and lymphatic outflow in the gland itself and in neighboring organs;
  • pathogenic and conditionally pathogenic microflora.

Acute prostatitis is usually associated with an infection of the prostate tissue.But, as a rule, the two factors are interrelated and together create a vicious circle that complicates the treatment of prostatitis.

The inflamed prostate becomes painful.Pain may be felt in the perineum, groin, pelvis and lower back.It intensifies sharply on palpation during a rectal examination or defecation.

The prostate enlarges, pinching the urethra.This makes it difficult for urine to flow out of the bladder.The stream of urine becomes weak.The patient must contract their abdominal muscles for the act of urination to take place.In acute cases, urinary tract obstruction and acute urinary retention sometimes occur.

Inflammation leads to disruption of the outflow of prostatic juice and its stagnation.The resulting swelling disrupts the processes of cellular metabolism and respiration in the gland.This creates conditions for the process to become chronic.In case of prolonged prostatitis, neighboring organs may become inflamed: the seminal tubercle, Cooper's glands, seminal vesicles.The chronic form of the disease is associated with risks of developing male infertility, adenoma and prostate cancer.

In recent years, it has been found that in 70-80% of cases prostatitis occurs due to stagnant processes in the gland.Venous disorders are less common, but they also cause prostatitis, especially if they are accompanied by hemorrhoids and varicocele on the left (dilatation of the testicular vein).

Ranking

The American National Institute of Health identifies 4 categories of prostatitis:

  • Acute prostatitis (category I)
  • Chronic bacterial prostatitis (category II)
  • Chronic prostatitis/chronic pelvic pain syndrome (category III)
  • Asymptomatic chronic prostatitis (category IV)

Due to its occurrence, prostatitis is divided into two types:

  • Non-infectious
  • Infectious

The inflammatory process can develop quickly, accompanied by sharp symptoms (acute stage), or slowly, with symptoms cleared and gradually increasing.

Non-infectious prostatitisin most cases it is associated with stagnation of prostate secretions and impaired blood and lymphatic circulation in the gland itself and in neighboring organs.

Infectious prostatitisdevelops due to the penetration of pathogenic or opportunistic microflora into the prostate tissue: bacteria, viruses, fungi.The infection can enter the prostate in different ways:

  • Urinogenic (ascending): the entry point is the urethra.It should be noted that the infection can also enter descending, for example, in cases of purulent pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphogenic: Infection from adjacent pelvic organs can enter the prostate through lymph due to inflammation of the rectum (rectitis) or bladder (cystitis), as well as through infected hemorrhoidal veins.
  • Hematogenous (through the blood): caused by the presence in the body of foci of chronic infection (tonsillitis, decayed teeth) or complications of acute infections (flu, acute respiratory infections, tonsillitis, etc.).

The most common causative agents of prostatitis are:

  • bacteria: Escherichia coli, Proteus, Gardnerella (gram-negative);staphylococci, streptococci (gram-positive);
  • viruses (flu, herpes, cytomegalovirus, ARVI pathogens);
  • mycoplasma;
  • chlamydia;
  • specific flora (gonococci, trichomonas, mycobacterium tuberculosis).

Depending on the nature of the course, prostatitis occurs:

  • Spicy
  • Chronic

Acute prostatitisusually occurs under the influence of pathogenic (opportunistic) microflora in the presence of predisposing factors.Its progression is rapid and its symptoms pronounced.If not treated in time, a purulent process may develop, leading to the wasting of prostate tissue.If poorly treated, acute prostatitis often becomes chronic.

Chronic prostatitishas a smoother course, symptoms cleared.However, it can get worse from time to time, and the symptoms will then correspond to an acute process.However, complete remission between exacerbations does not always occur, and the patient may constantly experience discomfort.Chronic prostatitis can cause impotence, male infertility, prostate adenoma or cancer.

There is an asymptomatic chronic form of the disease, when the patient does not complain, but the secretion of the prostate contains an increased number of purulent elements (leukocytes).

Complications

Without proper treatment, the inflammatory process can lead to purulent wasting of the prostate tissue.In addition, inflammation can spread to neighboring organs: seminal tubercle, Cooper's glands, seminal vesicles, urethra.As a result, the following complications may arise:

  • Prostate abscess
  • Prostate sclerosis/fibrosis (functional gland tissue is replaced by connective tissue)
  • Prostate cysts
  • Prostatic stones
  • Vesiculitis (inflammation of the seminal vesicles)
  • Colliculitis (inflammation of the seminal tubercle)
  • Epididymo-orchitis (inflammation of the testicles and their appendages)
  • Posterior urethritis
  • Erectile dysfunction/impotence
  • Ejaculation disorder
  • Infertility
  • Prostate adenoma
  • Prostate cancer

Symptoms

Different forms of prostatitis have their own characteristics and severity of symptoms.In general, the following manifestations are characteristic of prostatitis:

  • Pain in the groin, lower back, perineum (can radiate along the spermatic cords).
  • The pain intensifies with defecation and digital rectal examination.
  • Urodynamic disorders (frequent urination, urinary retention, difficulty urinating, weak stream, incomplete emptying of the bladder).
  • Prostatorrhea (involuntary release of prostatic juice, especially in the morning and during bowel movements).
  • Sexual function disorders (decreased libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • The temperature rises to 39-40 degrees
  • Acute urinary retention
  • General intoxication
  • Leukocyturia, protein and mucus in urine
  • Blood in urine and semen
  • Leukocytosis in prostate secretions
  • Hypoechogenicity and enlargement of the gland, increased blood flow according to ultrasound data

Symptoms of chronic prostatitis

  • Body temperature generally does not exceed 37°C.
  • Pain sensations are reduced and smoothed
  • Discharge from the urethra during bowel movements
  • Urinary problems
  • Decreased libido
  • Erectile dysfunction
  • Ejaculation disorders (premature or delayed ejaculation)

Reasons

The main causes of the development of prostatitis are infections and stagnation of prostate secretions.The following factors contribute to the appearance of prostatitis:

  • Infections and opportunistic flora with weakened immunity
  • Physical inactivity
  • “Sedentary” work
  • Long-term sexual abstinence
  • Coitus interruptus (with delayed ejaculation)
  • Excessive sexual activity leading to exhaustion of the gland
  • Alcohol abuse
  • Decreased local immunity (hypothermia, use of immunosuppressants, immunodeficiency, autoimmune diseases)
  • Pelvic organ injuries
  • Manipulations of the prostate and neighboring organs (prostate biopsy, surgery, catheterization, cystoscopy, etc.)
  • Chronic diarrhea or constipation

Diagnosis

To detect prostatitis, many methods are used, which can be divided into 3 groups: digital rectal examination, laboratory tests and instrumental methods.

Digital rectal examcarried out by a urologist-andrologist after interview with the patient.This method allows you to assess the size, shape and certain structural features of the prostate.If the size of the prostate is enlarged and the procedure itself is painful for the patient, the doctor can pre-diagnose prostatitis.

If the case is not acute, the doctor may perform a prostate massage during the examination to obtain prostatic secretion, the study of which is an important link in the diagnosis of prostatitis.If acute bacterial prostatitis is suspected, prostate massage is contraindicated: such manipulation can lead to the spread of the pathogen and blood poisoning.

To clarify the diagnosis, the patient will be asked to undergoinstrumental studies, such as:

  • transrectal ultrasound examination of the prostate and pelvic organs (reveals structural features, the presence of inflammation and purulent foci, stones, cysts and other neoplasms);
  • Dopplerography (characteristics of blood flow in the gland);
  • flowmetry (determination of urination speed and time);
  • magnetic resonance imaging of the pelvic organs (a very informative and safe study that allows differential diagnosis with other diseases).

If necessary, a diagnosis of neighboring organs of the genitourinary system is carried out: urethroscopy, urethrography and urethrocystography.

Laboratory researchare a necessary part of the diagnosis of prostatitis:

  • General urine analysis (before and after prostate massage)
  • General blood test
  • Blood test for proteins of the acute phase of inflammation (C-reactive protein, etc.)
  • Microscopic examination of prostate secretion after finger massage
  • Microscopic examination of a urethral scraping
  • Spermogram (sperm cytology and biochemistry)
  • Culture of urine, prostate secretions and semen
  • Determination of prostate specific antigen (PSA)
  • Prostate needle biopsy and histological examination of glandular tissue

The last two studies are necessary to rule out prostate cancer or adenoma.

The modern has an excellent, very informative diagnostic base.Urologists have extensive experience in the diagnosis and successful treatment of various forms of prostatitis, and the status of a multidisciplinary clinic allows you to use the services of specialists in related areas.The medical center has developed research packages including all types of necessary diagnostics at a very attractive price. 

Treatment

Treating prostatitis is not an easy task.This requires a thoughtful and integrated approach.The treatment protocol for this disease includes drug treatment and physiotherapeutic procedures;in some cases, surgery is necessary.

Drug therapy

Involves the use of the following drugs:

  • Antibiotics (after determining their sensitivity)
  • Antiseptics (local)
  • Vascular drugs (improving microcirculation in the prostate)
  • Non-steroidal anti-inflammatories
  • Alpha-1 blockers (for urinary problems)
  • Enzyme preparations (dilute prostate secretion, stimulate the immune system, relieve inflammation)
  • Immunomodulators
  • Antidepressants

Physiotherapeutic treatment

  • Electrical stimulation of the prostate (electrophoresis, galvanization, pulsed action)
  • Vibration
  • Laser therapy with rectal sensor (for chronic prostatitis)

For chronic prostatitis, prostate massage can be used as a therapeutic procedure.In the acute stage of the disease, this manipulation is not carried out in order to avoid the spread of infection and sepsis.

Surgical treatment

Prostatitis surgery is rarely used.This need arises in cases of severe suppuration of the prostate tissue, lack of positive dynamics in drug treatment and pathological enlargement of the prostate blocking the urethra.

Forecast

With early diagnosis and adequate treatment, acute prostatitis can be overcome.However, quite often the process becomes chronic, even with correct and timely treatment.

If the treatment is incorrect and the treatment deadlines are not respected (several months), the disease usually progresses chronically.Chronic prostatitis greatly affects a man's quality of life, as not only urinary function suffers, but also sexual function.In 30% of cases, erectile dysfunction, loss of orgasmic intensity, ejaculation problems and infertility are observed.It is completely impossible to cure chronic prostatitis, but with the right approach, stable remission can be achieved.

Benefits of visiting a professional clinic

  • Successful treatment of various forms of prostatitis
  • Experienced urologists-andrologists of the highest qualification
  • Multidisciplinary, allowing you to involve specialists in related fields in the treatment
  • Modern high-precision diagnostic and treatment equipment
  • Own European-class clinical diagnostic laboratory
  • Comfortable, high-tech hospitals
  • A set of urological diagnostic services at an attractive price

Prostatitis prevention

  • Choose safer sex to avoid sexually transmitted infections (STIs)
  • Support the immune system (vitamins, healthy diet, prevention of dysbiosis, reasonable antibiotic therapy, etc.)
  • Avoid hypothermia
  • Lead an active lifestyle
  • Have sex regularly, if possible, with only one partner (to avoid prostate stagnation and STIs)
  • Avoid interrupted sexual intercourse (this will relieve sperm stagnation)
  • See your urologist once a year as a preventative measure and twice a year if you are over 50 or have a history of prostate disease.

Frequently Asked Questions

How informative is the PSA test in diagnosing prostatitis?

Prostate specific antigen (PSA) is a marker of prostate cancer.It is known that in some cases prostate cancer presents a clinical picture similar to the manifestations of prostatitis.The PSA test is therefore used to differentiate between these two diseases.However, you should not bet on PSA.This antigen also increases in prostate adenoma, a benign growth of glandular tissue.With prostatitis, PSA levels may also increase during periods of active inflammation.During the remission phase, it decreases.Therefore, PSA cannot be used as definitive proof of prostate cancer or prostatitis.

Why is prostatitis difficult to treat?

Prostate capillaries have a special structure that creates a blood-prostatic barrier.This makes it difficult for certain types of antibiotics to penetrate the glandular tissues.In addition, microorganisms tend to form biofilms that reliably protect them from the action of antibacterial agents.Therefore, modern prostatitis treatment protocols necessarily include proteolytic enzymes capable of destroying biofilms.Bacteria become vulnerable and antibiotics work more effectively.Chronic prostatitis is the most persistent treated, the main characteristic of which is the wide variety of microflora present in the culture.In about 50% of cases, Enterococcus faecalis is sown, resistant to all aminoglycosides and cephalosporins.This narrows the list of effective antimicrobial agents, which also complicates treatment.