Prostatitis

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

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

Anatomy

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. The normal prostate weighs about 20 g, has a volume of 15-25 ml and measures 3 cm in length, 4 cm in width and 2 cm in depth.

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; covered with three layers of dense connective tissue (fascia) on the anterior, lateral, and posterior surfaces. The posterior surface of the prostate is bounded by an ampoule of the rectum. They are separated by a retrovexical fascia or Denonville fascia, which allows palpation of the posterior surface of the prostate.

The prostate gland is approximately 70% glandular tissue and 30% fibromuscular stroma. It is common for organs to be divided into 3 zones.

Transition zone.The transition zone consists of 10% of glandular tissue and 20% of cases of malignant prostate tumors. 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 excessive tissue growth.

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

Peripheral zone.It covers the back and side of the prostate and contains 70% glandular tissue. This is an area that is palpated through the rectum and allows the urologist to assess the condition of the prostate. Up to 70% of malignant tumors are localized in the peripheral zone. Therefore, digital rectal examination is an important diagnostic method and should be performed in patients older than 45 years.

Prostate functions:

• creation of prostate secretion which is an integral part of sperm and which 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 sperm 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 mechanism of urine retention.

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

All three diseases can coexist simultaneously in the same prostate. That is, the presence of prostatitis does not exclude 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 younger than 50 and the third most common in men older than 50.

Prostatitis accounts for 6 to 8% of outpatient urological visits.

The most common cause of prostatitis are strains of E. coli that are detected in 80% of cases. Less common 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 causes are cytomegalovirus, Mycobacterium tuberculosis, fungi and other rare pathogens. There are data indicating the presence of microorganisms in the prostate that were not detected in standard studies, but play a role in the occurrence of inflammatory changes and the further development of prostatitis symptoms.

Possible causes of prostatitis are:

• intraprostatic reflux of urine as a result of dysfunctional urination (urine, with certain predisposing factors, can enter the prostate through the prostate ducts, causing an inflammatory process);
• unprotected anal sex;
• foreskin narrowing (phimosis);
• autoimmune diseases;
• 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 activities;
• psychological factors (in a number of studies, the influence of psychological stress on the appearance of symptoms of chronic prostatitis has been proven - some patients have been diagnosed with psychosomatic disorders, in the treatment of which the reduction of prostatitis symptoms and the probability of its recurrence are reduced).

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

Symptoms

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

Diagnosis

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

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

Despite widespread prostatitis, acute bacterial prostatitis is not common - 5% of all cases. But his diagnosis is quite simple, because the picture of the disease is most often expressed: a man complains of frequent, painful urination, pain in the uterus and perineum. It is characterized by an increase in body temperature, and often to high values - below 39 ° C.

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

Digital rectal examination (DRE) is an important diagnostic manipulation if any prostate pathology is suspected. It is therefore advisable that men do not refuse to do so.

In acute bacterial prostatitis, the palpated prostate is sharply painful, edematous, most often enlarged. Ultrasound examination may show not only an increase in prostate size, but also foci of purulent fusion of prostate tissue (abscesses) - but this occurs rarely and, as a rule, is a consequence of an ongoing process.

Laboratory diagnosis, first of all, includes a general urine test, in which an increase in the number of leukocytes was noted. Bacteriological urine culture is recommended. Based on the results of the analysis, it is possible to determine the presence of bacteria and their sensitivity to antibiotics and, in that way, adjust the prescribed antibiotic therapy. 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 for diagnosis in acute prostatitis is contraindicated due to the increased risk of life-threatening conditions: bacteremia and sepsis. Determination of oncomarker (PSA), its fractions is also not recommended - due to the low content of information and data distortion in the background of inflammation.

Treatment of prostatitis

Antibiotic therapy is the basic therapy 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 prostate urethra is reduced, which improves urination and reduces the possibility of urine entering the prostate (intraprostatic reflux of urine), which is one of the 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) that effectively reduce pain and discomfort during urination, reducing prostate swelling, and also contribute to some improvement in the quality of urination.

Acute bacterial prostatitis is often the reason for hospitalization, where antibiotic therapy in the form of intravenous injections is prescribed. After stabilization of the patient's condition, the patient continues to receive antibiotics in the form of tablets for 15 or more days in order 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 the treatment of prostatitis in the clinic

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

Our doctors do not prescribe ineffective drugs and examinations "just in case", they do not treat non-existent diseases. When making a diagnosis, urologists rely on data obtained from the patient's examination, clinical picture, data from laboratory and instrumental studies. If surgical treatment is required, surgery is performed on the territory of the clinic.