What is prostatitis?This is the most common urological disease in men against the background of prostate inflammation, caused by pathogenic (certainly disease-causing) and conditionally pathogenic infection.
In most cases, in sexually active young men, it is a complication of mildly symptomatic or asymptomatic STIs.The cause of the development of prostatitis can be: Trichomonas, gonococci (causing gonorrhea), chlamydia, ureaplasma, mycoplasma.Among organisms not related to STIs, E. coli, fecal enterococci, etc.
According to the modern classification there are:
- Acute prostatitis.
- Chronic bacterial prostatitis.
- Chronic prostatitis (chronic pelvic pain syndrome) with signs of inflammation.
- Chronic prostatitis (chronic pelvic pain syndrome) without signs of inflammation.
- Asymptomatic prostatitis (asymptomatic) chronic prostatitis.
Currently, in most cases, we have to deal with this last category of prostatitis in men, as in recent years trichomoniasis, chlamydia, ureaplasmosis and mycoplasmosis have acquired a prominent role in the structure of STIs, which initially, in the vast majority of cases, do not present any manifestations, that is, they do not bother them in any way.And only after a long time they manifest themselves as a complication - prostatitis.
It should be said that asymptomatic prostatitis is detected in most patients who come simply for examination for STIs, in sexual partners of women with STIs, as well as in patients with infertility.
Causes of prostatitis
As a rule, prostatitis is diagnosed when:
- decreased physical activity (sedentary lifestyle);
- dysrhythmias of sexual life (prolonged sexual abstinence, often replaced by hyperactive sexual life);
- alcohol abuse;
- chronic constipation;
- as a result of infection with an STI - urethrogenic prostatitis, i.e. occurring when infections enter the prostate through the urethra;
- due to the penetration of pathogens from foci of chronic infection (chronic tonsillitis, sinusitis, kidney disease, etc.);
- for diseases of the rectum (hemorrhoids, anal fissure, paraproctitis) - endogenous prostatitis.This explains the detection of E. coli in most cases of chronic prostatitis.
Symptoms of prostatitis in men
It begins with an increase in temperature to 39-40°C with fever and chills, difficulty urinating, pain and burning when urinating;in severe cases, due to swelling of the glandular tissue, acute urinary retention occurs - a condition that requires surgical intervention.
It continues without manifestations.It is mainly detected in patients who seek an STI test after casual sexual intercourse.It is also detected in patients who came for examination as sexual partners of women with STIs or in patients with sperm pathology.
Manifestos:
- Discomfort and pain in the lower abdomen, perineum, sometimes patients note that the pain radiates to the head of the penis or the urethra.
- Urinary disorders.Frequent and painful urination, feeling of unfinished urination (often with hypothermia), urination one to several times at night, difficulty urinating and weakening of the urine stream.
- Sexual function disorder.Pain and discomfort during ejaculation, pain in the urethra and rectum, weakening or loss of the sensation of orgasm, etc.
- Changes in the fertilizing capacity of sperm.
- As a result, the patient's anxiety and nervousness increases, caused by hyperfixation of attention on their condition.
Complications of prostatitis
In the absence or inadequate treatment of prostatitis, the following complications may occur:
- Transition from acute to chronic prostatitis.
- Acute urinary retention (the patient cannot urinate for a long time) may require surgical intervention.
- Development of male infertility.
- Formation of scars and adhesions in the urethra with subsequent narrowing.
- Development of bladder inflammation (cystitis).
- Inflammatory kidney diseases (pyelonephritis, etc.).
- The occurrence of purulent inflammation of the prostate gland in men (prostatic abscess), requiring surgical intervention.
- Sepsis (penetration of infection into the bloodstream with subsequent damage to organs and systems of the whole body) is a formidable and life-threatening complication.It develops more often in patients with decreased function of the immune system, in patients with diabetes mellitus, patients with chronic renal failure, in patients with AIDS, etc.
Prostatitis diagnosis
The diagnosis of prostatitis is carried out in patients with characteristic complaints, as well as in patients with identified STIs and identified infertility.
Diagnosis includes:
- Digital examination of the prostate (through the rectum) with collection and examination of prostate secretion (juice), when the presence of inflammation in the gland is detected.
- Urine tests: general analysis, 2 or 4 glasses of urine, bacteriological examination (detection of prostatitis pathogens), cytological examination (detection of cancer).
- Uroflowmetry: assessment of the characteristics of the urinary stream, its quantity, flow rate, duration of urination.
- Ultrasound examinations to detect residual urine, organic prostate lesions, formal signs of prostatitis.
Sometimes, to diagnose prostatitis and exclude cancer, the following are additionally prescribed:
- Sperm studies.
- Prostate biopsy.
- PSA blood test (to detect cancer).
- Computed tomography of the pelvic organs.
- Nuclear magnetic resonance examination of pelvic organs, etc.
Prostatitis treatment
Treating bacterial prostatitis caused by an STI is not an easy task.Adequate and timely therapy leads to complete cure of this category of prostatitis after complete elimination (disappearance) of STI pathogens in most patients.It is worth mentioning that a complete cure for prostatitis caused by a common infection (not an STI) only occurs in 30% of cases, despite advances in modern medicine.In these cases, the objective is to achieve stable remission of the disease.
Modern prostatitis treatment includes:
- Antibacterial therapy for at least 2 weeks, sometimes up to 1-2 months or longer.
- Treatment of pain syndrome (anti-inflammatory drugs in the form of suppositories, injections, tablets).
- Treatment of urinary disorders (α-1 blockers, 5-α-reductase blockers).
- Physiotherapeutic methods of treatment (magnetic therapy, laser therapy, etc.).
- Prostate massage.
Patients are also recommended to make lifestyle changes, namely:
- regular sex life, without sexual excesses;
- give up alcohol and a sedentary lifestyle;
- mandatory use of barrier contraception;
- treatment of diseases of the digestive tract that cause stool retention, etc.