Symptoms of prostatitis and prostate adenoma in men

prostatitisIt is an inflammatory disease of the prostate. It is manifested by frequent urination, pain in the penis, scrotum, rectum, sexual disorders (erection dysfunction, premature ejaculation, etc. ), sometimes urinary retention, blood in the urine. The diagnosis of prostatitis is established by a urologist or andrologist according to a typical clinical picture, the results of a rectal examination. In addition, an ultrasound of the prostate, bakposev of prostatic secretion and urine is performed. Treatment is conservative - antibiotic therapy, immunotherapy, prostate massage, lifestyle correction.

General information

Prostatitis is an inflammation of the seminal gland (prostate) - the prostate. It is the most common disease of the genitourinary system in men. It most often affects patients aged 25-50 years. According to various data, 30-85% of men over 30 years old suffer from prostatitis. Possible formation of prostate abscess, inflammation of the testicles and appendages, which threatens infertility. The rise of infection leads to inflammation of the upper genitourinary system (cystitis, pyelonephritis).

The pathology develops with the penetration of an infectious agent that enters the prostate tissue from the organs of the genitourinary system (urethra, bladder) or from a distant inflammatory focus (with pneumonia, influenza, tonsillitis, furunculosis).

Prostate adenoma is a benign neoplasm of the paraurethral glands located around the urethra in its prostatic section. The main symptom of prostate adenoma is a violation of urination due to the gradual compression of the urethra by one or more growing nodules. The pathology is characterized by a benign course.

Only a small proportion of patients seek medical help, however, a detailed examination reveals the symptoms of the disease in every four men aged between 40-50 years and in half of men aged between 50-60 years. The disease is detected in 65% of men aged 60-70 years, 80% of men aged 70-80 years and more than 90% of men aged over 80 years. The severity of symptoms can vary significantly. Studies in the field of clinical andrology suggest that urination problems occur in about 40% of men with BPH, but only one in five patients in this group seeks medical help.

Causes of prostatitis

As an infectious agent in an acute process, Staphylococcus aureus (Staphylococcus aureus), Enterococcus (Enterococcus), Enterobacter (Enterobacter), Pseudomonas (Pseudomonas), Proteus (Proteus), Klebsiella (Klebsiella) and Escherichia coli (E. Coli) can act. Most microorganisms belong to the conditionally pathogenic flora and cause prostatitis only in the presence of other predisposing factors. Chronic inflammation is usually due to polymicrobial associations.

The risk of developing the disease increases with hypothermia, a history of infections, and specific conditions accompanied by congestion in the tissues of the prostate. There are the following predisposing factors:

• General hypothermia (single or permanent, associated with working conditions).
• A sedentary lifestyle, a specialty that forces a person to sit for a long time (computer operator, driver, etc. ).
• Constant constipation.
• Violations of the normal rhythm of sexual activity (excessive sexual activity, prolonged abstinence, incomplete ejaculation during "habitual" sexual intercourse devoid of emotional coloring).
• The presence of chronic diseases (cholecystitis, bronchitis) or chronic infectious foci in the body (chronic osteomyelitis, untreated caries, tonsillitis, etc. ).
• Previous urological diseases (urethritis, cystitis, etc. ) and sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea).
• Conditions that cause immune system suppression (chronic, irregular stress and malnutrition, regular lack of sleep, overtraining in athletes).

It is assumed that the risk of developing pathology increases with chronic intoxication (alcohol, nicotine, morphine). Some studies in the field of modern andrology prove that chronic perineal trauma (vibration, concussion) in drivers, motorcyclists and cyclists is a provoking factor. However, the vast majority of specialists believe that all these circumstances are not the true causes of the disease, but only contribute to the exacerbation of the latent inflammatory process in the tissues of the prostate.

A decisive role in the occurrence of prostatitis is played by congestion in the tissues of the prostate. Violation of capillary blood flow causes increased lipid peroxidation, edema, exudation of prostate tissues and creates conditions for the development of an infectious process.

The mechanism of development of prostate adenoma has not yet been fully determined. Despite the widespread opinion linking the pathology to chronic prostatitis, there are no data that confirm the connection between these two diseases. The researchers found no relationship between the development of prostate adenoma and alcohol and tobacco use, sexual orientation, sexual activity, sexually transmitted and inflammatory diseases.

There is a pronounced dependence of the incidence of prostate adenoma on the age of the patient. Scientists believe that adenoma develops as a result of hormonal imbalances in men during andropause (male menopause). This theory is supported by the fact that men who are castrated before puberty never suffer from pathology, and very rarely - men who are castrated after puberty.

symptoms of prostatitis

acute prostatitis

There are three stages of acute prostatitis, characterized by the presence of a certain clinical picture and morphological changes:

• acute catarrhal. Patients complain of frequent and often painful urination, pain in the sacrum and perineum.
• acute follicular. The pain becomes more intense, sometimes radiating to the anus, aggravated by defecation. Urination is difficult, urine flows in a thin stream. In some cases, there is urinary retention. A subfebrile condition or moderate hyperthermia is typical.
• acute parenchyma. Severe general intoxication, hyperthermia up to 38-40°C, chills. Dysuric disorders often - acute urinary retention. Sharp, throbbing pains in the perineum. Difficulty in defecation.

chronic prostatitis

In rare cases, chronic prostatitis becomes the result of an acute process, however, as a rule, a primary chronic course is observed. The temperature occasionally rises to subfebrile values. The patient notices a slight pain in the perineum, discomfort during urination and defecation. The most characteristic symptom is scanty secretion from the urethra during defecation. The primary chronic form of the disease develops over a considerable period of time. It is preceded by prostatosis (stagnation of blood in the capillaries), gradually turning into abacterial prostatitis.

Chronic prostatitis is often a complication of the inflammatory process caused by the causative agent of a specific infection (chlamydia, trichomonas, ureaplasma, gonococcus). Symptoms of a specific inflammatory process in many cases mask the manifestations of damage to the prostate. Perhaps a slight increase in pain during urination, mild pain in the perineum, scanty discharge from the urethra during defecation. A small change in the clinical picture often goes unnoticed by the patient.

Chronic inflammation of the prostate can be manifested by a burning sensation in the urethra and perineum, dysuria, sexual disorders, increased general fatigue. The consequence of potency violations (or fear of these violations) often becomes mental depression, anxiety and irritability. The clinical picture does not always include all the groups of symptoms listed, it differs in different patients and changes over time. There are three main syndromes characteristic of chronic prostatitis: pain, dysuria, sexual disorders.

There are no pain receptors in prostate tissue. The cause of pain in chronic prostatitis becomes almost inevitable due to the abundant innervation of Organs pelvic organs, involvement in the inflammatory process of the nerve pathways. Patients complain of pain of varying intensity - from poor and painful sleep to intense and disturbing sleep. There is a change in the nature of the pain (intensification or weakening) with ejaculation, excessive sexual activity, or sexual withdrawal. The pain radiates to the scrotum, sacrum, perineum, sometimes to the lower back.

As a result of inflammation in chronic prostatitis, prostate volume increases, compressing the urethra. The lumen of the ureter is reduced. The patient has frequent urge to urinate, feeling of incomplete emptying of the bladder. As a rule, dysuric phenomena are expressed in the early stages. Then, compensatory hypertrophy of the muscular layer of the bladder and ureters develops. Symptoms of dysuria during this period weaken and then increase again with decompensation of adaptive mechanisms.

In the early stages, dyspotence may occur, which manifests itself differently in different patients. Patients may complain of frequent nocturnal erections, cloudy orgasm, or worsening erections. Accelerated ejaculation is associated with a decrease in the threshold level of arousal in the orgasmic center. Painful sensations during ejaculation can cause you to refuse sexual activity. In the future, sexual dysfunctions will become more pronounced. In the advanced stage, impotence develops.

The degree of sexual disturbance is determined by many factors, including the patient's sexual constitution and psychological mood. Violations of potency and dysuria may be due both to changes in the prostate gland and to the suggestibility of the patient, who, if he has chronic prostatitis, expects the inevitable development of sexual disorders and micturition disorders. Psychogenic dyspotence and dysuria especially often develop in suggestible and anxious patients.

Impotence, and sometimes the very threat of possible sexual disorders, is difficult for patients to tolerate. Often there is a change of character, irritability, annoyance, excessive concern for one's own health and even "care for the disease".

There are two groups of symptoms of the disease: irritative and obstructive. The first group of symptoms includes increased urination, persistent (imperative) urge to urinate, nocturia, urinary incontinence. The group of obstructive symptoms includes difficulty urinating, delayed onset and increased time of urination, feeling of incomplete voiding, urination with slow and intermittent flow, need for straining. There are three stages of prostate adenoma: compensated, undercompensated and decompensated.

compensated internship

In the compensated phase, the dynamics of urination change. It becomes more frequent, less intense and less free. There is a need to urinate 1-2 times at night. As a rule, nocturia in stage I prostate adenoma is of no concern in a patient who associates constant nocturnal awakenings with the development of age-related insomnia. During the day, the normal frequency of urination can be maintained, however, patients with stage I prostate adenoma observe a waiting period, especially pronounced after a night's sleep.

Then the frequency of daytime urination increases and the volume of urine released by urination decreases. There are imperative impulses. The stream of urine, which previously formed a parabolic curve, is slowly discharged and falls almost vertically. Hypertrophy of the bladder muscles develops, due to which the efficiency of their emptying is maintained. There is little or no residual urine in the bladder at this stage (less than 50 ml). The functional status of the kidneys and upper urinary tract is preserved.

undercompensated stage

In stage II prostate adenoma, the bladder enlarges, dystrophic changes develop in its walls. The amount of residual urine is greater than 50 ml and continues to increase. During the entire act of urinating, the patient is forced to intensely tense the abdominal muscles and diaphragm, which leads to an even greater increase in intravesical pressure.

The act of urinating becomes multiphasic, intermittent, wavy. The passage of urine along the upper urinary tract is gradually disturbed. Muscle structures lose their elasticity, the urinary tract expands. Kidney function is impaired. Patients are concerned about thirst, polyuria, and other symptoms of progressive chronic renal failure. When compensation mechanisms fail, the third stage begins.

decompensated stage

The bladder in patients with stage III prostate adenoma is stretched, filled with urine, easily determined by palpation and visually. The upper edge of the bladder can reach the level of the navel and above. Emptying is impossible even with intense tension of the abdominal muscles. The urge to empty the bladder becomes continuous. There may be severe pain in the lower abdomen. Urine is frequently excreted in drops or very small portions. In the future, the pain and urge to urinate gradually decrease.

A characteristic paradoxical urinary retention, or paradoxical ischuria (bladder is full, urine is constantly excreted drip) develops. The upper urinary tract is enlarged, the functions of the renal parenchyma are impaired due to the constant obstruction of the urinary tract, leading to an increase in pressure in the pelvic system. The chronic kidney failure clinic is growing. If there is no medical assistance, patients die of progressive CRF.

complications

In the absence of timely treatment of acute prostatitis, there is a significant risk of developing a prostate abscess. With the formation of a purulent focus, the patient's body temperature rises to 39-40 ° C and can become agitated in nature. Periods of heat alternate with severe chills. Sharp pains in the perineum make urination difficult and defecation impossible.

Increased prostatic edema leads to acute urinary retention. Rarely, an abscess spontaneously ruptures in the urethra or rectum. When opened, cloudy, purulent urine with an unpleasant pungent odor appears in the urethra; when opened, the stool contains pus and mucus in the rectum.

Chronic prostatitis is characterized by a wavy course with periods of long-term remissions, during which inflammation in the prostate is latent or manifests with extremely weak symptoms. Patients who are not bothered by anything usually stop treatment and only recur when complications arise.

The spread of urinary tract infection causes pyelonephritis and cystitis to occur. The most common complication of the chronic process is inflammation of the testes and epididymis (epdidymis-orchitis) and inflammation of the seminal vesicles (vesiculitis). The result of these diseases is often infertility.

Diagnosis

To assess the severity of prostate adenoma symptoms, the patient is asked to complete a urination diary. During the consultation, the urologist performs a digital examination of the prostate. To exclude infectious complications, sampling and examination of prostate secretion and urethral smears is performed. Additional tests include:

• ultrasound.In the ultrasound procedure of the prostate, the volume of the prostate is determined, stones and areas with congestion are detected, the amount of residual urine, the condition of the kidneys and urinary tract are evaluated.
• Urodynamic study. Uroflowmetry allows you to reliably assess the degree of urinary retention (urination time and urine flow rate are determined by a special device).
• Meaning of tumor markers.To exclude prostate cancer, it is necessary to assess the PSA (prostate-specific antigen) level, the value of which should normally not exceed 4 ng/ml. In controversial cases, a prostate biopsy is performed.

Cystography and excretory urography for prostate adenoma have been performed less frequently in recent years due to the emergence of new, less invasive and safer research methods (ultrasound). Cystoscopy is sometimes performed to exclude conditions with similar symptoms or in preparation for surgical treatment.

Prostatitis treatment

Treatment of acute prostatitis

Patients with an uncomplicated acute process are treated by an outpatient urologist. With severe intoxication, suspected purulent process, hospitalization is indicated. Antibacterial therapy is carried out. Preparations are selected taking into account the sensitivity of the infectious agent. Antibiotics are widely used that can penetrate prostate tissue well.

With the development of acute urinary retention in prostatitis, they resort to installing a cystostomy rather than a urethral catheter, as there is a danger of a prostate abscess forming. With the development of an abscess, an endoscopic transrectal or transurethral opening of the abscess is performed.

Chronic prostatitis treatment

The treatment of chronic prostatitis must be complex, including etiotropic therapy, physical therapy, correction of immunity:

• antibiotic therapy. The patient receives long courses of antibacterial drugs (within 4-8 weeks). The selection of the type and dosage of antibacterial drugs, as well as the determination of the duration of treatment, is carried out individually. The drug is chosen based on the sensitivity of the microflora according to the results of urine culture and prostate secretion.
• Prostate massage.Gland massage has a complex effect on the affected organ. During massage, the inflammatory secret accumulated in the prostate is squeezed into the ducts, then enters the urethra and is removed from the body. The procedure improves blood circulation in the prostate, which minimizes congestion and ensures better penetration of antibacterials into the tissue of the affected organ.
• Physiotherapy.To improve blood circulation, laser exposure, ultrasonic waves and electromagnetic vibrations are used. If it is impossible to carry out physiotherapeutic procedures, the patient is given warm medicated microclysters.

In long-standing chronic inflammation, consultation with an immunologist is indicated to select immunocorrective therapy tactics. The patient is counseled about lifestyle changes. Making certain lifestyle changes for a patient with chronic prostatitis is both a curative and preventative measure. The patient is recommended to normalize sleep and wakefulness, establish a diet, perform moderate physical activity.

Conservative therapy

Conservative therapy is carried out in the early stages and in the presence of absolute contraindications to surgery. To reduce the severity of the symptoms of the disease, alpha blockers, 5-alpha reductase inhibitors, herbal preparations (African plum peel extract or sabal fruit) are used.

Antibiotics are prescribed to fight the infection that often accompanies prostate adenoma. At the end of the course of antibiotic therapy, probiotics are used to restore normal intestinal microflora. Perform immunity correction. The atherosclerotic vascular changes that develop in most elderly patients impede the flow of drugs to the prostate, so special medications are prescribed to normalize blood circulation.

Surgery

There are the following surgical methods for treating prostate adenoma:

1. TOUR(transurethral resection). Minimally invasive endoscopic technique. The operation is performed with an adenoma volume of less than 80 cm3. Not applicable for renal failure.
2. adenomectomy.It is performed in the presence of complications, the adenoma mass is greater than 80 cm3. Currently, laparoscopic adenomectomy is widely used.
3. Prostate laser vaporization.It allows performing surgeries with a tumor mass smaller than 30-40 cm3. It is the method of choice for young patients with prostate adenoma, as it saves sexual function.
4. laser enucleation(holmium - HoLEP, thulium - ThuLEP). The method is recognized as the "gold standard" for the surgical treatment of prostate adenoma. It allows to remove an adenoma with a volume greater than 80 cm3 without open intervention.

There are several absolute contraindications to the surgical treatment of prostate adenoma (decompensated diseases of the respiratory and cardiovascular systems, etc. ). If surgical treatment is not possible, bladder catheterization or palliative surgery is performed - cystostomy, placement of a urethral stent.

prediction and prevention

Acute prostatitis is a disease that has a pronounced tendency to become chronic. Even with timely appropriate treatment, more than half of patients end up with chronic prostatitis. Recovery is not always achieved, however, with correct and consistent therapy and following the doctor's recommendations, it is possible to eliminate unpleasant symptoms and achieve a long-term stable remission in a chronic process.

Prevention is eliminating risk factors. It is necessary to avoid hypothermia, to alternate between sedentary work and periods of physical activity, to eat regularly and fully. For constipation, laxatives should be used. One of the preventive measures is the normalization of sexual life, as both excessive sexual activity and sexual abstinence are risk factors in the development of prostatitis. If symptoms of a urological or sexually transmitted disease appear, you should consult a doctor in a timely manner.