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Prostatitis

prostatitis symptoms in men

Prostatitis is an inflammatory disease of the prostate gland (prostate gland) 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, disturbances in urodynamics (urine output) may indicate the presence of prostatitis.Untreated prostatitis can cause male infertility and prostate cancer.

This is one of the most common male diseases, requiring careful 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, careful attention and an individual approach to each case inevitably lead patients to recovery and stable, long-term 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 the age of 50, almost all men, one way or another, bear the burden of this disease.And if up to 35 years of age predominantly infectious prostatitis is recorded, then at a more mature age the non-infectious form predominates and, in general, is diagnosed several times more often than bacterial inflammation of the prostate gland.

Anatomy and physiology of the prostate

The prostate gland (prostate gland) is located in the lower front part of the pelvis, below the bladder.It consists of glandular and smooth muscle tissue surrounded by a fibrous capsule.The urethra passes through the body of the prostate from the bladder, where 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 an important 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.In 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 the semen.Creates favorable conditions for sperm activity.Therefore, with chronic gland dysfunction, male infertility may occur.

Pathogenesis

There are two main reasons for developing prostatitis:

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

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

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

The prostate enlarges, compressing the urethra.This makes it difficult for urine to exit the bladder.The urine stream becomes weak.The patient has to distend the abdominal muscles for urination to occur.In acute cases, urinary tract obstruction and acute urinary retention sometimes occur.

Inflammation leads to interruption of the flow of prostate 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.With prolonged prostatitis, neighboring organs can 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 discovered 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 accompanied by hemorrhoids and varicocele on the left (dilation of the testicular vein).

Classification

The American National Institutes 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 vivid symptoms (acute stage), or slowly, with dull and gradually increasing symptoms.

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

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

  • Urinogenic (ascending): the entry point is the urethra.It should be noted that the infection can also enter through the descending route, for example, in purulent pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphogenic: infection from adjacent pelvic organs can enter the prostate via lymph due to inflammation of the rectum (proctitis) or bladder (cystitis), as well as from 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).

According to 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.It has a rapid course and pronounced symptoms.If not treated in time, a purulent process may occur, leading to the melting of prostate tissue.If treated incorrectly, acute prostatitis often becomes chronic.

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

There is an asymptomatic chronic form of the disease, when the patient has no complaints, but the prostate secretion contains an increased number of purulent elements (leukocytes).

Complications

Without adequate therapy, the inflammatory process can lead to purulent melting of prostate tissue.Also, inflammation can spread to nearby organs: seminal tubercle, Cooper's glands, seminal vesicles, urethra.Thus, the following complications may occur:

  • Prostate abscess
  • Sclerosis/fibrosis of the prostate (the functional tissue of the gland is replaced by connective tissue)
  • Prostate cysts
  • prostate stones
  • Vesiculitis (inflammation of the seminal vesicles)
  • Coliculitis (inflammation of the seminal tubercle)
  • Epididymis-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 (may 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 prostate 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

Chronic prostatitis symptoms

  • Body temperature is generally no higher than 37ºC
  • Pain sensations are dulled and softened
  • Discharge from the urethra during bowel movements
  • Urinary disorders
  • Decreased libido
  • Erectile dysfunction
  • Ejaculation disorders (premature or delayed ejaculation)

Reasons

The main reasons for the development of prostatitis are infections and stagnation of prostate secretions.The following factors contribute to the onset 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 depletion of the gland
  • Alcohol abuse
  • Decreased local immunity (hypothermia, use of immunosuppressants, immunodeficiency, autoimmune diseases)
  • Pelvic organ injuries
  • Manipulations on the prostate and nearby organs (prostate biopsy, surgery, catheterization, cystoscopy, etc.)
  • Chronic diarrhea or constipation

Diagnosis

To detect prostatitis, several 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 conversation with the patient.This method allows you to assess the size, shape and some features of the structure of the prostate.If the size of the prostate is enlarged and the procedure itself is painful for the patient, the doctor may pre-diagnose prostatitis.

If the case is not acute, the doctor may perform a prostate massage during the examination to obtain prostate 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, like:

  • 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 (features of blood flow in the gland);
  • uroflowmetry (determination of urination speed and time);
  • magnetic resonance imaging of the pelvic organs (highly informative and safe study that allows differential diagnosis with other diseases).

If necessary, diagnostics of organs close to the genitourinary system are carried out: urethroscopy, urethrography and urethrocystography.

Laboratory researchare a necessary component of prostatitis diagnosis:

  • 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 scrapings of the urethra
  • Spermogram (sperm cytology and biochemistry)
  • Culture of urine, prostate secretion and sperm
  • Determination of prostate specific antigen (PSA)
  • Needle biopsy of the prostate and histological examination of glandular tissue

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

The modern one has an excellent and highly informative diagnostic base.Urologists have extensive experience in diagnosing and successfully treating various forms of prostatitis, and the status of a multidisciplinary clinic allows you to use the services of specialists in related fields.The medical center has developed research packages that include all types of necessary diagnostics at a very attractive price. 

Treatment

Treating prostatitis is not an easy task.It requires a considered and integrated approach.The treatment protocol for this disease includes drug therapy and physiotherapeutic procedures, in some cases surgical intervention is necessary.

Drug therapy

It involves the use of the following medications:

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

Physiotherapy treatment

  • Electrical stimulation of the prostate (electrophoresis, galvanization, pulsed action)
  • Vibromassage
  • Rectal sensor laser therapy (for chronic prostatitis)

In chronic prostatitis, prostate massage can be used as a therapeutic procedure.In the acute phase of the disease, this manipulation is not performed to prevent the spread of infection and sepsis.

Surgical treatment

Surgery for prostatitis is rarely used.This need arises in case of severe suppuration of prostate tissue, lack of positive dynamics in drug treatment and pathological enlargement of the prostate gland blocking the urethra.

Forecast

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

If the treatment is incorrect and the terms of treatment are not observed (several months), the disease often follows a chronic course.Chronic prostatitis greatly affects a man's quality of life, because 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, a stable remission can be achieved.

Advantages of visiting a professional clinic

  • Successful treatment of various forms of prostatitis
  • Experienced urologists-andrologists of the highest qualifications
  • Multidisciplinary, allowing specialists from related areas to be involved in the treatment
  • Modern, high-precision diagnostic and treatment equipment
  • Own European-class clinical diagnostic laboratory
  • Comfortable, high-tech hospitals
  • A package of urological diagnostic services at an attractive price

Prostatitis prevention

  • Choose protected 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 a partner (to avoid prostate stagnation and STIs)
  • Avoid interrupted sexual intercourse (this will alleviate sperm stagnation)
  • Visit your urologist once a year for preventive purposes and twice a year if you are over 50 or have a history of prostate disease.

FAQ

How informative is the PSA test in diagnosing prostatitis?

Prostate-specific antigen (PSA) is a marker for prostate cancer.It is known that in some cases prostate cancer presents a clinical picture similar to the manifestations of prostatitis.Therefore, the PSA test is used to differentiate these two diseases.However, you should not bet on PSA.This antigen also increases in prostate adenoma, a benign growth of glandular tissue.In 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-prostate barrier.This makes it difficult for some types of antibiotics to penetrate the gland tissue.In addition, microorganisms tend to form biofilms, which reliably protect them from the action of antibacterial agents.Therefore, modern protocols for the treatment of prostatitis necessarily include proteolytic enzymes that can destroy biofilms.Bacteria become vulnerable and antibiotics work more effectively.Chronic prostatitis is the most persistently treated, whose main characteristic is the wide variety of microflora in the culture.In approximately 50% of cases, Enterococcus faecalis is sown, resistant to all aminoglycosides and cephalosporins.This reduces the list of effective antimicrobial agents, which also complicates treatment.