Prostatitis

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

May present with a variety of clinical signs and complaints.

Anatomy

The prostate is a small gland that is part of the male reproductive system and is a hormone-dependent organ. Its shape and size have been compared to a large walnut. A normal prostate gland 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 gland 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 gland is enclosed by a sheath consisting of smooth muscle, collagen, and elastic fibers; covered by three layers of dense connective tissue (fascia) on the front, side, and back. The back of the prostate gland borders the rectal canal. They are separated by the posterior capsule or the choroid of Denonville, which allows palpation of the posterior surface of the prostate.

The prostate gland accounts for about 70% of glandular tissue and 30% of fibrous tissue. Traditionally, people divide the agency into 3 zones.

Transfer area.The transition zone accounts for 10% of glandular tissue and 20% of prostate malignancies. In this area, one of the main age-related diseases in men is formed - prostatic hyperplasia, which can lead to difficulty urinating due to tissue overgrowth.

Center.The area around the ejaculatory duct. Consists of glandular tissue, connective tissue and muscle elements. Tumors in this area are extremely rare.

Peripheral area.Covers the back and sides of the prostate gland and contains 70% of glandular tissue. This is an area that is palpable through the rectum and allows the urologist to assess the condition of the prostate. Up to 70% of melanomas are localized precisely in the periphery. Therefore, digital rectal examination is an important diagnostic modality and should be performed in patients over 45 years of age.

Prostate function:

• produces secretory prostaglandins, which are an integral part of sperm and participate in the liquefaction of sperm, as well as saturate it with nutrients such as various enzymes and vitamins, citric acid, zinc ions, which improves sperm motility and activity;
• The prostate gland contains smooth muscle fibers that help release sperm from the urethra during ejaculation, prevent sperm from entering the bladder and participate in the mechanism of urinary retention.

Prostatitis, prostatic hyperplasia and prostate cancer are the 3 main diseases of the prostate gland.

All three diseases can coexist in the same prostate at the same time. That is, the presence of prostatitis does not exclude the presence of prostatic hyperplasia and prostate cancer in the patient and vice versa.

Causes of prostatitis

Statistically, prostatitis is the most common urological disease - after prostate hyperplasia and prostate cancer - in men under the age of 50 and the third most common in men over the age of 50.

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

The most common causative agent of prostatitis is strains of E. coli, 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 prostatitis is still poorly defined and under investigation. In patients with HIV infection and other serious changes in the immune system, the causative agents can be cytomegalovirus, mycobacterium tuberculosis, fungi, and other rare pathogens. There are data indicating that the presence of microorganisms in the prostate is not detected in the standard studies, but plays a role in the occurrence of inflammatory changes and the subsequent development of prostate cancer. prostatitis symptoms.

Possible causes of prostatitis are:

• Intrastatic reflux of urine due to urinary dysfunction (urine, with certain predisposing factors, can enter the prostate gland through the ducts of the prostate, causing an inflammatory process);
• unprotected anal sex;
• narrowing of the foreskin (phimosis);
• autoimmune diseases;
• changes in the function and anatomy of the pelvic floor muscles;
• changes in the central nervous system, including functional and anatomical changes in the brain;
• trauma and abnormal sexual activity;
• Psychological factors (in some studies, the effect of psychological stress on the onset of symptoms of chronic prostatitis has been demonstrated - in some patients diagnosed with a psychological disorder. , in which treatment has been shown to reduce the symptoms of prostatitis and its recurrence).

Risk factors for prostatitis also include: abstinence or excessive sexual activity, habits that limit ejaculation, smoking, night work, sedentary lifestyle, inadequate intake of nutrientsLiquids and poor diet.

The symptoms

• pain or burning when urinating (dysuria);
• urinary disorders;
• urine discoloration;
• 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 during ejaculation;
• increased body temperature (with acute bacterial prostatitis).

Diagnose

According to the NIH (National Institutes of Health) generally recognized classification of prostatitis, there are four types of disease, traditionally represented by Roman numerals:

• I - acute bacterial prostatitis;
• II - chronic bacterial prostatitis;
• III - chronic bacterial 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 chronic prostatitis (asymptomatic).

Despite the widespread prevalence of prostatitis, acute bacterial prostatitis is uncommon - accounting for 5% of all cases. But his diagnosis is quite simple, since the picture of this disease is often the most obvious: a man complains of frequent, painful, painful urination in the uterus and perineum. An increase in body temperature is characteristic, and often reaches a high value - below 39 ° C.

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

Digital rectal examination (DRE) is an important diagnostic maneuver if any prostate disease is suspected. Therefore, advice for men is not to refuse to have sex.

In acute bacterial prostatitis, the prostate gland is painful to the touch, edematous, often enlarged. Ultrasound examination can not only reveal an increase in the size of the prostate gland, but also reveal pus-filled foci of prostate tissue (abscess) - but this happens sporadically and as a rule. , is the result of a running process.

First of all, the laboratory diagnosis consists of a general urinalysis, in which an increase in the number of white blood cells is noted. Bacterial urine culture is recommended. Based on the results of the analysis, it is possible to determine the presence of bacteria and their susceptibility to antibiotics, thereby adjusting antibiotic therapy as prescribed. General blood tests are also performed to evaluate the general condition of the body and its response to the inflammatory process.

Prostatectomy for diagnosis in acute prostatitis is contraindicated because of the increased risk of life-threatening: bacteremia and sepsis. Identification of the cancer marker (PSA), its segments is also discouraged - due to the low information content and distorted data against the background of inflammation.

Prostatitis treatment

Antibiotic therapy is the basic therapy for patients with prostatitis of all types.

Alpha blockers are also an effective class of drugs. As a result of their action, the tone of the smooth muscles of the prostate gland, bladder neck and prostatic part of the urethra is reduced, thereby improving the ability to urinate and reducing the ability of urine to enter the prostate gland. paralysis (intrastatic reflux of urine), 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 prostatic hyperplasia.

An anti-inflammatory drug (Diclofenac) can be used, which reduces pain and discomfort during urination, reduces swelling of the prostate gland, and also contributes to improving the quality of urination.

Acute bacterial prostatitis is often the reason for hospitalization in a hospital, where intravenous antibiotic therapy is prescribed. After the patient's condition stabilized, the patient continued to receive oral antibiotics for 15 days or more to prevent acute prostatitis from turning into chronic bacterial prostatitis.

According to statistics, 10% of patients with acute prostatitis progress to the stage of chronic bacterial prostatitis. Another 10% of patients will develop chronic pelvic pain syndrome (chronic prostatitis IIIb) in the future.

How is prostatitis treated in the clinic?

Urologists treat prostatitis and other diseases of the genitourinary system, based on international clinical guidelines. This means that they not only use their expertise, but are also guided by scientifically proven and accepted diagnostic and therapeutic approaches worldwide.

Our doctors do not prescribe ineffective drugs and provide "just in case" medical care, not treating non-existent diseases. When making a diagnosis, the urologist relies on data obtained from the physical examination, clinical images, data from laboratory and instrumental studies. If surgical treatment is required, surgery is performed on the territory of the clinic.