Symptoms of Prostatitis and Prostate Adenoma in Men

prostatitisIt is an inflammatory disease of the prostate. Manifested as frequent urination, pain in the penis, scrotum, and rectum, sexual dysfunction (erectile dysfunction, premature ejaculation, etc. ), sometimes urinary retention, and blood in the urine. The diagnosis of prostatitis is made by a urologist or andrologist based on typical clinical manifestations and rectal examination results. In addition, prostate ultrasound, prostatic secretions and urine bakposev were performed. Treatment is conservative - antibiotic therapy, immunotherapy, prostate massage, lifestyle modification.

General information

Prostatitis is inflammation of the semen (prostate) gland - the prostate. It is the most common disease of the male genitourinary system. Most commonly affects patients 25-50 years of age. According to various data, 30-85% of men over the age of 30 suffer from prostatitis. Prostate abscesses may form, inflammation of the testicles and appendages, threatening infertility. The rise in infection leads to inflammation of the upper genitourinary system (cystitis, pyelonephritis).

Pathology develops with the infiltration of infectious agents into prostate tissue from urogenital organs (urethra, bladder) or distant inflammatory foci (pneumonia, influenza, tonsillitis, furuncle).

Prostate adenomas are benign tumors of the paraurethral glands, located around the urethra in the portion of their prostate. The main symptom of prostate adenoma is urinary disturbance due to progressive compression of the urethra by one or more growing nodules. Pathology is characterized by benign processes.

Only a small percentage of patients seek medical help, however, 4 out of 4 men in their 40s and 50s experience symptoms of the disease, compared to half of men in their 50s and 60s. symptoms. The disease is detected in 65% of men 60-70 years old, 80% of men 70-80 years old and over 90% of men over 80 years old. The severity of symptoms can vary widely. Research in the field of clinical andrology shows that about 40% of men with BPH experience urination problems, but only one in five of this group seek medical help.

Causes of Prostatitis

As infectious agents in acute processes, Staphylococcus aureus, Enterococcus, Enterobacter, Pseudomonas, Proteus, Klebsiella) and Escherichia coli (E. Coli) can both play a role. Most microorganisms belong to the opportunistically pathogenic group and can only cause prostatitis in the presence of other susceptibility factors. Chronic inflammation is often due to the association of multiple microorganisms.

The risk of developing the disease increases with hypothermia, a history of certain infections, and conditions that accompany prostate tissue congestion. There are the following predisposing factors:

• General hypothermia (one-time or permanent, depending on work conditions).
• Sedentary lifestyles, professions that force people to sit for long periods of time (computer operators, drivers, etc. ).
• Persistent constipation.
• Violation of the normal rhythm of sexual activity (excessive sexual activity, prolonged abstinence, incomplete ejaculation during "habitual" intercourse without emotional color).
• Presence of chronic disease (cholecystitis, bronchitis) or chronic infection (chronic osteomyelitis, untreated caries, tonsillitis, etc. ) in the body.
• Previous urological diseases (urethritis, cystitis, etc. ) and sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea).
• Conditions that lead to a suppressed immune system (chronic stress, irregular and malnutrition, frequent lack of sleep, overtraining in athletes).

It is hypothesized that chronic intoxication (alcohol, nicotine, morphine) increases the risk of developing pathology. Chronic perineal trauma (vibration, concussion) in motorists, motorcyclists, and cyclists has been demonstrated by some studies in modern andrology as a contributing factor. However, the vast majority of experts believe that all of these conditions are not the real cause of the disease, but simply exacerbate the inflammatory process that is dormant in the prostate tissue.

The congestion of prostate tissue plays a decisive role in the occurrence of prostatitis. Disruption of capillary blood flow leads to increased lipid peroxidation, edema, exudation of prostate tissue, and creates conditions for the development of an infectious process.

The pathogenesis of prostate adenoma has not been fully defined. Although this pathology is widely believed to be associated with chronic prostatitis, there are no data to confirm a link between the two diseases. Researchers have not found any relationship between the development of prostate adenomas and alcohol and tobacco use, sexual orientation, sexual activity, sexually transmitted diseases and inflammatory diseases.

The incidence of prostate adenoma is significantly dependent on the age of the patient. Scientists believe that adenomas are the result of an imbalance in male hormones during andropause (male menopause). This theory is supported by the fact that men who are castrated before puberty never suffer from pathology and that men who are castrated after puberty are very rare.

symptoms of prostatitis

acute prostatitis

Acute prostatitis is divided into three stages, which are characterized by certain clinical manifestations and morphological changes:

• acute catarrh. The patient complains of frequent, painful urination, and pain in the sacrum and perineum.
• acute follicle. Pain that becomes more severe, sometimes radiates to the anus, and worsens with bowel movements. Difficulty urinating, and the urine flows out in a thin stream. In some cases, urinary retention occurs. Low heat conditions or moderately high temperatures are typical.
• acute parenchyma. Severe systemic poisoning, body temperature up to 38-40°C, chills. Urinary disturbance, usually - acute urinary retention. Severe, throbbing pain in the perineum. Difficulty defecation.

chronic prostatitis

In rare cases, chronic prostatitis can be the result of an acute process, but a primary chronic process is usually observed. The temperature occasionally rises to subcalorific values. The patient noted mild pain in the perineum and discomfort during urination and defecation. The most typical symptom is low urethral discharge during bowel movements. The predominant chronic form of the disease develops over a considerable period of time. It was previously prostatitis (stagnant blood in the capillaries), which gradually became non-bacterial prostatitis.

Chronic prostatitis is usually a complication of the inflammatory process caused by specific infectious agents (Chlamydia, Trichomonas, Ureaplasma urealyticum, Neisseria gonorrhoeae). In many cases, symptoms of a specific inflammatory process mask the presentation of prostate damage. Pain may increase slightly during urination, mild pain in the perineum, and little urethral discharge during defecation. Small changes in clinical presentation are usually not noticed by patients.

Chronic inflammation of the prostate can manifest as a burning sensation in the urethra and perineum, dysuria, sexual dysfunction, and increased generalized fatigue. The consequences of violating potency (or fearing those violations) are usually depression, anxiety, and irritability. The clinical presentation does not always include all listed symptom groups, varies in different patients, and varies over time. Chronic prostatitis has three main symptoms: pain, dysuria, and sexual dysfunction.

There are no pain receptors in prostate tissue. The cause of chronic prostatitis pain is almost unavoidable due to the rich innervation of the pelvic organs, the inflammatory processes involved in neural pathways. Patients complain of pain of varying intensity—from weakness and pain to intense, disturbing sleep. The nature of pain changes (intensifies or diminishes) with ejaculation, excessive sexual activity, or sexual abstinence. Pain radiates to the scrotum, sacrum, perineum, and sometimes to the lower back.

Due to the inflammation of chronic prostatitis, the prostate increases in volume and squeezes the urethra. The lumen of the ureter is narrowed. The patient has frequent urination and a feeling of incomplete bladder emptying. Usually, dysuria is manifested in the early stages. Compensatory hypertrophy of the muscular layer of the bladder and ureter then occurs. Symptoms of dysuria diminish during this period and then worsen again as adaptive mechanisms decompensate.

In the initial stage, functional impairment may develop, which manifests differently in different patients. Patients may complain of frequent nocturnal erections, blurred orgasms, or worsening erections. Accelerated ejaculation is associated with a reduction in the orgasmic-centric excitation threshold level. Pain during ejaculation can lead to refusal to engage in sexual activity. In the future, sexual dysfunction will become more pronounced. In late stages, impotence develops.

The degree of sexual dysfunction is determined by many factors, including the patient's sexual constitution and psychological mood. Violation of potency and dysuria may be due to changes in the prostate and the patient's implication that if he suffers from chronic prostatitis, the development of sexual dysfunction and dysuria is expected to be inevitable. Psychogenic dysfunction and dysuria are often present, especially in suggestible, anxious patients.

Impotence, sometimes even the threat of a possible sexual disorder, is unbearable for the patient. There are often personality changes, irritability, disgust, excessive concern for their own health, and even "care about disease".

The disease has two groups of symptoms: irritant and obstructive. The first group of symptoms includes increased urination, persistent (urgent) urge to urinate, nocturia, and incontinence. This group of obstructive symptoms includes dysuria, delayed and increased urination time, incomplete emptying, intermittent slow urination, and the need for strain. Prostate adenomas are divided into three stages: compensated, subcompensated and decompensated.

Compensation stage

During the compensatory phase, the dynamics of voiding behavior change. It becomes more frequent, less intense and less free. Need to urinate 1-2 times at night. Typically, nocturia in prostate adenoma stage I is not a cause for concern in patients who associate persistent nocturnal awakenings with the development of age-related insomnia. During the day, normal urination frequency can be maintained, but patients with stage I prostate adenoma experience a waiting period, especially after nighttime sleep.

Then the frequency of urination during the day increases and the amount of urine per urination decreases. There is an urgent urge. The previously parabolic stream of urine is expelled slowly, falling almost vertically. Bladder muscle hypertrophy develops, thus maintaining its emptying efficiency. At this stage, there is little or no residual urine (less than 50 mL) in the bladder. The functional status of the kidneys and upper urinary tract is preserved.

sub-compensation stage

In stage II prostate adenomas, the bladder volume increases and dystrophic changes in its walls appear. The residual urine volume exceeded 50 ml and continued to increase. During the entire urination process, the patient is forced to intensely tighten the abdominal muscles and diaphragm, which leads to an even greater increase in pressure within the bladder.

The urination behavior becomes multi-stage, intermittent, and fluctuating. The passage of urine along the upper urinary tract is gradually disturbed. Muscle structures lose elasticity and the urethra dilates. Impaired renal function. Patients are concerned about symptoms of progressive chronic renal failure such as thirst and polyuria. The third phase begins when the compensation mechanism fails.

decompensation period

The bladder of a patient with stage III prostate adenoma is stretched and filled with urine, which is easily identified by palpation and vision. The upper edge of the bladder can reach above the navel. Even if the abdominal muscles are tense, it cannot be emptied. The desire to empty the bladder becomes constant. There may be severe pain in the lower abdomen. Urine is often excreted in drops or very small amounts. After that, the pain and the urge to urinate gradually diminish.

Characteristic paradoxical urinary retention or paradoxical ischia (full bladder, continuous drop-by-drop discharge). The upper urinary tract is enlarged, and the renal parenchymal function is impaired due to the continuous obstruction of the urinary tract, resulting in increased pelvic pressure. The clinical incidence of chronic renal failure is increasing. Without medical care, patients die from progressive CRF.

complication

In the absence of prompt treatment for acute prostatitis, there is a high risk of developing a prostate abscess. As purulent lesions form, the patient's body temperature rises to 39-40°C and becomes busy in nature. High temperatures alternate with severe chills. Severe pain in the perineum makes it difficult to urinate, making it impossible to have a bowel movement.

Increased prostate edema leads to acute urinary retention. In rare cases, an abscess bursts spontaneously into the urethra or rectum. When opened, purulent cloudy urine with an unpleasant pungent odor appears in the urethra; when opened, stool contains pus and mucus in the rectum.

Chronic prostatitis is characterized by a fluctuating course with prolonged periods of remission, during which the inflammation in the prostate is latent or manifested with very poor symptoms. Patients who are not bothered by anything usually stop treatment and turn around only when complications arise.

Transmission of the infection through the urinary tract leads to pyelonephritis and cystitis. The most common complications of the chronic process are inflammation of the testis and epididymis (epididymochitis) and inflammation of the seminal vesicles (seminal vesicles). The result of these diseases is usually infertility.

diagnosis

To assess the severity of prostate adenoma symptoms, patients were asked to complete a voiding diary. During the consultation, the urologist performs a digital examination of the prostate. To rule out infectious complications, prostate secretions and urethral smears were sampled and examined. Other tests include:

• echo.During prostate ultrasound, the volume of the prostate is determined, stones and areas of congestion are detected, residual urine volume is assessed, and the condition of the kidneys and urinary tract is assessed.
• Urodynamic studies.Uroflowmetry allows you to reliably determine the extent of urinary retention (the time of urination and the speed of the flow of urine are determined by special instruments).
• Definition of tumor markers.To rule out prostate cancer, it is necessary to assess the level of PSA (prostate-specific antigen), whose value should usually not exceed 4 ng/ml. In controversial cases, a prostate biopsy is performed.

The frequency of cystography and excretory urography for prostate adenomas has decreased in recent years due to the advent of new, less invasive and safer research methods (ultrasound). Cystoscopy is sometimes done to rule out disease with similar symptoms or to prepare for surgery.

treat prostatitis

Treatment of acute prostatitis

Patients with an uncomplicated acute course were treated on an outpatient basis by a urologist. Severe poisoning, suspected purulent process, requiring hospitalization. Take antibacterial treatment. The formulation is selected taking into account the susceptibility to the infectious agent. Antibiotics are widely used and penetrate well into prostate tissue.

With the development of acute urinary retention following prostatitis, they resorted to the installation of a cystostomy instead of a urinary catheter because of the risk of developing a prostate abscess. As the abscess develops, the endoscopic abscess is performed through the rectal or through the urethral opening.

Treat chronic prostatitis

The treatment of chronic prostatitis should be complex, including symptomatic treatment, physical therapy, and immune correction:

• antibiotic treatment. Prescribe a long course of antibiotics (within 4-8 weeks) to the patient. The selection of the type and dose of antibacterial drug, as well as the determination of the duration of the course of treatment, are carried out individually. Drugs were selected based on the sensitivity of the microbial community based on the results of urine culture and prostate secretion.
• Prostate massage.Glandular massage has complex effects on the affected organs. During the massage, the inflammatory secrets that build up in the prostate are squeezed into the duct, then into the urethra and out of the body. The procedure improves blood circulation to the prostate, thereby minimizing congestion and ensuring better penetration of antimicrobials into the tissues of the affected organ.
• physiotherapy.To improve blood circulation, laser irradiation, ultrasonic waves and electromagnetic vibrations are used. If physical therapy procedures are not possible, warm medicated microenemas are prescribed for the patient.

In chronic, long-term inflammation, consultation with an immunologist is recommended to select strategies for immunocorrective therapy. Advise patients on lifestyle changes. Making certain lifestyle changes in patients with chronic prostatitis is both a therapeutic and preventive measure. Patients are advised to normalize sleep and wakefulness, establish dietary habits, and engage in moderate physical activity.

Conservative treatment

Conservative treatment is performed at an early stage and in the presence of absolute contraindications to surgery. To reduce the severity of disease symptoms, alpha-blockers, 5-alpha reductase inhibitors, herbal preparations (African plum bark extract or sabal fruit) are used.

Antibiotics are used to fight the infection that often accompanies prostate adenomas. At the end of the course of antibiotic treatment, probiotics are used to restore normal intestinal flora. Perform immunocorrection. The atherosclerotic vascular changes seen in most older patients prevent the flow of drugs to the prostate, so special drugs need to be prescribed to normalize circulation.

Operation

There are several surgical options for treating prostate adenomas:

1. travel(transurethral resection). Minimally invasive endoscopic technique. Surgery is performed when the adenoma volume is less than 80 cm3. Not suitable for renal failure.
2. Adenoma resection.It was performed in the presence of complications and the mass of the adenoma was more than 80 cm3. Currently, laparoscopic adenoma resection is widely used.
3. Laser Vaporization of the Prostate.Allows you to operate on tumor masses smaller than 30-40 cm3. It is the method of choice for young men with prostate adenoma because it allows you to preserve sexual function.
4. laser denucleation(Holmium - HoLEP, Thulium - ThuLEP). This method is recognized as the "gold standard" for surgical treatment of prostate adenomas. Adenomas larger than 80 cm3 can be resected without open intervention.

Surgical treatment of prostate adenomas has many absolute contraindications (decompensated diseases of the respiratory and cardiovascular systems, etc. ). If surgery is not possible, bladder catheterization or palliative surgery - cystostomy, installation of a urethral stent.

Prediction and Prevention

Acute prostatitis is a disease with obvious chronic tendency. Even with timely and adequate treatment, more than half of patients will eventually develop chronic prostatitis. Recovery is far from always achieved, however, with correct and consistent treatment and following your doctor's recommendations, it is possible to eliminate unpleasant symptoms and achieve long-term stable remission in a chronic course.

Prevention is the elimination of risk factors. It is necessary to avoid hypothermia, to alternate between periods of sedentary work and physical activity, to eat regularly and adequately. For constipation, laxatives should be used. One of the preventive measures is the normalization of sexual life, since both excessive sexual activity and sexual abstinence are risk factors for the development of prostatitis. If symptoms of a urinary system or sexually transmitted disease occur, seek medical attention immediately.