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prostatitis

Symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the male prostate that has a negative impact on sexual function and the urinary process.Pain in the perineum, groin, lower back, and pelvic area, and urodynamic disturbances (outflow of urine) may indicate the presence of prostatitis.Untreated prostatitis can lead to male infertility and prostate cancer.

This is one of the most common male disorders and requires careful attention and effective systemic treatment.This is exactly what you'll find in a specialist clinic urology department to solve your prostatitis problem.Highly qualified uro-andrologists have been successfully treating acute and chronic prostatitis for many years.Complex treatment, careful attention, and individualization of each case inevitably lead to patient recovery and stable, long-term remission.

Prevalence

Prostatitis ranks 5th among the 20 major urological diseases.It is thought that by the age of 30, 30% of the male population has prostatitis, by 40-40%, and 50 years later, almost all men are bearing the burden of the disease in some way.If predominantly infectious prostatitis is recorded before the age of 35 years, then at more mature ages non-infectious prostatitis predominates and, in general, bacterial inflammation of the prostate is diagnosed several times more frequently.

Anatomy and Physiology of the Prostate

The prostate (prostate) is located in the lower front part of the pelvis, below the bladder.It is composed of glandular and smooth muscle tissue surrounded by a fibrous capsule.The urethra passes from the bladder through the prostatic body, and the ejaculatory duct opens into the bladder.

The prostate is a hormone-dependent organ.It is formed and functions under the influence of male hormones (androgens).Testosterone plays a leading role in this process.

The prostate is connected to the seminal tubercle, which acts as a valve for the ejaculatory ducts.As part of the male reproductive system, the prostate affects erection, ejaculation, and orgasm.The nerves responsible for erections pass through the gland.In the chronic course of the disease, they are involved in inflammatory processes and erectile dysfunction occurs.

The secretion produced by the prostate is part of semen.It creates favorable conditions for sperm activity.Therefore, with chronic dysfunction of the glands, male infertility may occur.

Pathogenesis

There are two main reasons for the occurrence of prostatitis:

  • Prostatic secretion stagnates against the background of impaired blood circulation and lymphatic outflow to the gland itself and adjacent organs;
  • Pathogenic and opportunistic microbiota.

Acute prostatitis is often associated with an infection of the prostate tissue.Often, however, these two factors are interrelated, creating a vicious cycle that complicates the treatment of prostatitis.

An inflamed prostate can become painful.Pain may be felt in the perineum, groin, pelvis, and lower back.This sensation is acutely enhanced during digital rectal examination or palpation during defecation.

The prostate enlarges and squeezes the urethra.This makes it difficult for urine to flow from the bladder.The urine stream becomes weak.The patient must tense their abdominal muscles to urinate.Urinary tract obstruction and acute urinary retention sometimes occur in acute cases.

Inflammation causes disruption and stagnation of the flow of prostatic fluid.The resulting swelling disrupts cellular metabolism and respiratory processes in the glands.This sets the stage for the process to become chronic.If prostatitis lasts for a long time, nearby organs may become inflamed: seminal tubercle, Cooper's gland, seminal vesicles.The chronic form of the disease is associated with a risk of male infertility, adenomas, and prostate cancer.

In recent years, it has been found that 70-80% of prostatitis is caused by gland stagnation.Venous disease is less common but can also cause prostatitis, especially if accompanied by hemorrhoids and left-sided varicocele (dilated testicular veins).

Classification

The National Institutes of Health divides prostatitis into 4 categories:

  • Acute prostatitis (category I)
  • Chronic bacterial prostatitis (category II)
  • Chronic prostatitis/chronic pelvic pain syndrome (category III)
  • Asymptomatic chronic prostatitis (category IV)

Depending on how it occurs, prostatitis is divided into two types:

  • non-infectious
  • contagious

The inflammatory process can develop rapidly, with noticeable symptoms (acute phase), or it can develop slowly, with symptoms gradually disappearing.

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 prostatitisProduced due to penetration of prostate tissue by pathogenic or opportunistic microflora: bacteria, viruses, fungi.Infection can enter the prostate in different ways:

  • Urogenic (ascending): Entrance is the urethra.Of note, infections can also enter via the descending route, as in suppurative pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphogenic: Infections from adjacent pelvic organs can travel through the lymph into the prostate due to inflammation of the rectum (proctitis) or bladder (cystitis) and infected hemorrhoidal veins.
  • Hematogenous (through blood): caused by the presence of chronic infectious lesions (tonsillitis, dental caries) or acute infectious complications (influenza, acute respiratory infection, tonsillitis, etc.) in the body.

The most common pathogens of prostatitis are:

  • Bacteria: Escherichia coli, Proteus, Gardnerella (Gram-negative); Staphylococcus, Streptococcus (Gram-positive);
  • Viruses (influenza, herpes, cytomegalovirus, ARVI pathogens);
  • Mycoplasma;
  • Chlamydia;
  • Specific bacterial groups (gonococci, trichomoniasis, tubercle bacilli).

Depending on the nature of the course of the disease, prostatitis occurs:

  • hot
  • Chronic

acute prostatitisUsually occurs under the influence of pathogenic (opportunistic) microflora in the presence of predisposing factors.The disease progresses rapidly and has obvious symptoms.If left untreated, a suppurative process may develop, causing the prostate tissue to melt.If not treated properly, acute prostatitis often becomes chronic.

chronic prostatitisThe course of the disease was mild and the symptoms disappeared.However, it will worsen from time to time, and then the symptoms will correspond to the acute course.However, complete remission is not always possible between acute attacks, and patients may continue to feel discomfort.Chronic prostatitis can lead to impotence, male infertility, adenomas, or prostate cancer.

There is a chronic asymptomatic form of the disease, in which the patient does not experience any discomfort but has an increased number of purulent components (white blood cells) in the prostate secretions.

complication

Without proper treatment, the inflammatory process can lead to purulent melting of prostate tissue.In addition, inflammation can spread to nearby organs: sperm tubercle, Cooper's gland, seminal vesicles, urethra.Therefore, the following complications may occur:

  • prostate abscess
  • Prostatic sclerosis/fibrosis (replacement of functional glandular tissue by connective tissue)
  • prostate cyst
  • prostate stones
  • Seminal vesiculitis (inflammation of the seminal vesicles)
  • Papulitis (inflammation of spermatoderma)
  • Epididymo-orchitis (inflammation of the testicles and their appendages)
  • posterior urethritis
  • Erectile Dysfunction/Impotence
  • Ejaculation disorders
  • infertility
  • prostate adenoma
  • prostate cancer

symptom

Different forms of prostatitis have their own characteristics and severity of symptoms.Generally speaking, the following symptoms are characteristic of prostatitis:

  • Pain in the groin, lower back, perineum (may radiate along the spermatic cord).
  • Pain worsened during defecation and digital rectal examination.
  • Urodynamic disorders (frequent urination, urinary retention, dysuria, weak urinary flow, incomplete bladder emptying).
  • Prostatic leakage (involuntary release of prostate fluid, especially in the morning and during bowel movements).
  • Sexual dysfunction (loss of libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • The temperature rises to 39-40 degrees
  • acute urinary retention
  • general poisoning
  • Leukocyturia, protein, and mucus in urine
  • Blood in urine and semen
  • Increased leukocytes in prostate secretions
  • According to ultrasound data, hypoechoicity, enlarged glands, and increased blood flow

Symptoms of chronic prostatitis

  • Body temperature is usually no higher than 37°C
  • Pain sensation becomes dulled and smoothed
  • Discharge from the urethra during defecation
  • urinary tract disease
  • loss of libido
  • erectile dysfunction
  • Ejaculation disorders (premature or delayed ejaculation)

reason

The main causes of prostatitis are infection and stagnation of prostate secretions.The following factors can cause prostatitis:

  • Opportunistic flora for infection and reduced immunity
  • lack of physical activity
  • "Sedentary" work
  • long term abstinence
  • In vitro ejaculation (delayed ejaculation)
  • Glandular exhaustion from excessive sexual activity
  • alcoholism
  • Decreased local immunity (hypothermia, use of immunosuppressants, immune deficiency, autoimmune diseases)
  • pelvic organ damage
  • Procedures on the prostate and nearby organs (prostate biopsy, surgery, catheterization, cystoscopy, etc.)
  • chronic diarrhea or constipation

diagnosis

There are many ways to detect prostatitis, which can be divided into three categories: digital rectal examination, laboratory examination, and instrumental methods.

Digital rectal examinationIt is performed by a urologist-andrologist after a conversation with the patient.This method allows you to evaluate some characteristics of the prostate's size, shape, and structure.Doctors can pre-diagnose prostatitis if the prostate increases in size and the surgery itself is painful for the patient.

If the situation is not acute, the doctor may perform prostate massage during the examination to obtain prostate secretions. Its study is an important part of diagnosing prostatitis.Prostatic massage is contraindicated if acute bacterial prostatitis is suspected: such procedures can lead to the spread of pathogens and blood poisoning.

To confirm the diagnosis, the patient will be asked to undergo an examinationInstrumental Studies,For example:

  • Transrectal ultrasonography of the prostate and pelvic organs (showing structural features, presence of inflammatory and purulent foci, stones, cysts and other tumors);
  • Dopplerography (glandular flow characteristics);
  • Uroflowmetry (determines the speed and timing of urination);
  • Magnetic resonance imaging of the pelvic organs (an informative and safe study that allows for differential diagnosis with other conditions).

If necessary, the diagnosis can be performed on organs near the genitourinary system: urethroscopy, urethrography and urethrocystography.

laboratory researchIs an essential component of the diagnosis of prostatitis:

  • General urinalysis (before and after prostate massage)
  • General blood tests
  • Blood tests for acute phase proteins of inflammation (C-reactive protein, etc.)
  • Microscopic examination of prostate secretions after finger massage
  • Microscopic examination of urethral scrapings
  • Sperm diagram (cytology and biochemistry of sperm)
  • Urine, prostate secretions, and sperm cultures
  • Prostate-specific antigen (PSA) measurement
  • Prostate biopsy and histological examination of glandular tissue

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

Modern diagnostic systems have an excellent, information-rich diagnostic foundation.Urologists have extensive experience in diagnosing and successfully treating all forms of prostatitis, and multidisciplinary clinic status gives you access to the services of experts in relevant fields.The medical center has developed research packages that include all necessary types of diagnostics at very attractive prices. 

treat

Treating prostatitis is not an easy task.It requires a thoughtful and integrated approach.Treatment options for this disease include medications, physical therapy procedures, and in some cases surgical intervention.

drug treatment

Involves the use of the following medications:

  • Antibiotics (after determining susceptibility to them)
  • Preservatives (local)
  • Vascular medications (to improve prostate microcirculation)
  • NSAIDs
  • Alpha-1 blockers (for urinary problems)
  • Enzymes (dilute prostate secretions, stimulate immune system, relieve inflammation)
  • immunomodulator
  • antidepressants

physical therapy

  • Prostate electrical stimulation (electrophoresis, electroplating, pulse action)
  • vibration massage
  • Laser treatment with rectal sensor (for chronic prostatitis)

For chronic prostatitis, prostate massage can be used as a treatment.In the acute stage of the disease, this procedure is not performed to avoid the spread of infection and sepsis.

surgical treatment

Prostatitis is rarely treated surgically.This need arises when there is severe suppuration of the prostate tissue, lack of aggressive motivation for medical treatment, and pathological enlargement of the prostate blocking the urethra.

predict

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

If treatment is incorrect and the duration of treatment (several months) is not adhered to, the disease often has a chronic course.Chronic prostatitis greatly affects men's quality of life because not only urinary function is affected, but sexual function is also affected.Erectile dysfunction, loss of orgasm intensity, ejaculation problems and infertility occur in 30% of cases.Chronic prostatitis is completely impossible to cure, but with the right approach, stable remission can be achieved.

Benefits of visiting a professional clinic

  • Successfully Treats All Forms of Prostatitis
  • Experienced top qualified urologists and andrologists
  • Multidisciplinary, allowing you to involve experts in relevant fields in your treatment
  • High-precision modern diagnostic and treatment equipment
  • Own European-level clinical diagnostic laboratory
  • Comfortable and high-tech hospital
  • Attractively priced urology diagnostic package

Prevent prostatitis

  • Choose protected sex to avoid sexually transmitted infections (STIs)
  • Support the immune system (vitamins, healthy diet, prevention of dysbiosis, appropriate antibiotic treatment, etc.)
  • Avoid hypothermia
  • Live an active lifestyle
  • If possible, have sex regularly with one partner (to avoid prostate stasis and STIs)
  • Avoid interrupting intercourse (this will relieve sperm stasis)
  • Visit your urologist once a year for preventive purposes or 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, the clinical manifestations of prostate cancer are similar to those of prostatitis.Therefore, the PSA test is used to differentiate between these two diseases.However, you shouldn't bet on PSA.This antigen is also increased in prostate adenomas (benign growths of glandular tissue).In prostatitis, PSA levels also increase during periods of inflammatory activity.It decreases during the remission phase.Therefore, PSA cannot be used as clear evidence of prostate cancer or prostatitis.

Why is prostatitis difficult to treat?

Prostate capillaries have a special structure that forms a blood-prostate barrier.This makes it difficult for certain types of antibiotics to penetrate the glandular tissue.In addition, microorganisms tend to form biofilms, which reliably protect them from the action of antimicrobial agents.Therefore, modern regimens for the treatment of prostatitis must include proteolytic enzymes that can disrupt biofilms.The bacteria become weaker and the antibiotics work more effectively.Chronic prostatitis is the one that most requires ongoing treatment and is primarily characterized by the diversity of the microbial flora in cultures.Enterococci resistant to all aminoglycosides and cephalosporins colonize approximately 50% of cases.This narrows the range of effective antimicrobials and complicates treatment.