Prostatitis

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

A wide range of clinical signs and complaints can be identified.

Anatomy

The prostate is a small gland that is part of the male reproductive system and a hormone-dependent organ. Its shape and size are comparable to those of a large walnut. A normal prostate gland weighs about 20 g, its volume is 15-25 ml and its length is 3 cm, width 4 cm and depth 2 cm.

The prostate gland is located in the small pelvis, below the bladder and above the rectum. Urethra, urea passes through the thickness of the gland. The prostate is surrounded by a capsule composed of smooth muscle, collagen and elastic fibers; Covered with three layers of dense connective tissue (fascia) on the anterior, lateral, and posterior surfaces. The posterior surface of the prostate is bordered by a rectal ampulla. They secrete retrovesian fascia or denonville fascia, which allows palpation of the posterior surface of the prostate gland.

The prostate gland is about 70% glandular tissue and 30% fibromuscular stroma. Normally, the body is divided into 3 zones.

Transition zone.In the transition zone, 10% of glandular tissue and 20% of malignant tumors of the prostate fall. One of the major age-related diseases in men develops in this zone - benign prostatic hyperplasia, which can lead to difficulty urinating due to excessive growth of tissues.

Central zone.The area surrounding the ejaculatory ducts. Consists of glandular tissue, connective tissue, and muscle elements. Tumors are very rare in this area.

Peripheral zone.It covers the back and sides of the prostate gland and contains 70% of the glandular tissue. This is the area that is felt through the rectum and allows the urologist to assess the condition of the prostate gland. Up to 70% of malignant tumors are localized precisely in the peripheral zone. Therefore, digital rectal examination is an important diagnostic method and should be performed in patients older than 45 years.

Prostate functions:

• Production of prostate secretion, which is an integral part of sperm and participates in ejaculate fluid, as well as its saturation with nutrients such as various enzymes and vitamins, citric acid, zinc ions, which help improve sperm motility and activity;
• The prostate contains smooth muscle fibers that help sperm from the urethra during ejaculation, prevent sperm from entering the bladder, and participate in the urinary retention mechanism.

Prostatitis, benign prostatic hyperplasia, and prostate cancer are the three major diseases of the prostate.

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

Causes of prostatitis

According to statistics, prostatitis is the most common urological disease - after prostate hyperplasia and prostate cancer - in men under 50 and the third most common in men over 50.

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

The most common causative agent of prostatitis is E. coli strains, which are detected in 80% of cases. More rare pathogens are enterococci, Pseudomonas aeruginosa, Klebsiella and other gram-negative bacteria. The role of sexually transmitted infections (e. g. , chlamydia trachoma) in prostate inflammation has not yet been clearly established and studied. In patients with HIV and other severe changes in the immune system, possible causative agents are cytomegalovirus, mycobacterial tuberculosis, fungi, and other rare pathogens. There is evidence to suggest the presence of microorganisms in the prostate gland that have not been identified in standard studies but play a role in detecting inflammatory changes and the subsequent development of prostatitis symptoms.

Possible causes of prostatitis are:

• Intraprostatic reflux of urine as a result of dysfunctional urination (urine, with certain predisposing factors, can enter the prostate gland through the prostate ducts, causing the inflammatory process);
• Unprotected anal sex;
• Narrowing of the niscart (phimosis);
• Autoimmune diseases;
• Functional and anatomical changes in the pelvic floor muscles;
• Changes in the central nervous system, including functional and anatomical changes in the brain;
• Traumatic and unusual sexual activity;
• Psychological factors (a number of studies have confirmed the effect of psychological stress on the symptoms of chronic prostatitis - some patients are diagnosed with psychosomatic disorders, which have been shown to reduce the symptoms of prostatitis and the likelihood of recurrence).

Risk factors for prostatitis also include: abstinence or excessive sexual activity, ejaculation habits, smoking, night work, sedentary lifestyle, insufficient fluid intake, and diet.

Symptoms

• Pain or burning when urinating (dysuria);
• Urinary disorders;
• Change in urine color;
• The appearance of blood in the urine;
• Pain in the abdomen, groin or lumbar region;
• Pain in the perineum;
• Pain or discomfort in the penis and testicles;
• Pain with ejaculation;
• Increased body temperature (with acute bacterial prostatitis).

Diagnosis

According to the generally accepted classification of prostatitis NIH (National Institutes of Health), there are four categories of the disease traditionally denoted 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;
• III b - chronic prostatitis / chronic pelvic pain syndrome without signs of inflammation;
• IV - Asymptomatic (asymptomatic) chronic prostatitis.

Despite the prevalence of prostatitis, acute bacterial prostatitis is not common - 5% of all cases of the disease. But its diagnosis is quite simple, since the picture of the disease is most often expressed: a man complains of frequent, painful urination, pain in the uterus and perineum. It is characterized by an increase in body temperature and often with high values - less than 39 ° C.

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

Digital rectal examination (DRE) is an important diagnostic manipulation if any pathology of the prostate gland is suspected. It is therefore advisable that men do not refuse to hold it.

In acute bacterial prostatitis, on palpation the prostate is sharply painful, swollen, most often enlarged. Ultrasound examination can show not only the size of the prostate gland, but also the foci of purulent fusion of the prostate tissue (abscess) - but this happens rarely and is usually the result of an ongoing process.

Laboratory diagnosis primarily involves a general urine test that shows an increase in the number of leukocytes. Bacteriological 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, and thus prescribe antibiotic therapy. A general blood test is also performed to assess the general condition of the body and the response to the inflammatory process.

Acute prostate secretion during acute prostatitis is contraindicated due to the increased risk of life-threatening conditions: bacteremia and sepsis. It is also not recommended to determine the oncomarker (PSA), its fractions - due to the low content of information and data distortion in the background of inflammation.

Treatment of prostatitis

Antibiotic therapy is the main therapy for all categories of prostatitis patients.

Alpha-blockers are also an effective group of drugs. Their action reduces the tone of the smooth muscles of the prostate gland, neck of the bladder and part of the prostate gland, which improves urination and reduces the possibility of entering the prostate gland (intraprostatic reflux), which 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 prostate hyperplasia.

It is possible to use anti-inflammatory drugs (diclofenac) that effectively reduce pain and discomfort when urinating, reduce prostate swelling and also help to improve the quality of urination to some extent.

Acute bacterial prostatitis is often the reason for hospitalization where antibiotic therapy is prescribed in the form of intravenous injections. Once the patient’s condition has stabilized, the patient continues to take antibiotics in tablet form for 15 days or more to prevent acute prostatitis over chronic bacterial prostatitis.

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

How prostatitis is treated in the clinic

Urologists treat prostatitis and other diseases of the genitourinary system based on international clinical guidelines. This means that they use not only their professional knowledge, but also lead the world of scientifically proven and accepted diagnosis and therapy.

Our doctors do not prescribe ineffective drugs and examinations "just in case", do not treat non-existent diseases. When making a diagnosis, urologists rely on data obtained from the examination of the patient, the clinical picture, the data of laboratory and instrumental studies. If surgical treatment is required, surgery is performed on the clinic site.