Chronic prostatitis

Chronic prostatitis is a prolonged inflammation that occurs due to infection or simultaneous pathologies in the prostate gland.

Signs of chronic prostatitis

Chronic prostatitis is diagnosed in men of all ages.According to statistics, this disease is the most common reason for a visit to a urologist in patients under 50 years of age.In a chronic form, a bacteriological examination detects the pathogen only in 5-10% of patients.In most cases, other factors are considered the cause of the disease.It is known that the presence of an infection is not a prerequisite for the onset of the disease.Chronic prostate inflammation is a poletiological pathology, which is the result of actions of some provocative causes and factors.In 90-95% of patients, antibacterial therapy has limited effectiveness or is not required at all.

Classification of chronic prostatitis

Classification of chronic prostatitis from the etiological feature distinguishes between the two main forms of the disease: chronic bacterial (infectious) prostatitis and chronic non -bacterial (aseptic)/chronic pelvic pain (KTS).

The etiological classification of chronic prostatitis includes:

  1. Chronic bacterial prostatitis.
  2. Chronic prostatitis non -bacterial (aseptic)/CTB ("prostatin", or "painful prostate gland" is an outdated term used to determine pathology).
  3. Chronic non -bacterial (aseptic)/CTB prostatitis with an inflammatory component (leukocyte concentration has increased significantly in the secret of the prostate, sperm, first part of urine).
  4. Non -bacterial (aseptic)/CTB prostatitis without an inflammatory component (white cell concentration in the secret of the prostate, sperm, the first part of the urine is insufficient for inflammation).
  5. Chronic ashmptomic prostatitis (discovered in laboratory studies, does not show itself clinically).

Chronic bacterial prostatitis is a rare pathology, as seen from the above statistics.Infection is the cause of repeated chronic prostate inflammation in one of the ten patients.Pathology is often associated with other infectious diseases of the genitourinary organs.Most often, its cause is a non -specific infection, however, in the presence of STSPP, chronic inflammation of the gland can be caused by chlamydia, ureaplasmosis, mycoplasmosis or other specific microorganisms.

Chronic non -bacterial (aseptic) prostatitis, or chronic pain syndrome, is a repeated long -term recurring disease that occurs as a result of aseptic inflammation of the prostate.This is a slightly determined pathology.In the presence of symptoms of the disease, tests determine white blood cells in the secret of the gland, in the seed of the seed, in the initial part of the urine, but the results of bacteriological examination are negative.In other cases, there are neither signs of infection nor pronounced leukocytosis with bright symptoms.

There are also chronic prostatitis in the phase of irritation and chronic prostatitis at the remination phase.A cyclical course is characteristic of both bacterial and non -infectious inflammation of the prostate gland.Determination of chronic prostatitis leads to an increase in symptoms in both cases.

Patanatomical (pathomorphological) classification of chronic prostatitis is of limited interest to patients and clinical doctors.

Causes of chronic prostatitis

Causes of chronic bacterial inflammation of the prostate gland

Chronic infectious prostatitis occurs due to infection of the prostate gland tissue.Most often, the cause of inflammation is E. coli, or e.Coli, less carved microbes of Enterococci, Klebsell, Proteus, Pseudomonas.

Like some other microbes, E. coli is capable of forming biofilma, thin, made up of bacterial accumulations and tightly adjacent to the canal mucosa.This explains why it is not always possible to cure chronic prostatitis.It is believed that the infection spreads as a contagious way through the urethra.However, lymphogenic and hematogenous spread of infection is also possible.

Predisposing factors for the emergence of chronic infectious prostatitis are as follows:

  • active sexual age;
  • prostate adenoma, or benign prostate hyperplasia;
  • narrowing of the urethra;
  • Unlock the extreme penis meat;
  • Bladder neck hypertrophy;
  • medical procedures (bladder catheterization, cystoscopy);
  • Genetic and anatomical characteristics predisposes to the disease.

Causes of chronic non -bacterial inflammation of the prostate gland

The causes of non -bacterial chronic prostatitis are exactly unknown.Perhaps the disease is caused by viruses or bacteria, which are not identified during bacterial secretion of the prostate gland.However, most scientists and doctors believe that chronic prostatitis non -bacterial (aseptic)/CTB is a polyetological disease that occurs as a result of combinations of some adverse factors, namely:

  • cycling;
  • irritation of the prostate gland tissue when urine enters its canals;
  • irritation of the prostate gland as a result of the use of any product or drink (especially with food allergies or celicia);
  • functional disorders of the nerve intrigue of the pelvic organs;
  • Pelvic floor muscle atrophy;
  • stress, psycho -emotional loads;
  • Pathology in the prostate gland, remaining behind the long acute prostatitis;
  • hormonal disorders;
  • Bladder diseases;
  • Cold climate.

Since the exact causes of the disease are little known, the treatment of chronic prostate can be difficult.

Symptoms of chronic prostatitis

Chronic bacterial (infectious) prostatitis is characterized by a cyclical course.The irritation phase is replaced by a phase of forgiveness.There are practically no symptoms between irritation.There is a clear link between other diseases of the genitourinary organs - urethritis, epididymm, cystitis.The cause of these pathologies, as a rule, is the same pathogen that causes chronic prostate.Symptoms during irritation are represented by dysuric phenomena (frequent urination, rubber and burning pain during urination) and pain of various intensity in the perineum, scrotum, sacrum, radiation in the penis.

The general condition is usually satisfactory.There are no signs of intoxication, there is no increase in body temperature.The prostate gland when examined through the rectum (for rectum) can be normal or slightly swollen, without a sharp characteristic pain of acute prostatitis.

Chronic prostatitis non -bacterial (aseptic)/KTB is characterized by pain of varying degrees of severity (from stupid lungs to intense) in the pelvis, perineum, sacrum and are "cards of visits" of the disease (chronic chronic prostatitis).Signs of inflammation of the prostate gland are poorly expressed and observed in 50% of cases.In other patients, they may be missing.

The presence of blood in semen, painful spill, defecation, dysourical phenomena are possible.The severity of the symptoms can vary.The pain is given to the turn, the rectum, making it difficult to find a person in a sitting position.Fatigue, unreasonable fatigue, articular pain and muscles are also possible.Some patients complain of a sexual machine, erectile dysfunction (powerless).

Chronic asymptomatic prostatitis has no symptoms characteristic of this disease, that is, its name.During laboratory study of prostate secret, leukocytosis is determined, an increase in the levels of a specific prostate antigen is possible.There are no other signs of the disease.

Diagnosis of chronic prostatitis

The main methods for diagnosing chronic infectious prostatitis are laboratory tests and current tests that allow you to detect the source of leukocytes in the urine and sperm.

A three -wall urine test helps identify inflammation.To do this, the patient urinates three containers for analysis.Prostate massage between the second and third containers leads to stimulation of the secretion of the gland.As a result, urine in the third vessel will contain the discharge of the prostate gland (leukocytes, red blood cells, bacteria), which is determined during the analysis.There is no need to massage the prostate specifically and explore the pure glandular secret.

Urine from the third vessel can be sent to a bacteriological examination with planting in a nutritious medium.In the presence of bacterial growth, a test of pathogen to antibiotics is performed.The method helps to perform the treatment more accurately and more effective.Since the secret of the prostate is an important part of the sperm, microscopy and ejacula bacteria also make it possible to make the correct diagnosis.

Chronic bacterial (infectious) prostatitis is associated with a slight increase in PSA.Its level decreases after successful treatment.Ultrasound and other instrumental studies have no significant diagnostic value.

Diagnosis of non -bacterial (aseptic)/CTB prostatitis can be difficult.Often the diagnosis is made by excluding other pathologies of the genitourinary tract and bacterial prostatitis.For this, instrumental and laboratory methods are used: Urine microscope (a three -walled test is also used after prostate massage), sperm or prostate secrets, followed by planting in a nutrient medium.The list of studies includes PSA tests (differential diagnosis of cancer and prostate inflammatory diseases).

Microscopy reveals the presence of leukocytes in the urine, in the secret of the prostate, seed juice with negative results of bacteriological treatment methods.Instrumental research methods (ultrasound, cystoscopy, MRI, CT) do not detect signs of associated pathology.

Treatment of chronic prostatitis

For the successful treatment of chronic infectious prostatitis, rational and intended antibacterial therapy is necessary.Preparations of choice are fluoroquinolones that create large concentrations of medicine in the glandular tissue.The course of treatment lasts from six to 12 weeks.Such a duration of antibacterial therapy is necessary for the complete elimination of infection and relap prevention.Second drugs.

Chronic bacterial prostatitis can be cured with stable and adequate therapy.Patients with frequent relapses should check immunity status.It may also be necessary to rule out HIV infection, which is often the cause of the low effectiveness of antibacterial therapy.In such patients, it is possible to prescribe antibiotics at a sufficient dose to suppress the growth of bacteria.

Treatment of chronic prostatitis non -bacterial/KTS is difficult, as infection is not the cause of chronic pelvis pain or chronic abacterial prostatitis.It is necessary to bring the problem seriously and answer the question of how to treat a disease whose cause is exactly unknown.

The lack of a particular etiology explains why efforts to therapy of this pathology are often unsuccessful.

Methods of treatment of chronic aseptic prostatitis contain:

  1. Antibacterial therapy with fluoroquinolones (performed by all patients).It is possible to have an infection that is not detected during a bacteriological examination.
  2. Alpha-blocker.They contribute to improving blood circulation in prostate tissue.Effectiveness is low.
  3. NSAIDs and other anti -inflammatory drugs have severe effectiveness, relieve pain and improve symptoms.However, treatment is pathogenetic, after cancellation, renewal of the disease is possible.
  4. Exercises of physiotherapy and physiotherapy (yoga, sport, active lifestyle), helping improve blood circulation and eliminate venous stagnation, hypoxia, strengthening of pelvic muscles.The method helps patients with appropriate disorders.
  5. Antidepressants and anticonvulsants (effectiveness is not proven).
  6. Surgical treatment: laser or thin -iginal ablation of the (not effective) prostate gland.

Predict

In chronic infectious prostatitis in most patients, the prognosis is favorable.Sustainable and adequate antibacterial therapy allows you to succeed in more than 80% of cases.

Chronic non -bacterial (aseptic)/KTB prostatitis has a worse prediction.Treatment only helps a few patients.Others continue to suffer from chronic pain syndrome, despite using all available methods of treatment.The disease has a pronounced effect on the psycho -emotional sphere and sexual intercourse.