Chronic prostatitis

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

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

Classification of chronic prostatitis

The classification of chronic prostatitis by etiological characteristic distinguishes two major forms of the disease: chronic bacterial (infectious) prostatitis and chronic non -bacterial (aseptic) prostatitis/chronic pelvic pain (KTS).

The etiological classification of chronic prostatitis includes:

1. Chronic bacterial prostatitis.
2. Chronic non -bacterial (aseptic) prostatitis/CTB ("prostate" or "painful prostate gland" is an outdated term used to determine the pathology).
3. Chronic non -bacterial (aseptic) prostatitis/CTB with an inflammatory component (the concentration of leukocytes is significantly increased in the secret of the prostate, semen, the first part of the urine).
4. Chronic non -bacterial (aseptic) prostatitis/CTB without an inflammatory component (concentration of white blood cells in the secret of the prostate, semen, the first part of the urine is insufficient for inflammation).
5. Ashmptomic chronic prostatitis (found in laboratory tests is not shown clinically).

Chronic bacterial prostatitis is a rare pathology, as seen from the above statistics.The infection is the cause of chronic recurrent prostate inflammation in one of the ten patients.Pathology is often associated with other infectious diseases of the genius.Most often it is a non -specific infection, but 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 long -term recurrent disease that occurs as a result of aseptic prostate inflammation.This is a little study of pathology.In the presence of symptoms of the disease, the tests determine the white blood cells in the secret of the gland, in the semen, in the original part of the urine, but the results of the bacteriological examination are negative.In other cases, there are neither signs of infection nor pronounced leukocytosis with bright symptoms.

There is also chronic prostatitis in the exacerbation phase and chronic prostatitis in the remission phase.The cyclical course is characteristic of both bacterial and non -infectious inflammation of the prostate gland.Exacerbation of chronic prostatitis leads to an increase in symptoms in both cases.

Patanatomic (pathomorphological) classification of chronic prostatitis is a limited interest in patients and clinical doctors.

The causes of chronic prostatitis

Causes of chronic bacterial inflammation of the prostate gland

Chronic infectious prostatitis occurs due to infection of the tissues of the prostate gland.Most often the cause of the inflammation is E. coli, or E.Cars.Larger often carved germs of the genus Enterococci, Klebsell, Proteus, Pseudomonas.

Like some other germs, E. Coli is capable of forming biofilms, thin, consisting of bacterial deposits and tightly adjacent to the mucous membranes of the ducts.This explains why it is not always possible to cure chronic prostatitis.The infection is thought to spread as an ascending pathway through the urethra.Lymphogenic and hematogenous spread of infection is also possible.

The predisposing factors for the onset of chronic infectious prostatitis are as follows:

• sexually active age;
• prostate adenoma or benign prostate hyperplasia;
• narrowing of the urethra;
• Develop the extreme flesh of the penis;
• Hypertrophy of the bladder neck;
• Medical procedures (catheterization of the bladder, cystoscopy);
• Genetic and anatomical characteristics predisposing to the disease.

Causes of chronic no -bacterial inflammation of the prostate gland

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

• cycling;
• Irritation of the tissues of the prostate gland when the urine enters its ducts;
• prostate irritation as a result of the use of any products or beverages (especially with food allergies or Celiacia);
• Functional disorders of the nerve innervation of the pelvic organs;
• Atrophy of the pelvic floor muscles;
• stress, psychomation loads;
• Pathology in the prostate gland, remaining after many years of acute prostatitis;
• hormonal disorders;
• bladder diseases;
• Cold climate.

Because the exact causes of the disease are slightly known, the treatment of chronic prostatitis can be difficult.

Symptoms of chronic prostatitis

Chronic bacterial (infectious) prostatitis is characterized by a cyclic course.The exacerbation phase is replaced by a remission phase.There are virtually no symptoms between exacerbations.There is a clear link between other diseases of the genitatorial organs - urethritis, epididymines, cystitis.The cause of these pathologies is as a rule the same pathogen that causes chronic prostatitis.Symptoms during exacerbation are represented by dysuric phenomena (frequent urination, rubber and burning pain during urination) and pain of varying intensity in the perineum, scrotum, sacrum, with irradiation in the penis.

The general condition is usually satisfactory.There are no signs of intoxication, no fever.The prostate gland when examined through the rectum (of the rectum) can be normal or slightly swollen, without acute pain characteristic of acute prostatitis.

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

The presence of blood in sperm, painful ejaculation, bowel movements, dysric phenomena may be present.The severity of the symptoms can change.The pain is applied to the crotch, the rectum, which makes it difficult to find a person in a sitting position.Fatigue, unreasonable fatigue, joint and muscle pain are also possible.Some patients complain of decreased sexual urge, erectile dysfunction (impotence).

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

Diagnosis of chronic prostatitis

The main methods of diagnosing chronic infectious prostatitis are laboratory tests and local tests that allow you to understand the source of leukocytes in the urine and semen.

A three -channel urine test helps to identify inflammation.To this end, the patient urinates three containers for analysis.Prostate massage between the second and third container leads to stimulation of gland secretion.As a result, the urine in the third container will contain the elimination of the prostate gland (leukocytes, red blood cells, bacteria), which is determined during the analysis.It is not necessary to specifically massage the prostate and to examine the pure secret of the gland.

The urine from the third container can be sent for a bacteriological examination with a sowing of the nutrient medium.In the presence of bacterial growth, a test for the sensitivity of the pathogen to antibiotics is performed.The method helps to carry out treatment more accurate and more effective.Because prostatic secret is a significant part of sperm, microscopy and ejaculate bacteria also make it possible to make the correct diagnosis.

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

The diagnosis of chronic non -bacterial (aseptic) prostatitis/CTB can be difficult.Often the diagnosis is made by excluding other pathologies of the genological tract and bacterial prostatitis.For this, instrumental and laboratory methods are used: urine microscopy (three -stage test is also used after prostate massage), sperm or prostate secrets, followed by sowing a nutrient medium.The list of studies includes PSA analysis (differential diagnosis of cancer and inflammatory diseases of the prostate).

Microscopy reveals the presence of leukocytes in the urine, in the secret of the prostate, semen with negative results from the methods of bacteriological treatment.Instrumental methods of examination (ultrasound, cystoscopy, MRI, CT) do not reveal signs of concomitant pathology.

Treatment of chronic prostatitis

The successful treatment of chronic infectious prostatitis requires rational and purposeful antibacterial therapy.Optional preparations are fluoroquinolones that create high concentrations of the drug in the tissues of the gland.The course of treatment takes six to 12 weeks.A similar duration of antibacterial therapy is required to completely eliminate the infection and prevention of relapses.Second -core drugs.

Bacterial chronic prostatitis can be cured with consistent and adequate therapy.Patients with frequent relapses should check the immune status.It is also possible 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 dose sufficient to suppress the growth of bacteria.

Treatment for chronic non -bacterial prostatitis/KTS is difficult as the infection is not the cause of chronic pelvic pain or abacus chronic prostatitis.It is necessary to seriously approach the problem and to answer the question of how to treat a disease that is precisely unknown.

The lack of a particular etiology explains why attempts to treat this pathology are often unsuccessful.

The methods of treating chronic aseptic prostatitis contain:

1. Antibacterial therapy with fluoroquinolones (performed by all patients).There may be an infection that is not detected during a bacteriological examination.
2. Alpha-blockers.They contribute to the improvement of blood circulation in the prostate tissues.The efficiency is low.
3. NSAIDs and other anti -inflammatory drugs have strong effectiveness, relieve pain and improve symptoms.However, treatment is pathogenetic, after cancellation, the renewal of the disease is possible.
4. Exercises for physiotherapy and physiotherapy (yoga, sports, active lifestyles), helping to improve blood circulation and eliminate venous stagnation, hypoxia, strengthen the pelvic muscles.The method helps patients with appropriate disorders.
5. Antidepressants and anticonvulsants (effectiveness has not been proven).
6. Surgical treatment: laser or thin -cyginal prostate ablation (not effective).

Forecast

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

The chronic non -bacterial (aseptic) prostatitis/KTB has the highest prognosis.Treatment only helps some patients.Others continue to suffer from chronic pain syndrome, despite the use of all available treatment methods.The disease has a pronounced effect on the psycho -emotional sphere and sexual relations.