Symptoms of prostatitis and prostate adenoma in men

Prostatitisis an inflammatory disease of the prostate gland. Manifested by frequent urination, pain in the penis, scrotum, rectum, sexual disorders (erection dysfunction, early ejaculation, etc. ), sometimes urinary retention, blood in the urine. The diagnosis of prostatitis is established by a urologist or andrologist according to a typical clinical picture, the results of a rectal examination. Additionally, an ultrasound of the prostate, bakposev of prostatic secretion and urine is performed. Treatment is conservative - antibiotic therapy, immunotherapy, prostate massage, lifestyle correction.

General information

Prostatitis is an inflammation of the seminal (prostate) gland - the prostate. It is the most common disease of the genitourinary system in men. Most often affects patients aged 25-50 years. According to various data, 30-85% of men over the age of 30 suffer from prostatitis. Possible abscess formation of the prostate gland, inflammation of the testicles and appendages, which threatens infertility. The ascent of the infection leads to inflammation of the upper genitourinary system (cystitis, pyelonephritis).

Pathology develops with the penetration of an infectious agent that enters the prostate tissue from the organs of the genitourinary system (urethra, bladder) or from a distant inflammatory focus (with pneumonia, influenza, tonsillitis, furunculosis).

Prostate adenoma is a benign neoplasm of the paraurethral glands located around the urethra in its prostatic section. The main symptom of prostate adenoma is a violation of urination due to the gradual compression of the urethra by one or more growing nodules. The pathology is characterized by a benign course.

Only a small part of patients seek medical help, however, a detailed examination reveals the symptoms of the disease in every fourth man aged 40-50 years and in half of men aged 50-60 years. The disease is detected in 65% of men aged 60-70 years, 80% of men aged 70-80 years and more than 90% of men over the age of 80 years. The severity of symptoms can vary significantly. Studies in the field of clinical andrology suggest that problems with urination occur in about 40% of men with BPH, but only one in five patients in this group seek medical help.

Causes of prostatitis

As an infectious agent in an acute process, Staphylococcus aureus (Staphylococcus aureus), Enterococcus (Enterococcus), Enterobacter (Enterobacter), Pseudomonas (Pseudomonas), Proteus (Proteus), Klebsiella (Klebsiella) and Escherichia coli (E. Coli) can act. Most microorganisms belong to conditionally pathogenic flora and cause prostatitis only in the presence of other predisposing factors. Chronic inflammation is usually due to polymicrobial associations.

The risk of developing the disease increases with hypothermia, a history of specific infections and conditions accompanied by congestion in the tissues of the prostate. There are the following predisposing factors:

• General hypothermia (one-time or permanent, associated with working conditions).
• A sedentary lifestyle, a specialty that forces a person to be in a sitting position for a long time (computer operator, driver, etc. ).
• Constant constipation.
• Violations of the normal rhythm of sexual activity (excessive sexual activity, prolonged abstinence, incomplete ejaculation during a "habitual" sexual intercourse devoid of emotional coloring).
• The presence of chronic diseases (cholecystitis, bronchitis) or chronic infectious foci in the body (chronic osteomyelitis, untreated caries, tonsillitis, etc. ).
• Past urological diseases (urethritis, cystitis, etc. ) and sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea).
• Conditions that cause suppression of the immune system (chronic stress, irregular and malnutrition, regular lack of sleep, overtraining in athletes).

It is assumed that the risk of developing pathology increases with chronic intoxication (alcohol, nicotine, morphine). Some studies in the field of modern andrology prove that chronic perineal trauma (vibration, concussion) in motorists, motorcyclists and cyclists is a provoking factor. However, the vast majority of experts believe that all of these circumstances are not the real causes of the disease, but only contribute to the exacerbation of the latent inflammatory process in the tissues of the prostate.

A decisive role in the occurrence of prostatitis is played by congestion in the tissues of the prostate. Violation of capillary blood flow causes an increase in lipid peroxidation, edema, exudation of prostate tissues and creates conditions for the development of an infectious process.

The mechanism of development of prostate adenoma has not yet been fully determined. Despite the widespread opinion linking the pathology with chronic prostatitis, there is no data that would confirm the connection between these two diseases. Researchers have not found any relationship between the development of prostate adenoma and alcohol and tobacco use, sexual orientation, sexual activity, sexually transmitted and inflammatory diseases.

There is a pronounced dependence of the incidence of prostate adenoma on the age of the patient. Scientists believe that adenoma develops as a result of hormonal imbalances in men during andropause (male menopause). This theory is supported by the fact that men who are castrated before puberty never suffer from pathology, and extremely rarely - men who are castrated after it.

Symptoms of prostatitis

Acute prostatitis

There are three stages of acute prostatitis, which are characterized by the presence of a certain clinical picture and morphological changes:

• Acute catarrhal. Patients complain of frequent, often painful urination, pain in the sacrum and perineum.
• Acute follicular. The pain becomes more intense, sometimes radiating to the anus, aggravated by defecation. Urination is difficult, urine flows out in a thin stream. In some cases, there is urinary retention. Subfebrile condition or moderate hyperthermia is typical.
• Acute parenchymal. Severe general intoxication, hyperthermia up to 38-40°C, chills. Dysuric disorders, often - acute urinary retention. Sharp, throbbing pains in the perineum. Difficulty in defecation.

Chronic prostatitis

In rare cases, chronic prostatitis becomes the outcome of an acute process, however, as a rule, a primary chronic course is observed. The temperature occasionally rises to subfebrile values. The patient notes a slight pain in the perineum, discomfort during the act of urination and defecation. The most characteristic symptom is scanty discharge from the urethra during defecation. The primary chronic form of the disease develops over a considerable period of time. It is preceded by prostatosis (stagnation of blood in the capillaries), gradually turning into abacterial prostatitis.

Chronic prostatitis is often a complication of the inflammatory process caused by the causative agent of a specific infection (chlamydia, trichomonas, ureaplasma, gonococcus). Symptoms of a specific inflammatory process in many cases mask the manifestations of prostate damage. Perhaps a slight increase in pain during urination, mild pain in the perineum, scant discharge from the urethra during defecation. A slight change in the clinical picture often goes unnoticed by the patient.

Chronic inflammation of the prostate gland can be manifested by a burning sensation in the urethra and perineum, dysuria, sexual disorders, increased general fatigue. The consequence of violations of potency (or fear of these violations) often becomes mental depression, anxiety and irritability. The clinical picture does not always include all the listed groups of symptoms, differs in different patients and changes over time. There are three main syndromes characteristic of chronic prostatitis: pain, dysuric, sexual disorders.

There are no pain receptors in the prostate tissue. The cause of pain in chronic prostatitis becomes almost inevitable due to the abundant innervation of the pelvic organs, involvement in the inflammatory process of the nerve pathways. Patients complain of pain of varying intensity - from weak, aching to intense, disturbing sleep. There is a change in the nature of pain (intensification or weakening) with ejaculation, excessive sexual activity or sexual abstinence. Pain radiates to the scrotum, sacrum, perineum, sometimes to the lumbar region.

As a result of inflammation in chronic prostatitis, the volume of the prostate increases, squeezing the urethra. The lumen of the ureter is reduced. The patient has frequent urge to urinate, a feeling of incomplete emptying of the bladder. As a rule, dysuric phenomena are expressed in the early stages. Then compensatory hypertrophy of the muscular layer of the bladder and ureters develops. Symptoms of dysuria during this period weaken, and then increase again with decompensation of adaptive mechanisms.

In the initial stages, dyspotence may develop, which manifests itself differently in different patients. Patients may complain of frequent nocturnal erections, blurred orgasm, or worsening erections. Accelerated ejaculation is associated with a decrease in the threshold level of excitation of the orgastic center. Painful sensations during ejaculation can cause the refusal of sexual activity. In the future, sexual dysfunctions become more pronounced. At the advanced stage, impotence develops.

The degree of sexual disorder is determined by many factors, including the sexual constitution and the psychological mood of the patient. Violations of potency and dysuria can be due to both changes in the prostate gland and the suggestibility of the patient, who, if he has chronic prostatitis, expects the inevitable development of sexual disorders and urination disorders. Especially often psychogenic dyspotence and dysuria develops in suggestible, anxious patients.

Impotence, and sometimes the very threat of possible sexual disorders, is hard to tolerate by patients. Often there is a change in character, irritability, obnoxiousness, excessive concern for one's own health, and even "care for the disease. "

There are two groups of symptoms of the disease: irritative and obstructive. The first group of symptoms includes increased urination, persistent (imperative) urge to urinate, nocturia, urinary incontinence. The group of obstructive symptoms includes difficulty in urination, delayed onset and increased time of urination, a feeling of incomplete emptying, urination with an intermittent sluggish stream, the need for straining. There are three stages of prostate adenoma: compensated, subcompensated and decompensated.

Compensated stage

At the compensated stage, the dynamics of the act of urination changes. It becomes more frequent, less intense and less free. There is a need to urinate 1-2 times at night. As a rule, nocturia at stage I of prostate adenoma does not cause concern in a patient who associates constant nighttime awakenings with the development of age-related insomnia. During the day, the normal frequency of urination can be maintained, however, patients with stage I prostate adenoma note a waiting period, especially pronounced after a night's sleep.

Then the frequency of daytime urination increases, and the volume of urine released per urination decreases. There are imperative urges. The stream of urine, which previously formed a parabolic curve, is discharged sluggishly and falls almost vertically. Hypertrophy of the bladder muscles develops, due to which the efficiency of its emptying is maintained. There is little or no residual urine in the bladder at this stage (less than 50 ml). The functional state of the kidneys and upper urinary tract is preserved.

Subcompensated stage

At stage II of prostate adenoma, the bladder increases in volume, dystrophic changes develop in its walls. The amount of residual urine is over 50 ml and continues to increase. Throughout the act of urination, the patient is forced to intensely strain the abdominal muscles and diaphragm, which leads to an even greater increase in intravesical pressure.

The act of urination becomes multi-phase, intermittent, undulating. The passage of urine along the upper urinary tract is gradually disturbed. Muscle structures lose their elasticity, the urinary tract expands. Kidney function is impaired. Patients are worried about thirst, polyuria and other symptoms of progressive chronic renal failure. When the compensation mechanisms fail, the third stage begins.

Decompensated stage

The bladder in patients with stage III prostate adenoma is stretched, filled with urine, easily determined by palpation and visually. The upper edge of the bladder can reach the level of the navel and above. Emptying is impossible even with intense tension of the abdominal muscles. The desire to empty the bladder becomes continuous. There may be severe pain in the lower abdomen. Urine is excreted frequently, in drops or very small portions. In the future, the pain and urge to urinate gradually weaken.

A characteristic paradoxical urinary retention develops, or paradoxical ischuria (the bladder is full, urine is constantly excreted drop by drop). The upper urinary tract is enlarged, the functions of the renal parenchyma are impaired due to the constant obstruction of the urinary tract, leading to an increase in pressure in the pelvicalyceal system. The clinic of chronic renal failure is growing. If medical care is not provided, patients die from progressive CRF.

Complications

In the absence of timely treatment of acute prostatitis, there is a significant risk of developing a prostate abscess. With the formation of a purulent focus, the patient's body temperature rises to 39-40 ° C and can become hectic in nature. Periods of heat alternate with severe chills. Sharp pains in the perineum make it difficult to urinate and make defecation impossible.

The increase in prostatic edema leads to acute urinary retention. Rarely, an abscess spontaneously ruptures into the urethra or rectum. When opened, purulent, cloudy urine with an unpleasant pungent odor appears in the urethra; when opened, the feces contain pus and mucus in the rectum.

Chronic prostatitis is characterized by an undulating course with periods of long-term remissions, during which inflammation in the prostate is latent or manifests itself with extremely poor symptoms. Patients who are not bothered by anything often stop treatment and turn only when complications develop.

The spread of infection through the urinary tract causes the occurrence of pyelonephritis and cystitis. The most common complication of the chronic process is inflammation of the testicles and epididymis (epdidymo-orchitis) and inflammation of the seminal vesicles (vesiculitis). The outcome of these diseases is often infertility.

Diagnostics

In order to assess the severity of symptoms of prostate adenoma, the patient is asked to fill out a urination diary. During the consultation, the urologist performs a digital examination of the prostate. To exclude infectious complications, a sampling and examination of prostate secretion and smears from the urethra is performed. Additional testing includes:

• Echography.In the process of ultrasound of the prostate, the volume of the prostate gland is determined, stones and areas with congestion are detected, the amount of residual urine, the condition of the kidneys and urinary tract are assessed.
• Urodynamic study.Uroflowmetry allows you to reliably judge the degree of urinary retention (the time of urination and the speed of urine flow is determined by a special apparatus).
• Definition of tumor markers.To exclude prostate cancer, it is necessary to evaluate the level of PSA (prostate-specific antigen), the value of which should normally not exceed 4 ng / ml. In controversial cases, a biopsy of the prostate is performed.

Cystography and excretory urography for prostate adenoma have been performed less frequently in recent years due to the emergence of new, less invasive and safer research methods (ultrasound). Sometimes cystoscopy is performed to exclude diseases with similar symptoms or in preparation for surgical treatment.

Treatment of prostatitis

Treatment of acute prostatitis

Patients with an uncomplicated acute process are treated by a urologist on an outpatient basis. With severe intoxication, suspicion of a purulent process, hospitalization is indicated. Antibacterial therapy is carried out. Preparations are selected taking into account the sensitivity of the infectious agent. Antibiotics are widely used that can penetrate well into prostate tissues.

With the development of acute urinary retention on the fne of prostatitis, they resort to installing a cystostomy, and not a urethral catheter, since there is a danger of the formation of an abscess of the prostate. With the development of an abscess, an endoscopic transrectal or transurethral opening of the abscess is performed.

Treatment of chronic prostatitis

Treatment of chronic prostatitis should be complex, including etiotropic therapy, physiotherapy, immunity correction:

• Antibiotic therapy. The patient is prescribed long courses of antibacterial drugs (within 4-8 weeks). Selection of the type and dosage of antibacterial drugs, as well as determining the duration of the course of treatment is carried out individually. The drug is chosen based on the sensitivity of the microflora according to the results of urine culture and prostate secretion.
• Prostate massage.Massage of the gland has a complex effect on the affected organ. During the massage, the inflammatory secret accumulated in the prostate gland is squeezed out into the ducts, then enters the urethra and is removed from the body. The procedure improves blood circulation in the prostate, which minimizes congestion and ensures better penetration of antibacterial drugs into the tissue of the affected organ.
• Physiotherapy.To improve blood circulation, laser exposure, ultrasonic waves and electromagnetic vibrations are used. If it is impossible to carry out physiotherapeutic procedures, the patient is prescribed warm medicinal microclysters.

In chronic, long-term inflammation, an immunologist's consultation is indicated to select the tactics of immunocorrective therapy. The patient is given advice on lifestyle changes. Making certain changes in the lifestyle of a patient with chronic prostatitis is both a curative and a preventive measure. The patient is recommended to normalize sleep and wakefulness, establish a diet, conduct moderate physical activity.

Conservative therapy

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

Antibiotics are prescribed to fight the infection that often accompanies prostate adenoma. At the end of the course of antibiotic therapy, probiotics are used to restore the normal intestinal microflora. Carry out the correction of immunity. Atherosclerotic vascular changes that develop in most elderly patients prevent the flow of drugs into the prostate gland, so special medications are prescribed to normalize blood circulation.

Surgery

There are the following surgical methods for the treatment of prostate adenoma:

1. TOUR(transurethral resection). Minimally invasive endoscopic technique. The operation is carried out with an adenoma volume of less than 80 cm3. Not applicable for renal failure.
2. Adenomectomy.It is carried out in the presence of complications, the mass of the adenoma is more than 80 cm3. Currently, laparoscopic adenomectomy is widely used.
3. Laser vaporization of the prostate.Allows you to perform surgery with a tumor mass of less than 30-40 cm3. It is the method of choice for young patients with prostate adenoma, because it allows you to save sexual function.
4. Laser enucleation(holmium - HoLEP, thulium - ThuLEP). The method is recognized as the "gold standard" of surgical treatment of prostate adenoma. Allows you to remove an adenoma with a volume of more than 80 cm3 without open intervention.

There are a number of absolute contraindications to surgical treatment of prostate adenoma (decompensated diseases of the respiratory and cardiovascular systems, etc. ). If surgical treatment is not possible, bladder catheterization or palliative surgery is performed - cystostomy, installation of a urethral stent.

Forecast and prevention

Acute prostatitis is a disease that has a pronounced tendency to become chronic. Even with timely adequate treatment, more than half of the patients end up with chronic prostatitis. Recovery is far from always achieved, however, with correct consistent therapy and following the doctor's recommendations, it is possible to eliminate unpleasant symptoms and achieve a long-term stable remission in a chronic process.

Prevention is to eliminate risk factors. It is necessary to avoid hypothermia, alternate between sedentary work and periods of physical activity, eat regularly and fully. 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 in the development of prostatitis. If symptoms of a urological or sexually transmitted disease appear, you should consult a doctor in a timely manner.