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Prostatitis

symptoms of prostatitis in men

Prostatitis is an inflammatory disease of the prostate gland (prostate) in men, which has a negative impact on both sexual function and the process of urination.Pain in the perineum, groin, lower back and pelvic area, disturbances in urodynamics (urine outflow) may indicate the presence of prostatitis.Untreated prostatitis can cause male infertility and prostate cancer.

This is one of the most common male ailments, requiring careful attention and competent systemic treatment.This is exactly the approach to solving the problem of prostatitis that you will find in the urology department of a professional clinic.Highly qualified urologists-andrologists have been successfully treating acute and chronic prostatitis for many years.Complex therapy, careful attention and an individual approach to each case inevitably lead patients to recovery and stable, long-term remission.

Prevalence

Prostatitis ranks 5th among 20 main urological diagnoses.It is believed that at the age of 30, 30% of the male population suffers from prostatitis, at the age of 40 – 40%, and after 50 years, almost all men in one way or another bear the burden of this disease.And if up to 35 years of age predominantly infectious prostatitis is recorded, then at a more mature age the non-infectious form predominates, and in general it is diagnosed several times more often than bacterial inflammation of the prostate.

Anatomy and physiology of the prostate gland

The prostate gland (prostate) is located in the lower front part of the pelvis, below the bladder.It consists of glandular and smooth muscle tissue, surrounded by a fibrous capsule.The urethra passes through the body of the prostate from the bladder, into which the ejaculatory ducts open.

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

The prostate produces a secretion that is part of semen.It creates favorable conditions for sperm activity.Therefore, with chronic dysfunction of the gland, male infertility may occur.

Pathogenesis

There are two main reasons for the development of prostatitis:

  • stagnation of prostate secretion against the background of impaired blood circulation and lymph outflow in the gland itself and neighboring organs;
  • pathogenic and conditionally pathogenic microflora.

Acute prostatitis is usually associated with infection of prostate tissue.But, as a rule, both factors are interrelated and together create a vicious circle that complicates the treatment of prostatitis.

The inflamed prostate gland becomes painful.Pain can be felt in the perineum, groin, pelvis, and lower back.It sharply intensifies upon palpation during a rectal digital examination or defecation.

The prostate increases in size, pinching the urethra.This makes it difficult for urine to flow out of the bladder.The urine stream becomes weak.The patient has to strain his abdominal muscles in order for the act of urination to take place.In acute cases, urinary tract obstruction and acute urinary retention sometimes occur.

Inflammation leads to disruption of the outflow of prostate juice and its stagnation.The resulting swelling disrupts the processes of cellular metabolism and respiration in the gland.This creates conditions for the process to become chronic.With prolonged prostatitis, neighboring organs can become inflamed: the seminal tubercle, Cooper's glands, seminal vesicles.The chronic form of the disease is associated with risks of developing male infertility, adenoma and prostate cancer.

In recent years, it has been found that in 70-80% of cases, prostatitis occurs due to stagnant processes in the gland.Venous disorders are less common, but they also cause prostatitis, especially if accompanied by hemorrhoids and varicocele on the left (dilation of the testicular vein).

Classification

The American National Institute of Health identifies 4 categories of prostatitis:

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

Due to its occurrence, prostatitis is divided into two types:

  • Non-infectious
  • Infectious

The inflammatory process can develop rapidly, accompanied by vivid symptoms (acute stage), or slowly with erased gradually increasing symptoms.

Non-infectious prostatitisin most cases, it is associated with stagnation of prostate secretions and impaired blood circulation and lymph flow in the gland itself and nearby organs.

Infectious prostatitisdevelops due to the penetration of pathogenic or opportunistic microflora into the prostate tissue: bacteria, viruses, fungi.There are different ways that infection can enter the prostate:

  • Urinogenic (ascending): the portal of entry is the urethra.It should be noted that the infection can also enter through a descending route, for example, with purulent pyelonephritis (kidney disease) and other inflammatory diseases of the urinary tract.
  • Lymphogenous: infection from adjacent pelvic organs can enter the prostate through the lymph due to inflammation of the rectum (proctitis) or bladder (cystitis), as well as from infected hemorrhoidal veins.
  • Hematogenous (through the blood): caused by the presence in the body of foci of chronic infection (tonsillitis, carious teeth) or complications of acute infections (flu, acute respiratory infections, tonsillitis, etc.).

The most common causative agents of prostatitis are:

  • bacteria: Escherichia coli, Proteus, Gardnerella (gram-negative);staphylococci, streptococci (gram-positive);
  • viruses (influenza, herpes, cytomegalovirus, ARVI pathogens);
  • mycoplasma;
  • chlamydia;
  • specific flora (gonococcus, trichomonas, mycobacterium tuberculosis).

According to the nature of the course, prostatitis occurs:

  • Spicy
  • Chronic

Acute prostatitisusually occurs under the influence of pathogenic (opportunistic) microflora in the presence of predisposing factors.It has a rapid course and pronounced symptoms.If it is not treated in time, a purulent process may develop, leading to the melting of prostate tissue.If treated incorrectly, acute prostatitis often becomes chronic.

Chronic prostatitishas a milder course, erased symptoms.However, it can worsen from time to time, and then the symptoms will correspond to an acute process.However, complete remission between exacerbations does not always occur, and the patient may constantly feel discomfort.Chronic prostatitis can cause impotence, male infertility, adenoma or prostate cancer.

There is a chronic asymptomatic form of the disease, when the patient has no complaints, but the prostate secretion contains an increased number of purulent elements (leukocytes).

Complications

Without proper therapy, the inflammatory process can lead to purulent melting of prostate tissue.Moreover, inflammation can spread to nearby organs: seminal tubercle, Cooper's glands, seminal vesicles, urethra.Accordingly, the following complications may occur:

  • Prostate abscess
  • Sclerosis/fibrosis of the prostate (functional gland tissue is replaced by connective tissue)
  • Prostate cysts
  • Prostate stones
  • Vesiculitis (inflammation of the seminal vesicles)
  • Colliculitis (inflammation of the seminal tubercle)
  • Epididymo-orchitis (inflammation of the testicles and their appendages)
  • Posterior urethritis
  • Erectile dysfunction/impotence
  • Ejaculation disorder
  • Infertility
  • Prostate adenoma
  • Prostate cancer

Symptoms

Different forms of prostatitis have their own characteristics and severity of symptoms.In general, the following manifestations are characteristic of prostatitis:

  • Pain in the groin, lower back, perineum (may radiate along the spermatic cords).
  • The pain intensifies with defecation and digital rectal examination.
  • Urodynamic disturbances (frequent urination, urinary retention, difficulty urinating, weak stream, incomplete emptying of the bladder).
  • Prostatorrhea (involuntary release of prostate juice, especially in the morning and during bowel movements).
  • Sexual function disorders (decreased libido, erectile dysfunction, infertility).

Symptoms of acute prostatitis

  • Temperature rises to 39-40 degrees
  • Acute urinary retention
  • General intoxication
  • Leukocyturia, protein and mucus in the urine
  • Blood in urine and semen
  • Leukocytosis in prostate secretions
  • Hypoechogenicity and enlargement of the gland, increased blood flow according to ultrasound data

Symptoms of chronic prostatitis

  • Body temperature is usually no higher than 37C
  • Pain sensations are dulled and smoothed out
  • Discharge from the urethra during bowel movements
  • Urinary disorders
  • Decreased libido
  • Erectile dysfunction
  • Ejaculation disorders (premature or delayed ejaculation)

Reasons

The key reasons for the development of prostatitis are infections and stagnation of prostate secretions.The following factors contribute to the appearance of prostatitis:

  • Infections and opportunistic flora with weakened immunity
  • Physical inactivity
  • "Sedentary" work
  • Long-term sexual abstinence
  • Coitus interruptus (with delayed ejaculation)
  • Excessive sexual activity leading to depletion of the gland
  • Alcohol abuse
  • Decreased local immunity (hypothermia, use of immunosuppressants, immunodeficiency, autoimmune diseases)
  • Pelvic organ injuries
  • Manipulations on the prostate and nearby organs (prostate biopsy, surgery, catheterization, cystoscopy, etc.)
  • Chronic diarrhea or constipation

Diagnostics

To detect prostatitis, many methods are used, which can be divided into 3 groups: digital rectal examination, laboratory tests and instrumental methods.

Digital rectal examinationcarried out by a urologist-andrologist after a conversation with the patient.This method allows you to evaluate the size, shape and some features of the structure of the prostate gland.If the size of the prostate is enlarged and the procedure itself is painful for the patient, the doctor can pre-diagnose prostatitis.

If the case is not acute, the doctor may perform a prostate massage during the examination to obtain prostate secretion, the study of which is an important link in the diagnosis of prostatitis.If there is a suspicion of acute bacterial prostatitis, prostate massage is contraindicated: such manipulation can lead to the spread of the pathogen and blood poisoning.

To clarify the diagnosis, the patient will be asked to undergoinstrumental studies, such as:

  • transrectal ultrasound examination of the prostate gland and pelvic organs (reveals structural features, the presence of inflammation and purulent foci, stones, cysts and other neoplasms);
  • Dopplerography (features of blood flow in the gland);
  • uroflowmetry (determining the speed and time of urination);
  • magnetic resonance imaging of the pelvic organs (a highly informative and safe study that allows differential diagnosis with other diseases).

If necessary, diagnostics of nearby organs of the genitourinary system is carried out: urethroscopy, urethrography and urethrocystography.

Laboratory researchare a necessary component of the diagnosis of prostatitis:

  • General urine analysis (before and after prostate massage)
  • General blood test
  • Blood test for proteins of the acute phase of inflammation (C-reactive protein, etc.)
  • Microscopic examination of prostate secretion after finger massage
  • Microscopic examination of a scraping from the urethra
  • Spermogram (cytology and biochemistry of sperm)
  • Culture of urine, prostate secretion and sperm
  • Determination of prostate specific antigen (PSA)
  • Needle biopsy of the prostate and histological examination of gland tissue

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

The modern one has an excellent, highly informative diagnostic base.Urologists have extensive experience in diagnosing and successfully treating various forms of prostatitis, and the status of a multidisciplinary clinic allows you to use the services of specialists in related fields.The medical center has developed research packages that include all the necessary types of diagnostics at a very attractive price. 

Treatment

Treating prostatitis is not an easy task.It requires a thoughtful, integrated approach.The treatment protocol for this disease includes drug therapy and physiotherapeutic procedures, in some cases surgical intervention is required.

Drug therapy

Involves the use of the following medications:

  • Antibiotics (after determining sensitivity to them)
  • Antiseptics (local)
  • Vascular medications (improving microcirculation in the prostate)
  • Nonsteroidal anti-inflammatory drugs
  • Alpha-1 blockers (for urinary problems)
  • Enzyme preparations (thin the prostate secretion, stimulate the immune system, relieve inflammation)
  • Immunomodulators
  • Antidepressants

Physiotherapeutic treatment

  • Electrical stimulation of the prostate (electrophoresis, galvanization, pulsed action)
  • Vibromassage
  • Laser therapy with a rectal sensor (for chronic prostatitis)

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

Surgical treatment

Surgery for prostatitis is rarely resorted to.This need arises in case of serious suppuration of prostate tissue, lack of positive dynamics in drug treatment and pathological enlargement of the prostate gland blocking the urethra.

Forecast

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

If treatment is incorrect and treatment terms are not observed (several months), the disease usually takes a chronic course.Chronic prostatitis greatly affects a man’s quality of life, because not only urinary function suffers, but also sexual function.In 30% of cases, erectile dysfunction, loss of orgasmic intensity, problems with ejaculation, and infertility are observed.It is completely impossible to cure chronic prostatitis, but with the right approach, stable remission can be achieved.

Advantages of visiting a professional clinic

  • Successful treatment of various forms of prostatitis
  • Experienced urologists-andrologists of the highest qualification
  • Multidisciplinary, allowing you to involve specialists in related fields in treatment
  • High-precision modern diagnostic and treatment equipment
  • Own clinical diagnostic laboratory of European class
  • Comfortable and high-tech hospitals
  • A package of urological diagnostic services at an attractive price

Prevention of prostatitis

  • Choose protected sex to avoid sexually transmitted infections (STIs)
  • Support the immune system (vitamins, healthy diet, prevention of dysbiosis, reasonable antibiotic therapy, etc.)
  • Avoid hypothermia
  • Lead an active lifestyle
  • Have sex regularly, if possible, with one partner (to avoid prostate stagnation and STIs)
  • Avoid interrupted sexual intercourse (this will relieve sperm stagnation)
  • Visit your urologist once a year for preventative purposes and twice a year if you are over 50 years old or have a history of prostate disease.

Frequently Asked Questions

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 prostate cancer has a clinical picture similar to the manifestations of prostatitis.Therefore, the PSA test is used to differentiate between these two diseases.However, you shouldn't bet on PSA.This antigen also increases in prostate adenoma, a benign growth of gland tissue.With prostatitis, PSA levels can also increase during periods of active inflammation.During the remission phase it decreases.Therefore, PSA cannot be used as definitive proof of prostate cancer or prostatitis.

Why is prostatitis difficult to treat?

Prostate capillaries have a special structure that creates a hematoprostatic barrier.This makes it difficult for some types of antibiotics to penetrate the gland tissue.In addition, microorganisms tend to form biofilms, which reliably protect them from the action of antibacterial agents.Therefore, modern protocols for the treatment of prostatitis necessarily include proteolytic enzymes that can destroy biofilms.Bacteria become vulnerable, and antibiotics work more effectively.Chronic prostatitis is the most persistently treated, the key feature of which is the wide variety of microflora in the culture.In approximately 50% of cases, Enterococcus faecalis is sown, resistant to all aminoglycosides and cephalosporins.This narrows the list of effective antimicrobial agents, which also complicates treatment.