Chronic (bacterial) prostatitis is characterized by persistent or recurrent symptoms with confirmed bacterial infection in the prostate gland.
Prostatitis of this category occurs infrequently, in approximately 10% of all cases of prostatitis.The question of whether atypical pathogens, such as ureaplasma urealiticum, can provoke inflammation of the prostate is being discussed.They can be present in a man’s body without any signs of inflammation or complaints.
Causes of chronic prostatitis
The causes of chronic prostatitis are basically similar to the causes of acute bacterial prostatitis.The entry of microorganisms into the prostate in most cases occurs through the urethra - as a result of urine reflux into the ducts of the prostate gland.
Chronic bacterial prostatitis develops as a result of inadequate treatment or a short course of treatment for acute bacterial prostatitis.
Symptoms
- Discomfort or pain - in the perineum, lower abdomen, groin, scrotum, penis, during ejaculation
- Changes in urination - difficulty urinating, frequent urination in small portions, feeling of incomplete emptying of the bladder.
The patient may complain of a number of symptoms, or of any symptom individually.An increase in body temperature is uncharacteristic (or insignificant).
Important:
Many men associate erectile dysfunction with prostatitis.This is often facilitated by unprofessional publications in the media and advertising of dubious drugs.The fact that an erection can persist even with complete removal of the prostate (due to the presence of a malignant tumor of the organ) suggests that it itself does not play a role in maintaining an erection.
According to many authoritative urologists, erectile dysfunction in patients with chronic prostatitis is caused by psychogenic and neurotic problems.
Diagnostics
For the initial assessment, a questionnaire is used - the index of symptoms of chronic prostatitis.It can be used to objectify the patient’s complaints.
The standard method for diagnosing prostatitis is to perform a test.This is a microscopic and bacteriological study of urine samples obtained from different parts of the genitourinary tract and prostate secretions.However, the sample method is quite labor-intensive, and modifications of samples are now more often used.A possible alternative is to submit the ejaculate (sperm) for microscopic and bacteriological examination, since the ejaculate partially (at least 1/3) consists of prostate secretion.This method is more comfortable for patients, especially if they categorically refuse a rectal examination or diagnostic massage of the prostate gland in order to obtain prostate secretions.However, donating ejaculate has lower information content and reliability compared to a sample.
Submitting ejaculate for bacteriological examination is included in the diagnostic algorithm for infections of the male genital organs and when examining a man for infertility.
The results of laboratory tests (general urine test, general blood test, biochemical blood test, spermogram and other general clinical tests) in the case of chronic prostatitis are not informative.Most likely, these tests will show “normal”.
During a rectal examination, changes indicating an inflammatory process in the prostate are not always observed in patients with chronic prostatitis.That is, it is impossible to rely on the result of a rectal examination to diagnose chronic prostatitis.
The same is true for ultrasound diagnostics: it is incorrect to diagnose chronic prostatitis based only on ultrasound data.The European and American Association of Urology does not recommend ultrasound to diagnose prostatitis.The type of execution in this case is not important through the anterior abdominal wall - the lower abdomen or TRUS - through the rectum.It is incorrect to write “chronic prostatitis”, “ultrasound signs of chronic prostatitis”, “signs of prostatitis” in the conclusion of an ultrasound examination.Only a urologist has the prerogative to establish this diagnosis, who determines it on the basis of complaints, anamnesis, laboratory tests and - only after - ultrasound.
The most common ultrasound sign by which the diagnosis of chronic prostatitis is made is the so-called diffuse changes in the prostate gland associated with an inflammatory process or other changes in the prostate parenchyma.This is a kind of fibrotic process, the replacement of normal prostate parenchyma with scar tissue.However, there is no correlation between the number of fibrous changes in the prostate and the presence of complaints.With age, the chances of such “scars” appearing in the organ increase, but a man can live his entire life without feeling any discomfort in the perineum or pubic area.However, as soon as these changes are detected on an ultrasound, some “specialists” will diagnose prostatitis.And some men will have the feeling that they are really seriously ill, they will begin to listen to themselves, they will feel all the symptoms described on the Internet.
In many men over the age of 30, ultrasound may show diffuse changes in the prostate gland.However, the fibrotic process does not indicate the presence of prostatitis.
The diagnosis of chronic prostatitis is established based on the exclusion of other diseases of the genitourinary system - primarily urethritis, prostatic hyperplasia, urethral stricture, neurogenic urination disorders, prostate cancer, bladder cancer.
There is no specific picture for chronic prostatitis based on the results of routine examination.
Treatment of chronic prostatitis
Antibiotics of the fluoroquinolone group are the optimal antimicrobial drugs for the treatment of chronic bacterial prostatitis.The recommended course of antibiotic therapy is 4 to 6 weeks.Such a long course is justified by scientific data indicating a decrease in the likelihood of relapse of the disease.
For detected sexually transmitted infections (STIs), such as chlamydia, a macrolide antibiotic is prescribed.
There is evidence of decreased relaxation of the bladder neck in patients with chronic prostatitis, which leads to reflux of urine into the ducts in the urethra and causes inflammation of the prostate tissue and pain.For such patients, alpha-blockers are recommended.
When treating chronic prostatitis, it is advisable for patients to refrain from tempting offers to use herbal medicine.A feature of dietary supplements and herbal supplements is the instability of the plant components in a portion of the substance; they can differ even in the preparation of the same manufacturer.In addition, from the point of view of evidence-based medicine, the benefits of herbal medicine do not stand up to criticism.
Prostate massage, which was used as the basis of therapy in the mid-20th century, today, thanks to new scientific approaches and classifications, remains an important tool for diagnosing prostatitis, but not for its treatment.There is no need to use prostate massage as a therapeutic procedure (the effect has not been proven).There are suggestions that frequent ejaculation is similar in properties to therapeutic prostate massage sessions.
Other methods that have been proven to be effective in just one or a few studies or are still being investigated include:
- pelvic floor muscle training - some evidence suggests the effectiveness of special exercises for reducing the symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- acupuncture - a small number of studies indicate a benefit of acupuncture compared to placebo in patients with chronic prostatitis;
- extracorporeal shock wave therapy - based on the impact of acoustic pulses of significant amplitude on connective and bone tissue, widely used in the treatment of diseases of the musculoskeletal system, recently used in urology, its effectiveness is under study;
- behavioral therapy and psychological support - since chronic prostatitis is associated with low quality of life and the development of depression, these methods can improve the patient’s psychological state and help reduce some symptoms of the disease.
Separately worth mentioningasymptomatic (asymptomatic) chronic prostatitis.The diagnosis is most often made based on the results of a histological report - after a biopsy of the prostate gland or after surgical treatment of the prostate.The frequency of detection of inflammation in prostate tissue varies from 44% (with prostate biopsy) to 98-100% (after surgical treatment of the prostate).Scientists have suggested that the inflammatory changes identified in this way are nothing more than an age-related physiological feature.Nobody specifically diagnoses this category of prostatitis; it is a kind of accidental discovery.It does not require treatment and does not require any further action on the part of the doctor or the patient.