Chronic prostatitis

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

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.Chronicly, a bacteriological examination reveals the pathogen only in 5 to 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 occurrence of the disease.Chronic prostate inflammation is a polyetiological pathology, which is the result of actions of various causes and provocative factors.In 90-95% of patients, antibacterial therapy has limited efficacy or not required.

Classification of chronic prostatitis

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

The etiological classification of chronic prostatitis includes:

1. Chronic bacterial prostatitis.
2. Non -Bacterial (aseptic) prostatitis (CTB ("prostatini", or "painful prostate gland" is a outdated term used to determine pathology).
3. Non -Bacterial (aseptic) prostatitis chronic (CTB) with an inflammatory component (the concentration of leukocytes is significantly increased in the secret of the prostate, sperm, the first part of the urine).
4. Non -Bacterial (aseptic) chronic/CTB prostatitis without an inflammatory component (concentration of white blood cells at prostate secret, sperm, the first part of the urine is insufficient for inflammation).
5. ASHMPTomic chronic prostatitis (detected in laboratory studies is not clinically).

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

Non -bacterial (aseptic) prostatitis (aseptic), or chronic pain syndrome, is a long -term recurrent disease that occurs as a result of aseptic inflammation of the prostate.This is a little studied pathology.In the presence of symptoms of the disease, the tests determine white blood cells in the secrecy of the gland, in the seed, the initial portion of the urine, but the results of bacteriological examination are negative.In other cases, there are no signs of infection, nor leukocytosis pronounced with bright symptoms.

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

Patanatomic (Patomorphological) classification of chronic prostatitis is of limited interest for clinical patients and doctors.

The causes of chronic prostatitis

Causes of chronic bacterial inflammation of the prostate gland

Chronic infectious prostatitis occurs due to infection of prostate gland tissues.Most of the time, the cause of inflammation is E. coli, or e.Coli.Microbes less commonly sculpted of the genus Enterococci, Klebsell, Proteus, Pseudomonas.

Like some other microbes, E. coli is capable of forming biofilms, thin, consisting of bacterial accumulation and strongly adjacent to the mucous membranes of the ducts.This explains why it is not always possible to cure chronic prostatitis.Infection is believed to spread as an upward way by the urethra.However, lymphogenic and hematogenic dissemination of the infection is also possible.

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

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

Causes of non -bacterial chronic inflammation of the prostate

The causes of chronic non -bacterial prostatitis are precisely 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 non -bacterial (aseptic) prostatitis/CTB (aseptic) is a polyetiological disease that occurs as a result of combinations of several adverse factors, namely:

• cycling;
• Irritation of prostate gland tissues when urine enters its ducts;
• Prostate gland irritation as a result of the use of any products or drinks (especially with food allergies or celiac);
• Functional disorders of nerve innervation of the pelvic organs;
• Pelvic floor muscles atrophy;
• stress, psycho -emotional loads;
• Pathology in the prostate gland, remaining after long acute prostatitis;
• hormonal disorders;
• bladder diseases;
• Cold climate.

As the exact causes of the disease are little known, the treatment of chronic prostatitis can be difficult.

Symptoms of chronic prostatitis

Chronic (infectious) bacterial prostatitis is characterized by a cyclical course.The exacerbation phase is replaced by a phase of remission.There are virtually no symptoms between exacerbations.There is a clear connection among other diseases of genitourinary organs - urethritis, epididimmetes, cystitis.The cause of these pathologies, as a rule, is the same pathogen that causes chronic prostatitis.Symptoms during exacerbation are represented by dysurical phenomena (frequent urination, rubber and burning pain during urination) and pain with various intensity in the perineum, scrotum, sacred, with irradiation 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 examining through the rectum (by rectum) can be normal or slightly swollen without acute acute pain of acute prostatitis.

Non -bacterial (aseptic) prostatitis/ktb is characterized by pain of varying gravity (from stupid to intense lungs) in pelvis, peineum, sacred and are the "visiting card" of the disease (aseptic chronic prostatitis).Signs of inflammation of the prostate gland are poorly expressed and observed in 50% of cases.In other patients, they may be absent.

The presence of blood in sperm, painful ejaculation, defecation and dysuria phenomena are possible.The severity of symptoms may change.The pain is given to the groin, straight, making it difficult to find a person in a sitting position.Fatigue, irrational fatigue, joint and muscle aches are also possible.Some patients complain of decreased sexual desire, erectile dysfunction (impotence).

Asymptomatic chronic prostatitis has no characteristic symptoms of this disease, hence its name.During the prostate secrecy laboratory study, it is possible to a certain leukocytosis, it is possible an increase in the levels of a specific prostatic antigen.There are no other signs of the disease.

Chronic prostatitis diagnosis

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

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

The urine of the third container can be sent for a bacteriological examination with sowing to a nutrient medium.In the presence of bacterial growth, a test for the susceptibility of the pathogen to antibiotics is performed.The method helps conduct treatment more accurately and more effective.As the prostatic secret is a significant part of sperm, microscopy and ejaculated bacteria also enable correct diagnosis.

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

Non -bacterial (aseptic) chronic bacterial prostatitis diagnosis may be difficult.Often the diagnosis is made excluding other pathologies from the genitourinary tract and bacterial prostatitis.For this, instrumental and laboratory methods are used: urine microscopy (a three -law test is also used after prostate massage), sperm or prostate secrets, followed by sowing to a nutrient medium.The study list includes analysis for PSA (differential diagnosis of cancer and inflammatory prostate diseases).

Microscopy reveals the presence of leukocytes in the urine, in secret of the prostate, seed fluid with negative results of bacteriological treatment methods.Instrumental research methods (ultrasound, cystoscopy, magnetic resonance imaging, CT) do not reveal signs of concomitant pathology.

Treatment of chronic prostatitis

For the successful treatment of chronic infectious prostatitis, rational and directed antibacterial therapy is required.Preparations of choice are fluoroquinolones that create large drug concentrations in gland tissues.The course of treatment takes six to 12 weeks.This duration of antibacterial therapy is required for complete eradication of infection and relapse prevention.Second -drugs.

Chronic bacterial prostatitis can be cured with consistent and adequate therapy.Patients with frequent relapses need to verify immune status.It may also be necessary to exclude HIV infection, which is usually the cause of low efficacy of antibacterial therapy.In these patients, it is possible to prescribe antibiotics at a sufficient dose to suppress bacterial growth.

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

The absence of a certain etiology explains why attempts at therapy of this pathology are usually not successful.

Chronic aseptic prostatitis treatment methods 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-blockers.They contribute to the improvement of blood circulation in prostate tissues.Effectiveness is low.
3. NSAIDS and other anti -inflammatory drugs have severe effectiveness, relieve pain and improve symptoms.However, treatment is pathogenic after cancellation, the renewal of the disease is possible.
4. Physiotherapy and physiotherapy exercises (yoga, sport, active lifestyle), helping to improve blood circulation and eliminate venous stagnation, hypoxia, strengthening the pelvis muscles.The method helps patients with appropriate disorders.
5. Antidepressants and anticonvulsants (effectiveness is not proven).
6. Surgical treatment: laser or thin -oginal ablation of the prostate gland (not effective).

Forecast

In chronic infectious prostatitis in most patients, the prognosis is favorable.Consistent and adequate antibacterial therapy allows for success in over 80% of cases.

Non -Bacterial (aseptic) prostatitis/ktb (aseptic) has the worst forecast.Treatment only helps a few 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 and sexual relations.