Chronic prostatitis

Chronic prostatitis is a protracted 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 reason for a visit to a urologist in patients under 50 years old.In a chronic form, a bacteriological examination reveals the pathogen only in 5-10% 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 inflammation of the prostate is a polyetiological pathology, which is the result of the actions of several causes and provoking 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 feature distinguishes between two main 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 Chronic non -bacterial (aseptic) prostatitis/CTB (“prostatini”, or “painful prostate gland” is an outdated term used to determine the pathology).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 prostate, sperm, 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 prostate, sperm, the first part of urine is insufficient for inflammation).
5. Ashmptomic chronic prostatitis (detected in laboratory studies, does not show itself clinically).

Chronic bacterial prostatitis is a rare pathology, as can be seen from the above statistics.Infection is the cause of chronic recurrent inflammation of the prostate in one of ten patients.Pathology is often associated with other infectious diseases of the genitourinary organs.Most often, its cause is a non -specific infection, however, 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 inflammation of the prostate.This is a little -studied pathology.In the presence of symptoms of the disease, the tests determine the white blood cells in the secret of the gland, in the seed fluid, in the initial portion of 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 are also chronic prostatitis in the exacerbation phase and chronic prostatitis in the remission phase.A cyclic 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.

Pathanatomical (pathomorphological) classification of chronic prostatitis is of limited interest for patients and clinicist 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 inflammation is E. coli, or e. Coli.Less commonly carved microbes of the Enterococci genus, Klebsell, Proteus, Pseudomonas.

Like some other microbes, E. coli is capable of forming biofilms, thin, consisting of bacterial accumulations and tightly adjacent to the mucous membranes of the ducts.This explains why it is not always possible to cure chronic prostatitis.It is believed that the infection spreads as an ascending way through the urethra.However, lymphogenic and hematogenous spread of 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;
• Unscrew the extreme flesh of the penis;
• Hypertrophy of the neck of the bladder;
• medical procedures (catheterization of the bladder, cystoscopy);
• Genetic and anatomical features predisposing to the disease.

Causes of chronic non -bacterial inflammation of the prostate gland

The causes of chronic non -bacterial prostatitis are precisely unknown.Perhaps the disease is caused by viruses or bacteria, which are not identified during the 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 urine enters its ducts;
• irritation of the prostate gland as a result of the use of any products or drinks (especially with food allergies or celiacia);
• functional disorders of nervous innervation of the pelvic organs;
• Atrophy of the muscles of the pelvic floor;
• stress, psychoemotional loads;
• Pathology in the prostate gland, remaining after long -standing acute prostatitis;
• hormonal disorders;
• bladder diseases;
• Cold climate.

Since the exact causes of the disease are little 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 phase of remission.There are practically no symptoms between exacerbations.There is a clear connection between other diseases of the genitourinary organs - urethritis, epididymmets, cystitis.The cause of these pathologies, as a rule, is the same pathogen that causes chronic prostatitis.Symptoms during the exacerbation are represented by dysuric phenomena (frequent urination, rubber and burning pains during urination) and pain with various intensity in the perineum, scrotum, sacrum, 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 (per rectum) can be normal or slightly swollen, without a sharp pain characteristic of acute prostatitis.

Chronic non -bacterial (aseptic) prostatitis/KTB is characterized by pains of varying degrees of severity (from stupid lungs to intense) in the pelvis, perineum, sacrum and are the “visiting card” of the disease (aseptic chronic prostatitis).Signs of inflammation of the prostate gland 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, defecation, dysouric phenomena are possible.The severity of symptoms may change.Pain is given to the crotch, rectum, making it difficult to find a person in a sitting position.Fatigue, unreasonable fatigue, articular and muscle pains are also possible.Some patients complain of decreased sex drive, erectile dysfunction (impotence).

Asymptomatic chronic prostatitis does not have symptoms characteristic of this disease, hence its name.During the laboratory study of the secret of the prostate, leukocytosis is determined, an increase in the levels of a specific prostatic antigen is possible.There are no other signs of the disease.

Diagnosis of chronic prostatitis

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

A three -walled urine test helps to identify inflammation.To do this, the patient urinates three containers for analyzes.Prostate massage between the second and third containers leads to stimulation of the secretion of the gland.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 the analysis.There is no need to specially massage the prostate and explore the pure secret of the gland.

Urine from the third container can be sent to a bacteriological examination with sowing to a nutrient medium.In the presence of bacterial growth, a test is carried out for the susceptibility of the pathogen to antibiotics.The method helps to conduct treatment more accurately and more effective.Since the prostatic secret is a significant part of the sperm, microscopy and ejaculate bacterios 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 a successful treatment.Ultrasound and other instrumental studies do not have significant diagnostic value.

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

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

Treatment of chronic prostatitis

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

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

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

The absence of a certain etiology explains why attempts to therapy of this pathology are often unsuccessful.

Methods of treatment of chronic aseptic prostatitis contain:

1. Antibacterial therapy with fluoroquinolones (carried out 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 the tissues of the prostate.The effectiveness is low.
3. NSAIDs and other anti -inflammatory drugs have severe effectiveness, relieve pain and improve symptoms.However, treatment is pathogenetic, 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 muscles of the pelvis.The method helps patients with appropriate disorders.
5. Antidepressants and anticonvulsants (effectiveness is not proven).
6. Surgical treatment: laser or thin -iginal 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 you to achieve success in more than 80% of cases.

Chronic non -bacterial (aseptic) prostatitis/KTB has a worst forecast.Treatment helps only 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.