Chronic prostatitis

According to many experts, chronic prostatitis is an inflammatory disease caused by infection with possible additional autoimmune disease and is characterized by damage to the parenchymal and interstitial tissues of the organ.The disease has been known in medicine since 1850, but even today it is poorly understood and difficult to treat.Chronic bacterial (6-10%) and non-bacterial (80-90%) prostatitis are the most common and socially significant inflammatory diseases in men, significantly affecting their quality of life.The disease occurs mainly in people of young and middle age and is often complicated by disorders of copulatory and generative functions (reduced potency, infertility, etc.).In men, the disease is registered in 8-35% of cases between the ages of 20 and 40.

The cause of bacterial prostatitis is the pus flora that penetrates the gland from the urethra or over the lymphogenic and hematogenic path.The etiology of chronic non -bacterial prostatitis and their pathogenesis are still unknown.Men over 50 years are particularly affected.

Reasons for the development of the disease

Chronic prostatitis is currently considered a polyatiological disease.There is an opinion that the disease occurs as a result of an infection penetrating the prostate and the pathological process then runs without its participation.This is made easier by a number of non -infectious factors.

Infectious factors for the development of chronic prostatitis

In 90% of cases, pathogens penetrate the iron from the urethra, which means that acute or chronic prostatitis occurs.Cases of asymptomatic cars are found.The course of the disease is influenced by the condition of the protective forces of the human body and the biological properties of the pathogen.It is believed that the transition of acute prostatitis to chronic occurs due to the loss of fibrous tissue due to the loss of fiber tissue.

Among the causative agents of chronic prostatitis, the following pathogens are found:

• In 90% of cases, the disease is manifested by such gram-negative bacteria as Escherichia coli (E. coli), Enterococcus faecalis (fecal bacteria), slightly less often - pseudomonas aeruginosa, klebsiella spp., Proteus spp., Prooteus spp.Pseudomonas aeruginosa, Enterobacter aerogenes and Acinetobacter spp.Camera-positive enterosococci, streptococci and staphylococci bacteria are rare.
• The role of coagulasis-negative staphylococci, urea, chlamydia, trichomonia, gardnerella, anaerobic bacteria and fungi of the genus Candida were not finally clarified.

The infection penetrates the prostate in several ways:

• The rising path is the most likely that proves through a frequent combination of prostatitis and urethritis.
• Hematogenic prostatitis develops with the penetration of infections into the gland with a blood flow, which is observed with chronic tonsillitis, sinusitis, periodontitis, pneumonia, cholecystitis and cholangitis, astrigy skin diseases, etc.
• By contact, chronic prostatitis develops with urethritis and urethral stricts when the infection with the urine flowing penetrates into the gland, with purulent kidney infections, channel with epipidymitis, deferitis and funiCulitis, diagnostic and therapeutic urological interventions (catheterization, bouquet, urethral insulation), alsoTransurethral.
• Lymphogenically, the infection penetrates the prostate in proctitis, thrombophlebitis of hemorrhoidal veins, etc.

Non -infectious factors in the development of chronic prostatitis

Chemical factors

According to experts, the leading role in the development of chronic prostatitis is played by intraprostatic urine reflux, in which urine flows from the urethra into the gland, which leads to impaired emptying of the prostate and seminal vesicles.

During the disease, vascular reactions develop, leading to swelling of the organ, the nervous and humoral regulation of the tone of the smooth muscle tissue of the urethra is disrupted, and the activation of alpha occurs₁-adrenergic receptors cause the development of dynamic obstruction and contribute to the development of new intraprostatic refluxes.

In reflux, the urine contained in the urine leads to the development of a "chemical inflammatory reaction".

Hemodynamic disorders

Supports chronic inflammation and circulatory disorders of the pelvic organs and the scrotum.In people who run a seated lifestyle, for example driver, office worker, etc., with obesity, sexual abstinence, dysmetry of sex life develop, more often hypothermia, mental and physical overload.The consumption of sharp and sharp -seasoned foods, alcohol and smoking etc. help to maintain the inflammatory process.

Other factors

There are many other factors that support the chronic inflammatory process in the prostate.This includes:

• Hormonal.
• Biochemical.
• Violations of the immune response.
• Autoimmune mechanisms.
• Infectious and allergic processes.
• Features of the structure of the prostate glands, which lead to difficulty in complete drainage.

Very often it is not possible to determine the causes of chronic prostatitis.

Classification of prostatitis

According to the classification proposed by the National Institute of Health in the United States in 1995, prostatitis is divided into:

• Sharp (category I).Is 5 - 10%.
• Chronic bacteria (category II).Is 6 - 10%.
• Chronically non -bacterial inflammatory category (category IIIA).Is 80 - 90%.
• Chronic non-bacterial non-inflammatory (category IIIB) or chronic pelvic pain syndrome.
• Chronic prostatitis proven by accident (category IV).

Signs and symptoms of chronic prostatitis

The course of chronic prostatitis is long, but not monotonous.The exacerbation periods are replaced by relative space times that occur after comprehensive anti -inflammatory and antibacterial therapy.

The development of chronic bacterial prostatitis is often preceded by urethritis of bacterial or gonorrhea, non -bacterial circulatory disorders in the pelvic organs and in the skrotum (hemorrhoids, varicuses, etc.), sexual excesses.

Patients with chronic prostatitis present with many symptoms.Doctors have been treating them for years, but are very rarely checked for prostate disease.About a quarter of patients do not present any complaints, or the disease presents with few clinical symptoms.

Complaints from patients with chronic prostatitis can be divided into several groups.

Urination disorders related to the narrowing of the urethra:

• Difficulties at the beginning of urination.
• A weak stream of urine.
• Intermittent or decreased urination.
• A feeling of incomplete emptying of the bladder.

Symptoms caused by irritation of the nerve endings:

• Frequent urination.
• The calls for urination are sharp and strong.
• Urinating in small parts.
• Urinine incontinence during urination.

Pain syndrome:

• The intensity and type of pain varies.
• Location of pain: lower abdomen, perineum, rectum, groin and lower back, inner thighs.

Sexual dysfunction:

• Pain in the rectum and in the urethra during ejaculation.
• Sluggish erection.
• Loss of orgasm.
• Early ejaculation etc.

From the nervous system: neurotic disorders in the form of fixing the patient's attention to his state of health.

Signs and symptoms of chronic nonbacterial prostatitis

Chronic pelvic pain syndrome in men (CPPS) occurs with the usual symptoms of chronic prostatitis, but there are no bacteria in the 3rd part of the urine and prostate secretions.Chronic non -bacterial interstitial cystitis, diseases of the rectum, spastic myalgies syndrome of the pelvic floor and lesions of the prostate of functional nature, which are caused by disorders of the organization of the organ and its hemodynamics, can pretend CPPS.

With impaired neurovegetative function, atony and disruption of the innervation of the gland are observed, which is manifested by difficulties in rapid and complete closure of the urethral lumen.In this case, urine is excreted drop by drop for a long time after urination.In such patients, the study shows instability and increased excitability, which are manifested by increased sweating and excitability of cardiac activity, as well as changes in dermographism.

Disease complications

The long course of chronic prostatitis is complicated by disorders of sexual and reproductive functions, the development of diseases such as vesiculitis and epipidimitis, and sclerosis of the organ.Sclerosion of the organ worsens local microcirculation and urodynamics, as well as the results of surgical interventions.Fibrosis of perihumetral tissues leads to the development of urinary disorders.

Diagnosis

Due to the fact that there are many reasons for the development of chronic prostatitis, an overall complex of diagnostic studies for diagnosis is used.The success of the treatment depends on the correct determination of the causes of the disease.The diagnosis of chronic prostatitis is based on the following data:

• Classic triad of symptoms.
• A complex physical methods (finger recal examination of the prostate).
• A complex of laboratory methods (urine analysis and microscopy of the prostate, sowing and determination of the sensitivity of microflora compared to antibacterial pharmaceuticals, general urine and blood analysis).
• To detect gonococci, bacteriocopy smear made of urethral, PCR and serological methods (for the detection of urea and chlamydia).
• Ufluorometry.
• Prostate biopsy.
• A complex of instrumental methods (ultrasound).
• Determination of the patient's immune status.
• Determination of the neurological status.
• In the event of ineffective treatment and suspicion of complications, computer and magnetic resonance imaging, a blood culture etc. are carried out.

Palpation of the prostate

Of primary importance for the diagnosis of the disease is palpation of the prostate, which increases during the exacerbation phase and decreases during the resolution of the inflammatory process.In chronic prostatitis, the gland swells and hurts during the exacerbation phase.

The consistency of the organ can be different: areas of softening and hardening are palpated, areas of retraction are determined.By palpation it is possible to assess the shape of the gland, the condition of the seed tubercles and the surrounding tissues.

The process of transrectal digital examination is combined with the collection of glandular secretions.Sometimes it is necessary to collect the secretion from each lobe separately.

Analysis of a 3-cup sample of urine and prostatic secretions

The "gold standard" in the diagnosis of chronic prostatitis are:

• Collecting the first urine portion.
• Collection of the second portion of urine.
• Obtaining glandular secretions through massage.
• Collection of the third urine portion.

This is followed by a microscopic and bacteriological examination of the material.

With prostate inflammation:

• The number of germ (KBE) exceeds 10³/ml (10⁴/ml for epidermal staphylococci), but should not be neglected by a small number of microbes that are calculated by dozens and hundreds.
• The presence of 10-15 leukocytes in the field of vision, which was recognized by microscopy, is a generally recognized criterion for the presence of an inflammatory process.

The secret of the prostate and the 3rd parts of the urine are subjected to microscopic and bacteriological examinations:

• In chronic bacterial prostatitis, an increase in the number of leukocytes in the secret of the gland and the third post massage part of the urine is found, bacteria (mainly intestinal group) are released.
• In non-bacterial prostatitis, an increase in the number of leukocytes in the secretion of the gland is noted, but the microflora is not detected.
• With CTB there are no increased amounts of white blood cells and microflora.

The normal indicator of the secretion of the prostate:

• Leukocytes less than 10 in field of view.
• Lecithin grains are a large number.
• There is no microflora.

In chronic prostatitis in the secret of the prostate, it is determined:

• The number of leukocytes is 10-15 large in the field of view.
• The amount of lecithinkörners is reduced.
• The pH value of the secretion is shifted to the alkaline side.
• The acid phosphatase content is reduced.
• The activity of lysozyme is increased.

Telling negative results of the secret of the prostate does not prove the absence of an inflammatory process.

The value of the test of the secret of the prostate remains.A characteristic pattern in the form of a fern sheet is usually formed during crystallization.In the event of a violation of the aggregation properties of the prostatic secret, such a pattern does not form what occurs through changes in the androgenic hormonal background.

Ultrasound examination

If prostate disease is suspected, an ultrasound examination of the gland itself (transrectal ultrasound), the kidneys and the bladder is optimal, which allows us to determine:

• Volume and size of the gland.
• Presence of stones.
• Sizes of the seed bubbles.
• Condition of the bladder walls.
• amount of residual urine.
• Structures of the scrotum.
• Another kind of pathology.

Other methods of prostate examination

• The state of urodynamics (examination of the urine flow rate) can be easily and easily determined using an examination such as Uroflowmetry.With the help of this study, it is possible to recognize signs of a bladder output authority and to carry out dynamic monitoring.
• If abscess formation, benign hyperplasia and prostate cancer are suspected, a puncture biopsy is performed.
• In order to clarify the reasons for the development of infravesicular obstruction, X-ray and endoscopic examinations are carried out.
• In the event of a long -lasting inflammatory process, the implementation of urethrocystoscopy is recommended.

Differential diagnosis

Chronic prostatitis should be distinguished from vesiculoproprofostasis, autonomic prostatopathy, stagnant prostatitis, inherited soil, psychoneurological diseases, pseudo-formation, reflex sympathetic dystrophy, inflammatory diseases of other organs, interstitial cystitis, osteitis of the longitudinal type, longitudinal type, longitudinal type,Longitudinal type, longitudinal type, longitudinal type, osttitial cystitis, ofsexzususe, ofstitial systitis, ofstitial systitis, ofstitial systitis, ofstitial systitis, ofstitial systitis, ofstitial systitis, ofstitial systitis, ofstitial systitis, ofstitial systitis, ofstitial systitis, ofstitial systitis,Ofstitials, ostu.Dyshunture, sexual dyshunture, sexual dysfunction.Hypertrophy of the neck of the bladder, strictures of the urethra, tuberculosis, cancer of the prostate and bladder, urolithiasis, chronic epipidemia, inguinal hernias.

Treatment of chronic prostatitis

Treatment of chronic prostatitis should begin with changing the patient's lifestyle and diet.

When treating the disease, drugs are used simultaneously that affect different connections in the pathogenesis.

The main instructions of the therapy:

• Excretion of causal microorganisms.
• Anti -inflammatory therapy.
• Normalization of blood circulation in the prostate and pelvic organs.
• Normalization of adequate drainage of the prostate acinus.
• Normalization of the hormonal profile.
• Prevention of organ sclerotherapy.

Medicines of the following groups are used to treat chronic prostatitis:

• Antibacterial.
• Anticholinargic.
• Vasodilators.
• alpha₁–Adren blocking.
• Inhibitors 5 alpha-reductase.
• Cytokin inhibitors.
• Non -steroidal anti -inflammatory anti -inflammatory.
• Angoprotectors.
• Immun modulators.
• Preparations affecting the exchange of urates.

Antibiotics in the treatment of bacterial chronic prostatitis

Antibacterial therapy should be carried out taking into account the sensitivity of proven microorganisms to antibiotics.If the pathogen is not identified, empirical antimicrobial treatment is used.

The drugs of choice are fluoroquinolones of the IIV generation.They quickly penetrate the tissues of the gland using ordinary methods of application, show activity against a large group of gram-negative microorganisms, as well as ureaplasma and chlamydia.In case of failure of antimicrobial treatment, it should be assumed:

• Microflora polyurezancy,
• Short (less than 4 weeks) treatment courses,
• Wrong selection of the antibiotic and its dosage,
• Changes to the type of pathogen,
• The presence of bacteria that live in the channels of the prostate covered with a protective extracellular membrane.

The duration of the treatment should be at least 4 weeks with the mandatory subsequent bacteriological control.In the event of a preservation in the 3rd part of the urine and in the secret of the prostate of the bacteriuria, more than 10³The correspondence of re -antibacterary therapy for a period of 2 to 4 weeks is prescribed.

Cytokine inhibitors in the treatment of chronic prostatitis

Cytokines are glycoproteins secreted by immune and other cells under conditions of inflammatory and immune response.They are actively involved in the development of a chronic inflammatory process.

Non -steroidal anti -inflammatory medication

Non-steroidal anti-inflammatory drugs have an anti-inflammatory effect, reducing pain and fever.They are widely used in the treatment of chronic prostatitis in the form of tablets and suppositories.The most effective route of introduction is the rectal route.

Immunotherapy

In the treatment of bacterial chronic prostatitis, along with antibiotics and anti-inflammatory drugs, immunomodulating agents are used.The most effective is the rectal route of their introduction.The immunomodulator is widely used, which increases the functional activity of phagocytes, which contributes to more effective elimination of pathogens.

Alpha blockers in the treatment of chronic prostatitis

It has been found that adrenerge alpha-1 shoes normalize the tone of the smooth muscles of the prostatic part of the urethra, seed bubbles and prostate capsules, which makes medication of this group very effective when treating the disease.Adrenerges Alpha-1 shoes are used in patients with pronounced urine disorders in the absence of an active inflammatory process.

With CTB, the treatment period is between 1 and 6 months.

5A reductase inhibitor for the treatment of abacterial prostatitis and CPPS

It was found that testosterone under the influence of the enzyme 5a-reductase is converted into the prostate form 5a-dihydrotestosterone, the activity of which in prostate cells is more than five times higher than the activity of testosterone itself, which leads to an increase in the size of the organ in the elderly due to the epithelial and stromal components.

When taking a 5A reductase inhibitor for 3 months, an atrophy of the electricity tissue, an atrophy of the glandular tissue, an inhibition of the secretion function, a reduction in pain and the glandular volume as well as reducing the tension and swelling of the organ will be observed for 6 months.

The role of antisclerotic drugs in the treatment of chronic prostatitis

With long -term inflammation of the prostate, fibrosis occurs, which is expressed in disorders of microcirculation and urodynamics.Antisclerotics are used to prevent the process of fibrosis.

Other drugs used to treat chronic prostatitis

In addition to the medication described above, the following drugs are used to treat the disease:

• Antihistamines.
• Vasodilatorers and angi -protectors.
• Immunosuppressant.
• Drugs that affect urate metabolism and trisodium citric acid.

Vegetable products

Effective in the treatment of prostatitis, the use of the drug in the form of candles that contain a complex of biologically active peptides that have been isolated from the prostate gland from cattle.

Under the influence of the drug:

• Stimulation of metabolic processes in the tissues of the gland.
• Improvement of microcirculation.
• Reduction of edema, leukocyte infiltration, stagnation and pain.
• Prevention of thrombosis in the venules of the prostate.
• Increase in the activity of the secretory epithelium of acinus.
• Improvement of sexual function (increased libido, restoration of erectile function and normalization of spermatogenesis).

Finger massage of the prostate gland

A number of researchers say that chronic prostatitis should use a finger massage taking into account known contraindications.

Physiotherapy

The effectiveness of physiotherapeutic procedures in the treatment of prostatitis has not been proven today, the mechanism of action has not been scientifically established, and adverse reactions have not been studied.

Prevention of chronic prostatitis

By preventing the development of chronic prostatitis, you should know:

• The risk of developing the disease increases over the years.
• Representatives of the Negroid race are more predisposed to the disease.
• A family adjustment for the disease is not excluded.

People with a disposition for the development of chronic prostatitis should be more attentive to their health.

Tips for preventing the disease:

• Take enough liquid.The microflora is rinsed out of the urethra by frequent urination.
• Prevent diarrhea and constipation.
• Stick to a balanced diet.Avoid consuming foods rich in carbohydrates and saturated fats as these lead to weight gain.
• You should limit as much as possible the consumption of substances that irritate the urethra: hot and spicy foods, smoked foods, sauces and spices, coffee and alcohol.
• Stop smoking.Nicotine has a negative effect on the condition of the vascular walls.
• Don't get too cold.
• Don't hesitate to empty your bladder.
• Guide an active lifestyle and do sports.Make exercises to strengthen the pelvic muscles, which avoids venous blood venue, which in turn maintains normal prostate function.
• Have a regular sex life.Avoid prolonged abstinence.The gland must be freed from secretions in a timely manner.
• Stay committed to a monogamous relationship.Promiscuous sex increases the likelihood of contracting sexually transmitted diseases.
• If you have problems with the urogenital organs, contact a urologist immediately.