Chronic prostatitis

Chronic prostatitis is prolonged inflammation that occurs due to an infection or concomitant pathology 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 an urologist in patients under the age of 50.In a chronic form, a bacteriological examination reveals pathogen that in 5 to 10% of patients.In most cases, other factors are considered to be the cause of the disease.We know that the presence of an infection is not a prerequisite for the occurrence of the disease.Chronic inflammation of prostate is a polyetiological pathology, which is the result of the actions of several causes and provocation factors.In 90 to 95% of patients, antibacterial therapy has limited efficiency or is not necessary at all.

Classification of chronic prostatitis

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

The etiological classification of chronic prostatitis includes:

1. Chronic bacterial prostatitis.
2. Chronic non -bacterial prostatitis (aseptic) / CTB ("prostatini", or "painful prostate gland" is an obsolete term used to determine pathology).
3. Chronic non -bacterial (aseptic) / CTB prostatitis with an inflammatory component (the concentration of leukocytes is considerably increased in the secret of prostate, sperm, the first part of the urine).
4. Chronic non -bacterial prostatitis (aseptic) / CTB without inflammatory component (concentration of white blood cells in the secret of prostate, sperm, the first part of the urine is insufficient for inflammation).
5. Chronic ashmpptomic prostatitis (detected in laboratory studies cannot be clinically).

Chronic bacterial prostatitis is a rare pathology, as shown by the above statistics.Infection is the cause of chronic recurring inflammation of prostate in one of the ten patients.Pathology is often associated with other infectious diseases of the genitorerinary organs.Most often, its cause is a non-specific infection, however, in the presence of SSPP, chronic inflammation of the gland can be caused by chlamydia, ureaplasmosis, mycoplasmosis or other specific micro-organisms.

Chronic non -bacterial (aseptic) prostatitis, or chronic pain syndrome, is a long -term recurring disease that occurs following aseptic inflammation of the prostate.It is a little studied pathology.In the presence of symptoms of the disease, tests determine white blood cells in the secret of the gland, in the seed fluid, in the initial part of the urine, but the results of the bacteriological examination are negative.In other cases, there are no signs of infection or pronounced leukocytosis with brilliant symptoms.

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

The pathanatomical classification (pathomorphological) of chronic prostatitis is a limited interest in clinical patients and doctors.

The causes of chronic prostatitis

Causes of chronic bacterial inflammation of the prostate gland

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

Like some other microbes, E. coli is capable of forming biofilms, thin, made up of bacterial accumulations and closely adjacent to the mucous membranes of the conduits.This explains why it is not always possible to cure chronic prostatitis.It is believed that the infection propagates as an upward path through the urethra.However, lymphogenic and hematogenous propagation of infection is also possible.

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

• Sexually active age;
• Adenoma of prostate, or benign prostate hyperplasia;
• narrowing of the urethra;
• Unscrew the extreme flesh of the penis;
• Hypertrophy of the bladder neck;
• Medical procedures (bladder catheterization, cystoscopy);
• Genetic and anatomical characteristics 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) / CTB prostatitis is a polyetiological disease that occurs following combinations of several negative factors, namely:

• bike;
• irritation of the fabrics of the prostate gland when urine enters its conduits;
• irritation of the prostate gland following the use of any product or drink (especially with food allergies or celiacia);
• functional disorders of the nervous innervation of pelvic organs;
• Atrophy of the pelvic floor muscles;
• Stress, psycho-emotional charges;
• Pathology in the prostate gland, remaining after a long 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.

Chronic prostatitis symptoms

Chronic (infectious) bacterial prostatitis is characterized by cyclic evolution.The exacerbation phase is replaced by a remission phase.There is practically no symptom between exacerbations.There is a clear link between other diseases of the genitorerinary organs - uretrite, epididyms, cystitis.The cause of these pathologies, as a rule, is the same pathogen which causes chronic prostatitis.Symptoms during exacerbation are represented by dysurical phenomena (frequent urination, rubber and burning pain during urination) and pain with various intensities in the perineum, scrotum, sacrum, with irradiation in the penis.

The general condition is generally satisfactory.There is no sign of poisoning, there is no increase in body temperature.The prostate gland during the examination through the rectum (by rectum) can be normal or slightly swollen, without acute pain characteristic of acute prostatitis.

Chronic non -bacterial (aseptic) / KTB prostatitis is characterized by pains of various degrees of severity (stupid to intense lungs) in the basin, the perineum, the sacrum and are the "business card" of the disease (chronic aseptic prostatitis).The signs of inflammation of the prostate gland are poorly expressed and are observed in 50% of cases.In other patients, they can be absent.

The presence of blood in sperm, painful ejaculation, defecation, dystouric phenomena are possible.The severity of the symptoms can change.Pain is given to the crotch, the rectum, which makes it difficult to search for a person in a sitting position.Fatigue, unreasonable fatigue, joint and muscle pain is also possible.Some patients complain about a decrease in libido, an erectile dysfunction (helplessness).

Asymptomatic chronic prostatitis has no symptoms characteristic of this disease, hence its name.During the Laboratory Study of Prostate Secret, leukocytosis is determined, an increase in the levels of a specific prostatic antigen is possible.There is no other sign of the disease.

Diagnosis of chronic prostatitis

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

A three yards test helps identify inflammation.To do this, the patient urine three containers for analyzes.The massage of the prostate between the second and third containers leads to the stimulation of the secretion of the gland.Consequently, 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.

The urine of the third container can be sent to a bacteriological examination with sowing to a nutritious environment.In the presence of bacterial growth, a test is carried out for the sensitivity of the pathogen to antibiotics.The method helps to perform more precisely and more efficient treatment.Since the secret of prostate is an important part of sperm, microscopy and ejaculat for bacteria also make it possible to make the right diagnosis.

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

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

Microscopy reveals the presence of leukocytes in the urine, in the secrecy 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, a rational and targeted antibacterial treatment is necessary.The preparations of choice are fluoroquinolones which create large concentrations of the drug in the tissues of the gland.The course of treatment goes from six to 12 weeks.Such a duration of antibacterial therapy is necessary for complete eradication of infections and the prevention of relapses.Drugs of the second.

Chronic bacterial prostatitis can be healed with coherent and adequate therapy.Patients with frequent relapses must check the immune condition.It may also be necessary to exclude HIV infection, which is often the cause of low efficiency in antibacterial treatment.In these patients, it is possible to prescribe antibiotics at a sufficient dose to remove bacterial growth.

Treatment of non -bacterial prostatitis / chronic bacterial kts is difficult, as infection is not the cause of chronic pain in the basin or albacious chronic prostatitis.It is necessary to seriously approach the problem and answer the question of how to deal with a disease, the cause of which is exactly unknown.

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

Chronic aseptitis treatment methods 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 improving blood circulation in prostate tissues.Efficiency 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 muscles in the basin.The method helps patients with appropriate disorders.
5. Antidepressants and anticonvulsants (efficiency is not proven).
6. Surgical treatment: laser or slim-on-ouginal ablation of the prostate gland (not effective).

Forecast

In chronic infectious prostatitis in most patients, the prognosis is favorable.Coherent and adequate antibacterial therapy allows you to succeed in more than 80% of cases.

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