Prostatitis acute is an infectious inflammation of the gland of the prostate, accompanied by inflammation and the formation of purulent foci in the prostate. Manifestations of prostatitis acute depend on the stage (catarrhal, follicular, parenchymatous, abscessed) and may include dysuric disorders, pain in the perineum, fever, poisoning. The diagnosis is based on palpation of the prostate, ultrasound and Doppler study of the prostate, the study of the discharge of the urethra and prostate secretion. Treatment of prostatitis acute includes the administration of therapy antimicrobial, Nsaids, antispasmodics, analgesics, immunomodulators, physiotherapy.
Acute and chronic prostatitis are the most common and socially significant diseases of man. In the clinic of urology, prostatitis is diagnosed in 30-58% of men in the reproductive and working age (30-50 years). For prostatitis acute is accompanied by disorders of sexual function and fertility, disorders of the state psychoemotional and social disadaptation.
Causes of prostatitis acute
Causative Agents of prostatitis acute are mainly non-specific infectious agents that penetrate the tissues of the prostate, the gram-negative (Escherichia coli, Klebsiella, Proteus) or gram-positive (staphylococci, enterococci, streptococci)
Often prostatitis acute can be caused by pathogens urogenital infections:
- chlamydia
- trichomoniasis,
- Ureaplasma,
- gonorrhea,
- mycoplasmosis,
- thrush etc.
Most often, the penetration of agents microbial in prostate tissue occurs transcanalicular way – through the excretory ducts of the glands in the wall of the urethra later. Therefore, the urethritis of any origin is very often complicated with prostatitis acute. Less microbial flora gets into the prostate from the bladder in cystitis acute. The introduction of pathogens in the gland is significantly facilitated by the increase of intraurethral pressure (reprehenderat, stones urethra), the conduct of the endourethral manipulation (bougienage of the urethra, urinary catheterization, ureteroscopy, cystoscopy, etc.).
In addition, prostatitis acute, can be the result of hematogenous infection, provided by the conditions of the blood supply of the prostate with a well-developed system of arterial and venous anastomoses. When called hematogenous drift germs can get into the prostate tissue from distant focus in purulent tonsillitis, sinusitis, caries, cholecystitis, bronchitis, pyoderma, etc. Can lymphogenous infection of the prostate from the bowel with anal fissures, proctitis, colitis.
For non-infectious factors that contribute to the development of prostatitis acute include congestion persistent in the veins of the pelvis and alteration of drainage acini of the prostate. The stagnation can be caused by disritmia sexuality and sexual violations – a practice of the interruption of sexual relations, lack of or irregular sexual activity, excessive sexual activity, etc. the Pathological deposition of the venous blood of the line of the pelvis can be observed when sedentary lifestyle, frequent constipation, colds, chronic (especially alcohol) poisoning, varicose veins of the pelvis.
Forms of prostatitis acute
In the development of prostatitis acute distinguish the following forms, which are the stages:
- catarrhal,
- follicular,
- parenchymal,
- abscessed.
Prostatitis acute begins with a catarrhal inflammation of the mucous and submucous layer of the excretory ducts of individual lobules of the gland. In addition to the inflammation of the walls of the pipes contributes to the stagnation of Muco-purulent secret in the follicles of the prostate and the progression of the inflammation, in relation to the who can develop focal suppuration of lobules acute follicular prostatitis. When multiple lesions of lobules and dissemination of the participation of the parenchyma and interstitial tissue of the prostate in suppurative inflammation, prostatitis acute enters into its next phase – parenchymal. In the case of the merger of small ulcers in the large home, forming an abscess of the gland of the prostate, which can be opened in the urethra, the perineum, the rectum or the bladder.
Symptoms of prostatitis acute
Clinical manifestations of prostatitis acute correspond to the phases of the process. Common manifestations are pain, disorders of urination and intoxication.
In the acute catarrhal stage of prostatitis feel the weight and pain in the perineum. Dysuric disorders are characterized by painful, frequent urination, especially at night. The temperature of the body remains within the normal range, may be slightly elevated; intoxication missing. Palpation examination of the prostate is not changed or slightly increased, little painful. The study of prostate secretion, detected an increase in white blood cells, the accumulation of Muco-purulent threads. In the urine during the emptying of the excretory ducts of the acini appear white blood cells. Prostate massage is usually impossible due to the pain. The treatment given in the catarrhal stage of prostatitis acute, leading to the recovery of 7-10 days.
The follicular form of prostatitis acute occurs with more intensity, accompanied by a dull pain in the perineum, irradiating in the penis, rectum or sacrum. In this context, the urination painful and difficult, until the development of acute retention urinary. The act of defecation acute follicular prostatitis is also difficult because of the expressed pain. Due to the increase in body temperature to 38°C, the deterioration of the General conditions. Palpation per rectum is determined in the enlargement of the eu, dense, intense, asymmetric prostate, so sudden and painful in some areas when digital examination. Urine collected after the palpation of the gland, contains a large number of leukocytes and purulent filaments, forming a turbid precipitate. Massage to get a prostate secretion in the phase follicular of prostatitis acute is contraindicated. With the vigorous treatment of acute follicular prostatitis can be resolved favorably; otherwise, it moves to the next, parenchymal phase.
Clinic of acute parenchymatous prostatitis develops rapidly. Characterized by severe hyperthermia (up to 39-39,5°C and above) with chills, General weakness, depression of appetite, thirst. First urination abruptly learning and complicated, can leave completely. Try to empty the bladder or of the intestine are accompanied by intense pain. Develop painful tenesmus, constipation, flatulence. The pain extends to the rectum, is of a throbbing character, forcing the patient to take a position forced – lying with the legs crossed. With the development of reactive inflammation of the rectum from the anus of mucus.
Determined by palpation diffusely enlarged, with unclear contours of the gland, extremely painful to the slightest touch. Prostate massage in parenchymal phase of prostatitis acute is contraindicated with force. Sometimes, because of a pararectal tissue swelling and tenderness, and rectal examination is not possible to drive. In the urine with a pronounced album sanguinem cellam, pyuria. The result of acute parenchymatous prostatitis can serve as resolution of the disease, the formation of an abscess of the prostate or prostatitis chronic.
Diagnosis of prostatitis acute
The recognition and the identification of the stage of prostatitis acute is performed by a urologist and is based on a thorough physical examination, laboratory and instrumental examination. Examination of the prostate through the rectum to determine the size, consistency, homogeneity, symmetry, cancer; the pain of reaction, the focus of the destruction, signs of purulent fusion of tissues. Palpation of the prostate in prostatitis acute is done with great care and without gross pressure and massage movements. Obtained in the prostate secretion revealed an increase in the number of leucocytes and amyloid Taurus, reducing the number of lecithin granules.
In prostatitis acute, there is an increase leukocyturia in the third part of the urine and the urine collected after the palpation of the prostate. For the allocation of the causative agent of prostatitis acute, it is necessary to perform bacterial analysis of urine and urethral discharge with antibiotics, PCR studies of drains, blood cultures sanguinem culture. The nature and severity dysuric disorders in prostatitis acute is estimated using uroflowmetries.
Ultrasound of the prostate with moderate pain syndrome can be performed transrectal; in the case of pronounced pain reaction – transabdominal. Anoscopically loved the shape, the magnitude of the cancer, the presence of focal or diffuse changes, which laid the foundations of prostatitis acute. The use of Doppler studium allows for a detailed and differentiated to evaluate the vascularization of the prostate.
When planning surgical tactics in relation to destructive forms of prostatitis acute appropriate, CT or MRI of pelvis.
Treatment of prostatitis acute
The leading role in the treatment of prostatitis acute belongs to the causal treatment. You need the first appointment antimicrobial (antibacterial, antiviral, antitrichomonal, antimycotic) drugs to suppress the reproduction of the microorganisms in the gland and the tissues of the urethra. To reduce cramps and painful urination prescribe analgesics, spasmolytics, and rectal candles with Anaesthesinum or belladonna, hot microclysters. In the complex therapy of prostatitis acute used Nsaids, enzymes, immunomodulators, vitamins, infusion solutions.
Physical therapy in prostatitis acute is performed after the decrease in the symptoms of acute. With the aim of anti-inflammatory, decongestant, analgesic actions, improving microcirculation and local immunity applied rectal electrophoresis, UHF-therapy, microwave therapy, prostate massage. In prostatitis acute shown to comply with bed rest, leaving the diet, sexual peace.
When retention urinary on the background of prostatitis acute prevent the realization of catheterization of the bladder, preferring trocar cystostomy. When abscess of the prostate occurs the need of the surgery - opening and drainage of the nasal cavity.
Of the cure of the prostatitis acute is judged by the restoration of the structure of the tissue glands and their functions, the normalization of the composition of the juice of the prostate, the elimination of the pathogens causing the inflammation of body fluids.
Prognosis and prevention
As a general rule, a timely and reasonable causal treatment leads to cupping of signs of prostatitis acute. The abscess of the prostate or chronic inflammation occurs in advanced cases.
Prevention of prostatitis acute should include debridement of the infectious focus in the body, transport and endourethral endovesical manipulations in accordance with the rules of asepsis, the timely treatment of You and urethritis, the normalization of sexual activity and physical activity.