Prostatitis chronic is a prolonged inflammation of the gland of the prostate, which leads to problems of morphology and functioning of the prostate. Prostatitis chronic is manifested prostatic triad of pain in the pelvic region and the genitals, urinary disorders, sexual disorders. Diagnosis of prostatitis chronic includes the palpation of the gland, study of prostate secretion, ultrasound, uroflowmetry, in, needle biopsy of the prostate. In prostatitis chronic show complex medicine, physiotherapy, massage prostate, instillation urethra later. Surgical treatment is advisable in complicated forms of prostatitis chronic.
Prostatitis chronic
Prostatitis chronic is the most common male disease: approximately 50% of men suffer from some type of inflammation of the prostate. Prostatitis chronic often affects men aged 20 to 40 years, in the period of maximum sexual and reproductive activity. In this sense, the detection and treatment of chronic prostatitis in urology is becoming not only medical, but also the social side.
Classification of prostatitis chronic
According to the modern classification of prostatitis developed in 1995, we distinguish 3 categories of the disease:
- I. prostatitis Acute.
- II. Prostatitis chronic source bacterial.
- III. Chronic nonbacterial prostatitis Genesis/chronic pelvic pain Syndrome – a syndrome that is not associated with obvious signs of infection and continued for 3 months or more.
- III A prostatitis chronic with an inflammatory component (detection in the prostate secretion of white cells of the blood and infectious agents);
- III B prostatitis chronic with no inflammatory component (leukocytes and pathogens in the prostate secretion).
- IV. Asymptomatic prostatitis chronic (no complaints in the identification of leukocytes in prostatic secret).
In the presence of the infectious component talking about bacterial (infection) prostatitis chronic; in the absence of microbial pathogens – nonbacterial (not contagione) prostatitis. It is believed that 90-95% of all cases there is a non-bacterial chronic prostatitis and only 10-5% is bacterial.
The causes of prostatitis chronic
The etiology and pathogenesis of chronic bacterial prostatitis are associated with any type of infection of the prostate following ways: upwards (through the urethra), descending (when reflux of infected urine from the bladder), hematogenous (blood highways) or lymphogenous (for lymphatic collectors). Most uropathogens are E. coli, Klebsiella, Proteus, Staphylococcus, Enterococcus, CORINE, fungi, parasites, and pathogenic viruses. Together with the non-specific flora the development of the prostatitis chronic can participate the agents specific urethritis (chlamydia, Mycoplasma, gonococcus, Trichomonas, Gardnerella).
However, for the development of the prostatitis chronic is not so much the presence and activity of micro-organisms such as the state of the pelvic organs and circulation in them, the presence of comorbidities, the level of protective mechanisms.
Therefore, the appearance of prostatitis chronic, can contribute to a number of factors. First of all, it is urological diseases, pyelonephritis, cystitis, urethritis, stricture of urethra, increatos until the end of the prostatitis acute, orchitis, epididymitis etc. Microbial etiologist can get into the prostate from distant focus of infection, for example, sinusitis, tonsillitis, dental caries, chronic bronchitis, pneumonia, pyoderma, etc. Predispose to chronic inflammation, local and General, hypothermia, overheating, stay in a humid environment, fatigue, malnutrition, rare urination, etc.
Chronic non-bacterial prostatitis is usually associated with congestive (congestive) phenomena in the prostate caused by stasis of the circulation and vein in the pelvic organs and impaired drainage acini of the prostate. Local obstructio causes overflow of the blood vessels of the prostate with blood, swelling of incomplete emptying of secretions, the breach of the barrier, secretory, motor, contractile function of the gland.
Congestive changes generally caused by factors of behavioral, long-term sexual deprivation, the practice, interrupted or prolonged sexual activity, excessive sexual activity, lack of exercise, prolonged sitting, chronic poisoning (alcohol, nicotine, drugs), occupational hazards (vibration). For the development of nonbacterial prostatitis chronic predisposing pathology of the pelvic organs and nerve structures of their innervation (e.g., spinal cord injury), adenoma of the prostate, hemorrhoids, constipation, androgenodeficiency, etc. reasons.
The symptoms of prostatitis chronic
Prostatitis chronic is manifested by local and General symptoms. Local manifestations belongs prostatic triad, which is characterized by pain, dysuria and sexual dysfunction. Pain in prostatitis chronic a pain constant in nature, localized in the perineum, genitals, suprapubic, groin. Pain syndrome increases at the beginning and at the end of urination, with pain radiating to the glans of the penis, the scrotum, sacrum, the rectum. The pain may increase after sex or in relation to the long-term abstinence; to weaken or strengthen after the orgasm to be more intense at the time of ejaculation.
The intensity of the pain syndrome in the prostatitis chronic varies from discomfort to Express that violate the sleep and performance demonstrations. Pain with difficulties of location in the sacrum are often considered as low back pain or sciatica, in relation to a patient long treated without a doctor's assistance.
Urination in prostatitis chronic and painful learning. While there may be a difficulty start miscet, a weakening or discontinuity of the urine stream, sensation of emptying incomplete bladder, frequent night urination, with burning in the urethra. In the urine in prostatitis chronic can detect the presence of floating yarns. After a bowel movement or physical exertion of urethral appear allocation , due to a reduction in the tone of the prostate. In prostatitis chronic can be a cause itching, feeling cold or excessive sweating in the crotch, a local discoloration of the skin, associated with the stagnation of the circulation of the blood.
Prostatitis chronic accompanied by serious alterations of the sexual function. Phenomena gipotenzia may be worsening, painful erections, prolonged and frequent night erections, difficulty or early ejaculation, loss of libido (reduced libido), erasing orgasms Hematospermias, infertility. The Sexual dysfunction is always hard, man experienced, which leads to psycho-emotional disorders, up to neurosis and depression, and even worsen the sexual function.
Exacerbation of prostatitis chronic accompanied by a slight increase in body temperature and deterioration of health. The general state in the prostatitis chronic is characterized by the increase of irritability, lethargy, anxiety, fatigue, loss of appetite, sleep disturbance, reduced work capacity, creativity and physical activity.
Almost a quarter of patients with chronic prostatitis symptoms for a long time absent, resulting in late treatment for the urologist. Long-lasting prostatitis chronic can be complicated by impotence, vesiculitis, epididymoorchitis, male infertility, incontinence, stone formation, cysts of the gland of the prostate, sclerosis of the prostate, is the development of adenoma and prostate cancer.
Diagnosis of prostatitis chronic
Necessary for the diagnosis of prostatitis chronic of the information is obtained through comprehensive laboratory and instrumental examination. Initial examination for suspected prostatitis chronic to include the clarification of anamnesis and complaints, carrying out external inspection of the genitalia for discharge, lesions, lesions, digital rectal examination of the prostate with the aim of determining the shape, boundaries, consistency, tenderness of the breast.
In order to determine the structural and functional changes of the prostate is shown holding ultrasound of the prostate (TRUS). Important methods in the diagnosis of chronic prostatitis are the study of the secret prostate, urinalysis, bacteriological examination of smear from the urethra and urine, 3 cups of samples of urine, PCR and REEF study scraping in pathogens of genital infections, the determination of prostate-specific antigen (PSA).
Clinically significant prostatitis chronic is the detection in the analysis of causative agents of chlamydiosis, mycoplasmosis, herpes, cytomegalovirus, trichomoniasis, gonorrhea, candidiasis, and nonspecific bacterial flora. The fence prostate secretion studies carried out after urination and the massage of the prostate. Symptoms of prostatitis chronic are the increase in the number of cells in the field of view, reducing the number of lecithin granules, the presence of pathogenic microorganisms.
In General urine analysis in prostatitis chronic may show pyuria, pyuria, erythrocyturia. Bacteriological urine culture helps to identify the degree and nature of the bacteriuria. With reproductive disorders shows a study of sperm MAR test.
The degree and the causes of cancellation, help you determine urodynamic studies (uroflowmetry, cystometry, profilometry, and electromyography). With the data from studies of prostatitis chronic could be differentiated from stress incontinence, neurogenic bladder, etc. When hematuria, Hematospermias, obstructive voiding an examination endoscopic urethroscopy, and cystoscopy. To remove the adenoma and the prostate cancer requires the determination of PSA, in some cases, a biopsy of the prostate with the morphological studies of tissues.
Treatment of the prostatitis chronic
Prostatitis chronic care difficult, but remember that the recovery is still possible and largely depends on the mood of the patient, the timeliness of his appeal to the specialist for adherence to all requirements of the urologist. The mainstay of treatment of chronic bacterial prostatitis antimicrobial therapy in accordance with antibiotics at least 2 weeks. To reduce the pain and inflammation, Nsaids are appointed ; to relax the muscles of the prostate, the restoration of urodynamics and outflow secretion prostatic sample reception a-adrenoblokatorov.
With the aim of improving the drainage of the prostate, of the local microcirculation and the muscle tone is held a course of therapeutic massage of the prostate. A massage of the prostate gland should result in the allocation of not less than 4 drops of prostate secretion. Prostate massage is contraindicated in acute bacterial prostatitis, abscess of the prostate, hemorrhoids, stones of the prostate, rectal fissures, hyperplasia and prostate cancer.
To relieve the pain of the syndrome in the prostatitis chronic can be recommended paraprostatic lock, acupuncture. Important in the treatment of prostatitis chronic plays a physiotherapy appointment of medicinal electrophoresis, ultrasound, phonophoresis, magnetic therapy, laser magneticam illic, inductometer, mud, SMT, hot hip bath temperature of 40 – 45°C, enemas with hydrogen sulfide and mineral waters, and instillation into the urethra.
With the development of complications associated with prostatitis chronic surgical treatment: the removal of strictures of the urethra; TUR of the prostate or prostatectomy when sclerosis of the prostate; transurethral resection of the bladder with multiple sclerosis the neck, the puncture and drainage of cysts and abscesses of the prostate; circumcisio with phimosis caused by recurrent urinary tract infections, etc.
Prevention of chronic prostatitis
Prevention of chronic prostatitis requires compliance with hygiene genital, timely treatment of urogenital and extragenital infections, the normalization of regularity sexual life, sufficient physical activity, prevent constipation, timely emptying of the bladder.
To avoid the repetition of prostatitis chronic necessary dynamic checks andrologist (urologist); preventive courses of physiotherapy, multivitamins, immunomodulators, with the exception of hypothermia, overheating, stress, bad habits.