prostatitisIt is an inflammatory disease of the prostate. Manifested by frequent urination, pain in the penis, scrotum, rectum, sexual disorders (erectile dysfunction, premature ejaculation, etc. ), sometimes urinary retention, blood in the urine. The diagnosis of prostatitis is established by a urologist or andrologist according to a typical clinical picture, resulting from a rectal examination. In addition, an ultrasound of the prostate is performed, bakposev of prostatic secretion and urine. Treatment is conservative - antibiotic therapy, immunotherapy, prostate massage, lifestyle correction.
General information
Prostatitis is an inflammation of the seminal gland (prostate) - the prostate. It is the most common disease of the genitourinary system in men. Most often it affects patients aged 25-50 years. According to various data, 30-85% of men over 30 years old suffer from prostatitis. Possible formation of prostate abscess, inflammation of the testicles and appendages, which threatens infertility. The rise of infection leads to inflammation of the upper genitourinary system (cystitis, pyelonephritis).
Pathology develops with the penetration of an infectious agent that enters the prostate tissue from the organs of the genitourinary system (urethra, bladder) or from a distant inflammatory focus (with pneumonia, flu, tonsillitis, furunculosis)
causes of prostatitis
As an infectious agent in an acute process, Staphylococcus aureus (Staphylococcus aureus), Enterococcus (Enterococcus), Enterobacter (Enterobacter), Pseudomonas (Pseudomonas), Proteus (Proteus), Klebsiella (Klebsiella) and Escherichia coli (E. Coli) can act . Most microorganisms belong to the conditionally pathogenic flora and cause prostatitis only in the presence of other predisposing factors. Chronic inflammation usually occurs due to polymicrobial associations.
The risk of developing the disease increases with hypothermia, a history of specific infections, and conditions accompanied by congestion in the prostate tissues. There are the following predisposing factors:
- General hypothermia (single or permanent, associated with working conditions).
- Sedentary lifestyle, specialty that forces the person to sit for a long time (computer operator, driver, etc. ).
- Constant constipation.
- Violations of the normal rhythm of sexual activity (excessive sexual activity, prolonged abstinence, incomplete ejaculation during "usual" intercourse without emotional coloring).
- The presence of chronic diseases (cholecystitis, bronchitis) or chronic infectious foci in the body (chronic osteomyelitis, untreated caries, tonsillitis, etc. ).
- Previous urological diseases (urethritis, cystitis, etc. ) and sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea).
- Conditions that cause suppression of the immune system (chronic stress, irregular and malnutrition, regular lack of sleep, overtraining in athletes).
It is assumed that the risk of developing pathology increases with chronic intoxication (alcohol, nicotine, morphine). Some studies in the field of modern andrology prove that chronic perineal trauma (vibration, concussion) in drivers, motorcyclists and cyclists is a triggering factor. However, the vast majority of experts believe that all these circumstances are not the true causes of the disease, but only contribute to the exacerbation of the latent inflammatory process in the prostate tissues.
A decisive role in the occurrence of prostatitis is played by congestion in the prostate tissues. Violation of capillary blood flow causes increased lipid peroxidation, edema, exudation of prostate tissues and creates conditions for the development of an infectious process.
symptoms of prostatitis
acute prostatitis
There are three stages of acute prostatitis, characterized by the presence of a certain clinical picture and morphological changes:
- acute catarrhal🇧🇷Patients complain of frequent and often painful urination, pain in the sacrum and perineum.
- acute follicular🇧🇷The pain becomes more intense, sometimes radiating to the anus, aggravated by defecation. Urination is difficult, urine comes out in a thin stream. In some cases, there is urinary retention. Subfebrile condition or moderate hyperthermia is typical.
- acute parenchyma🇧🇷Severe general intoxication, hyperthermia up to 38-40°C, chills. Dysuric disorders, often - acute urinary retention. Sharp, throbbing pains in the perineum. Difficulty defecating.
chronic prostatitis
In rare cases, chronic prostatitis becomes the result of an acute process, but, as a rule, a primary chronic course is observed. Temperature occasionally rises to subfebrile values. The patient notes a slight pain in the perineum, discomfort during urination and defecation. The most characteristic symptom is scanty discharge from the urethra during defecation. The primary chronic form of the disease develops over a considerable period of time. It is preceded by prostatitis (stagnation of blood in the capillaries), gradually turning into abacterial prostatitis.
Chronic prostatitis is often a complication of the inflammatory process caused by the causative agent of a specific infection (chlamydia, trichomonas, ureaplasma, gonococcus). Symptoms of a specific inflammatory process, in many cases, mask the manifestations of damage to the prostate gland. Perhaps a slight increase in pain during urination, slight pain in the perineum, scanty discharge from the urethra during defecation. A small change in the clinical picture often goes unnoticed by the patient.
Chronic inflammation of the prostate can be manifested by a burning sensation in the urethra and perineum, dysuria, sexual disturbances, increased general fatigue. The consequence of violations of potency (or fear of these violations) often becomes mental depression, anxiety and irritability. The clinical picture does not always include all the listed groups of symptoms, it differs in different patients and changes over time. There are three main syndromes characteristic of chronic prostatitis: pain, dysuria, sexual disturbances.
There are no pain receptors in the prostate tissue. The cause of pain in chronic prostatitis becomes almost inevitable due to the abundant innervation of Organs pelvic organs, involvement in the inflammatory process of nerve pathways. Patients complain of pain of varying intensity - from weak, painful sleep to intense, disturbing sleep. There is a change in the nature of the pain (intensification or weakening) with ejaculation, excessive sexual activity or sexual withdrawal. The pain radiates to the scrotum, sacrum, perineum, sometimes to the lower back.
As a result of inflammation in chronic prostatitis, the prostate enlarges, compressing the urethra. The lumen of the ureter is narrowed. The patient has a frequent urge to urinate, a feeling of incomplete emptying of the bladder. As a rule, the dysuric phenomena are expressed in the first stages. Then, compensatory hypertrophy of the muscular layer of the bladder and ureters develops. Symptoms of dysuria during this period weaken and then increase again with the decompensation of adaptive mechanisms.
In the early stages, dyspotency may occur, which manifests itself differently in different patients. Patients may complain of frequent nocturnal erections, cloudy orgasm, or worsening erections. Accelerated ejaculation is associated with a decrease in the threshold level of excitation of the orgasmic center. Painful sensations during ejaculation can cause the refusal of sexual activity. In the future, sexual dysfunctions become more pronounced. In the advanced stage, impotence develops.
The degree of sexual disturbance is determined by many factors, including the patient's sexual constitution and psychological mood. Violations of potency and dysuria may be due both to changes in the prostate gland and to the suggestibility of the patient, who, if he has chronic prostatitis, expects the inevitable development of sexual disorders and urinary disorders. Psychogenic dyspotency and dysuria develop especially often in suggestible and anxious patients.
Impotence, and sometimes the very threat of possible sexual disorders, is difficult for patients to tolerate. Often there is a change in character, irritability, irritation, excessive concern for one's own health, and even "beware of illness. "
Complications
In the absence of timely treatment of acute prostatitis, there is a significant risk of developing an abscess in the prostate. With the formation of a purulent focus, the patient's body temperature rises to 39-40 ° C, and he can become restless in nature. Periods of heat alternate with intense chills. Sharp pains in the perineum make urination difficult and defecation impossible.
Increased prostatic edema leads to acute urinary retention. Rarely, an abscess ruptures spontaneously in the urethra or rectum. When opened, purulent, cloudy urine with an unpleasant pungent odor appears in the urethra; when opened, the stool contains pus and mucus in the rectum.
Chronic prostatitis is characterized by a undulating course with periods of long-term remissions, during which inflammation in the prostate is latent or manifests itself with extremely weak symptoms. Patients who are not bothered by anything usually stop treatment and switch only when complications arise.
The spread of infection through the urinary tract causes the occurrence of pyelonephritis and cystitis. The most common complication of the chronic process is inflammation of the testes and epididymis (epididymo-orchitis) and inflammation of the seminal vesicles (vesiculitis). The result of these diseases is usually infertility.
Diagnosis
The characteristic clinical picture simplifies the diagnostic process in acute and chronic prostatitis. Is required:
treatment of prostatitis
Treatment of acute prostatitis
Patients with an uncomplicated acute process are treated by a urologist on an outpatient basis. With severe intoxication, suspected purulent process, hospitalization is indicated. Antibacterial therapy is carried out. Preparations are selected taking into account the sensitivity of the infectious agent. Antibiotics are widely used and can penetrate prostate tissues well.
With the development of acute urinary retention against the background of prostatitis, resort to the installation of a cystostomy, and not a urethral catheter, since there is a danger of formation of a prostate abscess. With the development of an abscess, an endoscopic transrectal or transurethral opening of the abscess is performed.
Chronic prostatitis treatment
Treatment of chronic prostatitis should be complex, including etiotropic therapy, physiotherapy, correction of immunity:
- antibiotic therapy🇧🇷The patient is given long courses of antibacterial drugs (within 4-8 weeks). The selection of the type and dosage of antibacterial drugs, as well as the determination of the duration of treatment, is carried out individually. The drug is chosen based on the sensitivity of the microflora according to the results of the culture of urine and prostate secretion.
- Prostate massage.Gland massage has a complex effect on the affected organ. During the massage, the inflammatory secret accumulated in the prostate is squeezed out into the ducts, enters the urethra and is removed from the body. The procedure improves blood circulation in the prostate, which minimizes congestion and ensures better penetration of antibacterial drugs into the tissue of the affected organ.
- Physiotherapy.To improve blood circulation, laser exposure, ultrasonic waves and electromagnetic vibrations are used. If it is impossible to carry out physiotherapeutic procedures, the patient is given warm medicinal microclysters.
In chronic, long-standing inflammation, consultation with an immunologist is indicated to select immunocorrective therapy tactics. The patient receives guidance on lifestyle changes. Making certain changes in the lifestyle of a patient with chronic prostatitis is both a curative and preventive measure. The patient is recommended to normalize sleep and wakefulness, establish a diet, perform moderate physical activity.
For the treatment of prostatitis, antibiotic therapy is most effective. Phytotherapy, immunocorrectors and hormonal preparations can also be used as prescribed by a doctor.
In the absence of acute symptoms, prostatitis can be treated with physiotherapy methods. In case of abscesses and suppurations, surgical intervention is recommended.
drug treatment
Treatment of prostatitis using antibiotic therapy should start with bakposev, the purpose of which is to assess the body's sensitivity to this type of antibiotic. In violation of urination, a good result is the use of anti-inflammatory drugs.
Medicines are taken in tablets, in acute cases - in the form of a dropper or intramuscularly. For the treatment of chronic forms of prostatitis, rectal suppositories are effective: with their help, drugs reach their goal faster and have a minimal effect on other organs.
Anti-coagulant and anti-inflammatory drugs have also proven to be good.
antibacterial therapy
Antibiotics are an effective remedy in the fight against bacterial prostatitis. In order to achieve the desired effect and not harm the body, the choice of drug, dosage and treatment regimen should be done by a doctor. For the correct selection of the most effective drugs, he will have to find out which type of pathogen caused prostatitis, and also check whether the patient has a tolerance for antibiotics of a certain group.
For the effective treatment of chronic prostatitis, antibiotics from the fluoroquinolone group have proven themselves well. Its action is aimed at suppressing a bacterial infection and strengthening the body's own immunity. In addition, a bacteriostatic antibiotic is recommended for the prevention and treatment of concomitant diseases of the genitourinary system.
Treatment of prostatitis caused by mycoplasma and chlamydia can be additionally carried out with macrolide drugs and tetracyclines, which slow down the spread of infection.
The duration of using antibacterial drugs is 2-4 weeks. In case of positive dynamics, the course can be extended.
Physiotherapy
Physiotherapeutic methods in the treatment of prostatitis are aimed at activating blood circulation in the pelvic area, improving the metabolic processes of the prostate and cleaning the ducts. If physiotherapy is combined with the intake of antibiotics, their effect is enhanced.
The main methods include:
- magnetotherapy;
- laser therapy;
- electrophoresis;
- heating;
- ultrasound;
- mud treatment;
- high frequency irradiation;
- physiotherapy.
One of the oldest methods - transrectal prostate massage, according to modern research, has no proven effectiveness.
Non-specific treatments
Non-specific treatments for prostatitis include:
- hirudotherapy;
- curative fasting;
- acupuncture;
- diet according to the Ostrovsky method;
- alkalinization of the body according to the Neumyvakin method.
All non-traditional methods of treating prostatitis are strongly recommended to be coordinated with your doctor.
Surgery
Surgical methods are used in complex and emergency cases:
- for draining purulent abscesses, which are removed by laparoscopic methods by puncture;
- in violation of urination due to damage to the urinary tract;
- with large volume of the affected area;
- with a significant number of stones in the body of the gland.
Stones and sclerotic tissues are removed by endoscopic methods. With a large area of damage or multiple stones, resection of the prostate is resorted to.
Transurethral resection is also effective for bacterial prostatitis. Thus, it is possible to reduce the risk of relapse.
folk remedies
Treatment of prostatitis with folk remedies is unlikely to be effective on its own, but in combination with medical and physiotherapeutic methods it may be applicable. These include: bee products, decoctions of herbs and seeds, tinctures of garlic, ginger, beaver creek, fresh vegetables, pumpkin seeds.
In acute cases of the course of the disease, you should consult a doctor, and in no case do not self-medicate! In case of rupture of a purulent abscess, a lethal outcome is possible.
candles for prostatitis
Treatment of prostatitis with rectal suppositories is much more effective than pills, if only because the rectum is much closer to the prostate, which means that the drug will work faster.
The composition of drugs for the treatment of prostatitis can be completely different, they are prescribed to solve a certain problem.
- Antibacterial agents are especially effective for prostatitis caused by chlamydia.
- Analgesics are used for symptomatic treatment, they relieve pain well.
- Immunostimulants improve blood circulation, relieve swelling and are used in complex therapies.
- Phytopreparations have a moderate effect. They, like candles in beekeeping products, are used as an addition to the main treatment.
- Ichthyol-based compositions promote blood flow in the area of \u200b\u200bthe intestinal mucosa, which accelerates the attenuation of inflammatory processes and slightly improves immunity.
- Enzyme-based products prevent scar tissue from forming. It is recommended to take as part of complex therapy with antibiotics, anti-inflammatory drugs and analgesics.
auxiliary drugs
For the symptomatic treatment of prostatitis in men, such as pain relief when urinating, you can also take antispasmodics that relax smooth muscles and thereby quickly relieve pain.
Anticoagulant and anti-inflammatory dietary supplements based on bee products, pumpkin seed oil and palm fruit extracts contribute to general recovery.
Diet and lifestyle
For the treatment of prostatitis, a correct, balanced diet and a healthy lifestyle are very important. Food should not contain spicy, fried, salty and pickled food. In the acute form, alcohol is strictly prohibited.
Food should contain enough fiber to prevent constipation. The protein content must be reduced. It is desirable to supplement the diet with herbs, ginger, pumpkin seeds.
non-drug treatment
Non-drug therapy methods allow you to act directly on the prostate, increase the concentration of drugs in its tissues, help to eliminate congestion.
Microwave hyperthermia is performed using a rectal probe that is inserted into the patient's anus. On the device, you can set the required temperature for a certain type of exposure. To increase drug concentration in the prostate, heating to 38-40°C is required. To achieve an antibacterial effect - 40-45 ° C.
Today, non-drug treatment focuses on laser therapy. The possibilities of this technique are wide. Under the influence of a laser, the following processes occur in the prostate:
- activation of redox reactions;
- improves blood microcirculation;
- new capillaries are formed;
- pathogenic microflora is suppressed;
- the process of cell division is activated, which contributes to tissue regeneration.
During the period of research on the effects of laser therapy on patients with prostatitis, a side effect was noted, but positive for treatment purposes. In those who completed the course, potency increased, erectile dysfunction was eliminated, and vitality was restored. To achieve this result, it is necessary to use a beam with a certain wavelength. In general, low-level laser radiation is used to treat chronic prostatitis.
Patients can, on their own initiative, take a course of laser therapy, if not prescribed by the attending physician.
Surgical treatment of chronic prostatitis
Chronic prostatitis does not pose a threat to the patient's life, but can significantly reduce its quality. The most serious complication of this disease is the formation of stones in the tissues of the gland. To free it from the prostoliths, transurethral resection is used.
The surgery is performed under the control of TRUS.
If complications such as sclerosis of the prostate occur, transurethral electrosurgery is performed. If, in combination with this pathology, sclerosis of the bladder neck is observed, a partial resection of the prostate is performed.
With the blockage of the seminal and excretory ducts, endoscopic operations are indicated to eliminate violations of the patency of the secret. For this, an incision is made in the seminal vesicles and excretory ducts. With an abscess, complete removal of the gland is possible.
Consequences of untreated prostatitis
Even if the symptoms of prostatitis do not appear for a long time, it is necessary to undergo regular examinations by a urologist. Not fully cured prostatitis can be accompanied by the formation of calcifications, which must be removed along with the gland. Experts are sure that there are no other ways to remove or dissolve stones.
In addition, pathogenic microorganisms can migrate to neighboring organs, causing inflammation. Running prostatitis can cause the development of adenoma and prostate cancer.
Forecast and prevention
Acute prostatitis is a disease that has a pronounced tendency to become chronic. Even with proper and timely treatment, more than half of patients end up with chronic prostatitis. Recovery is not always achieved, however, with correct and consistent therapy and following the doctor's recommendations, it is possible to eliminate unpleasant symptoms and achieve long-term stable remission in a chronic process.
Prevention consists of eliminating risk factors. It is necessary to avoid hypothermia, alternate between sedentary work and periods of physical activity, eat regularly and fully. For constipation, laxatives should be used. One of the preventive measures is the normalization of sexual life, since both excessive sexual activity and sexual abstinence are risk factors in the development of prostatitis. If symptoms of a urological or sexually transmitted disease appear, you should consult a doctor in a timely manner.