Chronic prostatitis

Chronic prostatitis is lengthy inflammation that occurs in the prostate due to infections or simultaneous pathologies.

Chronic prostatitis is diagnosed in men of all ages.According to statistics, this disease is the most common reason for a urologist in patients under the age of 50.In chronic form, a bacteriological examination only shows the pathogen in 5-10% of the patients.In most cases, other factors are considered the cause of the disease.It is known that the presence of an infection is not a prerequisite for the occurrence of the disease.Chronic inflammation of the prostate is a polyetiological pathology that is the result of the effects of several causes and provocative factors.In 90-95% of patients, antibacterial therapy has only limited effectiveness or is not necessary at all.

Classification of chronic prostatitis

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

The etiological classification of chronic prostatitis includes:

1. Chronic bacterial prostatitis.
2. Chronic non -bacterial (aseptic) prostatitis/CTB ("prostate" or "painful prostate glands" is an outdated term used to determine the pathology).
3. Chronic non -bacterial (aseptic) prostatitis/CTB with an inflammatory component (the concentration of leukocytes is significantly increased in the secret of the prostate, sperm, the first part of the urine).
4. Chronic non -bacterial (aseptic) prostatitis/CTB without inflammatory component (concentration of white blood cells in the secret of the prostate, sperm, the first part of the urine is not sufficient for inflammation).
5. Ashmptomic chronic prostatitis (demonstrated in laboratory studies is not clinical).

Chronic bacterial prostatitis is a rare pathology, as can be seen from the above statistics.Infection is the cause of chronic recurring inflammation of the prostate in one of ten patients.Pathology is often associated with other genitarian organs.Most of the time, its cause is a non -specific infection.In the presence of STSPP, however, chronic inflammation of the gland can be caused by chlamydia, urea, mycoplasmosis or other specific microorganisms.

Chronic non -bacterial (aseptic) prostatitis or chronic pain syndrome is a long -term recurrent disease that occurs as a result of an aseptic inflammation of the prostate.This is a small pathology.In the presence of symptoms of the disease, the tests determine the 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 light symptoms.

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

Patanatomical (patomorphological) classification of chronic prostatitis is of limited interest for patients and clinicalist 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 tissue of the prostate gland.Mostly the cause of the inflammation E. coli or e.Coli.Less frequently carved microbes of the Enterococci genre Klebsell, Proteus, Pseudomonas.

Like some other microbes, E. coli is able to form thinly forming biofilms, consisting of bacterial accumulations and close to the mucosal membranes of the channels.This explains why it is not always possible to heal chronic prostatitis.It is believed that the infection spreads through the urethra as a rising path.However, a lymphogenic and hematogenic spread of the infection is also possible.

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

• sexually active age;
• Prostate -Denoma or benign prostate -hyperplasia;
• Narrowing of the urethra;
• Screw the extreme meat of the penis;
• Hypertrophy of the bladder;
• Medical interventions (catheterization of the bladder, cystoscopy);
• Genetic and anatomical features that predispose for 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 that are not identified during the bacterial secretion of the prostate.However, most scientists and doctors believe that chronic non -bacterial (aseptic) prostatitis/CTB is a polyetiological disease that occurs due to combinations of several undesirable factors, namely:

• Ride a bike;
• General of the tissue of the prostate when the urine enters into its channels;
• Reviation of the prostate gland as a result of the use of products or drinks (especially for food allergies or celiac disease);
• Functional diseases of the nervous innovation of the pelvic organs;
• Atrophy of the muscles of the pelvic floor;
• Stress, psychoemotional loads;
• Pathology in the prostate remain after 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.

Symptoms of chronic prostatitis

Chronic bacterial (infectious) prostatitis is characterized by a cyclical course.The deterioration phase is replaced by a remission phase.There are practically no symptoms between exacerbations.There is a clear connection between other diseases of the genitarian organs - urethritis, epididymms, cystitis.The cause of these pathologies is usually the same pathogen that causes chronic prostatitis.The symptoms during the exacerbation are represented by dysuric phenomena (frequent urination, rubber and combustion pain during urination) and pain with different intensity in the perineum, the scrotum, its crossbone with radiation in the penis.

The general condition is usually satisfactory.There is no sign of poisoning, there is no increase in body temperature.The prostate gland can be normal or slightly swollen when examining the rectum (per rectum), without sharp pain that is characteristic of acute prostatitis.

Chronic non -bacterial (aseptic) prostatitis/KTB is characterized by pain in different severity (from stupid lungs to intensive) in the pool, perineum, sacrum and the "guest map" of the disease (aseptic chronic prostatitis).Signs of inflammation of the prostate are poorly expressed and observed in 50% of cases.They cannot be present in other patients.

The presence of blood in sperm, painful ejaculation, defecation and dysouric phenomena are possible.The severity of the symptoms can change.The step and the rectum is given pain, which makes it difficult to find a person in a seated position.Fatigue, inappropriate tiredness, joint and muscle pain are also possible.Some patients complain of a reduced sex drive, erectile dysfunction (impotence).

Asymptomatic chronic prostatitis has no symptoms that are characteristic of this disease.During the laboratory study as the secret of the prostate, leukocytosis is determined, an increase in the mirrors of a specific prostate activity is possible.There are no other signs of the disease.

Diagnosis of chronic prostatitis

The main methods for the diagnosis of chronic infectious prostatitis are laboratory tests and topical tests with which you can find out the source of leukocytes in urine and sperm.

A three -walled urine test helps to identify inflammation.For this purpose, the patient urinates three containers for analyzes.Prostate massage between the second and the third container leads to stimulation of the secretion of the gland.As a result, the urine in the third container contains the discharge of the prostate (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 from the third container can be sent to a bacteriological examination with a nutrient medium.In the presence of bacterial growth, a test for the susceptibility of the pathogen against antibiotics is carried out.The method helps to carry out the treatment more precisely and more effectively.Since the prostatic secret is an essential part of the sperm, microscopy and ejaculation bacteria also enable correct diagnosis.

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

The diagnosis of chronic non -bacterial (aseptic) prostatitis/CTB can be difficult.The diagnosis is often made by excluding other pathologies of the genitarian tract and bacterial prostatitis.For this purpose, instrumental and laboratory methods are used: microscopy of urine (a three -way test is also used according to prostate massage), sperm or secrets of the prostate, followed by a nutrient medium.The list of studies includes an analysis for PSA (differential diagnosis of cancer and inflammatory diseases of the prostate).

Microscopy shows the presence of leukocytes in the urine in the secret of the prostate seed fluid with negative results of bacteriological treatment methods.Instrumental research methods (ultrasound, cystoscopy, MRI, CT) show no signs of simultaneous pathology.

Treatment of chronic prostatitis

Rational and targeted antibacterial therapy is required for the successful treatment of chronic infectious prostatitis.Preparations of the choice are fluorchinolons that create great concentrations of the drug in the tissues of the gland.The course of treatment lasts six to 12 weeks.Such a duration of antibacterial therapy is required for the full extermination of the infection and relapse prevention.Second drugs.

Bacterial chronic prostatitis can be healed with consistent and appropriate therapy.Patients with frequent relapses must check the immune status.It may also be necessary to exclude HIV infections, which is often the cause of the low effectiveness of antibacterial therapy.In such patients, it is possible to prescribe antibiotics in a dose that is sufficient to suppress bacterial growth.

Treating chronic non -bacterial prostatitis/KTS is difficult because the infection is not the cause of chronic pain in pelvis or an abacterial chronic prostatitis.It is necessary to seriously approach the problem and to answer the question of how a disease should be treated, the cause of which is exactly unknown.

The lack of a certain etiology explains why attempts to treat this pathology are often unsuccessful.

Treatment methods of chronic aseptic prostatitis contain:

1. Antibacterial therapy with fluorchinolons (carried out by all patients).It is possible to have an infection that is not demonstrated during a bacteriological examination.
2. Alpha blocker.They contribute to improving blood circulation in the tissue of the prostate.The effectiveness is low.
3. NSAIDS and other anti -inflammatory drugs have a serious effectiveness, relieve pain and improve symptoms.However, the treatment is pathogenetic, after the cancellation it is possible to renew the disease.
4. Physiotherapy and physiotherapy exercises (yoga, sport, active lifestyle) that help improve blood circulation and to eliminate venous stagnation, hypoxia that strengthen the muscles of the pelvis.The method helps patients with adequate disorders.
5. Antidepressants and anticonvulsants (effectiveness is not proven).
6. Surgical treatment: laser or thin -dilated of the prostate (not effective).

forecast

With chronic infectious prostatitis in most patients, the forecast is favorable.With consistent and appropriate antibacterial therapy, you can achieve success in more than 80% of cases.

Chronic non -bacterial (aseptic) prostatitis/KTB has a worst forecast.The treatment only helps some patients.Despite all available treatment methods, others continue to suffer from chronic pain syndrome.The disease has a pronounced influence on psychoemotional sphere and sexual relationships.