Prostatitis is a disease characterized by the presence of inflammation and / or infection in the prostate.
It can present with a wide range of clinical symptoms and complaints.
Anatomy
The prostate is a small gland that is part of the male reproductive system and a hormone-dependent organ. Its shape and size were compared to a large walnut. The normal prostate is approx. 20 g, volume 15-25 ml, size 3 cm, width 4 cm, depth 2 cm.
The prostate gland is located in the small pelvis, below the bladder and above the rectum. The urethra, the urethra, passes through the thickness of the gland. The prostate is made up of smooth muscle, collagen, and elastic fibers; covered with three layers of dense connective tissue (fascia) on the anterior, lateral, and posterior surfaces. The posterior surface of the prostate is bounded by an rectal ampoule. They are separated by retrovesical fascia or Denonville fascia, which allows the posterior surface of the prostate gland to be palpated.
The prostate is approx. 70% glandular tissue and 30% fibromuscular stroma. It is customary to divide the organ into 3 zones.
Transition zone.The transition zone accounts for 10% of glandular tissue and 20% of malignant prostate cancer. In this zone, one of the main age-related diseases in men develops - benign prostatic hyperplasia, which can cause difficulty urinating due to tissue overgrowth.
Central zone.The area surrounding the ejaculate channels. It consists of glandular tissue, connective tissue, and muscle elements. Tumors are extremely rare in this area.
Peripheral zone.It covers the back and sides of the prostate gland and contains 70% of the glandular tissue. This is an area that is palpable through the rectum and allows the urologist to assess the condition of the prostate gland. Up to 70% of malignancies are located exactly in the peripheral zone. Therefore, digital rectal examination is an important diagnostic method to be performed in patients older than 45 years.
Prostate functions:
- the production of prostate secretion, which is an integral part of sperm and is involved in the liquefaction of the ejaculate and saturated with nutrients such as various enzymes and vitamins, citric acid, zinc ions, which help to improve sperm motility and activity;
- The prostate contains smooth muscle fibers that help release sperm from the urethra during ejaculation, prevent sperm from entering the bladder, and participate in the mechanism of urinary retention.
The three main diseases of the prostate are prostate, benign prostatic hyperplasia and prostate cancer.
All three diseases can co-exist in the same prostate. That is, the presence of prostatitis does not rule out the presence of prostatic hyperplasia and prostate cancer in the patient and vice versa.
Causes of prostatitis
According to statistics, prostatitis is the most common urological disease - after prostate hyperplasia and prostate cancer - in men under 50 years of age and a third in men over 50 years of age.
Prostatitis accounts for 6-8% of outpatient urological visits.
The most common pathogen of prostatitis is the E. coli strain, which is detected in 80% of cases. Less common pathogens are enterococci, Pseudomonas aeruginosa, Klebsiella and other gram-negative bacteria. The role of sexually transmitted infections (e. g. , chlamydia trachomatis) in prostatitis is still unclear and is currently being studied. Potential pathogens in HIV infection and other severe changes in the immune system include cytomegalovirus, mycobacterium tuberculosis, fungi, and other rare pathogens. There are data that indicate the presence of microorganisms in the prostate gland that have not been detected by standard tests, but play a role in the onset of inflammatory changes and the subsequent development of symptoms of prostatitis.
Possible causes of prostatitis:
- intraprostatic reflux of urine due to dysfunctional urination (urine can enter the prostate through the channels of the prostate with certain predisposing factors, causing an inflammatory process);
- unprotected anal sex;
- foreskin stenosis (phimosis);
- autoimmune disease;
- functional and anatomical changes in pelvic floor muscles;
- changes in the central nervous system, including functional and anatomical changes in the brain;
- traumatic and unusual sexual activity;
- psychological factors (several studies have demonstrated the effect of psychological stress on the incidence of symptoms of chronic prostatitis - some patients have been diagnosed with psychosomatic disorders in the treatment of which a reduction in the symptoms and likelihood of relapse of prostatitis has been noted).
Risk factors for prostatitis include abstinence or excessive sexual activity, habit of restraining ejaculation, smoking, night work, sedentary lifestyle, inadequate fluid intake, and poor diet.
Symptoms
- pain or burning when urinating (dysuria);
- urinary disorders;
- discoloration of the urine;
- the appearance of blood in the urine;
- pain in the abdomen, groin or lower back;
- pain in the perineum;
- pain or discomfort in the penis and testicles;
- pain with ejaculation;
- increased body temperature (with acute bacterial prostatitis).
Diagnostics
According to the NIH (US National Institutes of Health) generally recognized classification of prostatitis, there are four categories of diseases, traditionally referred to by Roman numerals:
- I - acute bacterial prostatitis;
- II - chronic bacterial prostatitis;
- III - chronic abacterial prostatitis / chronic pelvic pain syndrome (CP / CPPS);
- IIIa - chronic prostatitis / chronic pelvic pain syndrome with signs of inflammation;
- IIIb - chronic prostatitis / chronic pelvic pain syndrome without signs of inflammation;
- IV - asymptomatic (asymptomatic) chronic prostatitis.
Despite the widespread occurrence of prostatitis, acute bacterial prostatitis is uncommon - 5% of all cases of the disease. But its diagnosis is quite simple, as the picture of the disease is most often pronounced: one complains of frequent, painful urination, uterine pain, and perineum. An increase in body temperature is typical and often high values - less than 39 ° C.
Diagnosis of acute bacterial prostatitis involves a digital rectal examination (rectal examination) that involves feeling (touching) the prostate gland with the index finger through the anus (rectum).
Digital rectal examination (DRE) is an important diagnostic manipulation if any pathology of the prostate gland is suspected. Therefore, it is advisable for men not to deny behavior.
In acute bacterial prostatitis, the tactile prostate is sharply painful, edematous, and most often enlarged. Ultrasound may show not only an increase in the size of the prostate, but also foci of purulent fusion of the prostate tissue (abscesses) - this is rare, however, and is usually the result of a running process.
Above all, laboratory diagnostics include a general urine test in which an increase in the number of leukocytes is detected. Bacteriological urine culture is recommended. Based on the results of the analysis, the presence of bacteria and their susceptibility to the antibiotic can be determined and thus the prescribed antibiotic therapy can be modified. A general blood test is also performed to assess the general condition of the body and its response to the inflammatory process.
For the diagnosis of acute prostatitis, the intake of prostate secretion is contraindicated due to the increased risk of a life-threatening condition: bacteremia and sepsis. Determining the fractions of the oncomarker (PSA) is also not recommended - due to the low information content and data bias in the background of inflammation.
Treatment of prostatitis
Antibiotic therapy is all therapy for patients with prostatitis.
Alpha-blockers are also an effective class of drugs. As a result, the tone of the smooth muscles of the prostate gland, bladder neck and urethral prostate decreases, thereby improving urination and reducing the chance of urine entering the prostate (urinary intraprostatic reflux), which is one of the causes of prostatitis. The most effective and popular drugs are tamsulosin and silodosin. It is also widely used to improve urination in patients with prostatic hyperplasia.
It is possible to use anti-inflammatory drugs (Diclofenac) that are effective in reducing pain and discomfort during urination, reducing prostate swelling, and also contribute to some improvement in the quality of urination.
Acute bacterial prostatitis is often the cause of hospitalization, where antibiotic therapy is prescribed in the form of intravenous injections. After the patient's condition has stabilized, the patient continues to receive antibiotics in the form of tablets for 15 or more days to prevent the transition from acute prostatitis to chronic bacterial prostatitis.
According to statistics, 10% of patients with acute prostatitis develop chronic bacterial prostatitis. An additional 10% of patients will develop chronic pelvic pain syndrome (chronic prostatitis IIIb) in the future.
What is the treatment of prostatitis in the clinic
Urologists treat prostatitis and other diseases of the urogenital system according to clinical guidelines. This means that they not only use their professional knowledge, but are also guided by scientifically proven and globally accepted diagnostic and therapeutic methods.
Our doctors do not prescribe ineffective drugs and tests "in every case", they do not treat non-existent diseases. In making the diagnosis, urologists rely on data from the patient's study, clinical picture, and laboratory and instrumental data. If surgical treatment is required, a surgical operation is performed at the clinic area.