Prostatitis is a disease characterized by the presence of inflammation and/or infection located in the prostate.
There may be a wide range of clinical signs and main complaints.
anatomy
The prostate is a small gland, part of the male reproductive system, and a hormone-dependent organ. Its shape and size are compared to a large walnut. A normal prostate weighs about 20 grams, has a volume of 15-25 milliliters, is 3 cm long, 4 cm wide, and 2 cm deep.
The prostate 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 surrounded by a capsule composed of smooth muscle, collagen, and elastic fibers; the front, side, and back surfaces are covered with three layers of dense connective tissue (fascia). The posterior surface of the prostate is bounded by the ampulla of the rectum. They are separated by the posterior bladder fascia or Denonville fascia, and the posterior surface of the prostate can be palpated.
The prostate is approximately 70% glandular tissue and 30% fibromuscular matrix. Organs are usually divided into 3 areas.
Transition zone.The transition zone accounts for 10% of glandular tissue and 20% of prostate cancer cases. In this area, one of the main age-related diseases in men is formed-benign prostatic hyperplasia, which can cause dysuria due to excessive tissue growth.
The heartland.The area around the ejaculatory duct. It is composed of glandular tissue, connective tissue and muscle components. Tumors in this area are extremely rare.
Peripheral area.Covers the posterior and lateral sides of the prostate and contains 70% of the glandular tissue. This is the area accessible through the rectum where the urologist can assess the condition of the prostate. Up to 70% of malignant tumors are precisely located in the surrounding area. Therefore, digital rectal examination is an important diagnostic method and should be performed in patients over 45 years of age.
Prostate function:
- The production of prostate secretion, which is a component of sperm, participates in the liquefaction of ejaculation, and is saturated with various enzymes, vitamins, citric acid, zinc ions and other nutrients, which helps to improve the vitality and activity of sperm;
- The prostate contains smooth muscle fibers that help release sperm from the urethra during ejaculation, preventing sperm from entering the bladder and participating in the mechanism of urinary retention.
Prostatitis, benign prostatic hyperplasia and prostate cancer are the three major diseases of the prostate.
These three diseases can exist in the same prostate at the same time. In other words, the presence of prostatitis does not exclude the presence of prostate hyperplasia and prostate cancer, and vice versa.
Causes of prostatitis
According to statistics, prostatitis is the most common urinary system disease in men under 50, second only to prostate hyperplasia and prostate cancer, and ranks third among men over 50.
Prostatitis accounts for 6% to 8% of urology outpatient visits.
The most common pathogen of prostatitis is an E. coli strain, which can be detected in 80% of cases. The rarer pathogens are Gram-negative bacteria such as Enterococcus, Pseudomonas aeruginosa and Klebsiella. The role of sexually transmitted infections (such as Chlamydia trachomatis) in prostate inflammation has not been clearly established and is under study. In patients with HIV infection and other severe changes in the immune system, possible pathogens are cytomegalovirus, Mycobacterium tuberculosis, fungi, and other rare pathogens. There are data showing that microorganisms are not detected in the prostate in standard studies, but they play a role in the appearance of inflammatory changes and the subsequent development of prostatitis symptoms.
The possible causes of prostatitis are:
- Urine reflux in the prostate due to urinary dysfunction (Urine has certain predisposing factors and can enter the prostate through the prostate catheter and cause inflammation);
- Unprotected anal sex;
- Narrowing of the foreskin (phimosis);
- Autoimmune diseases;
- Functional and anatomical changes of the pelvic floor muscles;
- Changes in the central nervous system, including changes in brain function and anatomy;
- Traumatic and unusual sexual activity;
- Psychological factors (in many studies, the influence of psychological stress on the occurrence of chronic prostatitis symptoms has been proven-psychosomatic disorders have been diagnosed in some patients, and the reduction of prostatitis symptoms and possible recurrence during treatment have been noticed).
Risk factors for prostatitis also include: abstinence or excessive sexual activity, the habit of suppressing ejaculation, smoking, night work, a sedentary lifestyle, insufficient fluid intake and poor diet.
symptom
- Pain or burning during urination (dysuria);
- Urinary system diseases;
- Discoloration of urine;
- Blood in the urine;
- Pain in the abdomen, groin or lower back;
- Perineal pain;
- Pain or discomfort in the penis and testicles;
- Painful ejaculation;
- Increased body temperature (acute bacterial prostatitis).
diagnosis
According to the classification of prostatitis recognized by the NIH (National Institutes of Health), there are four types of diseases, which are traditionally represented by Roman numerals:
- I-acute bacterial prostatitis;
- II-Chronic bacterial prostatitis;
- III- Chronic bacterial 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.
Although prostatitis is widespread, acute bacterial prostatitis is uncommon—accounting for 5% of all disease cases. But his diagnosis is simple, because the symptoms of the disease are the most common: a man complains of frequent urination, painful urination, pain in the uterus and perineum. An increase in body temperature is characteristic and usually reaches a high value-below 39°C.
The diagnosis of acute bacterial prostatitis involves a digital rectal examination (rectal examination), which involves feeling (palpating) the prostate through the anus (rectum) with the index finger.
If any pathology of the prostate is suspected, digital rectal examination (DRE) is an important diagnostic procedure. Therefore, it is recommended that men do not refuse to proceed.
In acute bacterial prostatitis, the palpated prostate is severely painful, edema, and the most common is swelling. Ultrasound can show not only an increase in the size of the prostate, but also a purulent fusion lesion (abscess) of the prostate tissue-but this happens rarely and is usually the result of a running process.
First, laboratory diagnosis includes a general urine test in which an increase in the number of white blood cells is noted. Bacteriological urine culture is recommended. Based on the results of the analysis, the presence of bacteria and their sensitivity to antibiotics can be determined, and the prescribed antibiotic treatment can be adjusted. General blood tests are also performed to assess the general condition of the body and its response to the inflammatory process.
Due to the increased risk of life-threatening diseases: bacteremia and sepsis, the use of prostate secretions to diagnose acute prostatitis is prohibited. To determine the tumor marker (PSA), its score is also not recommended-due to low information content and data distortion in the context of inflammation.
Treatment of prostatitis
Antibiotic treatment is the basic treatment for patients with various types of prostatitis.
Alpha-blockers are also a group of effective drugs. Due to their effects, the tension of the smooth muscle of the prostate, the bladder neck and the prostate of the urethra is reduced, thereby improving urination and reducing the possibility of urine entering the prostate (intraprostatic reflux), which is one of the causes of prostatitis. The most effective and popular drugs are tamsulosin and silodosin. They are also widely used to improve urination in patients with benign prostatic hyperplasia.
Anti-inflammatory drugs (diclofenac) can be used, which can effectively relieve pain and discomfort during urination, reduce prostate swelling, and also help improve the quality of urination.
Acute bacterial prostatitis is usually a cause of hospitalization. In the hospital, doctors will prescribe intravenous antibiotics. After the patient's condition is stable, the patient continues to receive antibiotic therapy in the form of tablets for 15 days or more to prevent the transition from acute prostatitis to chronic bacterial prostatitis.
According to statistics, 10% of patients with acute prostatitis will develop chronic bacterial prostatitis. In the future, 10% of patients will develop chronic pelvic pain syndrome (chronic prostatitis IIIb).
How is prostatitis treated clinically
Urologists treat prostatitis and other genitourinary diseases according to international clinical guidelines. This means that they not only use their expertise, but are also guided by scientifically proven and recognized global methods of diagnosis and treatment.
Our doctors do not prescribe invalid drugs and "just in case" checks, and do not treat non-existent diseases. When making a diagnosis, urologists rely on data obtained from patient examinations, clinical pictures, laboratory and instrumental research data. If surgical treatment is required, surgery is performed within the clinic.