What is prostatitis?This is the most common urological disease in men against the background of inflammation of the prostate, caused by pathogenic (undoubtedly the cause of the disease) and conditionally pathogenic infection.
In most cases, in young and sexually active men, it is a complication of slightly or asymptomatic STIs.The cause of the development of prostatitis can be: Trichomonas, gonococci (causing gonorrhea), chlamydia, ureaplasma, mycoplasma.Among organisms not related to STIs, E. coli, fecal enterococci, etc. are of great importance.
According to the modern classification there are:
- Acute prostatitis.
- Chronic bacterial prostatitis.
- Chronic prostatitis (chronic pelvic pain syndrome) with signs of inflammation.
- Chronic prostatitis (chronic pelvic pain syndrome) without signs of inflammation.
- Asymptomatic chronic prostatitis (asymptomatic).
Currently, in most cases, we have to deal with the last category of prostatitis in men, since in recent years trichomoniasis, chlamydia, ureaplasmosis and mycoplasmosis have acquired a leading role in the structure of STIs, which initially, in the vast majority of cases, do not present any manifestations, that is, they do not bother the person in any way.And only after a long time do they manifest themselves as a complication: prostatitis.
It should be said that asymptomatic prostatitis is detected in the majority of patients who come simply for an STI examination, in the sexual partners of women with STIs, as well as in patients with infertility.
Causes of prostatitis
As a rule, prostatitis is diagnosed when:
- decreased physical activity (sedentary lifestyle);
- arrhythmias of sexual life (prolonged sexual abstinence, often replaced by a hyperactive sexual life);
- alcohol abuse;
- chronic constipation;
- as a result of an STI infection: urethrogenic prostatitis, that is, which occurs when infections enter the prostate from the urethra;
- due to the penetration of pathogens from foci of chronic infection (chronic tonsillitis, sinusitis, kidney disease, etc.);
- for diseases of the rectum (hemorrhoids, anal fissure, paraproctitis): endogenous prostatitis.This explains the detection of E. coli in most cases of chronic prostatitis.
Symptoms of prostatitis in men.
It begins with an increase in temperature to 39-40°C with fever and chills, difficulty urinating, pain and burning when urinating;In severe cases, due to inflammation of the glandular tissue, acute urinary retention occurs, a condition that requires surgical intervention.
Proceed without demonstrations.It is primarily detected in patients seeking STI testing after casual sexual intercourse.It is also detected in patients who come for an examination as sexual partners of women with STIs or in patients with sperm pathology.
Manifestos:
- Discomfort and pain in the lower abdomen, perineum, sometimes patients notice that the pain radiates to the head of the penis or to the urethra.
- Urinary disorders.Frequent and painful urination, feeling of unfinished urination (often with hypothermia), urination one to several times a night, difficulty urinating, and weakening of the urine stream.
- Sexual function disorder.Pain and discomfort during ejaculation, pain in the urethra and rectum, weakening or loss of the sensation of orgasm, etc.
- Changes in the fertilizing capacity of sperm.
- As a result, the patient's anxiety and nervousness increases, caused by a hyperfixation of attention on his condition.
Complications of prostatitis
In the absence or improper treatment of prostatitis, the following complications may occur:
- Transition from acute to chronic prostatitis.
- Acute urinary retention (the patient cannot urinate for a long time) may require surgical intervention.
- Development of male infertility.
- Formation of scars and adhesions in the urethra with subsequent narrowing.
- Development of inflammation of the bladder (cystitis).
- Inflammatory kidney diseases (pyelonephritis, etc.).
- The appearance of purulent inflammation of the prostate in men (prostatic abscess), which requires surgical intervention.
- Sepsis (penetration of infection into the bloodstream with subsequent damage to organs and systems throughout the body) is a formidable and life-threatening complication.It develops more frequently in patients with decreased function of the immune system, in patients with diabetes mellitus, patients with chronic renal failure, patients with AIDS, etc.
Diagnosis of prostatitis
The diagnosis of prostatitis is made in patients with characteristic complaints, as well as in patients with identified STIs and identified infertility.
The diagnosis includes:
- Digital examination of the prostate (through the rectum) with collection and examination of prostate secretion (juice), when the presence of inflammation in the gland is detected.
- Urine examinations: general analysis, 2 or 4 glasses of urine, bacteriological examination (detection of prostatitis pathogens), cytological examination (detection of cancer).
- Uroflowmetry: evaluation of the characteristics of the urine stream, its quantity, flow rate, duration of urination.
- Ultrasound examinations to detect residual urine, organic lesions of the prostate, formal signs of prostatitis.
Sometimes, to diagnose prostatitis and exclude cancer, the following are also prescribed:
- Sperm studies.
- Prostate biopsy.
- PSA blood test (to detect cancer).
- Computed tomography of the pelvic organs.
- Nuclear magnetic resonance examination of the pelvic organs, etc.
Prostatitis treatment
Treating bacterial prostatitis caused by an STI is not an easy task.Adequate and timely therapy leads to complete cure of this category of prostatitis after complete elimination (disappearance) of STI pathogens in most patients.It is worth saying that complete cure of prostatitis caused by a vulgar infection (not an STI) occurs only in 30% of cases, despite the achievements of modern medicine.In these cases, the goal is to achieve stable remission of the disease.
Modern prostatitis treatment includes:
- Antibacterial therapy for at least 2 weeks, sometimes up to 1-2 months or more.
- Treatment of pain syndrome (anti-inflammatory drugs in the form of suppositories, injections, tablets).
- Treatment of urinary disorders (α-1 blockers, 5-α-reductase blockers).
- Physiotherapeutic treatment methods (magnetic therapy, laser therapy, etc.).
- Prostate massage.
Patients are also recommended to make lifestyle changes, namely:
- regular sexual life without sexual excesses;
- abandon alcohol and a sedentary lifestyle;
- mandatory use of barrier contraceptives;
- treatment of diseases of the digestive tract that cause stool retention, etc.