Prostatitis, chronic – persistent inflammation of the prostate, which leads to the rupture of the morphology and functioning of the prostate. Chronic prostatitis is manifested prostatic triad – pain in the pelvic area and genitals, disorders of urination, sexual disorders. The diagnosis of chronic prostatitis includes palpation of the breast, the search for the secret of the prostate, ULTRASOUND, uroflowmetry, a drawing of the prostate. In the case of chronic prostatitis showed complete pharmacological, physiotherapeutic treatment, massage prostate, instillation rear of the urethra. The surgical treatment is advisable when complicated forms of chronic prostatitis.
Chronic prostatitis
The chronic prostatitis is the most frequent male illness: about 50% of men suffer from some form of inflammation of the prostate. Chronic prostatitis usually affects men in between the ages of 20 and 40 years of age, are in a period of maximum sexual, reproductive and work. In this regard, the identification and the treatment of chronic prostatitis acquired in urology, not only medical, but also socially significant aspect.
Classification of chronic prostatitis
According to the modern classification of prostatitis, developed in 1995, are 3 categories of disease:
- I. Acute prostatitis.
- II. The chronic bacterial prostatitis source.
- III. Prostatitis chronic non-bacterial genesis/Syndrome of chronic pelvic pain – a symptom, not associated with obvious signs of infection, and in the course of 3 and more months.
- III – chronic prostatitis with the presence of inflammatory component (detection of secret of the prostate white blood cells and infectious agents);
- III B – chronic prostatitis lack of an inflammatory component (white blood cells and pathogens in the secret of the prostate).
- IV. Asymptomatic prostatitis (chronic absence of a complaint, the identification of leukocytes in prostatic secret).
In the presence of infections component speak bacterial (infectious) chronic prostatitis; in the case of the absence of microbial pathogens – non-bacterial (not contagione) prostatitis. Considering that 90-95% of all cases of the chronic prostatitis is not bacterial and only 10-5% - bacterial.
The causes of chronic prostatitis
The etiology and pathogenesis chronic bacterial prostatitis linked with the hit of infection of the prostate gland in the following ways: bottom-up (through the urethra), down (when throwing the infected urine from the bladder), hematogenous (for vessels motorways) or lymphogenous (for lymphatic collectors). This uropathogens act and. coli, klebsiella, proteus, aureus, enterococcus, CORINE, fungal, parasitic and viral pathogens. Together with the non-specific flora developing chronic prostatitis may participate in the pathogen-specific urethritis (chlamydia, mycoplasma, gonococcus, trichomonas, Gardnerella).
However, for the development of chronic prostatitis is not so important the presence and activity of micro-organisms, since the state of the pelvic organs and circulation in them, the presence of concomitant diseases, the level of defense mechanisms.
Then the occurrence of chronic prostatitis, can contribute to a number of factors. First of all, it is urological diseases –pyelonephritis, cystitis, urethritis, urethral stricture, increatos until the end of the acute prostatitis, orchitis, epididymitis, etc., Microbial etiologist can enter in the prostate of the remote areas of outbreaks of infection, for example, if you have sinusitis, tonsillitis, dental caries, chronic bronchitis, pneumonia, pyoderma, etc Predispose to chronic inflammation, local and general hypothermia, overheating, stay in a moist environment, fatigue, poor diet, a rare urination, etc.
Prostatitis chronic non-bacterial is usually associated with congestive (stagnant phenomena in the prostate gland, precisely, venous stasis, blood circulation in the pelvic organs, and violation of the drainage acini of the prostate. Local obstructio leads to an overload of the blood vessels of the prostate the blood, edema, its incomplete emptying from the secret, breach of the barrier, secretory, motor, contractile function breast.
Stagnant, the changes usually are due to behavioural factors – long sexual deprivation, and practice, interrupted or prolonged sexual acts, excessive sexual activity, physical inactivity, long the seat of chronic intoxication (alcohol, nicotine, drugs), occupational hazard (vibration). For the development of non-bacterial chronic prostatitis prepares pathology pelvic and neural structures, in exercising their stimulus (for example, spinal cord lesions), adenoma of the prostate, hemorrhoids, constipation, androgenodeficiency, and other reasons.
The symptoms of chronic prostatitis
Chronic prostatitis is manifested in the local and general symptomatology. Local events refers prostatic triad, characterized by pain, dysuria, and the violation of sexual function. The pain in the case of chronic prostatitis lead to permanent aching in nature, are localized in the perineal area, genitals, above the pubis, the groin. The pain is amplified at the beginning and at the end of urination, radiating pain in the glans penis, the scrotum, the sacrum, the rectum. The pain may increase after sexual intercourse or long abstinence; decrease or increase after the orgasm become more intense directly at the moment of ejaculation.
The intensity of the pain in case of chronic prostatitis varies from sensations of discomfort before expressed, to violate sleep, and the integrity of the events. Pain with restricted localization in the rump are often classified as back pain or sciatica, in relation to which the patient can long-term care alone, without resorting to medical assistance.
Urination in the case of chronic prostatitis of learning, and painful. If this may be the difficulty of the beginning miscet, the weakening or intermittent jet of urine, feeling of incomplete emptying of the bladder, frequent nighttime stimuli, burning sensation in the urethra. In the urine in cases of chronic prostatitis can detect the presence of the sail, wires. After a bowel movement or physical load of the urethra appear to be selection , because of the decrease of the tone of the prostate. In the case of chronic prostatitis may be the appearance of itching, feeling cold or excessive sweating in the perineum, the local change of the coloration of the skin associated with circulatory stagnation.
Chronic prostatitis accompanied by severe impairment of sexual function. Phenomena gipotenzia can be expressed in the damage, pain, prolonged erection and frequent night erections, difficulties or premature ejaculation, loss of sexual desire (decreased libido), cleared orgasms, Hematospermias, infertility. Sexual disorders is always difficult, as lived by a man, resulting in psycho-emotional disorders, up to neurosis and depression, even more aggravating the sexual function.
Acute prostatitis and chronic are accompanied by a slight increase in body temperature and deterioration of health. The general state in case of chronic prostatitis, characterized by irritability, apathy, anxiety, fatigue, loss of appetite, sleep disturbances, decreased work capacity, creativity, and physical activity.
Nearly a quarter of patients with chronic prostatitis the symptoms of the disease long-term missing, that door at the end of treatment at the urologist. Long for chronic prostatitis may be complicated by impotence, vesiculitis, epididymoorchitis, male infertility, urinary incontinence, from the formation of stones and cysts in the prostate gland, sclerosis of the prostate, is the development of adenoma and carcinoma of the prostate.
The diagnosis of chronic prostatitis
Necessary for the diagnosis of chronic prostatitis of information that you receive with the help of integrated laboratory-instrumental examination. The initial examination if you suspect chronic prostatitis includes understand medical history and complaints, keeping the external inspection of the genitals for any discharge, rashes, sores, finger rectal examination of the prostate, with the aim to define the contours, boundaries, consistency, pain in the breast.
To determine structural and functional changes of the prostate gland is shown holding ULTRASOUND of the prostate (transrectal ultrasound). Important techniques in the diagnosis of chronic prostatitis need to the search for the secret of the prostate, the sharing of a urine analysis, bacteriological examination of the tract of the urethra and of urine, (3 cups) of urine samples, PCR and BARRIER research took a sample of the pathogens of genital infections, the definition of a prostate-specific antigen (PSA).
Clinically significant in the case of chronic prostatitis is the way to identify in the analysis of pathogens chlamydia, mycoplasmosis, herpes, cytomegalovirus, trichomoniasis, gonorrhea, candida infection, as well as non-specific bacterial flora. Fence the secret of the prostate gland studies done after urination and the carrying out of massage of the prostate. Signs of chronic prostatitis need to increase the number of leukocytes in the field of view, the reduction of the number of granules of lecithin grains, the presence of microflora pathogenic.
In general, the analysis of the urine in cases of chronic prostatitis can occur leucocyturia, pyuria, erythrocyturia. Bacteriology urine culture to identify the degree and nature of bacteriuria. When reproductive violations illustrated the research body and the MAR-test.
The degree and the causes of disorders of urination all contribute to determine urodynamic research (uroflowmetry, cystometry, profilometry, and electromyography (emg). With the help of the research data chronic prostatitis fails to differentiate of stress incontinence, neurogenic bladder, etc. With hematuria, Hematospermias, obstructive urination shown the endoscopic examination - urethroscopy, cystoscopy. For the removal of the adenoma, and carcinoma of the prostate requires the definition of a DOG, in some cases – the performance of a prostate biopsy with morphological study of fabrics.
The treatment of chronic prostatitis
Chronic prostatitis curable, is not easy, but you need to remember that the recovery is still possible, and largely depends on the attitude of the patient, the timeliness of its conversion to a specialist, the definition in respect of all the requirements of the urologist. The basis of the treatment of chronic bacterial prostatitis is the antimicrobial therapy in accordance with antibiotics duration of not less than 2 weeks. To reduce the pain and inflammation are assigned FANS ; for the relaxation of the musculature of the prostate, recovery of urodynamics and outflow prostatic secret shown to a reception in-blockers.
With the aim of improving the drainage of the prostate, local circulation, muscle tone, and takes place a course of massage therapy of carcinoma of the prostate. Massage of the prostate needs to the end of the selection not less than 4 drops of the secretion of the prostate gland. Massage of the prostate is contraindicated during the acute bacterial prostatitis, abscess of the prostate, hemorrhoids, stones in the prostate, fissures of the rectum, hyperplasia and carcinoma of the prostate.
To relieve the pain of chronic prostatitis can be recommended paraprostatic block, acupuncture. Essential in the treatment of chronic prostatitis relegated physiotherapy with the appointment of a medicinal electrophoresis, ultrasound, phonophoresis, magnetic therapy, laser magneticam illic, inductometer, mud, SMT, warm sedentary baths the temperature of 40 – 45°C, enemas with hydrogen sulfide and mineral waters, of instillation into the urethra.
With the development of complications associated with chronic prostatitis, surgical treatment: resolution of stricture of the urethra; a TOUR of the prostate, or prostatectomy when the sclerosis of the prostate; transurethral resection of the bladder during sclerosis his neck, puncture and drainage of cysts and abscesses of the prostate; circumcisio when phimosis, called recurrent urinary tract infections, etc.
Prevention of chronic prostatitis
Notice of chronic prostatitis requires the observance of sexual hygiene, timely treatment urogenital and extragenital infections, the normalization of regularity sexual life, sufficient physical activity, the prevention of constipation, timely emptying of the bladder.
For the elimination of relapse of chronic prostatitis are necessary dynamic controls consultation (urologist); prevention training, physiotherapy, multivitamins, immunomodulators; exception of hypothermia, overheating, stress, bad habits.