The diagnosis of "chronic prostatitis" (CP) is put in the presence of smoldering inflammation of the prostate tissue, which lasts for 3 months or longer. Under the influence of precipitating factors, remission, periodic exacerbations replaced. The disease occurs in one out of five men. 30% of patients with this diagnosis at the age from 20 to 50 years. Completely cure chronic prostatitis is almost impossible, but in most cases it is possible to achieve stable remission, subject to the recommendations of the doctor (what doctor deals with the treatment of prostatitis).
The types of chronic prostatitis
The universal is classification according to which there are several types of chronic prostatitis:
- Acute bacterial (at relapse).
- Chronic bacterial.
- Chronic aseptic (abacterial) prostatitis, which is divided into 2 subtypes: chronic pelvic pain syndrome, inflammatory or noninflammatory nature (prostatodynia).
- Flowing asymptomatic (latent) chronic prostatitis.
The symptoms of chronic prostatitis in men does not always appear in strict order. The degree of their severity depends on the characteristics of the organism.
Chronic bacterial prostatitis
The bacteria cause inflammation of the prostate in 6-10% of cases. The bacterial form of chronic prostatitis is usually provoked by non-specific infections (Escherichia coli, Staphylococcus aureus, hemolytic Streptococcus), penetrating into the prostate from other organs or the external environment. Inflammation caused by a type of bacteria that develops slowly with the erased symptoms, so chronic infectious prostatitis is often acute, when he was running. Sometimes inflammation manifested by mild itching, burning and even pain in the urethra, disorder of urination. About the active development of infection evidenced by abdominal pain and fever. This is the first signs that started the defeat of the other pelvic organs. The formation of abscesses.
Reasons
Nonspecific infections usually penetrate the prostate can damage the mucous membranes of the genital organs due to inflammation, damage, foreign bodies, instrumental urological procedures. On the skin surface of the perineum is always a certain amount of intestinal bacteria, hence the importance of hygiene before sexual intercourse. If the area of the anus, groin, scrotum are excess moisture and irritation, the pathogens begin to penetrate the thickness of the epidermis. Non-specific pathogens of chronic prostatitis fall in prostate tissue on the urethra during oral sex, because the throat often found Streptococcus, some gram-negative bacteria. Often, the infection occurs through the hands of the men. Most men with chronic bacterial prostatitis, belong to the age group 20 to 40 years, as this period is peak for sexual activity. Ignoring of barrier contraception leads to frequent infections specific pathogens inflammation of the prostate. The most dangerous among them are the following:
- Mycoplasma;
- Ureaplasma;
- Trichomonas;
- Chlamydia.
Erectile dysfunction on the background of chronic bacterial prostatitis often lead to sexual neurosis, in consequence of which man becomes irritable, aggressive.
Treatment
Modern methods of treatment of bacterial prostatitis involve antibiotics, active against detected during the diagnosis of the pathogen. As a subsidiary means prescribed antispasmodics, analgesics class NSAIDs, diuretics. Anti-bacterial first-line drugs are second-line antibiotic – macrolides. The scheme can also involve the sulfonamides. Quickly cure your chronic prostatitis impossible. Depending on the nature of the inflammation of therapy is from 2 to 12 weeks. If within 2 weeks of positive dynamics is absent, then the drug changes. Unsatisfactory result from antibiotic therapy in chronic prostatitis due to the following reasons:
- Short course;
- Low concentration of the active substance;
- Education in the Lumina of the ducts and acini of the prostate (protruding pouches that make up the glandular tissue of the prostate gland) colonies of resistant bacteria.
Antibiotics are introduced not only orally, but also by intraprostatically and endolymphatic (injections in imposed or lymph node).
Fungal prostatitis
Fungal (mycotic) prostatitis is a separate subtype of chronic forms of the disease. The fungus enters as unprotected sexual contact and limfatica from other organs. Symptoms of prostate tissues often oiled, so the inflammation passes into the chronic form. Under normal immune system fungal colonies do not reproduce more than the safe limits. The risk of developing candidal prostatitis elevated in diabetics, men with a positive HIV status, as well as those suffering from systemic diseases.
Abacterial prostatitis
Chronic pelvic pain, exciting the coccyx and perineum, is a sign of abacterial prostatitis (the prevalence is 80-90%, including prostatodynia 20-30%). Other manifestations may not be at all. In the diagnosis of pathogenic microorganisms not found in the juice of the prostate or in the urine or in the ejaculate. Inflammatory in nature pelvic pain in the aforementioned biological fluids increases the number of white blood cells. Besides pain, chronic abacterial prostatitis periodically show symptoms such as blood in the ejaculate, discomfort during ejaculation and bowel movements, difficulty urinating. Some men have markedly reduced libido, erectile function deteriorates, there is a General weakness and muscle pain.
Causes and treatment
The probable causes of chronic non-bacterial prostatitis:
- Systemic diseases.
- Of vascular pathology, circulation.
- Autoimmune disorders.
- Stagnant processes.
The exact cause of development of chronic non-communicable (non-specific) prostatitis is not always possible to identify, therefore, medical therapy is often unsuccessful. For drainage of purulent prostate is bladder catheterization. With the ineffectiveness of drug treatment, surgical in the form of either fine-needle transurethral laser ablation of the prostate (minimally invasive destruction of overgrown tissue).
Chronic calculous prostatitis
Chronic calculous form of the prostatitis also is abacterial. Stones (practicality) in the prostate are formed due to stagnation of secretions. They consist of products of inflammatory reactions, salts, necrotic masses. Pathology usually develops on the background of congestive (congestive) chronic prostatitis, urolithiasis (stones migrate from the kidneys and bladder), disturbed metabolism, adenoma.
Signs of chronic prostatitis with calcification:
- Violation of urination.
- Groin pain, tailbone.
- Blood in the semen.
- The deterioration of an erection.
For dissolution of stones in the prostate are administered special drugs and produce rectal massage. If conservative methods do not work, then resort to surgery. The activated form of chronic calculous prostatitis can lead to an abscess of the gland or atrophy of the organ.
Asymptomatic prostatitis
When latent chronic prostatitis any signs of the missing. The only thing that is detected when the diagnosis is leukocytosis of prostate secretion and the likely increase in PSA level. Asymptomatic prostatitis detected accidentally during routine examination or during the treatment on another occasion.
The effects of chronic prostatitis
Itself chronic prostatitis for men life is not dangerous. Threatening can be the consequences, if time does not seek medical help. Complications often develop in younger patients. In chronic prostatitis, the protective function of the gland is disturbed, reduced the amount of zinc, lysozyme required for normal operation. As a result, the organ becomes a source of permanent infection. Pathogens frequently migrate in the testicles, the rectum, causing epididymitis, abscess. When moving infection by ascending paths may develop pyelonephritis, renal failure. Because the prostate is actively involved in the formation of the ejaculate, it constant inflammation can lead to infertility. Often a woman can not get pregnant not because of the poor quality of her partner's sperm, and defective semen. Attempts to conceive naturally for a long time fail (read more about the impact of prostatitis on the conception of a child). Severe complication is scarring of the bladder wall, the prostate, urethra. Long-term inflammatory deform the fabric, they frown, become non-functional. Also, the probability of development of benign prostatic hyperplasia (BPH), which can catalyze the cancer process.
Diagnosis of chronic prostatitis
On consultation, the doctor explains in detail the history of the patient, it is particularly important to describe any disorders in intimate life. Range of complaints in men with chronic prostatitis can be very extended: from sexual dysfunction to anxiety. ¼ Of all patients do not notes any symptoms, the abnormality is detected incidentally. The importance of history. Typical precursors of various types of chronic prostatitis: infectious bacterial or gonorrheal urethritis noninfectious diseases − hemorrhoids, varicocele, varicose veins lose veins in the legs. Of paramount importance in the diagnosis of chronic prostatitis have a palpation of the gland and analysis of its secret (read more about the sowing prostate secretion). During acute prostate size increases slightly, and in periods of remission, comes back to normal, only slight swelling. The secret is obtained by rectal massage of the prostate. If the inflammatory process is focal in nature, that consistency on uneven alternating sections of Zapadni, vitolini, razmagcheniu. In such cases, the prostatic juice is obtained separately by each part. Changes gland secretion, which is indicators of chronic prostatitis:
- The shift of acidity towards alkalinity;
- Increased lysozyme activity;
- The decrease of acid phosphatase.
High informativity of different fluorescent-Cytology of prostatic juice, as well as test its crystallization. In healthy men juice kristallizuetsya in the form of a fern leaf. The violation of the geometry of the figure indicates endocrine abnormalities due to which there is a lack of androgens. In some cases, in the diagnosis of infectious chronic prostatitis used alimentary provocation – the patient intentionally consume spicy food or alcohol, resulting in aktiviziruyutsya the causative agents of gonorrhea and Trichomonas. Sluggish inflammatory processes are manifested with the introduction of pyrogenal or prednisolone. Among the laboratory studies are considered the most informative test, called trehstakannoy sample. The patient urinates first into one glass, then the second, then the massage of the prostate. Remaining in the bladder urine is collected in a third Cup. She, along with the ejaculate is subjected to bacteriological research. The number of required tests also takes a swab from the urethra for the presence of STDs. Not all conditional pathogens that grew in the cultures, are automatically considered agents of chronic prostatitis. In the microbiocenosis of their presence is a normal variant. Important growth titer (concentration). If the ratio is higher than 10 in 4 degrees, it is considered diagnostically significant. Otherwise, the patient shows dynamic observation and treatment. Informative method of diagnosis is TRUS or transabdominal ultrasound examination. On sonographic signs, you can determine the duration and severity of inflammation. The main exeprince in chronic prostatitis:
- The volume of the breast is increased to 20 cm3 or more;
- Sclerotic and fibrous transformation of the tissues;
- Stones;
- Swelling.
Urine flow rate and the presence of obstructive changes in the ureter allows you to track uroflowmetry. For the differentiation of chronic prostatitis from cancer and hyperplasia, if necessary, performed a biopsy of the prostate. PSA levels in chronic prostatitis in remission is normal or slightly elevated. On the background of active inflammatory process may rise to 8-10 ng/ml. the Diagnosis of non-bacterial chronic prostatitis is more complicated. Have to conduct a number of tests to exclude bacterial forms of inflammation, abnormalities of other pelvic organs. Microscopy of urine and ejaculate shows the excess level of blood, but ultrasound, cystoscopy, CT scan of comorbidities did not reveal.
General methods of therapy of chronic prostatitis
In addition to the specific treatments for different types of chronic prostatitis, there are common used in all types of inflammations. Effective way healing effect on the prostate is massage. It has a direct effect on prostate tissue, improves blood circulation and lymph flow, removes products of inflammatory reactions. During exacerbation of prostate massage is not carried out.