Chronic prostatitis

Chronic prostatitis is a prolonged inflammation that occurs due to concomitant infections or pathologies in the prostate gland.

Chronic prostatitis is diagnosed in men of all ages.According to statistics, this disease is the most common reason for a visit to a urologist in patients under the age of 50.In a chronic form, a bacteriological examination reveals the pathogenic agent only in 5-10% of patients.In most cases, other factors are considered the cause of the disease.It is known that the presence of an infection is not a prerequisite for the occurrence of the disease.Chronic inflammation of the prostate is a polyiethological pathology, which is the result of the actions of different causes and provocative factors.In 90-95% of patients, antibacterial therapy has limited effectiveness or is not required at all.

Classification of chronic prostatitis

The classification of chronic prostatitis by the etiological characteristic distinguishes between two main forms of the disease: chronic bacterial prostatitis (infectious) and chronic non -bacterial prostatitis (aseptic)/chronic pelvic pain (KTS).

The etiological classification of chronic prostatitis includes:

1. Chronic bacterial prostatitis.
2. Prostatitis/ctb non -chronic (aseptic) ("prostatini" or "painful prostate gland" is an obsolete term used to determine the pathology).
3. Chronic prostatitis/CTB (aseptic) with an inflammatory inflammatory component (the concentration of leukocytes has significantly increased in the secret of the prostate, sperm, the first part of the urine).
4. Prostatitis/CTB Non -Chronic (aseptic) batteric without an inflammatory component (concentration of white blood cells in the secret of the prostate, sperm, the first part of the urine is insufficient for inflammation).
5. Chronic ashmpetomic prostatitis (detected in laboratory studies, does not show itself clinically).

Chronic bacterial prostatitis is a rare pathology, as can be seen from the above statistics.The infection is the cause of the chronic recurrent inflammation of the prostate in one of the ten patients.The pathology is often associated with other infectious diseases of the parental -urinary organs.Very often, its cause is an non -specific infection, however, in the presence of STSPP, chronic inflammation of the gland can be caused by clamidia, ureaplasmosis, mycoplasmosis or other specific microorganisms.

Non -kiss (aseptic) chronic prostatitis or chronic pain syndrome is a long -term recurring disease that occurs due to the aseptic inflammation of the prostate.This is a somewhat studied pathology.In the presence of symptoms of the disease, the tests determine white blood cells in the secret of the gland, in the fluid of the seed, in the initial portion of the urine, but the results of the bacteriological examination are negative.In other cases, there are neither signs of infection, nor the leukocytosis pronounced with luminous symptoms.

There are also chronic prostatitis in the exacerbation and chronic prostatitis phase in the remission phase.A cyclical path is characteristic of the bacterial and non -infectious inflammation of the prostate gland.The exacerbation of chronic prostatitis leads to an increase in symptoms in both cases.

The pathanatomical classification (patomorphological) of chronic prostatitis is of limited interest for patients and clinical doctors.

The causes of chronic prostatitis

Causes of chronic bacterial inflammation of the prostate gland

Chronic infectious prostatitis occurs due to the infection of the fabrics of the prostate gland.Very often, the cause of inflammation is E. coli or e.Coli.Less commonly sculpted microbes of the genus Enterocchi, Klebsell, Proteus, Pseudomonas.

Like some other microbes, E. coli is able to form biofilm, thin, consisting of bacterial and strictly adjacent accumulations of the mucous membranes of the ducts.This explains why it is not always possible to cure chronic prostatitis.It is believed that the infection spreads as an ascending way through the urethra.However, lymphogenic and hematogenic of infection is also possible.

The predisposing factors for the occurrence of chronic infectious prostatitis are as follows:

• sexually active age;
• prostate adenoma or benign prostate hyperplasia;
• Restructuring of the urethra;
• Unscrew the extreme penis meat;
• Hypertrophy of the bladder neck;
• medical procedures (vavering of the bladder, cystoscopy);
• Genetic and anatomical characteristics that prepare for the disease.

Causes of chronic non -kissing inflammation of the prostate gland

The causes of chronic non -batteric prostatitis are precisely unknown.Perhaps the disease is caused by viruses or bacteria, which are not identified during the bacterial secretion of the prostate gland.However, most scientists and doctors believe that chronic non -bacterial prostatitis/ctb (aseptic) is a polyiethological disease that occurs following combinations of different adverse factors, that is to say:

• cycling;
• irritation of the fabrics of the prostate gland when the urine enters its ducts;
• irritation of the prostate gland following the use of any product or drinks (in particular with food allergies or celiacs);
• functional disorders of the nervous eagerness of the pelvic organs;
• Atrophy of the pelvic floor muscles;
• Stress, psychoemotive loads;
• Pathology in the prostate gland, remaining after a long acute prostatitis;
• hormonal disorders;
• bladder diseases;
• Cold climate.

Since the exact causes of the disease are little known, the treatment of chronic prostatitis can be difficult.

Symptoms of chronic prostatitis

Chronic (infectious) bacterial prostatitis is characterized by a cyclical path.The exacerbation phase is replaced by a phase of remission.Practically there are no symptoms between exacerbations.There is a clear connection among other diseases of the parental organs: urethritis, epididimmet, cystitis.The cause of these pathologies, as a rule, is the same pathogen that causes chronic prostatitis.The symptoms during the exacerbation are represented by unhappy phenomena (frequent urination, rubber and burning pain during urination) and pain with various intensity in the perineum, scrotum, sacrum, with irradiation in the penis.

The general condition is generally satisfactory.There are no signs of intoxication, there is no increase in body temperature.The prostate gland when examining through the rectum (per right) can be normal or slightly swollen, without a severe pain characteristic of acute prostatitis.

The prostatitis/ktb non -chronic (aseptic) abotterica is characterized by pains of various degrees of gravity (with stupid lungs to intense) in the pelvis, perineum, sacred and are the "visiting paper" of the disease (chronic aseptic prostatitis).The signs of inflammation of the prostate gland are scarcely expressed and are observed in 50% of cases.In other patients, they can be absent.

The presence of blood in the sperm, painful ejaculation, defecation, unhappy phenomena are possible.The severity of symptoms can change.The pain is given to the horse, the rectum, making it difficult to find a person in a sitting position.They are also possible fatigue, unreasonable fatigue, joint and muscle pain.Some patients complain of a reduction in sexual desire, erectile dysfunction (impotence).

Chronic asymptomatic prostatitis has no characteristic symptoms of this disease, therefore its name.During the laboratory study of the prostate secret, leukocytosis is determined, an increase in the levels of a specific prostate antigen is possible.There are no other signs of the disease.

Diagnosis of chronic prostatitis

The main methods for the diagnosis of chronic infectious prostatitis are laboratory tests and topical tests that allow you to discover the source of leukocytes in the urine and sperm.

A three -deserved urine test helps identify inflammation.To do this, the patient urinates three containers for analyzes.Prostate massage between the second and third container leads to the stimulation of the secretion of the gland.Consequently, the urine in the third container will contain the exhaust of the prostate gland (leukocytes, red blood cells, bacteria), which is determined during the analysis.It is not necessary to massage the prostate in particular and explore the pure secret of the gland.

The urine from the third container can be sent to a bacteriological examination with sowing on a nourishing medium.In the presence of bacterial growth, a test for the susceptibility of pathogen to antibiotics is carried out.The method helps to conduct treatment in a more accurate and effective way.Since prostate secret is a significant part of sperm, microscopy and ejaculate bacteria also allows you to make the correct diagnosis.

Chronic (infectious) bacterial prostatitis is accompanied by a slight increase in PSA.Its level is reduced after successful treatment.Ultrasounds and other instrumental studies do not have a significant diagnostic value.

The diagnosis of prostatitis/ctb non -chronic (aseptic) abotterica can be difficult.Often the diagnosis is made excluding other pathologies of the parental and bacterial prostatitis.For this reason, instrumental and laboratory methods are used: urine microscopy (a three -wall test is also used after prostate massage), sperm or prostate secrets, followed by sowing on a nourishing medium.The list of studies includes analysis for PSA (differential diagnosis of cancer and inflammatory prostate diseases).

Microscopy reveals the presence of leukocytes in the urine, in the secret of the prostate, seed fluid with negative results of the bacteriological treatment methods.The instrumental research methods (ultrasound, cystoscopy, magnetic resonance imaging, CT) do not reveal signs of concomitant pathology.

Treatment of chronic prostatitis

For the successful treatment of chronic infectious prostatitis, rational and targeted antibacterial therapy is required.The choice preparations are fluorochinolons that create large concentrations of the drug in the gland tissues.The course of the treatment lasts six to 12 weeks.This duration of antibacterial therapy is necessary for the complete eradication of infections and the prevention of relapses.Drugs of second Row.

Chronic bacterial prostatitis can be treated with coherent and adequate therapy.Patients with frequent recurrence should control the immune state.It may also be necessary to exclude the HIV infection, which is often the cause of the low effectiveness of antibacterial therapy.In such patients, it is possible to prescribe antibiotics at a sufficient dose to suppress bacterial growth.

The treatment of prostatitis/kts non -chronic abotterica is difficult, since infection is not the cause of chronic pain in the pelvis or in chronic abotteric prostatitis.It is necessary to seriously deal with the problem and answer the question on how to treat a disease, the cause of which is exactly unknown.

The absence of a certain etiology explains why attempts to therapy of this pathology have often not happened.

The methods of treatment of chronic aseptic prostatitis contain:

1. Antibacterial therapy with fluorochinoloni (carried out by all patients).It is possible to have an infection that is not detected during a bacteriological examination.
2. Alpha-blockers.They contribute to the improvement of blood circulation in prostate tissues.The effectiveness is low.
3. Fans and other anti -inflammatory drugs have serious effectiveness, relieving pain and improving symptoms.However, the treatment is pathogenetic, after cancellation, the renewal of the disease is possible.
4. Physiotherapy and physiotherapy exercises (yoga, sport, active lifestyle), helping to improve blood circulation and eliminate venous stagnation, hypoxia, strengthen the pelvis muscles.The method helps patients with appropriate disorders.
5. Antidepressants and anticonvulsants (effectiveness is not demonstrated).
6. Surgical treatment: laser or subtle -iginal ablation of the prostate gland (not effective).

Forecast

In chronic infectious prostatitis in most patients, the prognosis is favorable.Consistent and adequate antibacterial therapy allows you to achieve success in over 80% of cases.

Prostatitis/ktb non -chronic abotterica (KTB has a worst prediction. Treatment only helps some patients. Others continue to suffer from chronic pain syndrome, despite the use of all the treatment methods available. The disease has an effect pronounced on the psycho -emotional sphere and sexual relationships.