Acute prostatitis is an infectious inflammation of the prostate gland, accompanied by swelling, and the formation of purulent foci in the prostate. Symptoms of acute inflammation of the prostate depends on the stage (catarrhal, follicular, solid, vesicular) can contain dysuric disorders, pain in the perineum, fever, intoxication. Diagnosis is based on palpation of the prostate ultrasound, Doppler studium prostate, study of the discharge from the urethra, prostate secretion. Treatment of acute prostatitis includes the administration of antimicrobial therapy, Nsaids, antispasmodics, analgesics, immunomodulators, therapeutic gymnastics.
Acute, chronic prostate inflammation, or the common and socially significant diseases of the male. The clinical urologist, prostate diagnosed 30-58% of the men in the reproductive and working age (30-50 years). Acute prostatitis is accompanied by disorders of the sexual function, fertility, diseases of psycho emotional state, social disadaptation.
Causes of acute prostatitis
Pathogens, acute prostatitis, mostly non-specific infectious agents that penetrate into the tissues of the prostate, the gram-negative (Escherichia coli, Klebsiella, Proteus) or gram-positive (staphylococci, enterococci, streptococci)
Often acute prostatitis may be caused by pathogens urogenital infections:
- chlamydia
- trichomoniasis,
- Ureaplasma,
- gonorrhea,
- mycoplasmosis,
- candidiasis, etc.
Most often, the penetration of the antimicrobial agents in the prostatic tissue occurs in transcanalicular way through the excretory ducts of the glands in the wall of the posterior urethra. Therefore, the urethra to inflammation of any origin is very often complicated with acute inflammation of the prostate. Less microbiological flora into the prostate of the urinary bladder acute cystitis. The introduction of the pathogen in the gland significantly facilitated the increase in intraurethral pressure (reprehenderat, stones, urethra), the behaviour, the endourethral manipulation (bougienage of the urethra, urinary catheterization, ureteroscopy, cystoscopy, etc.).
Additionally, acute prostatitis may cause a hematogenous infection, helps the terms of the blood supply to the prostate is a well-developed system of arterial and venous anastomoses. When the called hematogenous drift bacteria can get into the prostate tissue, the remote foci of purulent tonsillitis, sinusitis, caries, cholecystitis, bronchitis, cause, etc. May be lymphogenous infection of the prostate, the bowel, the anal fissures, proctitis, colitis.
The non-infectious factors in the development of acute prostatitis include constant congestion, the veins of the pelvis, dysfunction of the drainage acini of the prostate. Stagnation caused by disritmia sexuality, sexual violations – a practice interrupted intercourse, lack of or irregular sexual activity, excessive sexual activity, etc. the Pathological deposition of blood in the venous line of the pool can be observed when the sedentary lifestyle, frequent constipation, colds, chronic (especially alcohol), poisoning, varicose veins in the pelvis.
Forms of acute prostatitis
The development of acute prostatitis distinguish the following forms, which are the stages:
- catarrhal,
- follicular,
- parenchyma,
- vesicular.
Acute prostatitis begins with catarrhal inflammation of mucous membrane, submucous layer of the excretory ducts of the individual lobules of the gland. Further swelling of the walls of the channels contributes to the stagnation of Muco-purulent secret, the follicles of the prostate gland and the progression of inflammation in connection with what may develop focal purulent lobules acute follicular prostatitis. If you have multiple lesions in lobules, diffuse involvement of the parenchyma, connective tissue in the prostate in suppurative inflammation, acute prostatitis in the next phase – parenchyma. In the event that the merger of the small ulcers, the large fireplace with an abscess of the prostate, which can be opened in the urethra, perineum, rectum or the bladder.
The symptoms of acute prostatitis
Clinical symptoms of acute prostatitis correspond to the stages of the process. Common symptoms of pain, urination disorders, intoxication.
The acute catarrhal stage of the prostate I can feel the weight of pain in the dam. Dysuric disorders characterized by painful, frequent urination, especially at night. The body temperature is maintained within the normal range, may be slightly elevated, intoxication, gone. Palpation examination of the prostate did not change, or slightly increased, little painful. The study of prostate secretion observed increase in white blood cells, the accumulation of Muco-purulent threads. The urine in the emptying of the excretory ducts of the aci to appear in the white blood cells. Prostate massage is usually impossible because of the pain. The treatment started in the catarrhal stage of acute prostatitis, leading the recovery from 7-10 days.
The follicular form of acute inflammation of the prostate occurs, brightly, accompanied by a dull aching in the perineum, radiating into the penis, the rectum or sacrum. In this light, the urination is painful, difficult, until the development of acute urinary retention. The act of defecation acute follicular prostatitis is difficult because of the expressed pain. Due to the increase in body temperature to 38°C, poor general condition. Palpation per rectum is defined enlarged, dense, intense, asymmetric prostate gland sharply painful in some areas when the digital test. Urine collected after palpation of the gland, contains a large number of white blood cells, and pus-filled fibers, in which a cloudy precipitate. Massage to obtain prostatic secretion in the follicular phase of acute prostatitis is contraindicated. Vigorous treatment of acute follicular prostatitis is also favorably resolved; otherwise, pass the following, parenchymal phase.
Clinic acute parenchyma prostatitis develops rapidly. Characterized by severe hyperthermia (39-39,5°C and above), chills, general weakness, depression, appetite, thirst. First urination sharp in learning, as well as the complicated, you may need to stop completely. Attempt to empty your urine or stool retention accompanied by intense pain. Develop painful, tenesmus, constipation, flatulence. The pain extends to the rectum, throbbing in nature, forcing the patient to make a forced position – lying down crossed legs. The development of reactive inflammation in the rectum, the rectum, the mucus.
Determined by palpation diffusely enlarged, blurred contours of the gland, extremely painful to the slightest touch. Prostate massage the parenchymal phase of an acute inflammation of the prostate is strongly contraindicated. Sometimes because of a pararectal tissue swelling, tenderness, rectal examination is not possible, to lead. The urine – pronounced album sanguinem cellak, pyuria. The result is acute parenchyma prostate can serve as resolution of the disease, formation of an abscess in the prostate or chronic prostatitis.
Diagnosis of acute prostatitis
The recognition, identification, the stage of acute prostatitis by a urologist, based on a comprehensive physical examination, laboratory, instrumental examination. Examination of the prostate through the rectum allows you to determine the size, consistency, homogeneity, symmetry, cancer; pain reaction, foci of destruction, signs of purulent fusion of tissues. Palpation of the prostate acute prostatitis is performed very gently, without harsh pressure and massaging movements. Obtained from the prostate secretion of growth of the white blood cell count, and amyloid Taurus, reducing the number of lecithin granules.
Acute inflammation of the prostate, increased leukocyturia, the third part of the urine, urine collected after palpation of the prostate. The distribution of the pathogen acute prostatitis is necessary to conduct bacterial analysis of urine or urethral discharge with antibiotics, PCR tests-remains, blood cultures the sanguinem cultura. The nature and severity dysuric disorders acute inflammation of the prostate is estimated using uroflowmetries.
Ultrasound of the prostate moderate pain syndrome can be performed transrectal; in the case of expressed pain reaction – trans abdominal. Anoscopically estimated in the form, the size of the cancer, the presence of focal or diffuse changes, this is determined by the stage of acute prostatitis. The use of Doppler studium allows for a detailed, differentiated assessment of the location of the prostate.
When planning surgical tactics regarding destructive form of acute inflammation of the prostate corresponding to CT, MRI or the pool.
Treatment of acute prostatitis
The leading role in the treatment of acute prostatitis belongs to the causal treatment. The earliest date for antimicrobial (antibacterial, antiviral, antitrichomonal, anti-fungal) medicines that suppress the reproduction of the microorganisms, the glands, the tissues of the urethra. To reduce the cramps, painful urination prescribe analgesics, spasmolytics, and rectal candles the Anaesthesinum or belladonna, heat microclysters. The complex therapy of acute prostatitis are used, Nsaids, enzymes, immunomodulators, vitamins, infusion solutions.
Physical therapy the acute inflammation of the prostate is performed after decrease in acute symptoms. With the aim of, anti-inflammatory, decongestant, analgesic actions, improving microcirculation, as well as the local immunity applied rectal electrophoresis, UHF-therapy, microwave therapy, prostate massage. Acute prostatitis is shown to comply with bed rest, sparing diet, sexual peace.
If urinary retention on the background of acute inflammation of the prostate, don't take out the bladder catheterization, rather, trocar cystostomy. If abscess of the prostate occurs, the need for surgical intervention - opening and draining the abscess cavity.
The course of treatment acute prostatitis is judged by the restoration of the tissue structure of glands, the functions, the normalization of the composition of the juice of the prostate is necessary, the pathogens causing the inflammation of body fluids.
Forecast, prevention
As a general rule, at a time reasonable causal treatment leads to cupping of signs of acute prostatitis. The abscess of the prostate, or chronic inflammation happens in special cases.
Prevention of acute prostatitis should include debridement of infectious foci in the body, book, endourethral endovesical manipulations in accordance with the rules of asepsis, timely treatment of Sexually transmitted diseases, urethra inflammation, the normalization of the sexual activity, the physical activity.