Chronic prostate inflammation is a prolonged inflammation of the prostate gland, which decreased morphology or functioning of the prostate. Chronic prostatitis is manifested prostatic triad of pain in the pelvic region, genital organs, urinary diseases, sexual disorders. Diagnosis of chronic prostatitis includes palpation of the gland, the examination of the prostate secretion, ultrasound, uroflowmetry, a needle biopsy of the prostate. The of chronic prostatitis shows complex medical, physiotherapy, massage, prostate, instillation posterior urethra. Surgical treatment is advisable complicated form of chronic inflammation of the prostate.
Chronic prostatitis
Chronic prostatitis is the most common male disease: approximately 50% of men suffer from some sort of prostatitis. Chronic prostatitis often affects year-old men 20 to 40 years, in the period of maximum sexual sexual activity. In this regard, detection, and treatment of chronic prostatitis urologist, not just medical, but also social aspects.
Classification of chronic prostatitis
According to the modern classification of the prostate developed in 1995, discrimination is different in 3 categories of the disease:
- I. Acute inflammation of the prostate.
- II. The chronic prostatitis is bacterial in origin.
- III. Chronic nonbacterial prostatitis Genesis/chronic pelvic pain Syndrome is a syndrome, which has no obvious signs of the infection continues 3 months or more.
- III A chronic prostatitis, an inflammatory component (detection of the prostate secretion white blood cells, or infectious agents);
- III B chronic prostatitis, the non-inflammatory components (leukocytes, pathogens in prostatic secretion).
- IV. Asymptomatic chronic prostatitis (not a complaint, the identification of white blood cells, the prostate-secret).
The presence of the infectious component talks to bacterial (infection) chronic prostatitis; in the absence of microbial pathogens, nonbacterial (no contagion) inflammation of the prostate. It is believed that 90-95% of all cases there is a non-bacterial chronic prostatitis, only 10-5% of bacterial.
The causes of chronic prostatitis
The etiology, pathogenesis of chronic bacterial prostatitis associated with any infection of the prostate as follows: upwards (through the urethra), down (if reflux of infected urine from the bladder), hematogenous (blood highways) or lymphogenous (lymphatic collectors). Most uropathogens are E. coli, Klebsiella, Proteus, Staphylococcus, Enterococcus, CORINNE, fungal, parasitic, and viral pathogens. Together with the non-specific flora the development of chronic inflammation of the prostate participate in agents specific urethritis (chlamydia, Mycoplasma, gonococcus, Trichomonas, Gardnerella).
However, the development of chronic prostatitis not so much the presence and activities of micro-organisms, as the state of the pelvic organs and the circulation, the presence of comorbidities, the level of protective mechanisms.
Therefore, the emergence of chronic prostate inflammation may contribute to a number of factors. First, the urological diseases, pyelonephritis, cystitis, urethritis, stricture of the urethra, increatos end of acute prostatitis, orchitis, epididymitis, etc. Microbial etiologist can get into the prostate, the remote foci of infection such as, sinusitis, tonsillitis, dental caries, chronic bronchitis, pneumonia, cause, etc. Predispose to chronic inflammation, the local general hypothermia, overheating, stay in the humid environment, fatigue, malnutrition, rare urination, etc.
Chronic not bacterial prostatitis is usually associated with congestive (congestive) symptoms of the prostate caused by stasis of the venous circulation in the pelvic organs and impaired drainage acini of the prostate. Local obstruction causing overflow, the arteries, the prostate, the blood, the swelling of incomplete emptying of secretions, breaking the barrier, secretory, motor, contractile function of the gland.
Congestive changes generally caused by behavioral factors, long-term sexual deprivation, exercise, interrupted or prolonged sexual activity, excessive sexual activity, lack of exercise, prolonged sitting, chronic intoxication (alcohol, nicotine, drugs), occupational (vibration). The development of nonbacterial chronic prostatitis predisposing to pathology of the pelvic organs, and neural structures of the innervation (e.g., spinal cord injury), adenoma of the prostate, hemorrhoids, constipation, androgenodeficiency, etc. ok.
The symptoms of chronic prostatitis
Chronic prostatitis is manifested in the local general symptoms. Local symptoms owe prostate triad, characterized by pain, dysuria, sexual dysfunction. Pain, chronic prostatitis, or a constant aching in nature, localized in the perineum, genitals, suprapubic, groin. Pain syndrome increases at the beginning and end of urination, pain radiating to the glans of the penis, scrotum, sacrum, the rectum. Pain may increase after sexual intercourse, or the connection is long-term abstinence; weaker or stronger after the orgasm to become more intense, in the moment of the ejaculation.
The intensity of the pain syndrome in chronic prostatitis varies from unpleasant to Express, to violate sleep, and performance manifestations. Pain limited localization of the sacrum is often considered as the low back pain or sciatica, in connection with the patient long treated without a physician's help.
The urination in chronic prostatitis, painful learning. Although it may be a rough start, misc, the weakening or discontinuity of the urinary stream, feeling of incomplete emptying of the bladder, frequent night urination, burning sensation in the urethra. In the urine, chronic inflammation of the prostate for the detection of floating fibers. After a bowel movement, or physical exertion, the urethral appear allocation due to decreased tone of the prostate. The chronic prostatitis can cause itching, feeling cold or excessive sweating between the legs, a local discoloration of the skin, associated with stagnation of blood circulation.
Chronic prostatitis accompanied by severe diseases, sexual function. The symptoms of low blood pressure may be worsening, painful erection, prolonged, frequent nocturnal erection difficulties or premature ejaculation, loss of libido (decreased libido), to delete an orgasm Hematospermias, infertility. Sexual dysfunction is always hard experienced people, leading to psycho-emotional disorders, like neurosis, depression, even better, spoil the sexual function.
Exacerbation of chronic prostatitis, accompanied by a small increase in body temperature, deterioration of health. General terms and conditions, the chronic inflammation of the prostate characterized by increased irritability, lethargy, anxiety, fatigue, loss of appetite, sleep disturbance, reduced work capacity, creative and physical activity.
Almost a quarter of patients with chronic prostatitis symptoms for a long time missing, that the late treatment of the urologist. Long duration of chronic prostatitis may be complicated by impotence, vesiculitis, epididymo orchitis, male infertility, incontinence, stone formation, cysts, and the prostate gland, sclerosis of the prostate, is the development of adenoma and prostate cancer.
Diagnosis of chronic prostatitis
Necessary for the diagnosis of chronic prostatitis information gained through comprehensive laboratory, instrumental examination. Initial examination of the suspected chronic prostatitis include the clarification of history, complaint, conducting an external inspection of the genitalia for discharge, lesions, irritation, rectal digital examination of the prostate with the aim of determining the shape, boundaries, consistency, tenderness of the breast.
Determines the structural and functional changes of the prostate is shown holding ultrasound of the prostate (TRUST). An important method in the diagnosis of chronic prostatitis the study of the secret prostate, urinalysis, bacteriological examination of the smear of the urethra, urine, 3 cups of urine samples, PCR, REEF study, scraping the causative agents of genital infections, determination of prostate-specific antigen (PSA).
Clinically significant chronic prostatitis, the recognition in the analysis of the causative agents of chlamydiosis, mycoplasmosis, herpes, cytomegalovirus, trichomoniasis, gonorrhea, candidiasis, non-specific bacterial flora. The fence prostate secretion to studies after urinating or prostate massage. Symptoms of chronic prostatitis, is increasing the number of cells in the field of view, reducing the number of lecithin granules, the presence of the pathogenic micro-organisms.
The general urine analysis in chronic prostatitis show pyuria, pyuria, erythrocyturia. The urine bacteriological culture helps to identify the extent, nature, bacteriuria. The reproductive disorders shows that a study of the semen and MAR test.
The degree causing voiding to determine urodynamic studies (uroflowmetry, cystometry, profilometry, and electromyography). Using the data of the studies of chronic prostate inflammation can be distinguished from stress incontinence, neurogenic bladder, etc. When hematuria, Hematospermias, obstructive voiding an endoscopic examination urethroscopy, cystoscopy. To eliminate the adenoma, prostate cancer requires the determination of PSA, in some cases, the histological examination of the prostate the morphological examination of tissue.
The treatment of chronic prostatitis
Chronic prostatitis cure difficult, but don't forget that the recovery still could be, largely depends on the mood of the patient, the timeliness, the appeal of the specialist's compliance with all requirements of the urologist. The mainstay of treatment of chronic bacterial prostatitis antimicrobial therapy in accordance with antibiotics at least 2 weeks. To reduce pain, inflammation, Nsaids, appointed ; to relax the muscles of the prostate, the restoration of urodynamics, outflow of prostate secretion shows, reception a-adrenoblokatorov.
With the aim of improving drainage of the prostate, the local micro-circulation, muscle tone, held, of course, the therapeutic massage of the prostate. The massage of the prostate should result in the distribution of not less than 4 drops of prostatic secretion. Prostate massage is contraindicated in acute bacterial prostatitis, abscess of the prostate, hemorrhoids, the stones, the prostate, anal fissures, hyperplasia, prostate cancer.
To relieve the pain syndrome in chronic prostatitis is also recommended for para-prostatic blockade, acupuncture. It is important that the treatment of chronic prostate inflammation plays a physiotherapy appointment medicinal electrophoresis, ultrasound, phonophoresis, magnetic therapy, laser-magnetic, I illic, inductometer, mud therapy, SMT, hot hip bath temperature of 40 – 45°C, enemas, hydrogen sulfide, mineral water, instillation into the urethra.
The complications of chronic prostatitis surgical treatment: the removal of the urethra; TUR of the prostate, or prostatectomy, when sclerosis prostate; transurethral resection of the bladder, the multiple sclerosis to the neck puncture, drainage of cysts, abscesses of the prostate; circumcisio the support of only phimosis is caused by recurrent urinary tract infections, etc.
Prevention of chronic prostatitis
Prevention of chronic prostatitis requires compliance with genital hygiene, timely treatment of urogenital and extragenital infections, normalization of regular sexual life, adequate physical activity, prevent constipation, timely emptying of the bladder.
To avoid the recurrence of chronic prostatitis necessary dynamic checks andrologist (urologist); prior courses in physical therapy, multivitamins, immunomodulators, except for the hypothermia, overheating, stress, bad habits.