Chronic (bacterial) prostatitis is characterized by constant or recurrent symptoms with confirmed bacterial infection in the prostate gland.
Prostatitis of this category is infrequent, in approximately 10% of cases from all cases of prostatitis.The question - whether atypical pathogens can, such as ureaplasma urealiticum), provoke inflammation of the prostate - is discussed.They may be present in the body of a man and without any signs of inflammation and complaints.
The causes of chronic prostatitis
The causes of chronic prostatitis are mainly similar to the causes of the development of acute bacterial prostatitis.In most cases, the ingress of microorganisms into the prostate occurs through the urethra - as a result of the casting of urine into the duct of the prostate gland.
Chronic bacterial prostatitis develops due to inadequate treatment or a short course of treatment of acute bacterial prostatitis.
Symptoms
- Discomfort or pain - in the crotch, lower abdomen, in the groin, scrotum, penis, during ejaculation
- Changes in urination - difficulty urination, rapid urination in small portions, a sense of incomplete emptying of the bladder.
The patient can complain about a number of symptoms and any symptom separately.An increase in body temperature is uncharacteristic (or slightly).
Important:
Many men associate erectile dysfunction with prostatitis.Often this is facilitated by unprofessional publications in the media and advertising of dubious drugs.The fact that an erection can remain even with a complete removal of a prostate (due to the presence of a malignant organ tumor), suggests that it itself does not play a role in maintaining an erection.
According to many authoritative urologists, erectile dysfunction in patients with chronic prostatitis is due to psychogenic and neurotic problems.
Diagnostics
For the primary assessment, a questionnaire is used - an index of symptoms of chronic prostatitis.On it, you can objectify the patient's complaints.
The standard method for diagnosing prostatitis is the performance of the sample.This is a microscopic and bacteriological study of urine samples obtained from different parts of the genitourinary tract and the secretion of the prostate gland.However, the test method is quite laborious, and at the moment, samples are more often used.A possible alternative is the delivery of ejaculate (sperm) for a microscopic and bacteriological examination, since ejaculate partially (at least 1/3) consists of a secretion of the prostate gland.This method is more comfortable for patients, especially if they categorically refuse a rectal examination or performing a diagnostic prostate massage in order to obtain a prostate secret.However, the surrender of the ejaculate has lower information and reliability compared to breakdown.
The delivery of ejaculate for a bacteriological examination is included in the diagnostic algorithm for infections of the male genital organs and when examining a man about infertility.
The results of laboratory tests (general urine analysis, a general blood test, a biochemical blood test, a spermogram and other general clinical tests) in the case of chronic prostatitis are non -informative.Most likely, these tests will show the “norm”.
During a rectal examination of changes indicating the inflammatory process in the prostate, in patients with chronic prostatitis, far from always observed.That is, it is impossible to rely on the result of a rectal study for the diagnosis of chronic prostatitis.
The same is true for the Uz-diagnostics: to make a diagnosis of chronic prostatitis, focusing only on ultrasound data, is incorrect.The European and American Association of Urologists is not recommended to perform an ultrasound for the diagnosis of prostatitis.The type of execution in this case is not important through the anterior abdominal wall - the lower abdomen or Trust - through the rectum.To write in the conclusion of the ultrasound study “Chronic prostatitis”, “Ultrasonic signs of chronic prostatitis”, “Signs of prostatitis” is wrong.The prerogative of the installation of this diagnosis has only a urologist who determines it on the basis of complaints, anamnesis, laboratory tests and - only after - ultrasound.
The most frequent ultrasonic sign, according to which the diagnosis of chronic prostatitis is established - the so -called diffuse changes in the prostate gland associated with the transferred inflammatory process or other changes in the Parenchyma of the prostate.This is a kind of fibrous process, replacing the normal parenchyma of the prostate with a scar fabric.However, there are no correlations of the number of fibrous changes in the prostate with the presence of complaints.With age, the chances of the appearance of such “scars” in the organ are increasing, but a man can live all his life, without feeling any discomfort in the crotch or pubic area.Nevertheless, as soon as these changes are found on an ultrasound, some “specialists” will diagnose prostatitis.And some men will have the feeling that they are really seriously ill, begin to listen to themselves, feel all the symptoms described on the Internet.
For many men over the age of 30, ultrasound can show diffuse changes in the prostate gland.However, the fibrous process does not indicate the presence of prostatitis.
The diagnosis of chronic prostatitis is established on the basis of the exclusion of other diseases of the genitourinary system - primarily urethritis, prostate hyperplasia, urethra stricture, neurogenic disorders of urination, prostate cancer, and bladder cancer.
There is no specific picture for chronic prostatitis based on the results of a routine examination.
Treatment of chronic prostatitis
Antibiotics of the phthikinolone group are optimal antimicrobial drugs for the treatment of chronic bacterial prostatitis.The recommended course of antibacterial therapy is from 4 to 6 weeks.Such a long course is justified by scientific data indicating a decrease in the probability of relapse of the disease.
If sexually transmitted infections (STIs), such as chlamydia, are prescribed an antibiotic group of macrolide groups.
There are data on a decrease in the relaxation of the neck of the bladder in patients with chronic prostatitis, which leads to reflux urine into the ducts in the urethra and causes inflammation of the tissue of prostate and pain.Such patients are recommended by the appointment of alpha-blockers.
In the treatment of chronic prostatitis, it is advisable for patients to refrain from tempting sentences for the use of herbal medicine.A feature of dietary supplements and plant additives is the instability of plant components in a portion of matter, they may differ even in the drug of the same manufacturer.In addition, from the point of view of evidence -based medicine, the benefits of herbal medicine do not withstand criticism.
Prostate massage, which in the middle of the 20th century was used as the basis of therapy, today, thanks to new scientific approaches and classification, remains an important tool for diagnosing prostatitis, but not its treatment.You do not need to use the prostate massage as a therapeutic procedure (the effect is not proven).There are assumptions that frequent ejaculation in its properties is similar to the sessions of the therapeutic massage of the prostate.
To other methods whose effectiveness has been proven as a result of just one or more studies or is still being studied: relate:
- Pilling bottom muscle training - some data indicate the effectiveness of special exercises to reduce symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- acupuncture - a small amount of studies indicates the advantage of acupuncture compared to placebo in patients with chronic prostatitis;
- Extracorporeal shock wave therapy-based on the effects of acoustic impulses of significant amplitude on connective and bone tissue, is widely used in the treatment of diseases of the musculoskeletal system, recently used in urology, its effectiveness is under study;
- Behavioral therapy and psychological support - since chronic prostatitis is associated with low quality of life and the development of depression, these methods can improve the patient’s psychological state and help reduce some symptoms of the disease.
Separately, it is worth mentioningAsymptomatic (asymptomatic) chronic prostatitis.The diagnosis is most often established according to the results of histological conclusion - after the performed biopsy of the prostate gland or after surgical treatment of the prostate.The frequency of detection of inflammation in the tissues of the prostate varies from 44% (with prostate biopsy) to 98-100% (after surgical treatment of the prostate).Scientists have suggested that inflammatory changes revealed in this way are nothing more than an age -related physiological feature.No one is engaged in specially diagnostics of this category of prostatitis, this is a kind of random find.It does not need treatment, it does not require any further action by the doctor and the patient.