Prostatitis in this category is rare, occurring in approximately 10% of all prostatitis cases. The question is whether atypical pathogens, such as ureaplasma urealiticum, can cause prostate inflammation. They can be present in a man's body without any signs of inflammation or complaints.
Causes of chronic prostatitis
The causes of chronic prostatitis are basically similar to those of acute bacterial prostatitis. The entry of microorganisms into the prostate occurs in most cases through the urethra - as a result of urinary reflux into the prostate ducts (intraprostatic urinary reflux).
Chronic bacterial prostatitis develops as a result of inadequate treatment or short-term treatment for acute bacterial prostatitis.
Symptoms
- Discomfort or pain - in the perineum, lower abdomen, groin, scrotum, penis, during ejaculation
- Changes in urination - difficulty urinating, frequent urination in small portions, feeling of incomplete emptying of the bladder.
The patient may complain of a number of symptoms or any symptom individually. An increase in body temperature is unusual (or insignificant).
Important:
Many men associate erectile dysfunction with prostatitis. This is often facilitated by unprofessional publications in the media and advertising of dubious drugs. The fact that an erection can persist even with complete removal of the prostate (due to the presence of a malignant tumor of the organ) suggests that it itself does not play a role in maintainingan erection.
According to many authoritative urologists, erectile dysfunction in patients with chronic prostatitis is caused by psychogenic and neurotic problems.
Diagnostic
For the initial assessment, the NIH-CPSI questionnaire is used - the Chronic Prostatitis Symptom Index. It can be used to objectify the patient's complaints.
The standard method for diagnosing prostatitis is to perform a Meares-Stamey 4-cup test. It is a microscopic and bacteriological study of urine samples obtained from different parts of the genitourinary tract and prostate secretions. However, the 4-glass sampling method is labor-intensive, and at present, modifications of the Meares-Stamey samples are more often used: 3-glass or 2-glass sample. A possible alternative is to subject the ejaculate (semen) to microscopic and bacteriological examination, because the ejaculate is partially (at least 1/3) made up of prostatic secretions. This method is more comfortable for patients, especially if they categorically refuse a rectal examination or a diagnostic prostate massage in order to obtain prostate secretions. However, ejaculate donation has lower information content and reliability than a 3- or 2-drink sample.
Submission of ejaculate to bacteriological examination is included in the diagnostic algorithm for infections of the male genital organs and when examining a man for infertility.
The results of laboratory tests (general urine test, general blood test, biochemical blood test, spermogram and other general clinical tests) in chronic prostatitis are not informative. Most likely, these tests will show "normal. "
During a digital rectal examination, changes indicating an inflammatory process in the prostate are not always observed in patients with chronic prostatitis. In other words, it is impossible to rely on the result of a digital rectal exam to diagnose chronic prostatitis.
The same goes for ultrasound diagnosis: it is incorrect to diagnose chronic prostatitis based on ultrasound data alone.The European and American Association of Urology does not recommend ultrasound to diagnose prostatitis. The type of execution in this case does not matter - transabdominal (through the anterior abdominal wall - lower abdomen) or transrectal (TRUS - through the rectum). It is incorrect to write "chronic prostatitis", "ultrasound signs of chronic prostatitis", "signs of congestive prostatitis" in the conclusion of an ultrasound scan. Only a urologist has the prerogative to establish this diagnosis, who determines it on the basis of complaints, anamnesis, laboratory analyzes and - only afterwards - an ultrasound scan.
The most common ultrasound sign for making the diagnosis of chronic prostatitis is the so-called diffuse changes in the prostate gland associated with an inflammatory process or other changes in the prostate parenchyma. This is a type of fibrotic process, the replacement of normal prostate parenchyma with scar tissue. Howeverthere is no correlation between the number of fibrous changes in the prostate and the presence of complaints. With age, the chances of such "scars" appearing in the organ increase, but a man can live his entire life without feeling any discomfort in the perineum or pubis area. However, as soon as these changes are detected on ultrasound, some "specialists" will diagnose prostatitis. And some men will feel that they are really seriously ill, they will begin to listen to themselves and will experience all the symptoms described on the Internet.
In many men over 30, ultrasound can reveal diffuse changes in the prostate. However, the fibrotic 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 - mainly urethritis, prostatic hyperplasia, urethral stenosis, neurogenic urination disorders, prostate cancer, bladder cancer.
There is no specific picture of chronic prostatitis based on the results of routine examination.
Treatment of chronic prostatitis
Antibiotics from the fluoroquinolone group are the optimal antimicrobial drugs for the treatment of chronic bacterial prostatitis. The recommended duration of antibiotic treatment is 4 to 6 weeks. Such a long course is justified by scientific data indicating a reduction in the risk of relapse of the disease.
For detected sexually transmitted infections (STIs), such as chlamydia trachomatis, a macrolide antibiotic is prescribed. These are the most effective.
There is evidence of decreased bladder neck relaxation in patients with chronic prostatitis, which leads to reflux of urine into the prostate ducts of the urethra and causes inflammation of the prostate tissue and pain. For these patients, alpha-blockers are recommended.
When treating chronic prostatitis, patients are advised to refrain from tempting offers to use medicinal plants. A feature of dietary supplements and herbal supplements is the instability of plant components in part of the substance; they may differ even in the preparation of the same manufacturer. Furthermore, from the point of view of evidence-based medicine, the benefits of herbal medicine do not stand up to criticism.
Prostate massage, which in the middle of the 20th century was used as a therapeutic basis, remains today, thanks to new scientific approaches and the Meares-Stamey classification, an important tool for the diagnosis of prostatitis, but not for itstreatment.It is not necessary to use prostate massage as a therapeutic procedure (the effect has not been proven).There are suggestions that frequent ejaculation has similar properties to therapeutic prostate massage sessions.
Other methods that have been shown to be effective in only one or a few studies or are still under investigation include:
- pelvic floor muscle training: some evidence suggests the effectiveness of special exercises in reducing symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- acupuncture – a small number of studies indicate a benefit of acupuncture compared to placebo in patients with chronic prostatitis;
- extracorporeal shock wave therapy - based on the impact of acoustic pulses of significant amplitude on connective and bone tissue, widely used in the treatment of diseases of the musculoskeletal system, recently used in urology, its effectiveness is at l'study ;
- behavioral therapy and psychological support - since chronic prostatitis is associated with poor quality of life and the development of depression, these methods can improve the psychological state of the patient and help reduce some symptoms of the disease.
It is worth mentioning separatelychronic asymptomatic prostatitis (asymptomatic). The diagnosis is most often made based on the results of a histological report - after a prostate biopsy or after surgical treatment of the prostate. The frequency of detection of inflammation in prostate tissue varies from 44% (with prostate biopsy) to 98-100% (after surgical treatment of the prostate). Scientists have suggested that the inflammatory changes thus identified are nothing more than an age-related physiological characteristic. No one specifically diagnoses this category of prostatitis, it's a kind of accidental discovery. It does not require any treatment and does not require any other action on the part of the doctor or patient.
How is chronic prostatitis treated in a specialized clinic?
Over the past 10 years, 47 monographs have been published in our country and 64 master's and doctoral dissertations on prostatitis have been defended. Not to mention the various "popular" publications, which colorfully describe the causes, diagnosis and different methods of treatment of the disease. What does that mean? The fact that the topic of prostatitis raises many questions and some, unfortunately, still do not have a clear answer. There are a large number of modern drugs whose effect is proven. However, the number of patients diagnosed with chronic prostatitis is not decreasing.
That is why, when diagnosing and treating prostatitis, urologists try to obtain the most complete picture possible. They question the patient in detail about signs and symptoms, study the results of previous examinations and pay attention not only to the clinical signs of the disease, but also to other aspects of health, including the neurological and psychological state of the patient. patient - as this can provoke the appearance of characteristic manifestations. At the same time, no unnecessary tests and studies are prescribed.