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Prostatitis

Prostatis is inflammation of the prostate gland (organ of the sex and reproductive system of a man) and the change as a result of this process of its physiological functions.

Symptoms-prostatitis-u-male

Spreading

According to various sources, prostatitis occurs in 35-40 %, and according to some authors, 70 % of men aged 18 to 50 years. The representative gland in the prevalence of the disease and a set of problems that occur at the same time occupies a leading place among urological pathology.

Classification

There are many classifications of prostatitis, hence a very peculiar terminology.The most common is the classification of prostatitis proposed by the US National Institute of Health (NIH) in 1995:

Category Description
Category I Acute bacterial prostatitis
Category II Chronic bacterial prostatitis
Category III Chronic abacterial prostatitis
Category IIia Inflammatory chronic pelvic pain syndrome
Category IIIB Syndrome of non -inflammatory chronic pelvic pain (prostatinia)
Category IV Sinimptomatic inflammatory prostatitis

This classification of prostatitis is based on clinical signs, the presence or absence of leukocytes and microorganisms in the secret of prostate, ejaculate and urine.

Category I

Acute bacterial prostatitisIt is expressed by acute infectious inflammation of the prostate gland with all related signs:

  • increased amount of leukocytes in the urine;
  • the presence of bacteria in the urine;
  • common signs of infection (increase in body temperature, symptoms of intoxication).

Category II

Chronic bacterial prostatitis- It is accompanied by appropriate symptoms and an increase in the number of leukocytes and bacteria in the secret of prostate, ejaculate and urine obtained after prostate massage.

Category III

Chronic pelvic pain syndrome (KTR)- The leading clinical symptom is the pain syndrome for more than 3 months in the absence of pathogenic microorganisms in the secret of the prostate, ejaculate and urine obtained after the prostate massage. The separation of the III A and III B is the presence of an increased number of leukocytes.

Category III A

Inflammatory chronic pelvic pain syndrome- is characterized by the presence of pain and prostatitis symptoms, and an increased amount of leukocytes is noted in the secretion of the prostate, ejaculate and portions of urine, after prostate massage, pathogenic microorganisms are not detected in these samples.

Category III b

Non -inflammatory syndrome of chronic pelvic pain- characterized by the presence of pain syndrome and symptoms of prostatitis, while there is no increase in the number of leukocytes and are not detected by standard methods of pathogenic microorganisms in the secret of the prostate, ejaculate and urine obtained after prostate massage.

Category IV

Sinimptomatic inflammatory prostatitis- the absence of symptoms characteristic of prostatitis, the disease is detected by accident during a histological examination of prostate tissue samples obtained in connection with diagnosis for other reasons (for example, conducting a prostate biopsy due to an increase in the level of a specific antigen - PSA).

Diagnosis of prostatitis

Symptoms of prostatitis are extremely diverse, but they can be combined into several groups.

Pain syndrome

As a result of insufficient supply of blood caused by inflammation or spasm of blood vessels feeding the prostate, oxygen starvation of the gland tissue is noted, as a result of which the by -products of pathological oxidation are formed that affect the nerve endings of the prostate.Since the prostate innervation is associated with the innervation of the pelvic floor, penis, scrotum, testicles, rectum - the localization of pain is variable.The following pain symptoms are most common:

  • Discomfort or pain in the perineum - basically appears after physical exertion, sexual intercourse, alcohol taking in the form of passing attacks;
  • Sensation of hot potatoes in the rectum;
  • Pain (discomfort) in testicles - patients are described as “ache”, “twisting”, are also associated with various provoking factors;
  • Discomfort, rubber and pain in the urethra - are mainly associated with the shift of the pH of the secret of the prostate in the acidic side.The sour secret of the prostate irritably acts on the mucous membrane of the urethra, so pain, more often in the form of a “burning”, occur after an act of urination or sexual intercourse, when part of the secret when reducing the muscles of the gland and the pelvis is squeezed into the lumen of the urethra.

Urination disorders syndrome

Associated with the close innervation of the prostate and bladder, as well as the participation of the prostate muscles in the act of urination.Dysuria can be accompanied by the following manifestations:

  • Far urination - frequent urination (happens up to 3 times per hour) with sharp and sudden calls (impossible to endure) and rather small portions;
  • A sense of incomplete emptying of the bladder - after the act of urination, it feels that urine remained in the bladder;
  • A weak or intermittent stream of urine - this can also be attributed to the symptom of the “last drop” - despite all the efforts of the patient after the act of urination from the canal, a drop of urine is still released.

Violation of ejaculation and orgasm

It is associated with damage to the prostatitis of the seed tubercle (colliculite) on the surface of which are nervous receptors that send the signal to the structures of the brain, where the feeling of orgasm is formed.Prostatitis does not directly cause an erection (blood supply to the penis during sexual arousal).

Main disorders:

  • Premature ejaculation or vice versa excessively protracted sexual intercourse - caused by inflammation of the seminal tubercle or its scarring due to the inflammatory process;
  • Erased orgasm - is also associated with the inflammation of the seed tubercle;
  • Pain during ejaculation - associated with the inflammatory process in the output ducts of the prostate through which sperm is released.

Violation of fertility

When changing the properties of the prostate, as a result of inflammation, the following changes in sperm are observed, reducing the man's ability to fertilize (fertility):

  • A decrease in the pH of sperm in the acidic side - since with inflammation of the prostate, acidic products of pathological oxidation begin to accumulate in secret.The acidic environment is extremely destructive for sperm causing their immobilization and even death;
  • Anglutination of sperm - gluing spermatozoa mainly with heads - is associated with a change in the physicochemical properties of secretions;
  • Asthenospermia - a decrease in sperm mobility - is closely connected with the shift of the pH in the acidic side and with a violation of the production of prostate lecitin carts, which ensure the vital activity of spermatozoa.

Urethropostatitis

In some cases, prostatitis is combined with chronic urethritis, which is manifested by meager mucous-inflammatory discharge from the urethra (mainly after a prolonged urinary retention).

Prostatitis and sexual disorders

The question "Does prostatitis cause impotence?"It is the cause of the disputes of specialists for decades.

Under the influence of sexual stimuli, with the full-fledged saturation of the body androgens in the formations of the cortical and subcortical region of the brain, a nervous signal occurs, transmitted to the center of an erection located in the spinal cord, from where it comes to the smooth muscles of the formations of the cavernous bodies of the penis, which either relax (arteries and sinusoids)(veins).In this process there is no role of the prostate gland.

Ejaculation and orgasm occurs with sufficient irritation of special receptor cells that are located in the area of the seminal tubercle into which the outlet ducts of the prostate flows, the same receptors are responsible for the departure of the nerve impulse to the cerebral cortex where the sensation of orgasm is formed.

The inflammatory process in the prostate gland (prostatitis) can lead to the defeat of the seed tubercle and, as a result, as a violations of a man’s potency, so premature ejaculation and echoing orgasm.Impotence in chronic prostatitis is pathogenetically associated with the degree of damage to the nerve apparatus of the prostate gland.This form of impotence (neuroreceptor impotence) is a characteristic example of a repercussive phenomenon, when the presence of pathological impulsation with the organs affected by the inflammatory process leads to irradiation of the excitation process that controls the sexual function and to the disorder of the latter.A certain, although not leading, role is played in the pathogenesis of neuroreceptor impotence, also some suppression of the androgenic activity of the testicles and sensitivity to the androgens of the centers of the hypothalamus and the pituitary gland.

At the same time, there is an opinion that in the Russian Federation there are both hyperdiagnosis of prostatitis and the reassignment of its role in the development of erectile dysfunction.

Diagnostics

The task of the doctor is to detect the inflammatory process in the prostate, the identification of the possible pathogen of the disease and the assessment of impaired function of the prostate gland.In 1990, Stamey wrote that prostatitis is a “garbage basket for clinical ignorance” due to the variety of terms used, diagnostic and treatment methods.At the same time, several simple and clinical and laboratory tests make it possible to correctly make a diagnosis, which allows you to start the appropriate therapy.

Putic rectal survey of the prostate gland

A very informative way.The inflammatory process can be judged by evaluating the shape, contours, dimensions of the gland, the presence of foci of compaction and (or) softening, pain.The main signs of prostatitis: increase or decrease in size, heterogeneity of consistency, the presence of foci of compaction and softening, pastability, pain.The fact that 80% of pancreatic cancer is detected through a rectal study speaks for itself.We can safely say that this research method will always be used.

Microscopic examination of the secretion of pancreas

It should be remembered that an increase in the number of leukocytes in secret does not always indicate prostatitis, becauseMethods of obtaining a secret during massage do not guarantee that the contents of the urethra and seed bubbles will not fall into it.At the same time, with obvious signs of prostatitis, the secret of the prostate can be normal.This is explained by the foci of inflammation, the presence of part of the expounded, or closed, output ducts.

Study of the secretion of the prostate gland

Expressed Prostatic Secretions-Eps) Secret Studies allows you to determine the presence of an inflammatory process in the prostate gland and partly its functional ability.It is the main method of diagnosing and monitoring the treatment of chronic prostatitis.The secret of prostate can be examined using light microscopy without painting or using special staining methods.Also, the secret of the prostate gland can be subjected to a bacteriological examination or examination by the method of polymerase chain reaction for the detection of pathogens in it.Get a secret with prostate massage.A secret released from the urethra is collected in a sterile test tube or on a clean object glass for research.Sometimes the secret of the prostate gland from the urethra does not follow.In such cases, the patient is recommended to immediately get on his feet.If, nevertheless, it was not possible to get a secret, more often this means that he did not get into the urethra, but in the bladder.In this case, the centrifugate of the washing fluid released from the bladder after massage of the prostate gland is examined.

  • Lipoid grains (lecitin bodies) - a specific product of normal physiological secretion of the glandular epithelium of the prostate gland.Gives a secret a milk look.Normally, the secret is rich in lecitin grains.A decrease in their number, along with an increase in the number of leukocytes, indicates an inflammatory process, a tumor;
  • Amyloid bodies - layered (starchy), body, which with a solution of Lugol are stained in purple or blue, like starch;
  • The amyloid bodies are a condensed secret of the gland, has an oval shape and a layer structure, resembling a tree trunk.They are not normal, their detection indicates a stagnation of the secret in the gland, which can be with adenomas, chronic inflammatory processes;
  • Erythrocytes can be single.They fall into a secret as a result of energetic massage of the prostate gland.Their increased amount is observed in inflammatory processes, neoplasms.
  • The descending of the epithelium in large quantities is observed at the beginning of inflammatory processes and with tumors, then often there is disability with protein and fatty degeneration of epithelial cells.Macrophages can be seen with a stagnation of a secret, for a long time of the current inflammatory process;
  • Betthera crystals are a day crystals formed during cooling and drying the mixed secret of the male gonads (prostatic juice with a sperm admixture) from spermine and phosphoric -layer salt.With azoospermia and sharply expressed oligozoospermia, Betthera crystals form quickly and in large quantities;
  • Redeational syndrome - stagnation syndrome is observed with gland adenoma.There is an abundance of macrophages, there are multi -core cells such as foreign bodies and amyloid bodies;
  • The symptom of fern is a symptom of crystallization of a secret -a form of falling crystals of sodium chloride depends on the physicochemical properties of the prostate secret.The study of the symptom is carried out by adding a drop of 0.9% sodium solution of chloride to the resulting secret of the prostate with further viewing after drying under a light microscope.In healthy men of reproductive age, crystallization of the prostate secret is characterized by a typical phenomenon of fern leaf (3+).Androgenic failure or the presence of prostatitis give various degrees of violation of the structure of crystals up to their absence.

Bacteriological studies of portions of urine and secretion of pancreas

Urethra smear, including PCR diagnostics

Serological diagnosis of agents (ELISA) that cause urinary tract infections

The reaction of immunofluorescence (reef) is straight and indirect

Identification of antibodies to well -known antigens.

Determination of the PSA (prostate -specific antigen) of blood serum

The American foundation for urological diseases recommends the annual passage of a rectal survey of the prostate gland, accompanied by a PSA for all men over the age of 50, and with a prostate cancer for blood relatives according to a male line.There is still a discussion about obtaining a dog immediately after a finger examination of the prostate gland Per Rectum.Recent studies could not confirm the presence of a significant increase in the content of the PSA immediately after a finger examination.Thus, the level of the PSA can be determined with the receipt of reliable results and after the survey of the pancreas.

Four -walled test

In order to diagnose chronic prostatitis, a 4-glass test was proposed, based on a comparative bacteriological assessment of the urine, approximately equal in terms of portion of urine, obtained before and after massage of the prostate gland, as well as its secret.

The diagnosis of prostatitis is established with a tenfold increase in the concentration of microorganisms in the secret of the prostate compared to their content in the urine (1, 2 and 3 portions) and an increase in the number of polymorphic-nuclear leukocytes> 10-16 in the field of view of the light microscope (increase by 200 times).Or an increase in the number of leukocytes of more than 300x106/l when calculating them in the counting chamber.Lecitine bodies, which are a product of the normal secretion of the glandular epithelium of the prostate gland, should densely cover the field of vision of the microscope (5-10 million in 1 ml).Amyloid bodies in the secret of prostate are found in a significantly smaller quantity.In men of mature age, they can be found 1-2 in the field of view.

Biochemical blood test

Immunological and hormonal profile (according to indications).

Ultrasound, Trusie

Ultrasound diagnosis of prostatitis by the abdominal and transrectal sensor (Trust).

Urofloometry

Treatment of prostatitis

Comprehensive treatment of patients with chronic prostatitis should include:

  • compliance with the general regime, diet, sexual sex hygiene, as well as attracting sexual partners in the presence of an infectious agent;
  • selection of effective drugs to suppress infection;
  • increasing the general reactivity of the body of the patient and immunobiological tolerance of microorganisms to drugs;
  • strengthening the outflow of secretion and activation of local reparative processes in the focus of inflammation;
  • sanitation of foci of infection in the previous and remote organs;
  • improvement of microcirculation in the prostate gland and pelvic organs;
  • the appointment of general strengthening funds, enzymes and vitamins;
  • Correction of hormonal disorders;
  • the appointment of antispasmodics;
  • the appointment of analgesic and anti -inflammatory drugs;
  • taking sedative and transforming drugs;
  • regulation of neurotrophic disorders by local analysting drugs;

Prostate massage

Prostate massage- A medical procedure that is used in order to diagnose and sometimes treat chronic prostatitis. The first massage of the prostate was described by Posner in 1893, and since 1936 it was widely introduced into the urological practice of O'Conory.However, in 1968, after the description of MEARES and StAMEY, a stage test for the diagnosis of prostatitis, the views on the causes of this disease changed and massage as a therapeutic procedure was crossed out of the lists of measures in many guidelines for the treatment of prostatitis in developed countries of the world.

But from the middle of the 90s of the 20th century, many doctors involved in the diagnosis and treatment of prostatitis began to note the inefficiency in some cases of proposed antibacterial therapy and the use of alpha-blockers, which led them to use in the practice of this forgotten method.

Basically, prostate massage is currently used as a diagnostic procedure for obtaining a prostate secretion (Expressed Prostatic Secretions -eps) - for its microscopic (cultural) study and for the pre- and after the massage test (Pre- and postmassage test -ppmt).massage.Massage is a medical procedure and must perform it a previously trained specialist.Massage is performed after urination, and when discharge from the urethra after its preliminary washing with an isotonic solution of sodium chloride, which is especially necessary in cases where a bacteriological examination of the secret is assumed.Prostate massage is performed through the anus, since the prostate gland is close to the rectum ampoule and only there is available for research.First, they massage one, then the other proportion of the prostate gland with the movements of the finger from the periphery to the central groove along the output ducts, trying not to touch the seed bubbles.The massage is completed by pressing on the area of the central furrow from above.A secret released from the urethra is collected in a sterile test tube or on a clean object glass for research.Sometimes the secret of the prostate gland from the urethra does not follow.In such cases, the patient is recommended to immediately get to his feet if it was not possible to get the secret, this means that he was not in the urethra, but in the bladder.In this case, the centrifugate of the washing fluid released from the bladder after massage of the prostate gland is examined.

Prostate massage for medical purposes (repetitic massage) is officially recommended by the Russian Federation of the Russian Federation as a therapeutic procedure for chronic prostatitis.Prostate massage is widely used for the treatment of prostatitis in the countries of Southeast Asia, China, and some countries of Europe.Some Severmerican and Canadian urologists also recommend the use of massage in combination with antibiotic therapy in the treatment of some forms of prostatitis.In essence, the assessment of the effectiveness or inefficiency of massage of the prostate was practically not carried out.There are several contradictory studies, in one, conducted by Egyptian doctors, there were no differences in groups of patients, some of which were massage in combination with antibiotic therapy and simply antibiotic therapy, in another, conducted by American and Phillipine researchers, on the contrary, in a group of patients with prostatitis, which received a combination of antibiotic therapy was notedSignificant improvement.

Supporters of the use of massage for therapeutic purposes believe that the main effect of its use is the drainage of the prostate ducts - i.e.their release from purulent and dead cells.Another effect is an increase in blood flow in the prostate gland, which improves the penetration of antibiotics into it and activates local protective immunological processes.

In the world literature there is little data on complications related to prostate massage.In 1990, Japanese doctors described the genital organs (Fournier), and in 2003, German doctors were permanent hemorrhage after a prostate massage with the development of embolistic stroke (hemorrhage) of the lungs.There is a study that after the massage the level of PSA (prostatospecific antigen) temporarily increases.Massage is contraindicated in acute inflammation of the prostate gland (acute prostatitis), with acute urethritis, orchitis, prostate cancer.Massage is not recommended for prostate calcinates and prostate adenoma. It is generally recommended that the prostate massage is recommended 2 or 3 times a week.

Physiotherapeutic procedures

Any physiotherapeutic procedures (prostate massage, warming, etc.) in acute prostatitis are contraindicated.

The use of physiotherapeutic procedures in the complex treatment of prostatitis aims to both directly effect on the prostate gland of physical agents in order to normalize functional and pathological changes, as well as electrophoretic administration of drugs into the tissue of the prostate.

The use of physiotherapeutic methods against the background of drug therapy gives a much better result than in treatment separately.The following methods of influencing the prostate gland have become widespread and proved their effectiveness:

  • shock-wave therapy;
  • electrical stimulation of the pancreas with modulated currents with tid or rectal electrodes;
  • thermotherapy in various versions (including high -frequency thermotherapy);
  • magnetotherapy;
  • microwave microwave technology;
  • Laser therapy.
  • transrectal ultrasonic therapy and phonophoresis;
  • Microclisms.