Prostatitis of this category occurs rarely, in about 10% of all cases of prostatitis. The question of whether atypical pathogens, such as ureaplasma urealiticum, can cause inflammation of the prostate is under discussion. They can be present in a man's body without any signs of inflammation or disorder.
Causes of chronic prostatitis
The causes of chronic prostatitis are substantially similar to the causes of acute bacterial prostatitis. The entry of microorganisms into the prostate in most cases occurs through the urethra, following the reflux of urine into the ducts of the prostate gland (intraprostatic urinary reflux).
Chronic bacterial prostatitis develops due to inadequate treatment or a short course of 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 series 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 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 maintaining erection.
According to many authoritative urologists, erectile dysfunction in patients suffering from chronic prostatitis is caused by psychogenic and neurotic problems.
Diagnostics
For the initial evaluation, the NIH-CPSI questionnaire is used: the Chronic Prostatitis Symptom Index. It can be used to objectify patient complaints.
The standard method for diagnosing prostatitis is to perform a 4-cup Meares-Stamey test. This is a microscopic and bacteriological study of urine samples obtained from different parts of the genitourinary tract and prostate secretions. However, the 4-glass sample method is quite laborious, and at the moment modifications of Meares-Stamey samples are most often used: 3- or 2-glass sample. A possible alternative is to subject the ejaculate (sperm) to microscopic and bacteriological examination, since the ejaculate is partially made up (at least 1/3) of prostatic secretion. This method is more convenient for patients, especially if they categorically refuse rectal examination or diagnostic massage of the prostate to obtain prostatic secretions. However, ejaculate donation has lower information content and reliability than a 3 or 2 drink sample.
The presentation of ejaculate for 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, spermiogram and other general clinical tests) in case of chronic prostatitis are not informative. Most likely, these tests will come back "normal. "
During rectal examination, changes indicating an inflammatory process in the prostate are not always observed in patients with chronic prostatitis. That is, it is impossible to rely on the result of a rectal examination to diagnose chronic prostatitis.
The same goes for ultrasound diagnostics: it is wrong to diagnose chronic prostatitis based only on ultrasound data.The European and American Association of Urology does not recommend ultrasound to diagnose prostatitis. The type of execution in this case is not important: 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 examination. Only the urologist has the prerogative to establish this diagnosis, who determines it on the basis of complaints, anamnesis, laboratory tests and - only after - ultrasound.
The most common ultrasound sign by which the diagnosis of chronic prostatitis is made are the so-called diffuse changes in the prostate gland associated with an inflammatory process or other changes in the prostate parenchyma. This is a kind 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 disorders. With age, the chances of such "scars" appearing in the organ increase, but a man can live his whole life without feeling any discomfort in the perineum or pubic area. However, as soon as these changes are detected via an ultrasound, some "specialists" will diagnose prostatitis. And some men will have the feeling that they are really seriously ill, they will begin to listen to themselves and feel all the symptoms described on the Internet.
In many men over the age of 30, ultrasound may show widespread changes in the prostate gland. 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 stricture, neurogenic disorders of urination, prostate cancer, bladder cancer.
There is no specific picture of chronic prostatitis based on the results of routine tests.
Treatment of chronic prostatitis
Antibiotics from the fluoroquinolone group are the optimal antimicrobial drugs for the treatment of chronic bacterial prostatitis. The recommended course of antibiotic therapy lasts 4 to 6 weeks. Such a long journey is justified by scientific data which indicates a decrease in the probability of relapse of the disease.
For sexually transmitted infections (STIs), such as Chlamydia trachomatis, a macrolide antibiotic is prescribed. They are the most effective.
There is evidence of reduced relaxation of the bladder neck in patients with chronic prostatitis, which leads to reflux of urine into the prostatic ducts into the urethra and causes inflammation of the prostatic tissue and pain. For such patients, alpha-blockers are recommended.
In the treatment of chronic prostatitis, it is advisable for patients to refrain from tempting offers to use herbal medicine. A feature of dietary supplements and herbal supplements is the instability of plant components in a portion 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 mid-20th century was used as a therapeutic basis, today, thanks to new scientific approaches and the Meares-Stamey classification, remains an important tool for the diagnosis of prostatitis, but not for its treatment.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 only been shown to be effective in one or a few studies or are still being studied include:
- pelvic floor muscle training: some evidence suggests the effectiveness of special exercises to reduce the 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 being studied ;
- behavioral therapy and psychological support: since chronic prostatitis is associated with a 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.
This is worth mentioning separatelyasymptomatic (asymptomatic) chronic prostatitis.. The diagnosis is often made based on the results of a histological report - after a biopsy of the prostate gland 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 identified in this way are nothing more than an age-related physiological feature. No one specifically diagnoses this category of prostatitis; it's kind of a chance discovery. It does not require treatment and does not require any further intervention by the doctor or the patient.
How is chronic prostatitis treated in a specialized clinic?
In the last 10 years in our country, 47 monographs have been published and 64 master's and doctoral theses on prostatitis have been defended. Not to mention the various "popular" publications that colorfully describe the causes, diagnosis and various methods of treatment of the disease. What does this mean? The fact is that the topic of prostatitis raises many questions and some, unfortunately, still do not have a clear answer. There are numerous modern drugs whose effect has been proven. However, the number of patients diagnosed with chronic prostatitis does not decrease.
That's why, when diagnosing and treating prostatitis, urologists try to get the most complete picture. 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 - since this can provoke the occurrence of characteristic manifestations. At the same time, unnecessary tests and studies are not prescribed.