Sharp prostatitis – the infectious and inflammatory damage of a prostate gland which is followed by hypostasis and formation of the purulent centers in prostate tissues. Displays of sharp prostatitis depend on a stage (catarrhal, follicular, parenchymatous, abstsediruyushchy) and can include dizurichesky frustration, crotch pains, fever, intoxication. Diagnostics is based on the given palpation of a prostate, ultrasonography and a dopplerometriya of a prostate gland, the research separated an urethra and a secret of a prostate. Treatment of sharp prostatitis includes purpose of antimicrobic therapy, NPVS, spazmolitik, analgetics, immunomodulators, physical therapy.
Sharp and chronic prostatitis are the most widespread and socially important male diseases. In clinical urology prostatitis is diagnosed for 30-58% of the men who are in reproductive and working-age (30-50 years). The course of sharp prostatitis is followed by disorders of sexual function and fertility, violations of a psychoemotional state and social disadaptation.
Reasons of sharp prostatitis
As causative agents of sharp prostatitis the nonspecific infectious agents getting into prostate tissues – gramotritsatelny (colibacillus, a klebsiyella, proteas) or grampolozhitelny mainly act (staphylococcus, enterokokk, streptococci). Quite often sharp prostatitis can be caused by causative agents of urogenital infections – clamidiosis, trichomoniasis, ureaplasmosis, gonorrhea, mycoplasmosis, candidiasis, etc.
Most often penetration of microbic agents into tissues of a prostate happens in the transkanalikulyarny way – through the output channels of gland opening in a wall of a back urethra. Therefore uretrit any genesis very often is complicated by sharp prostatitis. Less often microbic flora gets into a prostate from a bladder at sharp cystitis. Introduction of activators in gland is significantly facilitated with the increased intra urethral pressure (striktura, urethra stones), carrying out endourethral manipulations (a buzhirovaniya of an urethra, a kateterization of a bladder, an uretroskopiya, a tsistoskopiya etc.).
Besides, sharp prostatitis can be a consequence of hematogenic penetration of an infection that is promoted by conditions of blood supply of a prostate with widely developed system of arterial and venous anastomoz. At a hematogenic drift microbes can get to prostate tissues from the remote purulent centers at tonsillitis, sinusitis, caries, cholecystitis, bronchitis, a piodermiya, etc. Perhaps limfogenny infection of a prostate gland from intestines at anal cracks, proktita, colitis.
Carry the resistant kongestivny (stagnant) phenomena in veins of a basin to the noninfectious factors promoting development of sharp prostatitis and violation of drainage of atsinus of a prostate. Kongestiya can be called by a dizaritmiya of sex life and sexual violations – practice of the interrupted sexual intercourse, absence or an irregularity of sex life, excessive sexual activity, etc. Pathological deposition of blood in the venous course of a small pelvis can be noted at an inactive way of life, frequent locks, overcooling, chronic (generally alcoholic) intoxication, varicosity of veins of a basin.
Forms of sharp prostatitis
In development of sharp prostatitis allocate 3 forms which at the same time are its stages – catarrhal, follicular, parenchymatous, abstsediruyushchy.
Sharp prostatitis begins with a catarrhal inflammation – changes of a mucous and submucous layer of output channels of separate segments of gland. Further hypostasis of walls of channels promotes stagnation of a mucopurulent secret in follicles of a prostate and to progressing of an inflammation in this connection focal suppuration of segments – sharp follicular prostatitis can develop. At multiple defeat of segments and diffusion involvement of parenchymatous and interstitsialny tissue of prostate in pyoinflammatory process, sharp prostatitis passes into the following stage – parenchymatous. In case of merge of small abscesses in the large center prostate gland abscess which can be opened in an urethra, a crotch, a rectum or a bladder is formed.
Symptoms of sharp prostatitis
Clinical manifestations at sharp prostatitis correspond to process stages. As the general manifestations serve pain, violations of an urination and intoxication.
In a sharp catarrhal stage of prostatitis weight and crotch pain is felt. Dizurichesky frustration it is characterized by painful increase of an urination, especially at night. Body temperature remains within norm, can be slightly raised; intoxication is absent. At palpatorny survey the prostate is not changed or slightly increased, a little painful. The research of a secret of a prostate finds increase in leukocytes, a congestion of mucopurulent threads. In urine at depletion of output channels of atsinus leukocytes appear. Massage of a prostate is, as a rule, impossible in view of morbidity. The treatment begun in a catarrhal stage of sharp prostatitis leads to recovery in 7-10 days.
The follicular form of sharp prostatitis proceeds more brightly, being followed by the dull aching aches in a crotch irradiating in a penis, back pass or a sacrum. On this background the urination is painful and complicated, up to development of a sharp delay of urine. The act of defecation at sharp follicular prostatitis is also complicated because of the expressed pains. In view of temperature increase of a body to 38 °C the general state is broken. Palpatorno is defined by per rectum the increased, dense, intense, asymmetric prostate, sharply painful in certain sites at a manual research. The urine collected after gland palpation contains the leukocytes and purulent threads forming a muddy deposit in a large number. Performing massage for receiving a secret of a prostate in a follicular stage of sharp prostatitis is contraindicated. At vigorous treatment sharp follicular prostatitis can favorably be resolved; otherwise it passes into the following, parenchymatous stage.
The clinic of sharp parenchymatous prostatitis develops violently. The expressed hyperthermia (to 39-39,5 °C and above) from oznoba, the general weakness, appetite oppression, thirst is characteristic. In the beginning the urination is speeded sharply up and complicated, then can stop absolutely. Attempts of depletion of a bladder or intestines are followed by intensive pains. Painful tenezma, locks, a meteorizm develop. Pain extends to a rectum, has the pulsing character, forces the patient to adopt the compelled provision – lying with the drawn-in legs. At development of a jet inflammation of a rectum from back pass slime is emitted.
Palpatorno decides diffuzno increased, on indistinct contours of iron, extremely painful at the slightest touch. Massage of a prostate gland in a parenchymatous stage of sharp prostatitis is contraindicated categorically. Sometimes because of sharp hypostasis of pararectal cellulose and morbidity rectal examination does not manage to be conducted. In urine – sharply expressed leykotsittsriya, a piuriya. Permission of a disease, formation of abscess of a prostate or chronic prostatitis can serve as an outcome of sharp parenchymatous prostatitis.
Diagnosis of sharp prostatitis
Recognition and definition of a stage of sharp prostatitis is carried out by the urologist (andrologist) and is based on comprehensive fizikalny, laboratory and tool examination. The prostate research through a rectum allows to determine the sizes, a consistence, homogeneity, symmetry of gland; painful reaction, destruction centers, signs of purulent fusion of fabrics. Gland palpation at sharp prostatitis is carried out very carefully without rough pressing and the massing movements. In the received secret of a prostate increase in number of leukocytes and amyloid little bodies, decrease in amount of letsitinovy grains is found.
At sharp prostatitis the raised leykotsituriya in the third portion of urine and in the urine collected after a prostate palpation is noted. Allocation of the causative agent of sharp prostatitis requires carrying out a bakposev of urine and separated urethras with antibiotikogrammy, PTsR-researches of scrape, crops of blood on haemo culture. Character and weight of dizurichesky frustration at sharp prostatitis is estimated by means of an urofloumetriya.
Ultrasonography of a prostate gland at a moderate pain syndrome can be carried out transrektalno; in a case it is expressed to painful reaction – transabdominalno. Ekhoskopicheski is estimated a form, gland size, existence of focal or diffusion changes, the stage of sharp prostatitis is established. Use of a dopplerometriya allows to estimate in details and differentially a prostate vaskulyarization.
When planning surgical tactics concerning destructive forms of sharp prostatitis carrying out KT or MPT of a small pelvis is expedient.
Treatment of sharp prostatitis
The leading role in treatment of sharp prostatitis belongs to etiotropny therapy. Earlier appointment antimicrobic (antibacterial, antiviral, antitrikhomonadny, antimikotichesky) medicines is necessary for suppression of reproduction of microorganisms in iron and tissues of an urethra. For the purpose of reduction of spasms and morbidity of an urination appoint analgetics, spazmolitik, rectal candles with benzocaine or a belladonna, thermal microenemas. In complex therapy of sharp prostatitis NPVP, enzymes, immunomodulators, vitamins, infusions of solutions are used.
The physical therapy at sharp prostatitis is carried out after subsiding of sharp symptomatology. For the purpose of anti-inflammatory, antiedematous, soothing action, improvement of microcirculation and local immunity the rectal electrophoresis, UVCh-therapy, microwave therapy, massage of a prostate are applied. At sharp prostatitis observance of a bed rest, the sparing diet, sexual rest is shown.
At an urine delay against the background of sharp prostatitis carrying out a kateterization of a bladder avoid, giving preference to a troakarny tsistostomiya. At an abstsedirovaniye of a prostate gland there is a need of a surgical grant - opening and drainage of a cavity of abscess.
About an izlechennost of sharp prostatitis judge by restoration of structure of fabrics of glands and its functions, normalization of composition of juice of a prostate, elimination of the activators which caused an inflammation from biological liquids.
Forecast and prevention
As a rule, timely and reasonable etiotropny therapy leads to knocking over of symptoms of sharp prostatitis. Abstsedirovany prostates or synchronization of an inflammation it happens in the started cases.
Prevention of sharp prostatitis has to include sanitation of the infectious centers in an organism, carrying out endovezikalny and endourethral manipulations according to norms of an asepsis, timely treatment of STD and uretrit, normalization of sex life and physical activity.