Chronic prostatitis – the long inflammation of a prostate gland leading to violation of morphology and functioning of a prostate. Chronic prostatitis is shown by a pro-static triad – pain in the field of a basin and genitals, violations of an urination, sexual frustration. Diagnosis of chronic prostatitis includes gland palpation, a research of a secret of a prostate, ultrasonography, an urofloumetriya, an uretroskopiya, a punktsionny biopsy of a prostate gland. At chronic prostatitis complex drug, physiotherapeutic treatment, massage of a prostate gland, instillation of a back urethra is shown. Surgical treatment is expedient at the complicated forms of chronic prostatitis.
Chronic prostatitis – the most frequent male disease: about 50% of men suffer from this or that form of an inflammation of a prostate. Chronic prostatitis affects men aged from 20 up to 40 years which are in the period of the greatest sexual, reproductive and labor activity more often. In this regard identification and treatment of chronic prostatitis gets in urology not only medical, but also socially important aspect.
Classification of chronic prostatitis
According to the modern classification of prostatitis developed in 1995 mark out 3 categories of a disease:
- I. Sharp prostatitis.
- II. Chronic prostatitis of bacterial genesis.
- III. Chronic prostatitis of not bacterial genesis / Syndrome of chronic pelvic pain – the simptomokompleks which is not connected with obvious symptoms of an infection and proceeding of 3 and more months.
- III And – chronic prostatitis with existence of an inflammatory component (detection in a secret of a prostate of leukocytes and causative agents of an infection);
- The III B – chronic prostatitis with lack of an inflammatory component (leukocytes and activators in a prostate secret).
- IV. Asymptomatic chronic prostatitis (lack of complaints at identification of leukocytes in a pro-static secret).
In the presence of an infectious component speak about bacterial (infectious) chronic prostatitis; in case of lack of microbic activators – about not bacterial (noninfectious) prostatitis. It is considered that in 90-95% of all cases not bacterial chronic prostatitis and only in 10-5% - bacterial takes place.
Reasons of chronic prostatitis
The etiology and pathogenesis of bacterial chronic prostatitis are connected with hit of an infection in a prostate gland the next ways: ascending (through an urethra), descending (at throwing of the infected urine from a bladder), hematogenic (on blood highways) or limfogenny (on lymphatic collectors). More often uropatogenam act colibacillus, a klebsiyella, proteas, staphylococcus, , korinebakteriya, fungal, parasitic and virus activators. Along with nonspecific flora activators of specific uretrit can take part in development of chronic prostatitis (a hlamidiya, a mycoplasma, a gonokokka, a trichomonad, a gardnerella).
However for development of chronic prostatitis important not so much existence and activity of microorganisms, how many a condition of bodies of a small pelvis and blood circulation in them, existence of associated diseases, level of protective mechanisms.
Therefore developing of chronic prostatitis can be promoted by a number of factors. First of all, it is urological diseases – pyelonephritis, cystitis, uretrit, a striktura of an urethra, not cured up to the end sharp prostatitis, orkhit, an epididymite, etc. Microbic can get into a prostate from the remote centers of an infection, for example, in the presence of antritis, tonsillitis, caries, chronic bronchitis, pneumonia, piodermiya and so forth. Local and general overcooling, overheating, stay in the damp environment, exhaustion, defective food, a rare urination and so forth contribute to synchronization of an inflammation.
Not bacterial chronic prostatitis is usually connected with the kongestivny (stagnant) phenomena in a prostate gland caused stazy venous blood circulation in pelvic bodies and violation of drainage of atsinus of a prostate. The local kongestiya leads to overflow of vessels of a prostate blood, I will swell, to its incomplete depletion from a secret, to violation of barrier, sekretorny, motor, sokratitelny function of gland.
Stagnant changes are, as a rule, caused by behavioural factors – a long sexual deprivation, practice of the interrupted or prolonged sexual intercourses, excessive sexual activity, a hypodynamia, long sitting, chronic intoxications (alcoholic, nicotinic, narcotic), professional vrednost (vibration). Pathology of the pelvic bodies and nervous structures which are carrying out their innervation contributes to development of not bacterial chronic prostatitis (for example, injuries of a spinal cord), prostate adenoma, hemorrhoids, locks, androgenodefitsit, etc. the reasons.
Symptoms of chronic prostatitis
Chronic prostatitis is shown by local and general symptomatology. The pro-static triad which is characterized by pains, a dizuriya and violation of sexual function belongs to local manifestations. Pains at chronic prostatitis have the constant aching character, are localized in a crotch, genitals, over a pubis, in a groin. The pain syndrome amplifies at the beginning and the end of an urination, at the same time pains irradiate in a penis head, a scrotum, a sacrum, a rectum. Pain can increase after sexual intercourse or in connection with long abstention; to weaken or amplify after an orgasm, to become more intensively directly at the time of an ejaculation.
Intensity of a pain syndrome at chronic prostatitis varies from feelings of discomfort to expressed, interrupting a sleep and working capacity, manifestations. Pains with limited localization in a sacrum are quite often regarded as osteochondrosis or radiculitis in this connection the patient can is long to be treated independently, without resorting to the help of the doctor.
The urination at chronic prostatitis is speeded up and is painful. At the same time difficulty of the beginning of a miktion, easing or intermittence of a stream of urine, feeling of incomplete devastation of a bladder, frequent night desires, burning in an urethra can be noted. In urine at chronic prostatitis can find availability of floating threads. After defecation or physical activity from an urethra there are allocations () caused by decrease in a tone of a prostate. At chronic prostatitis emergence of an itch, cold sense or the increased perspiration in the crotches, local changes of coloring of skin connected with stagnation of blood circulation can be noted.
Chronic prostatitis is followed by the expressed violations of sexual function. The phenomena of a dispotention can be expressed in deterioration, morbidity of an erection, long and frequent night erections, difficulty or an early ejaculation, loss of sexual desire (decrease in a libido), the erased orgasms, a gemospermiya, infertility. Sexual frustration are always taken by the man hard, leading to psycho-emotional frustration, up to neurosis and a depression, even more worsening sexual function.
Exacerbations of chronic prostatitis are followed by slight increase of body temperature and deterioration in health. The general state at chronic prostatitis is characterized by the increased irritability, slackness, uneasiness, bystry fatigue, appetite loss, a sleep disorder, decrease in working capacity, creative and physical activity.
Practically at a quarter of patients with chronic prostatitis disease symptoms a long time are absent that leads to the late address to the urologist (andrologist). The long course of chronic prostatitis can be complicated by impotence, vezikulity, epididimoorkhity, male infertility, an urine incontience, formation of stones and cysts of a prostate gland, a prostate gland sclerosis, development of adenoma and prostate cancer.
Diagnosis of chronic prostatitis
Information, necessary for diagnosis of chronic prostatitis, is obtained by means of comprehensive laboratory and tool examination. Primary inspection at suspicion of chronic prostatitis includes clarification of the anamnesis and complaints, carrying out external examination of genitals regarding allocations, rashes, irritations, a manual rectal research of a prostate for the purpose of definition of contours, borders, a consistence, morbidity of gland.
For definition of structural and functional changes of a prostate gland performing ultrasonography of a prostate (TRUZI) is shown. As important methods in diagnosis of chronic prostatitis serve the research of a secret of a prostate, the general analysis of urine, a bacteriological research of dab from an urethra and urine, 3rd stakanny test of urine, PTsR and REEF a scrape research on causative agents of sexually transmitted infections, definition of the prostates-a specific anti-gene (PSAG).
At chronic prostatitis identification serves clinically significant in analyses of causative agents of clamidiosis, mycoplasmosis, herpes, a cytomegalovirus, trichomoniasis, gonorrhea, candidiasis, and also nonspecific bacterial flora. The prostate secret fence for a research is carried out after an urination and performing massage of a prostate gland. Increase in number of leukocytes under review, reduction of amount of letsitinovy grains, presence of pathogenic microflora are signs of chronic prostatitis.
In the general analysis of urine at chronic prostatitis the leykotsituriya, a piuriya, an eritrotsituriya can be found. Bacteriological crops of urine allow to reveal degree and character of a bakteriuriya. At reproductive violations the research of a spermogram and the MAR-test is shown.
Degree and causes of infringement of an urination help to define urodinamichesky researches (an urofloumetriya, a tsistometriya, a profilometriya, an electromyography). By means of these researches chronic prostatitis manages to be differentiated from a stressful incontience of urine, a neurogenetic bladder, etc. At a gematuriya, a gemospermiya, an obstructive urination endoscopic inspection - an uretroskopiya, a tsistoskopiya is shown. The exception of adenoma and a prostate cancer requires definition of the DOG, in certain cases – carrying out a biopsy of a prostate gland with a morphological research of fabrics.
Treatment of chronic prostatitis
Chronic prostatitis gives in to treatment not easy, however it is necessary to remember that recovery nevertheless perhaps and in many respects depends on a spirit of the patient, timeliness of his address to the expert, clearness of observance of all instructions of the urologist. The basis of treatment of bacterial chronic prostatitis is made by antimicrobic therapy according to antibiotikogrammy lasting not less than 2 weeks. For reduction of pain and an inflammation NPVS are appointed (diclofenac, an ibuprofen, , piroxicam); for relaxation of muscles of a prostate, restoration of an urodinamika and outflow of a pro-static secret reception of a-adrenoblokatorov is shown (, ).
For the purpose of improvement of drainage of a prostate gland, local microcirculation and a muscular tone a course of medical massage of a prostate is conducted. The session of massage of a prostate gland has to come to an end with allocation not less than 4 drops of a secret of a prostate. Massage of a prostate is contraindicated at sharp bacterial prostatitis, prostate abscess, hemorrhoids, prostate gland stones, cracks of a rectum, a giperplaziya and a prostate cancer.
For removal of a pain syndrome at chronic prostatitis can be recommended to a blockade paraprostatichesika, acupuncture. The importance in treatment of chronic prostatitis is allocated for physical therapy with purpose of a medicinal electrophoresis, ultrasound, ultrafonoforez, magnetotherapy, a lazeromagnitoterapiya, induktometriya, mud cure, SMT, hot sedentary bathtubs with the temperature of 40 - 45 °C, enemas with hydrosulphuric and mineral waters, instillations in an urethra.
At development of the complications connected with chronic prostatitis surgical treatment is shown: elimination urethras; The TOUR of a prostate or a prostatektomiya at a prostate gland sclerosis; a transurethral resection of a bladder at a sclerosis of his neck, a puncture and drainage of cysts and abscesses of a prostate; at the fimoz caused by recurrent infections of uric ways etc.
Prevention of chronic prostatitis
The prevention of chronic prostatitis demands respect for sexual hygiene, timely therapy of urogenital and ekstragenitalny infections, normalization of a regularity of sexual life, sufficient physical activity, prevention of locks, timely depletion of a bladder.
Dynamic surveys of the andrologist (urologist) are necessary for an exception of a recurrence of chronic prostatitis; preventive courses of physiotherapy, polyvitamins, immunomodulators; exception of overcooling, overheating, stresses, addictions.