Prostatitis of this category occurs infrequently, 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 debate. They can be present in a man's body without any signs of inflammation or discomfort.
Causes of chronic prostatitis.
The causes of chronic prostatitis are basically similar to the causes of acute bacterial prostatitis. The entry of microorganisms into the prostate in most cases occurs through the urethra, as a result of the reflux of urine into the ducts of the prostate gland (intraprostatic urine reflux).
Chronic bacterial prostatitis develops as a result of inadequate treatment or short 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 several symptoms or any symptom individually. An increase in body temperature is uncharacteristic (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 in the organ) suggests that it itself plays no role in maintaining the erection.
According to many reputable urologists, erectile dysfunction in patients with chronic prostatitis is caused by psychogenic and neurotic problems.
Diagnosis
For the initial evaluation, the NIH-CPSI questionnaire: the chronic prostatitis symptom index is used. It can be used to objectify the patient's 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 labor intensive, and modifications of the Meares-Stamey samples: 3-glass or 2-glass sample are now more commonly used. A possible alternative is to subject the ejaculate (sperm) to a microscopic and bacteriological examination, since the ejaculate is partially (at least 1/3) composed of prostate secretion. This method is more comfortable for patients, especially if they categorically refuse a digital rectal examination or a diagnostic prostate massage to obtain prostate secretions. However, ejaculate donation has lower information content and reliability compared to a 3- or 2-glass sample.
Submission of ejaculate for bacteriological examination is included in the diagnostic algorithm of infections of the male genital organs and in the examination for infertility of a man.
The results of laboratory tests (general urine analysis, general blood analysis, biochemical blood analysis, spermogram and other general clinical tests) in the case of chronic prostatitis are not informative. These tests will most likely 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 digital rectal examination to diagnose chronic prostatitis.
The same goes for ultrasound diagnosis: it is incorrect to diagnose chronic prostatitis based solely on ultrasound data.The European and American Urological Association 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" at the end of an ultrasound examination. Only the urologist has the prerogative to establish this diagnosis, who determines it based on complaints, anamnesis, laboratory tests and, only later, ultrasound.
The most common ultrasound sign by which the diagnosis of chronic prostatitis is made is the so-called diffuse changes in the prostate 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 discomfort.. With age, the chances of this type of "scars" appearing on the organ increase, but a man can live his entire life without feeling any discomfort in the perineum or pubic area. However, as soon as these changes are detected on an ultrasound, some "specialists" diagnose prostatitis. And some men will have the feeling that they are really seriously ill, they will start to listen to themselves and feel all the symptoms described on the Internet.
In many men over 30, ultrasound can show diffuse changes in the prostate. However, the fibrotic process does not indicate the presence of prostatitis.
The diagnosis of chronic prostatitis is established based on the exclusion of other diseases of the genitourinary system, mainly urethritis, prostatic hyperplasia, urethral stricture, neurogenic disorders of urination, prostate cancer and bladder cancer.
There is no specific picture of chronic prostatitis according to the results of a 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 course of antibiotic therapy is 4 to 6 weeks. Such a long course is justified by scientific data indicating a decrease in the probability of relapse of the disease.
For detected sexually transmitted infections (STIs), such as chlamydia trachomatis, a macrolide antibiotic is prescribed. They are the most effective.
There is evidence of decreased relaxation of the bladder neck in patients with chronic prostatitis, which causes reflux of urine into the prostatic ducts of the urethra and causes inflammation of the prostate tissue and pain. For these patients, alpha blockers are recommended.
When treating chronic prostatitis, it is advisable for patients to refrain from tempting offers to use herbal medicines. A feature of dietary supplements and herbal supplements is the instability of plant components in one portion of the substance, they can differ even in the preparation of the same manufacturer. Furthermore, from the point of view of evidence-based medicine, the benefits of herbal medicines do not withstand criticism.
Prostate massage, which in the mid-20th century was used as a basis of therapy, today, thanks to new scientific approaches and the Meares-Stamey classification, remains an important tool for the diagnosis of prostatitis, but not for your 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 been shown to be effective in only one or a few studies or are still being researched include:
- pelvic floor muscle training: some evidence suggests the effectiveness of special exercises in reducing 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 the connective and bone tissue, widely used in the treatment of diseases of the musculoskeletal system, recently used in urology, its effectiveness is under study;
- 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.
Separately it is worth mentioningasymptomatic chronic prostatitis (asymptomatic). The diagnosis is most often made based on the results of a histological report, after a biopsy of the prostate, or after surgical treatment of the prostate. The frequency of detection of inflammation in the 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 characteristic. No one specifically diagnoses this category of prostatitis; It is a kind of accidental discovery. It does not require treatment and does not require any additional action on the part of the doctor or the patient.
How is chronic prostatitis treated in a specialized clinic?
In the last 10 years, 47 monographs have been published in our country and 64 master's and doctoral theses on prostatitis have been defended. Not to mention the various "popular" publications, which colorfully describe the causes, diagnosis and various treatment methods 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 is a large number of modern drugs whose effect has been demonstrated. However, the number of patients diagnosed with chronic prostatitis is not decreasing.
Therefore, when diagnosing and treating prostatitis, urologists try to obtain 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 patient's neurological and psychological status, since this can cause the appearance of characteristic manifestations. At the same time, unnecessary tests and studies are not prescribed.