Prostatitis of this type occurs infrequently, accounting for about 10% of all cases of prostatitis. The question of whether atypical pathogens, such as ureaplasma urealiticum, can cause prostatitis is under discussion. They can be present in a man's body without any signs of inflammation or complaints.
Causes of chronic prostatitis
The causes of chronic prostatitis are essentially the same as those of acute bacterial prostatitis. Penetration of microorganisms into the prostate in most cases occurs through the urethra - due to urine reflux into the ducts of the prostate (intraprostatic urinary reflux).
Chronic bacterial prostatitis develops as a result of inadequate treatment or short-term treatment of acute bacterial prostatitis.
Symptom
- Discomfort or pain - in the perineum, lower abdomen, groin, scrotum, penis, during ejaculation
- Changes in urination - difficulty urinating, frequent urination in small amounts, feeling of incomplete bladder emptying.
Patients may complain of several symptoms or any individual symptom. Increased body temperature is not normal (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 after complete prostatectomy (due to the presence of malignant tumors in this organ) suggests that it itself plays no role in maintainingerection.
According to many reputable urologists, erectile dysfunction in patients with chronic prostatitis is due to psychological and neurological problems.
Diagnose
For initial assessment, the NIH-CPSI questionnaire was used - Chronic Prostatitis Symptom Index. It can be used to reflect patient complaints.
The standard method for diagnosing prostatitis is to perform a 4-cup Meares-Stamey test. This was a bacteriological and bacteriological study of urine samples obtained from different parts of the genital tract and prostatic secretions. However, the 4-cup sampling method is quite labor-intensive, and currently a modification of the Meares-Stamey sample is more commonly used: the 3-cup or 2-cup sample. A possible alternative is to submit ejaculated semen (sperm) for microscopic and bacteriological examination, as a portion of the ejaculate (at least 1/3) consists of prostatic secretions. This method is more comfortable for the patient, especially if they refuse a rectal examination or diagnostic prostate massage to obtain prostatic secretions. However, chimpanzee donation has lower information content and reliability than the 3-glass or 2-glass samples.
Sending ejaculate for bacteriological examination is included in the diagnostic algorithm for infections of the male genital organs and when examining infertility in men.
Laboratory test results (general urinalysis, general blood test, biochemical blood test, sperm count and other general clinical tests) in case of chronic prostatitis do nota lot of information. Most likely, these tests will give "normal" results.
During rectal examination, changes indicating an inflammatory process in the prostate are not always observed in patients with chronic prostatitis. This means that you cannot rely on the results of a rectal examination to diagnose chronic prostatitis.
The same is true for ultrasound diagnosis: the diagnosis of chronic prostatitis based solely on ultrasound data is inaccurate.The European and American Urological Associations do not recommend ultrasound for diagnosing prostatitis. The form of execution in this case is not important - transabdominal (through the anterior abdominal wall - lower abdomen) or transrectally (TRUS - through the rectum). Writing "chronic prostatitis", "ultrasound signs of chronic prostatitis", "signs of congestive prostatitis" in the ultrasound conclusion is incorrect. Only a urologist has the privilege of determining this diagnosis, who determines it based on the complaint, history, tests and - only later - ultrasound.
The most common ultrasound finding for the diagnosis of chronic prostatitis is called diffuse changes in the prostate related to the inflammatory process or other changes in the prostate parenchyma. This is a type of fibrotic process that replaces normal prostate parenchyma with scar tissue. HoweverThere was no correlation between the amount of fibrotic changes in the prostate and the presence of complaints. With age, the likelihood of such "scars" appearing in the organ increases, but a man can live his whole life without feeling discomfort in the perineum or pubic area. However, as soon as these changes are detected on ultrasound, some "experts" will diagnose prostatitis. And some men will have the feeling that they are really seriously ill, they will begin to listen to themselves and they will feel all the symptoms described on the Internet.
In many men over 30 years of age, ultrasound can show diffuse changes in the prostate. However, fibrosis 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 urinary disorders, Prostate cancer, bladder cancer.
There is no specific picture of chronic prostatitis based on routine examination results.
Treatment of chronic prostatitis
Antibiotics of the fluoroquinolone group are the optimal antibacterial drugs for the treatment of chronic bacterial prostatitis. The recommended course of antibiotic treatment is 4 to 6 weeks. Such a long course is supported by scientific data that shows a reduced likelihood of disease recurrence.
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, leading to reflux of urine into the prostatic duct in the urethra and causing prostatic tissue inflammation and pain. For such patients, alpha blockers are recommended.
When treating chronic prostatitis, patients should limit offers to use herbal medicines. A feature of dietary supplements and herbal supplements is the instability of the plant components within one portion of the substance, which can differ even when prepared by the same manufacturer. . Additionally, from the perspective of evidence-based medicine, the benefits of herbal medicine are unquestionable.
Prostate massage, which in the middle of the 20th century was used as a therapeutic basis, today, thanks to new scientific methods and the Meares-Stamey classification, remains an important tool for diagnosing inflammationprostate, not for treatment.There is no need to use prostate massage as a treatment (effectiveness unproven).It has been suggested that frequent ejaculation has similar properties to therapeutic prostate massage sessions.
Other methods that have been shown to be effective in just one or a few studies or are still being studied include:
- pelvic floor muscle training - some evidence shows the effectiveness of specific exercises in reducing symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- acupuncture - a small number of studies show a benefit of acupuncture compared with placebo in patients with chronic prostatitis;
- Extracorporeal shock wave therapy - based on the impact of acoustic pulses of significant amplitude on connective tissue and bones, widely used in the treatment of diseases of the musculoskeletal system, recently used inurology, its effectiveness is being studied;
- behavioral therapy and psychological support - since chronic prostatitis is associated with low quality of life and the development of depression, these methods can improve the patient's psychological state andHelps reduce some symptoms of the disease.
Worth mentioning separatelychronic asymptomatic prostatitis (no symptoms). Diagnosis is usually made based on the results of the histology report - after a prostate biopsy or after surgical treatment of the prostate. The frequency of detecting inflammation in prostate tissue varies from 44% (during prostate biopsy) to 98-100% (after surgical treatment of the prostate). Scientists suggest that the inflammatory changes identified in this way are nothing more than an age-related physiological feature. No one specifically diagnoses this type of prostatitis; it was a kind of serendipitous discovery. It requires no treatment and does not require any further action on the part of the doctor or patient.
How is chronic prostatitis treated in a specialist clinic?
In the past 10 years, our country has published 47 monographs and defended 64 master's and doctoral theses on prostatitis. Not to mention various "folk" publications that colorfully describe the causes, diagnosis and treatment methods of various diseases. What does that mean? The fact is that the topic of prostatitis raises a lot of questions, and, unfortunately, some still do not have clear answers. There are a large number of modern drugs with proven effects. However, the number of patients diagnosed with chronic prostatitis has not decreased.
That is why when diagnosing and treating prostatitis, urologists try to get the most complete picture. They ask patients in detail about signs and symptoms, study previous examination results, and pay attention not only to clinical signs of disease but also to other aspects of health, includingincluding the patient's neurological and psychological state - as this can cause the appearance of characteristic manifestations. At the same time, unnecessary tests and studies are not regulated.