Chronic prostatitis - causes, symptoms, diagnosis and treatment
Chronic prostatitis - Prolonged inflammation of the prostate gland, which leads to a violation of the morphology and functioning of the prostate. Chronic prostatitis is manifested prostatic triad - a pain in the pelvic region and genitals, urinary disorders, sexual disorders. Diagnosis of chronic prostatitis include palpation of the prostate, prostate secretion study, ultrasonography, uroflowmetry, cystoscopy, needle biopsy of the prostate. In chronic prostatitis is shown a complex medical, physiotherapy, massage, prostate, urethral instillations back. Surgical treatment is appropriate in complicated forms of chronic prostatitis.
Chronic prostatitis
inflammation of the prostate. Chronic prostatitis often affects men between the ages of 20 and 40 who are in the greatest period of sexual, reproductive and labor activity. In this connection, detection and treatment of chronic prostatitis Urology acquires not only medical, but also a socially significant aspect.
Acute prostatitis.
If you have an infectious component suggests bacterial (infectious) chronic prostatitis; in the absence of microbial pathogens - for non-bacterial (non-infectious) prostatitis. It is believed that 90-95% of all cases there is a chronic non-bacterial prostatitis, and only 10.5% - bacterial.
pyelonephritis, cystitis, urethritis, urethral stricture, uncured until the end of acute prostatitis, orchitis, epididymitis, and others. Microbial etioagent can enter the prostate from distant foci of infection, for example, in the presence of sinusitis, tonsillitis, dental caries, chronic bronchitis, pneumonia, pyoderma, etc. . Predispose to chronic inflammation localized and general hypothermia, overheating, stay in a moist environment, exhaustion, malnutrition, infrequent urination, and so forth.
Non-bacterial chronic prostatitis is usually associated with congestive (stagnant) in the prostate gland, caused by stasis of venous blood circulation in the pelvic organs and impaired drainage of prostate acini. Local congestion leads to overflow prostate blood vessels, edema, its incomplete emptying of secret, infringement of the barrier, secretory, motor, the contractile function of the prostate.
Stagnant changes are usually caused by behavioral factors - long sexual deprivation, practice interrupted or prolonged intercourse, excessive sexual activity, physical inactivity, prolonged sitting, chronic intoxication (alcohol, nicotine, drug), occupational hazards (vibrations). To the development of non-bacterial chronic prostatitis predisposing abnormality of pelvic organs and nerve structures, carrying out their innervation (eg, spinal cord injury), prostate adenoma, hemorrhoids, constipation, and other androgenodefitsit. Causes.
low back pain or sciatica, and therefore the patient can be treated for a long time on their own, without the help of a doctor.
Urination in chronic prostatitis and painful learning. This may mark the beginning of difficulty miktsii, weakening or intermittent urine stream, sensation of incomplete emptying of the bladder, frequent nocturnal urgency, burning sensation in the urethra. In the urine of chronic prostatitis can detect the presence of floating threads. After a bowel movement, or exercise of the urethra appear allocation (prostatoreya) due to a decrease in prostate tone. In chronic prostatitis can be observed the emergence of itching, feeling cold or excessive sweating in the perineum, local changes in skin color associated with stagnant circulation.
Chronic prostatitis is accompanied by severe disorders of sexual function. Dispotentsii phenomena can be expressed in a worsening, painful erection, prolonged and frequent nocturnal erections, difficulty or early ejaculation, loss of sex drive (libido), orgasm erased, haematospermia, infertility. Sexual dysfunction is always difficult experienced by man, leading to psycho-emotional disorders, up to neurosis and depression, further worsen sexual function.
Exacerbations of chronic prostatitis accompanied by a slight fever and malaise. The general condition of chronic prostatitis is characterized by increased irritability, apathy, anxiety, fatigue, loss of appetite, sleep disturbances, decreased ability to work, creativity and physical activity.
Almost a quarter of patients with chronic prostatitis symptoms long time are absent, which leads to late referral to a urologist (andrologist).
Prolonged course of chronic prostatitis may be complicated by impotence, vesiculitis, epididimoorhitom, male infertility, urinary incontinence, stone formation and cysts of the prostate, prostate sclerosis, the development of adenoma and prostate cancer.
TRUS).
The important methods in the diagnosis of chronic prostatitis are the study of prostate secretion, general urine analysis, bacteriological examination of smears from the urethra and urine, 3 cups of urine test, PCR and IFA study on scraping agents of genital infections, determination of prostate-specific antigen (PSA).
Clinically significant chronic prostatitis is the identification of pathogens in the analyzes of chlamydia, mycoplasma, herpes, cytomegalovirus, trichomoniasis, gonorrhea, candidiasis, as well as nonspecific bacterial flora.
Fence prostate secretion for research carried out after urinating and of prostate massage. Symptoms of chronic prostatitis are increasing the number of leukocytes in the field of view, reducing the number of lecithin granules, the presence of pathogenic microorganisms.
The general analysis of urine in chronic prostatitis can be found leucocyturia, Piura, red blood cell. Bacteriological urine culture reveals the extent and nature of bacteriuria. When reproductive disorders research shows sperm and MAR test.
The extent and causes of voiding help to determine the urodynamic studies (uroflowmetry, cystometry, profilometry, electromyography). With the help of these studies chronic prostatitis possible to differentiate from stress urinary incontinence, neurogenic bladder and others.
When hematuria, haematospermia, obstructive voiding shown endoscopy - ureteroscopy, cystoscopy.
To exclude adenoma and prostate cancer PSA is required, in some cases - biopsy of prostate tissue with a morphological study.
Prostate therapeutic massage. massage the prostate gland must end with the release of not less than 4 prostate secretion drops. Prostate massage is contraindicated in acute bacterial prostatitis, prostatic abscess, hemorrhoids, prostate stones, rectal fissures, hyperplasia and prostate cancer.
For pain relief in chronic prostatitis may be recommended paraprostatichesike blockade acupuncture.
Of great importance in the treatment of chronic prostatitis is given physiotherapy appointment iontophoresis, ultrasound, phonophoresis, magnetic therapy, laseromagnetotherapy, induktometrii, mud, SMT, hot sitz baths a temperature of 40 - 45 ° C, with hydrogen sulfide enemas and mineral waters, instillation into the urethra.
With the development of complications associated with chronic prostatitis, surgical treatment: removal of urethral strictures; TURP or prostatectomy with sclerosis of the prostate gland; transurethral resection of the bladder neck sclerosis him, puncture and drainage of cysts and abscesses of the prostate; circumcision with phimosis caused by recurrent urinary tract infections, and so on. d.
Prevention of chronic prostatitis
Prevention of chronic prostatitis requires adherence to sexual health, the timely treatment of urogenital and extragenital infections normalization of regular sexual life, enough physical activity, prevention of constipation, timely emptying of the bladder.
To eliminate the recurrence of chronic prostatitis necessary dynamic examinations andrologist (urologist); preventive courses physiotherapy, multivitamins, immunomodulators; exclusion of hypothermia, overheating, stress, bad habits.