Chronic prostatitis

Chronic prostatitis is a prolonged inflammation due to prostate infection or simultaneous pathological pathologies.

Chronic prostatitis is diagnosed in men of all ages.According to statistics, this disease is the most common cause of a urologist for patients under 50.In a chronic form, bacteriological examination shows the pathogen only in 5-10% of patients.In most cases, the cause of the disease is considered to be other factors.It is known that the presence of infection is not a prerequisite for the occurrence of the disease.The chronic inflammation of the prostate is a polyethiological pathology that results in the effects of many causes and provocative factors.In 90-95% of patients, antibacterial therapy is limited or not required at all.

Classification of chronic prostatitis

Classification of chronic prostatitis with an etiological properties distinguishes between two main forms of the disease: chronic bacteria (infectious) prostatitis and chronic non -bacterial (aseptic) prostatitis/chronic pelvic pain (KT).

Ethiological classification of chronic prostatitis includes:

1. Chronic bacterial prostatitis.
2. The chronic non -bacterium (aseptic) prostatitis/CTB ("prostatini" or "painful prostate gland" is an outdated term used to determine the pathology).
3. Chronic non -bacterial (aseptic) prostatitis/CTB inflammatory component (concentration of leukocytes has increased significantly in the first part of the prostate, sperm, urine).
4. Chronic non -bacterial (aseptic) prostatitis/CTB inflammatory component (concentration of white blood cells in the prostate secret, sperm, the first part of the urine is not sufficient for inflammation).
5. Ashmptomic is chronic prostatitis (not clinically detected in laboratory tests).

Chronic bacterial prostatitis is a rare pathology as shown from the above statistics.Infection is the cause of chronic recurrent inflammation of the prostate in one of the ten patients.Pathology is often associated with other infectious diseases of the gangitural organs.Most often the cause is a non -specific infection, but in the presence of STSPP, chronic inflammation of the gland can be caused by chlamydia, ureaplasmosis, mycoplasmosis or other specific microorganisms.

Chronic non -bacterial (aseptic) prostatitis or chronic pain syndrome is a long -term, recurring disease that results in aseptic inflammation of the prostate.This is a little studying pathology.In the presence of the symptoms of the disease, the tests determine the white blood cells in the secret of the gland, the seed fluid, the initial part of the urine, but the results of the bacteriological examination are negative.In other cases, there are no signs of infection or leukocytosis with bright symptoms.

There are also chronic prostatitis during the aggravation phase and chronic prostatitis in the remission phase.The cyclic path is characterized by both bacterial and non -infectious inflammation of the prostate gland.In both cases, the aggravation of chronic prostatitis leads to an increase in symptoms.

Classification of chronic prostatitis pathhanatomy (pathomorphological) is of limited interest for patients and clinical doctors.

Causes of chronic prostatitis

Causes of prostate chronic bacterial inflammation

Chronic infectious prostatitis is due to infection of the tissues of the prostate gland.Most often, the cause of inflammation is E. coli or e.Coli.The Enterococci Nation, Klebsell, Proteus, Pseudomonas are less carved microbes.

Like other microbes, E. coli is capable of forming biofilms, from thin, bacterial accumulation and closely adjacent to the canal mucosal membranes.This explains why chronic prostatitis cannot always be cured.It is believed that the infection spreads through the urethra in a growing way.At the same time, the spread of limogene and hematogenic infection is also possible.

The predisposing factors of the occurrence of chronic infectious prostatitis are as follows:

• sexually active age;
• prostate adenoma or benign prostate hyperplasia;
• narrowing of the urethra;
• Unscrew the extreme body of the penis;
• Hypertrophy of the bladder neck;
• medical procedures (bladder catheterization, cystoscopy);
• Genetic and anatomical characteristics prone to the disease.

Causes of chronic non -bacterial inflammation of the prostate gland

The causes of chronic non -bacterial prostatitis are exactly unknown.The disease may be caused by viruses or bacteria that are not identified during bacterial secretion of the prostate gland.However, most scientists and doctors believe that chronic gender -bacterial (aseptic) prostatitis/CTB is a polyethiological disease that results in a combination of many harmful factors, namely:

• cycling;
• Irritation of the tissues of the prostate gland when the urine enters the canals;
• Irritation of the prostate gland as a result of the use of any product or drink (especially with food allergies or celiacia);
• functional disorders of nervous innervation of the pelvic organs;
• Atrophy of the pelvic floor muscles;
• stress, psychoemotional loads;
• Pathology in the prostate gland, after long acute prostatitis;
• hormonal disorders;
• bladder diseases;
• Cold climate.

Because the exact causes of the disease are little known, the treatment of chronic prostatitis can be difficult.

Symptoms of chronic prostatitis

It is characterized by chronic bacterial (infectious) prostatitis cyclic paths.The aggravation phase is replaced by the phase of remission.There is virtually no symptom between aggravations.There is a clear connection between other diseases of the genitourinary organs - urethra, epididimet, cystitis.The cause of these pathologies is usually the same pathogen that causes chronic prostatitis.During the aggravation, symptoms with dysuric phenomena (frequent urination, rubber and burns during urination) and pain, perineum, scrotum, sacrum, penis radiation.

The general condition is usually satisfactory.There are no signs of intoxication, body temperature does not increase.The prostate, when examined through the rectum (by rectum), is normal or slightly swollen, acute prostatitis without sharp pain.

Chronic non -bacterial (aseptic) prostatitis/ktb is characterized by the pains of various severity (from stupid lungs to intense) and the "visiting card" (aseptic chronic prostatitis) of the disease.Signs of inflammation of the prostate gland are poorly expressed and can be observed in 50% of cases.Other patients may be missing.

The presence of blood in the sperm, painful ejaculation, emptying, and disburic phenomena.The severity of the symptoms may change.They give pain to the legs, the rectum, making it difficult to find a person in a sitting position.Fatigue, unreasonable fatigue, joint and muscle pain are also possible.Some patients complain about reducing sexual desire, erectile dysfunction (impotence).

Symptom -free chronic prostatitis has no symptoms that are typical of this disease, ie its name.Laboratory examination of the prostate secret is determined by leukocytosis and an increase in the level of a given prostate antigen is possible.The disease has no other sign.

Diagnosis of chronic prostatitis

The main methods of diagnosing chronic infectious prostatitis are laboratory tests and local tests that allow the source of leukocytes in urine and sperm.

The three -walled urine test helps to identify inflammation.To do this, the patient has three tanks for analysis.The prostate massage between the second and third containers leads to stimulation of the glandular secretion.As a result, the urine of the third container contains the emptying of the prostate gland (leukocytes, red blood cells, bacteria), which is determined during the analysis.There is no need to massage the prostate specifically and to explore the pure secret of the gland.

Urine from the third container can be delivered to bacteriological examination with nutrient sowing.In the presence of bacterial growth, a test is performed by the predisposition of pathogenic antibiotics.The method helps to perform more accurate and efficient treatment.Because the prostate secret is a significant part of the sperm, microscopy and ejaculate bacteria also allow the correct diagnosis.

Chronic bacterial (infectious) prostatitis is accompanied by slight growth of PSA.Decreases after successful treatment.Ultrasound and other instrumental tests have no significant diagnostic value.

Diagnosis of the chronic non -bacterium (aseptic) prostatitis/CTB can be difficult.The diagnosis is often made to exclude other pathologies of the genignurinary tract and bacterial prostatitis.To do this, instrumental and laboratory methods are used: urine microscopy (a three -wall test after prostate massage), prostate sperm or secrets, and then sown into a nutrient medium.The list of tests includes PSA analysis (differential diagnosis of inflammatory diseases of cancer and prostate).

Microscopy explores the presence of leukocytes in urine, prostate secret, seed fluid, with negative results of bacteriological treatment methods.Instrumental research methods (ultrasound, cystoscopy, MRI, CT) do not reveal signs of simultaneous pathology.

Treatment of chronic prostatitis

The successful treatment of chronic infectious prostatitis requires rational and targeted antibacterial therapy.Preparations chosen are fluoroquinolones that create high concentrations from the drug in the glandular tissues.The treatment process lasts six -12 weeks.Such a duration of antibacterial treatment requires a complete elimination of infection and relapse.Second Medicines.

Bacterial chronic prostatitis can be cured with proper therapy.Patients with frequent downturn should check the immune system.It may also be necessary to exclude HIV infection, which is often the cause of low efficiency of antibacterial therapy.In such patients, prescribing antibiotics with a dose that is sufficient to suppress the growth of bacteria.

Treatment of chronic non -bacterial prostatitis/KTS is difficult as infection is not the cause of chronic pain in the pelvis or abaction chronic prostatitis.You need to get serious about the problem and answer the issue of treating the disease, which is exactly unknown.

The lack of a certain etiology explains why the therapy of this pathology is not successful.

The methods of treating chronic aseptic prostatitis are included:

1. Antibacterial therapy with fluoroquinolones (made by all patients).It is possible with an infection that is not detected during bacteriological examination.
2. Alpha blockers.They contribute to the improvement of blood circulation in the tissues of the prostate.Efficiency is low.
3. NSAIDs and other anti -inflammatory drugs have severe efficiency, relieve pain and improve symptoms.However, the treatment is pathogenetic and after resignation the disease is possible.
4. Physiotherapeutic and physiotherapy exercises (yoga, sport, active lifestyle), helping to improve blood circulation and eliminate venous stagnation, hypoxia, and pelvic muscles.The method helps patients with the right disorder.
5. Antidepressants and anticonvulsants (efficiency is not proven).
6. Surgical treatment: Laser or thin ablation of the prostate gland (ineffective).

Forecast

Most patients in chronic infectious prostatitis are favorable.Consistent and appropriate antibacterial therapy allows you to achieve success in more than 80% of cases.

The chronic non -bacterium (aseptic) prostatitis/KTB has the worst prediction.Treatment only helps a few patients.Others continue to suffer from chronic pain syndrome, even though all available treatment methods are used.The disease has a particularly impact on the psycho -emotional sphere and sexual relationships.