Prostatitis of this category occurs rarely, in about 10% of all cases of prostatitis. The question of whether atypical pathogens such as Ureaplasma urealyticum can cause inflammation of the prostate is discussed. They can be in the male body without any signs of inflammation or complaints.
Causes of chronic prostatitis
The causes of chronic prostatitis are basically similar to the causes of acute bacterial prostatitis. Microorganisms enter the prostate in most cases through the urethra - as a result of urine flowing into the ducts of the prostate gland (intraprostatic urinary reflux).
Chronic bacterial prostatitis develops as a result of inadequate treatment or a short course of treatment of 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, a feeling of incomplete emptying of the bladder.
The patient may complain of a number of symptoms or any symptom individually. An increase in body temperature is not characteristic (or insignificant).
Important:
Many men associate erectile dysfunction with prostatitis. This is often helped by unprofessional publications in the media and advertising of questionable drugs. The fact that an erection can continue even with complete removal of the prostate gland (due to the presence of a malignant tumor in the organ) indicates that it itself does not play a role in maintaining an erection.
According to many reputable urologists, erectile dysfunction in patients with chronic prostatitis is caused by psychogenic and neurotic problems.
Diagnostics
NIH-CPSI questionnaire - Chronic Prostatitis Symptom Index is used for initial evaluation. It can be used to objectify the patient's complaints.
The standard method for diagnosing prostatitis is the 4 cup Meares-Stamey test. This is a microscopic and bacteriological examination of urine samples taken from various parts of the genitourinary system and prostate secretions. However, the 4-bottle sample method is labor-intensive, and currently modifications of Meares-Stamey samples are more commonly used: 3-bottle or 2-bottle samples. A possible alternative is to submit the ejaculate (sperm) for microscopic and bacteriological examination, since the ejaculate is partially (at least 1/3) prostate secretion. This method is more convenient for patients, especially if they categorically refuse rectal examination or diagnostic massage of the prostate gland to obtain prostate secretions. However, ejaculate donation has less information content and reliability than 3 or 2 vial samples.
Submission of ejaculate for bacteriological examination is included in the diagnostic algorithm of infections of the male genital organs and when examining a man for infertility.
During chronic prostatitis, the results of laboratory tests (general urine test, general blood test, biochemical blood test, spermogram and other general clinical tests) are not informative. Most likely, these tests will show "normal".
During a 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 results of a rectal examination to diagnose chronic prostatitis.
The same applies to ultrasound diagnostics: the diagnosis of chronic prostatitis based only on ultrasound data is incorrect.The European and American Urological Association does not recommend ultrasound for the diagnosis of prostatitis. In this case, the type of execution is not important - transabdominal (through the front wall of the abdominal cavity - lower abdomen) or transrectal (TRUS - through the rectum). It is incorrect to write "chronic prostatitis", "ultrasound signs of chronic prostatitis", "signs of congestive prostatitis" in the result of ultrasound examination. Only a urologist is authorized to make this diagnosis, which is determined only after complaints, anamnesis, laboratory tests and ultrasound.
The most common ultrasound sign for diagnosing chronic prostatitis is diffuse changes in the prostate gland associated with the 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 gland and the presence of complaints. With age, the chance of such "scars" appearing on the body increases, but a man can live his whole life without feeling any discomfort in the perineum or pubic region. However, some "experts" diagnose prostatitis after these changes are detected on ultrasound. And some men will feel 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 the age of 30, ultrasound can show diffuse changes in the prostate gland. However, the fibrotic process does not indicate the presence of prostatitis.
The diagnosis of chronic prostatitis is based on the exclusion of other diseases of the genitourinary system - primarily urethritis, hyperplasia of the prostate gland, narrowing of the urethra, neurogenic urinary disorders, prostate cancer, bladder cancer.
According to the results of routine examination, there is no special picture for chronic prostatitis.
Treatment of chronic prostatitis
Antibiotics from the fluoroquinolone group are optimal antimicrobial drugs for the treatment of chronic bacterial prostatitis. The recommended course of antibiotic therapy is 4-6 weeks. Such a long course is justified by scientific data showing that the probability of relapse of the disease decreases.
For detected sexually transmitted infections (STIs), for example, chlamydia trachomatis, a macrolide antibiotic is prescribed. They are the most effective.
There is evidence of reduced bladder neck emptying in patients with chronic prostatitis, which leads to backflow of the urethra into the prostatic ducts, causing inflammation and pain in the prostate tissue. Alpha-blockers are recommended for such patients.
During the treatment of chronic prostatitis, patients are advised to avoid tempting offers to use herbal medicines. A feature of dietary supplements and herbal supplements is the instability of plant components in a part of the substance, which can differ even in the preparation of the same manufacturer. In addition, the benefits of herbal medicines in terms of evidence-based medicine are not without criticism.
Prostate massage, which was used as the basis of therapy in the middle of the 20th century, today remains an important tool in the diagnosis of prostatitis, not for treatment, thanks to new scientific approaches and the Meares-Stamey classification.There is no need to use prostate massage as a therapeutic procedure (its effect has not been proven).There are suggestions that frequent ejaculation is similar to therapeutic prostate massage sessions.
Other methods that have been shown to be effective in only one or more studies or are still being investigated include:
- pelvic floor muscle training - some evidence shows the effectiveness of specific exercises to reduce the symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- acupuncture - a small number of studies show the benefit of acupuncture compared to placebo in patients with chronic prostatitis;
- extracorporeal shock wave therapy - based on the impact of significant amplitude acoustic pulses on connective and bone tissue, widely used in the treatment of musculoskeletal system diseases, recently used in urology, its effectiveness is being studied;
- 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 psychological state of the patient and help reduce some symptoms of the disease.
It is worth noting separatelyasymptomatic (asymptomatic) chronic prostatitis. The diagnosis is most often based on the results of a histological report - after biopsy of the prostate gland or surgical treatment of the prostate. The frequency of detection of inflammation in the prostate tissue varies from 44% (by prostate biopsy) to 98-100% (after surgical treatment of the prostate). Scientists suggested that the inflammatory changes identified in this way are nothing more than an age-related physiological feature. No one specifically diagnoses this category of prostatitis, it is a kind of accidental discovery. It does not require treatment and requires no further action by the doctor or the patient.
How is chronic prostatitis treated in a special clinic?
In the last 10 years, 47 monographs on prostatitis were published in our country, 64 candidate and doctoral theses were defended. Not to mention the various "folk" publications that colorfully describe the causes, diagnosis and various treatment methods of the disease. What does it mean? The topic of prostatitis raises many questions, and some of them, unfortunately, still do not have a clear answer. There are many modern drugs that have been proven to be effective. However, the number of patients diagnosed with chronic prostatitis is not decreasing.
Therefore, during the diagnosis and treatment of prostatitis, urologists try to get 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. this can cause characteristic manifestations. At the same time, unnecessary tests and studies are not prescribed.