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Inflammation of the prostate

Prostatitis (inflammation of the prostate gland) is an inflammation of the prostate gland (an organ of the male reproductive and reproductive system) and its physiological functions change as a result of this process.

symptoms of prostatitis in men

Spread

According to various sources, prostatitis occurs in 35-40% and according to some authors in 70% of men between the ages of 18-50. The prostate gland occupies a leading position in urological pathology in terms of the prevalence of the disease and the resulting complex of problems.

Classification

Prostatitis contains many classifications, so it is a very specific terminology. The most common classification of prostatitis proposed by the U. S. National Institutes of Health (NIH) in 1995 is:

Category Description
Category I. Acute bacterial prostatitis
II. Category Chronic bacterial prostatitis
III. Category Chronic bacterial prostatitis
Category IIIA Inflammatory chronic pelvic pain syndrome
Category IIIB Non-inflammatory chronic pelvic pain syndrome (prostatodynia)
ARC. Category Asymptomatic inflammatory prostatitis

This classification of prostatitis is based on clinical symptoms, the presence or absence of leukocytes and microorganisms in the secretion of the prostate, ejaculate and urine.

Category I.

Acute bacterial prostatitisAcute infectious inflammation of the prostate gland, with all the accompanying symptoms:

  • increased number of leukocytes in the urine;
  • the presence of bacteria in the urine;
  • general signs of infection (fever, symptoms of poisoning).

II. Category

Chronic bacterial prostatitis- with appropriate symptoms and an increase in the number of leukocytes and bacteria in the secretions of the prostate, ejaculate and urine obtained after prostate massage.

III. Category

Chronic pelvic pain syndrome (CPPS)- the leading clinical symptom of pain syndrome in the secretion of prostate, ejaculate and urine obtained after prostate massage in the absence of pathogenic microorganisms for more than 3 months. The criterion for separation into III A and III B is increased leukocyte count.

Category III A

Chronic pelvic pain is an inflammatory syndrome- characterized by pain syndrome and the presence of symptoms of prostatitis, while increased leukocytes are found in the secretion of the prostate gland, ejaculate and urine, after the prostate massage no pathogenic microorganisms can be detected in these samples by standard methods.

Category III B.

Non-inflammatory chronic pelvic pain syndrome- characterized by pain syndrome and the presence of symptoms of prostatitis, while the number of leukocytes and pathogenic microorganisms in the prostate is not increased, ejaculate and urine obtained after prostate massage are not detected by conventional methods.

ARC. Category

Asymptomatic inflammatory prostatitis- absence of symptoms characteristic of prostatitis, the disease is inadvertently detected during histological examination of prostate tissue samples obtained for other reasons at the time of diagnosis (eg prostate biopsy due to elevated prostate-specific levels) antigen - PSA).

Diagnosis of prostatitis

The symptoms of prostatitis are extremely varied, but can be divided into several groups.

Pain syndrome

Due to insufficient blood supply caused by inflammation or spasm of the vessels feeding the prostate, oxygen starvation of the glandular tissues is observed, resulting in the formation of by-products of abnormal oxidation that affect the prostate. Because prostate innervation is associated with pelvic floor, penis, scrotum, testicles, rectal innervation, the localization of pain varies. The following pain symptoms are the most common:

  • Unpleasant feeling or pain in the perineum - mainly after physical exertion, intercourse, alcohol consumption in the form of transient seizures;
  • Feeling of hot potatoes in the rectum;
  • Pain in the testicles (discomfort) - described by patients as "pain", "twisting", also associated with various provocative factors;
  • Urethral discomfort, cramps, and pain are primarily associated with a shift in the pH of prostate secretion to the acidic side. The acidic secretion of the prostate irritates the mucous membranes, so painful sensations, more often in the form of "burning, " occur after urination or intercourse, when part of the secretion enters the lumen of the urethra into the muscles of the gland and pelvis.

Urinary tract disorder syndrome

It is associated with tight innervation of the prostate and bladder, and the involvement of prostate muscles during urination. Dysuria may be accompanied by the following manifestations:

  • Frequent urination - frequent urination (up to 3 times per hour), with a sharp and sudden urge (impossible to tolerate) and fairly small doses;
  • Feeling of incomplete emptying of the bladder - after the act of urinating there is a feeling that the urine remains in the bladder;
  • Poor or intermittent urine flow - this may include the symptom of the "last drop" - despite all the efforts of the patient, a drop of urine is still released from the duct after the act of urination.

Ejaculation and orgasmic disorder

During prostatitis, it is associated with damage to ocular tuberculosis (colliculitis), which has nerve receptors on its surface that send a signal to the structures in the brain where it feels like an orgasm. Prostatitis does not directly cause erectile dysfunction (filling the penis with blood with sexual arousal).

Major violations:

  • Premature ejaculation, or conversely, excessive prolonged intercourse - caused by inflammation of the seminal tuberculosis or its scarring due to an inflammatory process;
  • Delayed orgasm - also associated with inflammation of the vulva;
  • Pain during ejaculation - involves an inflammatory process in the drainage ducts of the prostate through which sperm are released.

Deterioration of fertility

When the secretion properties of the prostate change due to inflammation, the following changes are observed in the sperm, which reduce the man's ability to fertilize (fertility):

  • A decrease in the pH of the sperm towards the acidic side - as the acidic products of the abnormal oxidation accumulate secretly as the prostate becomes inflamed. The acidic environment is extremely destructive to sperm, making it immobile and even dying;
  • Agglutination of sperm - mainly the gluing of sperm to the head - involves a change in the physico-chemical properties of the secret;
  • Astenospermia - a decrease in sperm motility - is closely related to a shift in pH to the acidic side and a violation by the prostate of the production of lecithin cells, which provide vital activity for sperm.

Urethroprostatitis

In some cases, prostatitis is combined with chronic urethritis, manifested by little mucopurulent discharge from the urethra (especially after prolonged urinary retention).

Prostatitis and sexual disorders

Question: Does prostatitis cause impotence? has been causing professional controversy for decades.

Under the influence of sexual stimuli, when the body is completely saturated with androgens, a nerve signal is formed in the cortical subcortical region of the brain, which travels to the erection center of the spinal cord, from where it goes toor narrow (veins). The prostate has no role in this process.

Ejaculation and orgasm occur when there is adequate irritation of special receptor cells located in the tuberculous region of the nucleus in which the drainage ducts of the prostate gland fall, the same receptors responsible for sending a nerve impulse to the cerebral cortex where the sensation is orgasm.

An inflammatory process in the prostate gland (prostatitis) can lead to damage to the genital tuberculosis and, as a result, lead to both a violation of the effectiveness of the man and premature ejaculation and cancellation of orgasm. The impotence of chronic prostatitis is pathogenetically related to the degree of damage to the prostate nervous system. This form of impotence (neuroreceptor impotence) is a typical example of a feedback phenomenon where the presence of abnormal impulses in organs affected by the inflammatory process leads to irradiation of the excitation process to centers that regulate sexual function and the latter disorder. There is some, although not leading, role in the pathogenesis of neuroreceptor impotence, some suppression of testicular androgenic activity, and sensitivity to androgens at the center of the hypothalamus and pituitary gland.

However, there is an opinion that there is both an overdiagnosis of prostatitis in the Russian Federation and an overestimation of its role in the development of erectile dysfunction.

Diagnostics

The doctor's job is to detect the inflammatory process in the prostate, to identify the possible pathogen of the disease, and to assess the dysfunction of the prostate gland. In 1990, Stamey wrote that prostatitis is a rubbish bin of clinical ignorance because of the variety of terms, diagnostic methods, and treatments used. However, a number of simple and clinical and laboratory tests allow for a correct diagnosis that allows the initiation of appropriate therapy.

Digital rectal examination of the prostate

In a very informative way. The inflammatory process can be judged by assessing the shape, contours, size of the gland, the presence of foci of compression and / or softening, and pain. The main signs of prostatitis are: increase or decrease in size, heterogeneity of consistency, presence of foci of compaction and softening, pasteurization, pain. The fact that 80% of pancreatic cancers are detected by rectal examination speaks for itself. We can safely say that this research method will always be applied.

Microscopic examination of pancreatic secretion

It should be recalled that an increase in the number of secret leukocytes does not always indicate inflammation of the prostate, because the methods of obtaining a secret during massage do not guarantee that the contents of the urethra and bladders will not be included. However, with obvious signs of inflammation of the prostate, the secret of the prostate may be normal. This is due to focal inflammation, the presence of some of the destroyed or closed excretory channels.

Examination of prostate secretions

Examination of the secretion of the prostate gland (expressed prostate secretion-EPS) makes it possible to determine the presence of the inflammatory process in the prostate and, in part, its functional capacity. It is the main method of diagnosing and monitoring chronic prostatitis. The secret of the prostate can be examined with a light microscope without staining or with special staining methods. In addition, the secretion of the prostate gland can be subjected to bacteriological examination or research by the polymerase chain reaction method to detect the infectious agents contained therein. Get the secret with the help of prostate massage. The secretion released from the urethra is collected in a sterile test tube or clear glass plate for analysis. Sometimes prostate secretions do not flow out of the urethra. In such cases, the patient is advised to recover immediately. If you still fail to obtain the secret, it more often means that it was not in the urethra but in the bladder. In this case, the centrifuge of the lavage fluid released from the bladder after massaging the prostate gland is examined.

  • Lipoid granules (lecithin bodies) are specific products of normal physiological secretion of the prostate gland epithelium. He takes a milky look at the secrets. Normally, the secret is rich in lecithin particles. A decrease in their number together with an increase in the number of leukocytes indicates an inflammatory process, a tumor;
  • Amyloid bodies are layered (starchy) bodies that turn purple or blue with Lugol's solution like starch;
  • The amyloid body is a thickened secretion of the gland, oval in shape and layered in structure, resembling a tree trunk. They do not normally occur, their detection indicates stagnation of secretions in the gland, which may be due to adenomas, chronic inflammatory processes;
  • Erythrocytes can be single. They enter the secret as a result of a powerful massage of the prostate. Increased number is observed in inflammatory processes, neoplasms.
  • Epithelial removal is observed in large amounts at the onset of inflammatory processes and in tumors, however, disquamation often occurs during protein and fatty degeneration of epithelial cells. Macrophages are seen by stagnation of secretions, a long-term current inflammatory process;
  • Bettcher crystals are long crystals that are formed when the secretions of male gonads (prostate juice mixed with sperm) mixed with spermine and phosphate salts are cooled and dried. With azoospermia and severe oligozoospermia, Bettcher crystals are formed rapidly and in large quantities;
  • Retention syndrome - stagnation syndrome is observed in glandular adenoma. Plenty of macrophages, there are multinucleated cells such as foreign bodies and amyloid bodies;
  • Fern symptom - a symptom of secretory crystallization - the form of precipitated crystals of sodium chloride depends on the physicochemical properties of prostate secretion. The symptom was examined by adding a drop of 0. 9% sodium chloride solution to the resulting prostate secretion and then examined after further microscopic drying. In men of healthy reproductive age, crystallization of prostate secretion is characterized by a typical fern leaf phenomenon (3+). The presence of androgen insufficiency or prostatitis results in varying degrees of damage to the structure of the crystals to their absence.

Bacteriological examination of urinary tract and pancreatic secretions

Urethral swab, including PCR diagnostics

Serological diagnosis of substances that cause urinary tract infections (ELISA)

The immunofluorescence reaction (RIF) is direct and indirect

Detection of antibodies against known antigens.

Determination of blood serum PSA (prostate-specific antigen)

The American Foundation for Urological Diseases recommends an annual rectal examination of the prostate gland, accompanied by PSA, for all men over the age of 50 and in the presence of prostate cancer in blood relatives on the male line. There is still a debate about obtaining PSA after digital examination of the rectal / prostate gland. Recent studies have not been able to confirm the presence of a significant increase in PSA content immediately after the digital study. Thus, PSA levels can be determined by obtaining reliable results and after examination of the pancreas.

Four glass samples

To diagnose chronic prostatitis, a 4-glass test was proposed based on a comparative bacteriological evaluation of approximately a portion of the urine obtained before and after massage of the prostate gland, as well as its secretion.

The diagnosis of prostatitis is made by a tenfold increase in the concentration of microorganisms in the secretion of the prostate relative to the urine content (1, 2 and 3 doses) and an increase in the number of polymorphonuclear leukocytes >10-16 in the field of view of the light microscope (200x magnification). Or an increase in the number of leukocytes of more than 300x106 / l when counted in the counting chamber. Lecithin bodies, which are products of normal secretion by the epithelium of the prostate gland, should densely cover the field of view of the microscope (5-10 million in 1 ml). Amyloid bodies in the secretion of the prostate are found in significantly smaller amounts. In mature men, there are 1-2 in the field of view.

Biochemical blood test

Immunological and hormonal profile (according to indications).

Ultrasound, TRUS

Ultrasound diagnosis of prostatitis with abdominal and transrectal transducer (TRUS).

Uroflometry

Treatment of prostatitis

Complex treatment of patients with chronic prostatitis should include:

  • adherence to general treatment regimens, diet, sexual hygiene, and involvement of sexual partners in treatment in the presence of an infectious agent;
  • selection of effective drugs to suppress infection;
  • increasing the overall reactivity of the patient's body and the immunobiological tolerance of the microorganisms to drugs;
  • increased efflux and activation of local reparative processes in the focus of inflammation;
  • hygiene of foci of infection in the demonstrative and distant organs;
  • improving the microcirculation of the prostate gland and pelvic organs;
  • appointment of fortifying agents, enzymes and vitamins;
  • correction of hormonal disorders;
  • appointment of anticonvulsants;
  • appointment of analgesics and anti-inflammatory drugs;
  • taking sedatives and sedatives;
  • regulation of neurotrophic disorders with topical analgesics;

Prostate massage

Prostate massagea medical procedure for the diagnosis and occasional treatment of chronic prostatitis. The first prostate massage was described by Posner in 1893 and has been widely introduced into the urological practice of O’Conory since 1936. However, in 1968, after Meares and Stamey described a milestone test for diagnosing prostatitis, views changed about the causes of this disease and massage as a therapeutic procedure was removed from the list of measures in several manuals for the treatment of prostatitis. the developed world.

But since the mid-1990s, many physicians involved in the diagnosis and treatment of prostatitis have begun to notice the ineffectiveness of recommended antibiotic therapy and the use of alpha-blockers in some cases, forcing them to use this forgotten method in practice. .

Basically, prostate massage is currently used as a diagnostic procedure to obtain prostate secretion (expressed prostate secretion-EPS) - microscopic (cultural) examination, as well as pre- and post-massagefor test (pre- and post-massage test - PPMT). perform your massage. Massage is a medical procedure that must be performed by a previously trained professional. The massage should be performed after urination or after removal from the urethra, after pre-washing with isotonic sodium chloride solution, which is especially necessary in cases where bacteriological examination of the secretion is suspected. The prostate is massaged through the anus because the prostate gland is adjacent to the ampoule of the rectum and is only accessible there. Massage one first and then another lobe of the prostate with finger movements from the periphery to the central groove along the excretory canals and try not to touch the nuclei. Finish the massage by pressing on the central sulcus area from above. The secretion released from the urethra is collected in a sterile test tube or clear glass plate for analysis. Sometimes prostate secretions do not flow out of the urethra. In such cases, the patient is advised to recover immediately. If the secret still failed to be obtained, it means that it was not in the urethra but in the bladder. In this case, the centrifuge of the lavage fluid released from the bladder after massaging the prostate gland is examined.

Therapeutic prostate massage (repetitive prostate massage) is officially recommended by the Ministry of Health of the Russian Federation for the treatment of chronic prostatitis. Prostate massage is widely used to treat prostatitis in Southeast Asia, China and some European countries. Some North American and Canadian urologists recommend the use of massage in combination with antibiotic therapy to treat some forms of prostatitis. In fact, little has been done to evaluate the effectiveness or ineffectiveness of prostate massage. There are a number of controversial studies, one by Egyptian physicians differentiating between groups of patients, some of whom received massage in combination with antibiotic therapy and simply antibiotic therapy, and another by American and Philippine researchers, on the contrary. , showed a significant improvement in the group of patients with prostatitis who received massage in combination with antibiotic therapy.

Proponents of the therapeutic use of massage believe that the main effect of its use is on the channels of the prostate - e. g. freeing them from purulent and dead cells. Another effect is to increase the blood flow to the prostate gland, which improves the penetration of antibiotics and activates local protective immunological processes.

There is little data in the world literature on the complications associated with prostate massage. In 1990, Japanese doctors described genital gangrene (Fournier), and in 2003, German doctors described perioprostatic bleeding after prostate massage with the development of pulmonary embolic stroke (bleeding). There is a study that temporarily increases PSA (prostate-specific antigen) levels after massage. Massage is contraindicated in acute inflammation of the prostate gland (acute prostatitis), acute urethritis, orchitis, prostate cancer. Massage is not recommended for calcification of the prostate and prostate adenoma, it is usually recommended to massage the prostate 2 or 3 times a week.

Physiotherapy procedures

Any physiotherapy procedure (prostate massage, warm-up, etc. ) is contraindicated in acute prostatitis.

The use of physiotherapy methods in the complex treatment of prostatitis targets both the direct effect of physical agents on the prostate gland to normalize functional and pathological changes, and the electrophoretic administration of drugs to prostate tissue.

The use of physiotherapy methods in the background of drug therapy gives much better results than with treatment alone. The following methods of affecting the prostate are widespread and have proven their effectiveness:

  • shock wave therapy;
  • electrostimulation of the pancreas with modulated current from the skin or rectal electrodes;
  • heat therapy in various versions (including high-frequency heat therapy);
  • magnetotherapy;
  • microwave microwave therapy;
  • laser therapy.
  • transrectal ultrasound therapy and phonophoresis;
  • microcycles.