Prostatitis of this category occurs rarely, in approximately 10% of all cases of prostatitis. The question of whether atypical pathogens, such as ureaplasma urealyticum, can provoke inflammation of the prostate is debated. They can be present in a man's body without signs of inflammation or complaints.
Causes of chronic prostatitis
The causes of chronic prostatitis are generally similar to the causes of acute bacterial prostatitis. Microorganisms enter the prostate in most cases through the urethra - as a result of urine reflux in the ducts of the prostate gland (intraprostatic urine 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 range of symptoms or any single symptom. The increase in body temperature is uncharacteristic (or insignificant).
Important:
Many men associate erectile dysfunction with prostatitis. This is often facilitated by unprofessional media publications and advertising of dubious drugs. The fact that the erection can continue even with complete removal of the prostate (due to the presence of a malignant tumor of the organ) suggests that it itself does not play a role in maintaining the erection.
According to many authoritative urologists, erectile dysfunction in patients with chronic prostatitis is caused by psychogenic and neurotic problems.
Diagnosis
The NIH-CPSI-Chronic Prostatitis Symptom Index questionnaire was used for initial assessment. It can be used to objectify the patient's complaints.
The standard method for diagnosing prostatitis is to perform the Meares-Stamey 4-cup test. This is a microscopic and bacteriological examination of urine samples obtained from different parts of the genitourinary tract and prostatic secretion. However, the 4-glass sample method is quite laborious, and currently modifications of the Meares-Stamey samples are more often used: 3-glass or 2-glass sample. A possible alternative is to submit the ejaculate (sperm) for microscopic and bacteriological examination, since the ejaculate consists partially (at least 1/3) of prostatic secretion. This method is more convenient for patients, especially if they categorically refuse a rectal examination or a diagnostic massage of the prostate gland in order to obtain prostate secretion. However, ejaculate donation has lower information content and reliability compared to a 3-cup or 2-cup sample.
The transmission of ejaculate for bacteriological examination is included in the diagnostic algorithm for infections of the male genital organs and when examining a man for infertility.
The results of laboratory tests (general urine test, general blood test, biochemical blood test, spermogram and other general clinical tests) in chronic prostatitis are not informative. Most likely these tests will show "normal".
During a rectal examination in patients with chronic prostatitis, changes indicating an inflammatory process in the prostate are not always observed. This means that it is impossible to rely on the result of a rectal examination to diagnose chronic prostatitis.
The same applies to ultrasound diagnostics: it is not correct to diagnose chronic prostatitis only on the basis of ultrasound data.The European and American Association of Urology does not recommend ultrasound for the diagnosis of prostatitis. The type of implementation in this case is not important - transabdominal (through the front abdominal wall - the lower part of the abdomen) or transrectal (TRUS - through the rectum). It is incorrect to write "chronic prostatitis", "ultrasound signs of chronic prostatitis", "signs of stagnant prostatitis" in the conclusion of the ultrasound examination. Only the urologist has the prerogative to make this diagnosis, who determines it on the basis of complaints, history, laboratoryexaminations and - only after - ultrasound.
The most common ultrasound sign used to diagnose chronic prostatitis are so-called diffuse changes in the prostate gland associated with an inflammatory process or other changes in the prostate parenchyma. This is a type of fibrous process, replacing the normal parenchyma of the prostate with scars. Howeverthere is no relationship between the number of fibrotic changes in the prostate and the presence of complaints. With age, the chances of the appearance of such "scars" in the organ increase, but a person can live his whole life without experiencing discomfort in the perineum or pubic area. However, as soon as these changes are detected on ultrasound, some "specialists"will diagnose prostatitis. And some men will have the feeling that they are really seriously ill, they will begin 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 fibrous process 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 - primarily urethritis, prostatic hyperplasia, urethral stricture, neurogenic urination disorders, prostate cancer, bladder cancer.
There is no specific picture for chronic prostatitis based on the results of a routine examination.
Treatment of chronic prostatitis
Antibiotics from the fluoroquinolone group are the optimal antimicrobial drugs for the treatment of chronic bacterial prostatitis. The recommended course of antibiotic therapy is 4 to 6 weeks. Such a long course is justified by scientific data showing a reduction in the 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, which leads to reflux of urine into the prostatic ducts into the urethra and causes inflammation of the prostatic tissue and pain. Alpha-blockers are recommended for such patients.
In the treatment of chronic prostatitis, it is recommended that patients refrain from tempting offers to use herbal medicines. A characteristic of nutritional supplements and herbal supplements is the instability of plant components in part of the substance, they can differ even in the preparation of the same manufacturer. Furthermore, from the perspective of evidence-based medicine, the benefits of herbal medicine are beyond criticism.
Prostate massage, which in the middle of the 20th century was used as the basis of therapy, today, thanks to new scientific approaches and the Meares-Stamey classification, remains an important tool for diagnosing prostatitis, but not for its treatment.It is not necessary to use prostate massage as a therapeutic procedure (the effect is not proven).There are suggestions that frequent ejaculation is similar in properties to prostate massage therapy sessions.
Other methods that have proven effective in only one or a few studies or are still being investigated include:
- training the muscles of the pelvic floor - some evidence suggests the effectiveness of special exercises in reducing the symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- acupuncture - a small number of studies have shown a benefit of acupuncture compared to placebo in patients with chronic prostatitis;
- extracorporeal shock wave therapy - based on the impact of acoustic pulses of significant amplitude on connective and bone tissue, widely used in the treatment of diseases of the musculoskeletal system, recently used in urology, its effectiveness is under study;
- 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 mentioning separatelyasymptomatic (symptomless) chronic prostatitis. The diagnosis is most often made based on the results of a histological examination - after a biopsy of the prostate gland or after surgical treatment of the prostate. The frequency of detection of inflammation in prostate tissue varies from 44% (with 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 characteristic. 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 on the part of the doctor or the patient.
How is chronic prostatitis treated in a specialized clinic?
For the last 10 years, 47 monographs have been published in our country and 64 master's and doctoral theses on prostatitis have been defended. Not to mention the various "folk" publications that colorfully describe the causes, diagnosis and various methods of treatment of the disease. What does this mean? The fact that the topic of prostatitis raises many questions, and some, unfortunately, still do not have a clear answer. There are a large number of modern drugs, the effect of which has been proven. However, the number of patients diagnosed with chronic prostatitis does not decrease.
Therefore, when diagnosing and treating prostatitis, urologists try to get the most complete picture. They question the patient in detail about signs and symptoms, study the results of previous tests and pay attention not only to the clinical signs of the disease, but also to other aspects of health, including the neurological and psychological state of the patient - the so-called. this can provoke the appearance of characteristic manifestations. At the same time, unnecessary tests and research are not prescribed.