Chronic (bacterial) prostatitis is characterized by constant or recurring symptoms with bacterial infection confirmed in the prostate gland.
Prostatitis of this category is uncommon, in approximately 10% of cases of all cases of prostatitis.The question is discussed, if atypical pathogens, such as uroaliticum ureplasma) cause inflammation of the prostate.They can be present in the body of a man and without any sign of inflammation and complaints.
The causes of chronic prostatitis
The causes of chronic prostatitis are mainly similar to the causes of the development of acute bacterial prostatitis.In most cases, the entry of microorganisms into the prostate occurs through the urethra, as a result of the smelting of urine in the duct of the prostate gland.
Chronic bacterial prostatitis develops due to inappropriate treatment or a short treatment of acute bacterial prostatitis.
Symptoms
- Discomfort or pain: in the crotch, the lower part of the abdomen, in the groin, scrotum, penis, during ejaculation
- Changes in urination: urine difficulty, fast urine in small portions, an incomplete emptying of the bladder.
The patient may complain about a series of symptoms and any separate symptoms.An increase in body temperature is not characteristic (or slightly).
Important:
Many men associate erectile dysfunction with prostatitis.Often, this is facilitated by non -professional publications in the media and the advertising of dubious drugs.The fact that an erection can remain even with a complete elimination of a prostate (due to the presence of an evil organ tumor), suggests that it does not play a role in maintaining an erection.
According to many authorized urologists, erectile dysfunction in patients with chronic prostatitis is due to psychogenic and neurotic problems.
Diagnosis
For primary evaluation, a questionnaire is used: an index of chronic prostatitis symptoms.In it, it can objectify the patient's complaints.
The standard method to diagnose prostatitis is sample performance.This is a microscopic and bacteriological study of urine samples obtained from different parts of the genitourinary tract and the secretion of the prostate gland.However, the test method is quite laborious, and at this time, samples are used more frequently.A possible alternative is the supply of ejaculate (sperm) for a microscopic and bacteriological examination, since partially ejaculate (at least 1/3) consists of a secretion of the prostate gland.This method is more comfortable for patients, especially if they categorically reject a rectal exam or perform a diagnostic prostate massage to obtain a prostate secret.However, ejaculate rendering has lower information and reliability compared to decomposition.
The delivery of ejaculate for a bacteriological examination is included in the diagnostic algorithm for the infections of the male genital organs and when examining a man about infertility.
The results of the laboratory tests (general urine analysis, a general blood analysis, a biochemical blood test, a sperm and other general clinical tests) in the case of chronic prostatitis are not informative.Most likely, these tests show the "standard."
During a rectal examination of changes that indicate the inflammatory process in the prostate, in patients with chronic prostatitis, far from always observing.That is, it is impossible to trust the result of a rectal study for the diagnosis of chronic prostatitis.
The same is true for UZ diagnoses: making a diagnosis of chronic prostatitis, focusing only on ultrasound data, is incorrect.It is not recommended that the European and American Association of Urologists perform an ultrasound for the diagnosis of prostatitis.The type of execution in this case is not important through the anterior abdominal wall, the lower abdomen or trust, through the rectum.To write at the conclusion of the ultrasound study "chronic prostatitis", "ultrasonic signs of chronic prostatitis", "signs of prostatitis" is incorrect.The prerogative of the installation of this diagnosis only has a urologist that determines it on the basis of complaints, anamnesis, laboratory tests and, only later, ultrasound.
The most frequent ultrasonic sign, according to which the diagnosis of chronic prostatitis is established, the diffuse changes called in the prostate gland associated with the inflammatory process transferred or other changes in the parenchyma of the prostate.This is a type of fibrous process, replacing the normal prostate parenchyma with a scar cloth.However, there are no correlations of the number of fibrous changes in the prostate with the presence of complaints.With age, the possibilities of the appearance of such "scars" in the organ are increasing, but a man can live his whole life, without feeling any discomfort in the crotch or the pubic area.However, as soon as these changes are in an ultrasound, some "specialists" will diagnose prostatitis.And some men will have the feeling that they are really sick, start listening to themselves, feeling all the symptoms described on the Internet.
For many men over 30 years, 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 on the basis of the exclusion of other diseases of the genitourinary system: mainly urethritis, prostate hyperplasia, urethra stenosis, neurogenic urination disorders, prostate cancer and bladder cancer.
There is no specific image for chronic prostatitis based on the results of a routine exam.
Treatment of chronic prostatitis
The antibiotics of the Ftikinolone group are optimal antimicrobial drugs for the treatment of chronic bacterial prostatitis.The recommended antibacterial therapy course is 4 to 6 weeks.Such a long course is justified by scientific data that indicate a decrease in the probability of relapse of the disease.
If sexually transmitted infections (STIs), such as clamidia, are prescribed an antibiotic group of macroll groups.
There are data on a decrease in the relaxation of the bladder neck in patients with chronic prostatitis, which leads to urine reflux to ducts in the urethra and cause inflammation of prostate and pain tissue.These patients are recommended by appointing Alpha-blockers.
In the treatment of chronic prostatitis, it is advisable that patients refrain from tempting sentences for the use of herbal medicine.A characteristic of dietary supplements and plants additives is the instability of the components of the plant in a part of the matter, they may even differ in the medication of the same manufacturer.In addition, from the point of view of evidence -based medicine, the benefits of herbal medicine do not resist criticism.
The prostate massage, which in the mid -twentieth century was used as the basis of therapy, today, thanks to the new scientific approaches and classification, it remains an important tool to diagnose prostatitis, but not its treatment.You do not need to use prostate massage as a therapeutic procedure (the effect is not tested).There are assumptions that frequent ejaculation in its properties is similar to the sessions of the therapeutic massage of the prostate.
To other methods whose effectiveness has been demonstrated as a result of only one or more studies or is still being studied: relate:
- Fund's caught muscle training: Some data indicate the effectiveness of special exercises to reduce the symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- Acupuncture: A small amount of studies indicates the advantage of acupuncture compared to placebo in patients with chronic prostatitis;
- Extracorporeal shock wave wave therapy based on the effects of significant acoustic impulses in connective and bone tissue is widely used in the treatment of musculoskeletal system diseases, recently used in urology, its effectiveness is under study;
- Behavioral therapy and psychological support: since chronic prostatitis is associated with 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.
Separately, it is worth mentioningAsymptomatic chronic (asymptomatic) prostatitis.The diagnosis is established more frequently according to the results of the histological conclusion, after the biopsy performed of the prostate gland or after the surgical treatment of the prostate.The inflammation detection frequency in the prostate tissues varies from 44% (with prostate biopsy) to 98-100% (after the surgical treatment of the prostate).Scientists have suggested that revealed inflammatory changes in this way are nothing more than a physiological characteristic related to age.No one is involved in diagnoses especially in this category of prostatitis, this is a random finding type.It does not need treatment, does not require any additional action by the doctor and the patient.