The chronic prostatitis hard inflammation of the prostate, which leads to the rupture of the morphology and of the functioning of the prostate. The chronic prostatitis is manifested prostatic triad – the pain in the pelvic region and genitals, disorders of urination, sexual disorders. The diagnosis of chronic prostatitis includes palpation of the gland, the search for the secret of the prostate, ULTRASOUND, uroflowmetry, in, puncture biopsy of the prostate. When the chronic prostatitis shows full of drugs, physiotherapy, massage prostate, instillation of the back of the urethra. The surgical treatment is advisable when complicated shapes of the chronic prostatitis.
The chronic prostatitis
The chronic prostatitis is the most common of men of the disease: approximately 50% of men suffer from a form of inflammation of the prostate. Chronic prostatitis is more common in men aged 20 to 40 years, in the period of the greatest sexual and reproductive activity. In this regard, the detection and treatment of chronic prostatitis acquires in urology is not only medical, social, and a visible aspect.
The classification of chronic prostatitis
According to the modern classification of prostatitis, designed in 1995, distinguishes 3 categories of disease:
- I. prostatitis Acute.
- II. The chronic prostatitis bacterial the genesis.
- III. Prostatitis chronic nonbacterial of the genesis/Syndrome of chronic pelvic pain syndrome is not associated with obvious signs of infection and continues for 3 months or more.
- III – chronic prostatitis with the presence of a component inflammatory (detection in the secret of the prostate gland leukocytes and infection);
- III B – chronic prostatitis with the absence of a component inflammatory (leukocytes and pathogens into the secret of the prostate).
- IV. Chronic prostatitis is an asymptomatic (no complaints in the case of leukocytes in prostatic secret).
If you have an infectious component speak bacterial (infection) prostatitis, chronic; in the case of the absence of microbial pathogens – on nonbacterial (non-contagione) prostatitis. It is believed that 90 to 95% of all cases had non-bacterial chronic prostatitis, and only 10-5% - bacterial.
The causes of chronic prostatitis
The etiology and pathogenesis bacterial chronic prostatitis linked to the spread of the infection in the prostate, in the following ways: bottom-up (through the urethra), downstream (during the casting process and contaminated by the urine from the bladder), gematogennim (blood vessels motorways) or lymphogenous (lymphatic collectors). Most uropathogens are acting escherichia coli, klebsiella, proteus, staphylococci, enterococci, CORINE, fungal, parasitic, and viral pathogens. With a non-specific flora the development of the chronic prostatitis may participate in pathogen-specific urethritis (chlamydia, mycoplasma, gonococci, trichomonas, Gardnerella).
However, for the development of the chronic prostatitis is important is not so much the presence and activity of micro-organisms, how the state of the pelvic organs and circulation in them, the presence of comorbidities, the level of protection mechanisms.
Therefore, the occurrence of chronic prostatitis may contribute to a number of factors. First of all, it is urological diseases –pyelonephritis, cystitis, urethritis), stricture of the urethra, increatos until the end of the prostatitis acute, orchitis, epididymitis, et al, Microbial etiologist can penetrate into the prostate of remote foci of infection, for example, if you have sinusitis, tonsillitis, dental caries, chronic bronchitis, pneumonia, pyoderma etc, Predispose to the chronicity of inflammation, local and general, hypothermia, overheating, the stay in a damp environment, fatigue, a poor diet, a rare disease of the urination and etc
Non-bacterial chronic prostatitis is usually associated with congestive heart failure (stagnant phenomena in the prostate gland due to venous stasis of the blood circulation in the pelvic organs and the violation of drainage of the acinus of the prostate. Local obstructio leads to an overflow of the vessels of the prostate through the blood, the swelling, incomplete emptying of the secret of the origin of the rupture of the barrier, of secretion, of the automobile, the contractile function of the gland.
The stagnation of changes, generally, are caused by behavioural factors – long sexual disadvantaged, the practice of interruption or renewed sexual acts excessive sexual activity, physical inactivity, the long siege, and chronic intoxications (alcohol, nicotine, drugs), occupational hazard (vibration). The development of nonbacterial prostatitis chronic predisposing pathology and pelvic nerve structures, performing their organic (for example, injuries of the spinal cord), adenoma of the prostate, hemorrhoids, constipation, androgenodeficiency, and other causes.
The symptoms of chronic prostatitis
The chronic prostatitis is manifested in local and global symptoms. Local manifestations of the part of the prostate of the triad, characterized by pain, dysuria, and violation of the sexual function. The pain when the chronic prostatitis is ongoing, painful nature, are localized in the area of the perineum, the genitals, above the pubes, in the groin. Syndrome the pain intensifies at the beginning and at the end of urination, pain radiating to the head of the penis, the scrotum, sacrum, the rectum. The sensation of pain may increase after sexual intercourse or long abstinence; weaken or intensify after the orgasm become more intense at the time of ejaculation.
The intensity of the pain during the chronic prostatitis varies from discomfort to cast, disturbing the sleep and the operation, the events. The pain limited to the location in the rump is often regarded as low back pain or sciatica, and the patient can long be treated independently, without the help of a doctor.
Urination in chronic prostatitis acclre and painful. This may be the difficulty of beginning miscet, weakening or discontinuity of urine stream, sensation of incomplete of the devastation of the bladder, frequent urination at night, a burning sensation in the urethra. In the urine in the chronic prostatitis may detect the presence of floating yarns. After defecation or of the physical load of the urethra appear of selection due to the reduction of the muscle tone of the prostate. When the chronic prostatitis can be the onset of itching, feeling cold, or increased sweating at the level of the perineum, the local variations of the skin coloration associated with the stagnation of the circulation of the blood.
Chronic prostatitis is accompanied by patent, disorders of the sexual function. The phenomenon gipotenzia can be expressed in the deterioration, the pain of the erection, prolonged and frequent erections at night, difficulty or premature ejaculation, loss of libido (decreased sex drive), erased, orgasms, Hematospermias, infertility. Sexual disorder is always difficult, always lived the man, leading to psycho-emotional disorders, up to neurosis and depression, further worsening of the sexual function.
The worsening of the chronic prostatitis is accompanied by a slight increase in body temperature and deterioration of health. The general condition when the chronic prostatitis is characterized by increased irritability, apathy, anxiety, fatigue, rapid, loss of appetite, sleep disturbances, decreased ability to work, of creation and of physical activity.
Almost a quarter of patients with the chronic prostatitis the symptoms of the disease, the long time, which leads to a delay in the handling of the urologist. Long-term, chronic prostatitis can cause impotence, vesiculitis, epididymoorchitis, male infertility, incontinence, education, stones and cysts of the prostate gland, sclerosis of the prostate, is the development of adenoma and cancer of the prostate.
The diagnosis of chronic prostatitis
Necessary for the diagnosis of chronic prostatitis the information is produced with the help of the built-in the laboratory of the survey tool. The initial assessment in suspected cases of chronic prostatitis includes the elucidation of the history and complaints, the completion of the clinical examination of the genital organs on the subject of body fluids, rash, irritation, a digital rectal examination of the prostate to determine the contours, limits, consistency, pain of breast.
To determine the structural and functional changes of the prostate shows the completion of an ULTRASOUND of the prostate (TRUS). Important methods in the diagnosis of chronic prostatitis is used in the search for the secret of the prostate, the total analysis of urine, examination bacteriological of the brush strokes of the urethra and the urine, 3 cups of urine samples, the PCR and the REEF scraping of the research on pathogens, genital infections, the definition of the prostate specific antigen (PSA).
Clinically significant when the chronic prostatitis is used to reveal in analyses of pathogens of chlamydia infection, mycoplasmosis, herpes, cytomegalovirus, trichomoniasis, gonorrhea, candidiasis, and non-specific bacterial flora. The closing of the secret of the prostate to the studies carried out after urination and the prostate massage. The symptoms of chronic prostatitis are used to the increase in the number of leukocytes in the field of vision, decreased amount of lecithin grains, the presence of the microflora pathogenic.
In general, the analysis of the urine in the chronic prostatitis can manifest itself leykotsituriya, pyuria, erythrocyturia. Bacteriological culture of urine is used to determine the extent and nature of the bacteriuria. When the reproduction of the violations demonstrated by a study of the sperm and MAR-test.
The extent and causes of the violation of urination to determine the urodinamicheskie of the study (uroflowmetry, cystometry, profilometry, and electromyography). Using the research data of the chronic prostatitis can be differentiated from stress incontinence, neurogenic bladder and other At the hematuria, Hematospermias, obstructive urination shown in the endoscopic examination - urethroscopy, cystoscopy. To the exclusion of the adenoma and the prostate cancer requires the definition of a DOG, in some cases, the realization of the biopsy of the prostate to the morphological study of tissues.
Treatment of chronic prostatitis
The chronic prostatitis is ready to healing is not easy, but it must be remembered that healing is still possible and a lot depends on the attitude of the patient, the rapidity of its appeal to a specialist, the definition of the compliance with all the requirements of an urologist. The basis of the treatment of prostatitis chronic bacterial antimicrobial therapy according to antibiotics minimum duration of 2 weeks. To reduce the pain and inflammation are appointed by NSAIDS ; for the relaxation of the musculature of the prostate, the restoration urodynamics and outputs of prostate secret illustrates the technical blockers.
In order to improve the drainage of the prostate, of the local microcirculation and the muscular tone of the course of therapeutic massage of the prostate. A prostate massage should end with a selection of no less than 4 drops of secret of the prostate. The prostate massage is contraindicated in prostatitis bacterial, abscess of the prostate, hemorrhoids, stones in the prostate, fissures in the rectum, hyperplasia and prostate cancer.
To relieve the pain of chronic prostatitis can be recommended paraprostatic blockade, acupuncture. Essential in the treatment of chronic prostatitis is relegated to the physiotherapy department with the appointment of a medicine in the electrophoresis, ultrasound, phonophoresis, magnetic therapy, laser magneticam illic, inductometer, the mud, the SMT, the more hot seat bath temperature of 40°To 45 ° c, enemas with hydrosulphuric and mineral water instillation into the urethra.
In the development of complications related to chronic prostatitis, shows the surgical treatment: the removal of strictures of the urethra; TOWER of the prostate, or prostatectomy, sclerosis of the prostate; transurethral resection of the bladder in multiple sclerosis in his neck of the uterus, puncture and drainage of cysts and abscesses of the prostate; circumcisio when phimosis, called recurrent urinary tract infections, etc
The prevention of chronic prostatitis
The warning of the chronic prostatitis requires the respect of sexual health, in a timely manner, the therapy urogenitalnih and extragenital infections, the normalization of the regularity of the sexual life, to an adequate exercise, prevention of constipation, time of emptying of the bladder.
For the exceptions of recurrence of chronic prostatitis necessary for dynamic examinations of the andrologist (urologist); and the prevention of the course of physical therapies, multivitamins, immunomodulators; with the exception of hypothermia, overheating, stress, bad habits.