Prostatitis in this category is rare, occurring in approximately 10% of all cases of prostatitis. The question is being discussed as to whether atypical pathogens such as Ureaplasma urealiticum can cause inflammation of the prostate. They can be present in a man's body without causing any signs of inflammation or discomfort.
Causes of chronic prostatitis
The causes of chronic prostatitis are fundamentally similar to the causes of acute bacterial prostatitis. In most cases, microorganisms enter the prostate via the urethra - as a result of the backflow of urine into the ducts of the prostate (intraprostatic urine backflow).
Chronic bacterial prostatitis occurs 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, feeling of incomplete bladder emptying.
The patient may complain of a range of symptoms or of each individual symptom. An increase in body temperature is atypical (or insignificant).
Important:
Many men associate erectile dysfunction with prostatitis. This is often encouraged by unprofessional publications in the media and advertising for dubious medications. The fact that an erection can persist even with complete removal of the prostate (due to the presence of a malignant tumor of the organ) suggests that it itself plays no role in maintaining an erection.
According to many renowned urologists, erectile dysfunction in patients with chronic prostatitis is caused by psychogenic and neurotic problems.
diagnosis
The NIH-CPSI questionnaire is used for the initial assessment – the Chronic Prostatitis Symptom Index. It can be used to objectify the patient's complaints.
The standard method for diagnosing prostatitis is to perform a 4-cup Meares-Stamey test. This is a microscopic and bacteriological examination of urine samples from various parts of the urogenital tract and prostate secretions. However, the 4-glass sample method is quite labor-intensive, and currently modifications of the Meares-Stamey samples are more commonly used: 3-glass or 2-glass sample. A possible alternative is to subject the ejaculate (sperm) to a microscopic and bacteriological examination, since the ejaculate consists partly (at least 1/3) of prostatic secretion. This method is more comfortable for patients, especially if they categorically refuse a rectal examination or diagnostic massage of the prostate to obtain prostatic secretion. However, ejaculate donation has lower information content and lower reliability compared to a 3-glass or 2-glass sample.
Submission of ejaculate for bacteriological examination is part of 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. That is, it is impossible to rely on the result of a rectal examination when diagnosing chronic prostatitis.
The same applies to ultrasound diagnostics: it is wrong to diagnose chronic prostatitis based on ultrasound data alone.The European and American Association of Urology does not recommend ultrasound to diagnose prostatitis. The method of execution in this case does not matter - transabdominal (through the anterior abdominal wall - lower abdomen) or transrectal (TRUS - through the rectum). It is incorrect to write "chronic prostatitis", "ultrasound signs of chronic prostatitis", "signs of congestive prostatitis" at the end of an ultrasound examination. The right to make this diagnosis belongs exclusively to a urologist, who makes it based on complaints, anamnesis, Laboratory tests and – only after – ultrasound determines.
The most common ultrasound sign by which the diagnosis of chronic prostatitis is made are the so-called diffuse changes in the prostate, which are accompanied by an inflammatory process or other changes in the prostate parenchyma. This is a type of fibrotic process in which the normal prostate parenchyma is replaced by scar tissue. HoweverThere is no connection between the number of fibrous changes in the prostate and the presence of symptoms. With age, the likelihood of such "scars" appearing in the organ increases, but a man can live his entire life without experiencing discomfort in the perineal or pubic area. However, as soon as these changes are detected on ultrasound, some "specialists" diagnosea prostatitis. And some men will feel that they are really seriously ill, they will begin to listen to themselves, and they will feel all the symptoms described on the Internet.
In many men over 30 years of age, diffuse changes in the prostate can be detected on ultrasound. However, the fibrotic process does not indicate the presence of prostatitis.
The diagnosis of chronic prostatitis is made on the basis of the exclusion of other diseases of the genitourinary system - primarily urethritis, prostatic hyperplasia, urethral stricture, neurogenic disorders of urination, prostate cancer, bladder cancer.
Based on the results of a routine examination, there is no specific picture of chronic prostatitis.
Treatment of chronic prostatitis
Antibiotics from the group of fluoroquinolones are the optimal antimicrobial drugs for the treatment of chronic bacterial prostatitis. The recommended duration of antibiotic therapy is 4 to 6 weeks. Such a long course is justified by scientific data indicating a reduction in the likelihood of the disease relapsing.
For identified 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, leading to backflow of urine into the prostatic ducts in the urethra, causing inflammation of prostate tissue and pain. Alpha blockers are recommended for such patients.
When treating chronic prostatitis, it is advisable for patients to avoid tempting offers to use herbal medicines. A feature of dietary supplements and herbal supplements is the instability of the plant components in part of the substance; they may also differ when prepared by the same manufacturer. Furthermore, the benefits of herbal medicine do not stand up to criticism from the perspective of evidence-based medicine.
Prostate massage, which served as the basis of therapy in the mid-20th century, is today still an important tool for diagnosing prostatitis, but not for treating it, thanks to new scientific approaches and the Meares-Stamey classification.There is no need to use prostate massage as a therapeutic procedure (the effect has not been proven).There is evidence that frequent ejaculation has similar properties to therapeutic prostate massage.
Other methods that have only been proven effective in one or a few studies or are still being researched include:
- Pelvic floor muscle training – some evidence suggests the effectiveness of specific exercises in relieving symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- Acupuncture – a small number of studies suggest a benefit of acupuncture compared to placebo in patients with chronic prostatitis;
- extracorporeal shock wave therapy – based on the effect 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 currently being studied;
- Behavioral therapy and psychological support - since chronic prostatitis is associated with a reduced quality of life and the development of depression, these methods can improve the patient's psychological state and help relieve some symptoms of the disease.
Worth mentioning separatelyasymptomatic (asymptomatic) chronic prostatitis. The diagnosis is usually made based on the results of histological findings - after a biopsy of the prostate or after surgical treatment of the prostate. The frequency of detection of inflammation in prostate tissue varies between 44% (on prostate biopsy) and 98-100% (after surgical treatment of the prostate). Scientists have 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 on the part of the doctor or patient.
How is chronic prostatitis treated in a specialist clinic?
Over the last 10 years, 47 monographs have been published and 64 master's and doctoral theses on the topic of prostatitis have been defended in our country. Not to mention the various "people's" publications in which the causes, diagnosis and various methods of treatment of the disease are described in detail. What does this mean? The fact that the topic of prostatitis raises many questions, and some, unfortunately, are not yet clearThere is an answer. There are a number of modern medications whose effectiveness has been proven. However, the number of patients diagnosed with chronic prostatitis is not decreasing.
That is why urologists try to get as complete a picture as possible when diagnosing and treating prostatitis. 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 neurological and psychological state of the patient - since this may cause the appearance of characteristic manifestationscause. At the same time, unnecessary tests and studies are not required.