Prostatitis of this category occurs rarely, in approximately 10% of all cases of prostatitis. Whether atypical pathogens, such as ureaplasma urealyticum, can cause prostatitis is debated. They can be present in a man's body without any signs of inflammation or discomfort.
Causes of chronic prostatitis
The causes of chronic prostatitis are basically similar to the causes of acute bacterial prostatitis. Microorganisms enter the prostate in most cases through the urethra - as a result of urine reflux into the prostate ducts (intraprostatic urine reflux).
Chronic bacterial prostatitis occurs as a result of inadequate treatment or short treatment of acute bacterial prostatitis.
Symptoms
- Discomfort or pain - in the perineum, lower abdomen, groin, scrotum, penis, during ejaculation
- Changes in urination - difficult urination, frequent urination in small portions, feeling of incomplete emptying of the bladder.
The patient may complain of a series of symptoms or of any symptom individually. An increase in body temperature is uncharacteristic (or insignificant).
Important:
Many men associate erectile dysfunction with prostatitis. Unprofessional announcements in the media and advertising of suspicious drugs often contribute to this. The fact that an erection can persist even after the prostate has been completely removed (due to the presence of a malignant tumor of the organ) suggests that it does not itself play a role in maintaining an erection.
According to many authoritative urologists, erectile dysfunction in patients with chronic prostatitis is caused by psychogenic and neurotic problems.
Diagnostics
The NIH-CPSI questionnaire - Chronic Prostatitis Symptom Index is used for the initial assessment. It can be used to objectify patient complaints.
The standard method for diagnosing prostatitis is to perform the Meares-Stamey 4-cup test. This is a microscopic and bacteriological study of urine samples obtained from different parts of the genitourinary tract and prostate secretions. However, the 4-glass sample method is quite labor-intensive, and currently modifications of the Meares-Stamey samples are more often used: the 3-glass or 2-glass sample. A possible alternative is to submit the ejaculate (sperm) for microscopic and bacteriological examination, because the ejaculate partially (at least 1/3) consists of prostate secretions. This method is more comfortable for patients, especially if they categorically refuse rectal examination or diagnostic prostate massage to obtain prostate secretions. However, ejaculate donation has less information content and reliability compared to a 3 or 2 glass sample.
Submission 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 the case of chronic prostatitis are not informative. Most likely these tests will show "normal".
During a rectal examination, changes indicating an inflammatory process in the prostate are not always observed in patients with chronic prostatitis. That is, it is impossible to rely on the result of a rectal examination to diagnose chronic prostatitis.
The same applies to ultrasound diagnostics: it is incorrect to diagnose chronic prostatitis only on the basis of ultrasound data.The European and American Association of Urologists does not recommend ultrasound for diagnosing prostatitis. The type of performance in this case is not important - transabdominal (through the front 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" in the conclusion of the ultrasound examination. .
The most common ultrasound sign used to diagnose chronic prostatitis is the so-called diffuse changes on the prostate associated with the inflammatory process or other changes in the prostate parenchyma. This is a type of fibrotic process, the replacement of normal prostate parenchyma by scar tissue. Howeverthere is no correlation between the number of fibrotic changes in the prostate and the presence of complaints. With age, the chances of such "scars" on the organ to appear increase, but a person can live a whole life without feeling 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 start listening to themselves, and they will feel all the symptoms described on the Internet.
In many men over the age of 30, ultrasound can show diffuse changes in the prostate. However, the fibrous process does not indicate the presence of prostatitis.
The diagnosis of chronic prostatitis is 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 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 that indicate a reduction in the likelihood of disease recurrence.
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, which leads to reflux of urine into the prostate ducts in the urethra and causes inflammation of the prostate tissue and pain. Alpha-blockers are recommended for such patients.
When treating chronic prostatitis, patients are advised to refrain from tempting offers to use herbal remedies. A characteristic of dietary supplements and herbal supplements is the instability of herbal components in part of the substance, they can differ even with preparations from the same manufacturer. In addition, from an evidence-based medicine perspective, the benefits of herbal medicine do not stand up to criticism.
Prostate massage, which was used as the basis of therapy in the middle of the 20th century, 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 has not been proven).There are suggestions that frequent ejaculation is similar in properties to therapeutic prostate massage.
Other methods that have been shown to be effective in only one or a few studies or are still being investigated include:
- pelvic floor muscle training - some evidence suggests the effectiveness of specific exercises to reduce symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- acupuncture - a small number of studies indicate the 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 being studied;
- 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 patient's psychological state and help reduce some symptoms of the disease.
It is especially worth mentioningasymptomatic (asymptomatic) chronic prostatitis. The diagnosis is most often made based on the results of histological findings - after prostate biopsy or after surgical treatment of the prostate. The frequency of detection of inflammation in the prostate tissue varies from 44% (with prostate biopsy) to 98-100% (after surgical treatment of the prostate). Scientists have suggested that the inflammatory changes identified in this way are nothing more than a physiological feature associated with age. No one specifically diagnoses this category of prostatitis, it is a kind of accidental discovery. It does not require treatment and does not require any further action by the doctor or the patient.
How is chronic prostatitis treated in a specialized clinic?
In the past 10 years in our country, 47 monographs were published and 64 master's and doctoral theses on prostatitis were defended. Not to mention the various "folk" publications, which colorfully describe the causes, diagnosis and various methods of treatment of the disease. What it means? The fact that the topic of prostatitis raises many questions, some of which, unfortunately, still do not have a clear answer. There are a large number of modern drugs whose effectiveness has been proven. However, the number of patients diagnosed with chronic prostatitis is not decreasing.
Therefore, when diagnosing and treating prostatitis, urologists try to get the most complete picture. They examine 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 patient's neurological and psychological state - which can cause the appearance of characteristic manifestations. At the same time, unnecessary tests and studies are not prescribed.