The diagnosis of "chronic prostatitis" (XN) is put in the presence of lazy inflammation of the tissues of the prostate, which lasts 3 months and longer. Under the influence of trigger factors remission replaced with periodic exacerbations. The disease occurs every fifth man. 30% of patients with this diagnosis between the ages of 20 and 50 years old. Fully cure the chronic form of prostatitis is almost impossible, but in most cases it is possible to obtain a stable remission on the condition that you comply with the recommendations of the physician (a doctor you can take care of the prostatitis).
The types of chronic prostatitis
Universal is considered to be classification, which distinguishes different types of chronic prostatitis:
- Acute bacterial (recurrence).
- Chronic bacterial.
- Chronic aseptic (abacterial) prostatitis, which is divided into 2 subspecies: the syndrome of chronic pelvic pain inflammatory or non-inflammatory character (prostatodynia).
- Asymptomatic flowing (latent) chronic prostatitis.
Data the symptoms of chronic prostatitis in men does not always appear in a strict order. The degree of their severity depends on the characteristics of the body.
Chronic bacterial prostatitis
The bacteria are the cause of inflammation of the prostate gland in 6-10% of cases. The bacterial form of chronic prostatitis is usually caused nonspecific infections (escherichia coli, staphylococcus aureus, haemolytic streptococci), which penetrate into the prostate to other organs or the external environment. The inflammation caused by this type of bacteria, is spread slowly cleared the symptoms, then chronic prostatitis infectious and often intensifies, it is already running. Sometimes the inflammation manifests moderate itching, burning, and also pain in the urethra, disorders of urination. The active development of infection evidenced by abdominal pain and fever. These are the first signs of what started the defeat of the other pelvic organs. Possible formation of abscesses.
Causes
Non-specific infection usually penetrate in the prostate, in case of damage of the genital mucous membranes due to inflammation, injury, foreign bodies, instrumental urological manipulation. On the surface of the skin of the perineum is always a certain amount of intestinal bacteria, this is so important to the hygiene prior to sexual intercourse. If in the area of the anus, the groin, the scrotum, are present over-hydration and irritation, the pathogens are beginning to penetrate in the thickness of the epidermis. Nonspecific agents of chronic prostatitis fall into the breast tissue for the ureter oral sexual contact, because in the throat is often found streptococci, some gram-negative bacteria. Often the infection takes place through the hands of more than a man. The majority of men who suffer from the disease, chronic bacterial prostatitis, belong to the age group from 20 to 40 years, because this period is the peak for sexual activity. Ignoring the funds of contraception barrier leads to frequent do the specific pathogens of inflammation of the prostate. The most dangerous of them are the following:
- Mycoplasmas;
- Ureaplasma;
- Trichomonas;
- Chlamydia.
Erection disorder, a background of chronic bacterial prostatitis is often regulated sexual neurosis, with the result that the man becomes irritable, aggressive.
Treatment
The modern methods of treatment of bacterial prostatitis suggest the intake of antibiotics active against detected during the resolution of a pathogenic agent. As aids prescribed anti-spasmodic, anti-pain class, NSAIDS, diuretics. Antibacterial drugs the first series are: antibiotics of the second row – macrolide. In the schema, may also be included sulfa drugs. Quickly cure the chronic prostatitis is impossible. Depending on the nature of the inflammation, the therapy lasts from 2 to 12 weeks. If within 2 weeks of the positive dynamic is missing, the drug is changing. Unsatisfactory the result of the antibiotic therapy in case of chronic prostatitis due to the following reasons:
- Short course;
- The low concentration of the active substance;
- The formation in the lumina and ducts, the acini of the prostate (grape-like pouches, which form the glandular tissue of the prostate) colonies of resistant bacteria.
Antibiotics are administered not only orally, but also intraprostatically and endolymphatic (through injections in taxes or lymph node).
Fungal prostatitis
Fungal (mycotic) prostatitis is a subtype of the chronic form of the disease. The pathogens penetrate as during sexual contact not protected, and with limfatica from other organs. The symptoms of damage to the tissues of the prostate often blurry, and then the inflammation becomes chronic. During the normal immunity of colonies, do not reproduce more secure standard. The risk of development of candida prostatitis up to date in diabetic men with positive HIV-status, and also those who suffer from systemic diseases.
Abacterial prostatitis
Chronic pelvic pain involving the coccyx and the horse, is a symptom of abacterial prostatitis (the prevalence is 80-90%, including prostatodynia 20-30%). Other manifestations may be not at all. When the diagnosis of pathogenic microorganisms is not detected neither in the juice of the prostate, nor in the urine, nor in the seminal fluid. When the inflammatory character of pelvic pain in these fluids increases the number of white blood cells. Beyond the pain, in the chronic abacterial prostatitis regularly you experience such symptoms, such as blood in the semen, discomfort during ejaculation, and defecation, difficulty urinating. Some men is greatly reduced libido, impairing erectile function, occurs weakness and muscle pain.
Causes and treatment
Likely causes of prostatitis chronic non-bacterial:
- Systemic diseases.
- Malocclusion of the blood vessels, the circulation of the blood.
- Autoimmune disorders.
- Stagnant processes.
The exact cause of the development of chronic non-infectious (non-specific) prostatitis is not always possible to identify, therefore, the pharmacological therapy is often unsuccessful. For the modern derivations from purulent detachable of the prostate takes place, the bladder catheterization. The ineffectiveness of pharmacological treatment applies surgery in the form of a transurethral fine-needle or laser ablation of the prostate (minimally invasive methods to the destruction of the fabric).
Chronic prostatitis, calculous
Chronic calculous form of prostatitis is abacterial. Stones (practicality) in the prostate are formed due to stagnation of secretions. They are composed of products of inflammatory reactions, salts, necrotic masses. The malocclusion usually develops on the background of stagnant (congestive) chronic prostatitis, kidney stones (stones can migrate from the kidneys and the bladder), metabolic disorder, of the adenoma.
Signs of chronic prostatitis with calcification:
- Violation of urination.
- Groin pain, coccyx.
- Blood in the semen.
- The deterioration of erectile dysfunction.
For dissolving the stones in the prostate administered special medications and produce rectal massage. If conservative methods do not work, then you resort to surgery. Launched in the form of chronic calculous prostatitis can lead to an abscess of the gland or atrophy of the organ.
Prostatitis asymptomatic
In the chronic latent prostatitis any signs missing. The only thing that is detected when the diagnosis, this leukocytosis secret of the prostate and the likely increase in the PSA level. Is detected prostatitis asymptomatic is a case: when there is an exam or when you log on for another reason.
The consequences of chronic prostatitis
Itself chronic prostatitis for the life of a man is not dangerous. Threatening may be its consequences, if time does not seek medical help. The complications most often develop in young patients. In the case of chronic prostatitis protective function the breast is broken, it reduces the amount of zinc, lysozyme, necessary for its proper functioning. As A result of an organ becomes a permanent source of infection. Pathogens often migrate in the testicles, the rectum, causing epididymitis, infections. When you move infections ascending ways can the development of pyelonephritis, renal failure. Because the prostate takes an active part in the formation of the seminal fluid, the constant inflammation can lead to infertility. Often the woman can't get pregnant not because of the poor quality of the sperm of their partner, but because of defect of seminal fluid. Attempts to conceive a child the natural way-long-have had to fail (to learn more about the impact of prostatitis to conceive a child). Serious complication is scarring of the bladder wall, most of the prostate, urethra. Long inflammatory deform the fabric, are frown, become functional. Also the probability of development of an adenoma of the prostate (BPH), which can act as a catalyst of the oncological process.
The diagnosis of chronic prostatitis
On the advice of a doctor in detail if the gun comes from the clinical history of the patient, particularly important to describe any violations of the intimate life. The range of complaints that men with chronic prostatitis can be extremely advanced: from sexual dysfunction, first of neurosis. ¼ Of all patients usually do not observe any symptoms, the malocclusion is detected randomly. The importance of history. Medium-sized predecessors, different types of chronic prostatitis: an infection is bacterial or gonococcal urethritis, for non-infectious − hemorrhoids, varicocele, the veins, the defeat of the veins of the legs. Of fundamental importance for the diagnosis of chronic prostatitis have palpation the breast, the analysis of its secret (read more pro-sowing the secret of the prostate). During a flare the size of the prostate increases slightly, and in periods of remission back to normal, it is possible to only a small degree of swelling. The secret is extracted using the rectal massage of the breast. If the inflammatory process leads to the focal character, the consistency of the organ is irregular: alternate Zapadni, VitaScene, razmagcheniu. In these cases, prostate juice receive separately by each share. Changes secret of the breast, are the indicators of chronic prostatitis:
- Displacement of acidity to alkali;
- Most of the activity of lysozyme;
- The reduction of the volume of the acid phosphatase.
High information are fluorescent by means of the cytological examination of the prostate in the fruit juice, and also the test of crystallization. In healthy men the juice crystallizes in the form of a leaf of fern. The geometry of the design testifies to endocrine disorders, due to which occurs the lack of androgens. In some cases, the diagnosis of chronic prostatitis infectious apply food provocation – the patient deliberately consume spicy foods or alcohol, with the consequence that activate agents of gonorrhoea and trichomonas. Lenses inflammatory processes occur with the introduction of pirogenala, or prednisolone. Among laboratory tests, the most informative is considered to be a test, called trehstakannoy test. The patient urinate first into a glass, then the second, after which it is made massage of the prostate. The remaining in the bladder the urine is collected in the third glass. She, along with the seminal fluid exposed to the studies bacteriological. In which the mandatory analysis also took a urethral swab for the presence of sexually transmitted diseases. Not all conditional pathogens, grew up with the culture, automatically considered to be pathogens of chronic prostatitis. In the microbiocenosis their presence is a variant of the norm. Important title of growth (concentration). If the amount exceeds 10 at 4 degrees, then it is considered diagnostic significant. Otherwise, the patient is shown the dynamic monitoring, and not treatment. Informative method of diagnosis is transrectal ultrasound or transabdominal ULTRASOUND-study. For ultrasound there is possible to define the duration and the severity of the inflammation. The main exeprince in the case of chronic prostatitis:
- Volume breast increases up to 20 cm3, and more;
- Sclerotic and fibrotic transformation of tissues;
- The stones;
- The swelling.
The speed of the flow of urine and the presence of obstructive changes in the ureter allows you to track uroflowmetry. For the differentiation of chronic prostatitis from cancer, and hyperplasia, if necessary, is carried out a biopsy of the breast. The level of PSA in the case of chronic prostatitis in remission is this normal or is slightly elevated. In the background is in an active inflammatory process may go up to 8-10 ng/ml. the Diagnosis of chronic prostatitis non-bacterial bit more complicated. It is necessary to conduct a series of analyses for the elimination of the bacterial form of inflammation, diseases of other pelvic organs. Microscopy of urine and seminal fluid, shows the overcoming of white blood cell levels, but ULTRASOUND, cystoscopy, CT comorbidities do not touch.
Common techniques of therapy of chronic prostatitis
In addition to specific treatment methods for various types of chronic prostatitis, there are common, used in all types of inflammation. An effective way to healing the impact on the prostate is the massage. He has a direct impact on the prostate tissue, improves blood and lymphatic circulation, eliminates the products of inflammatory reactions. Exacerbation of massage of the prostate is not available.