Chronic prostatitis – a prolonged inflammation of the prostate, leading to violate the morphology and the functioning of the prostate. Chronic prostatitis is manifested the triad – pain in the pelvic region and genitals, disorders of urination, disorders of sexual. The diagnosis of prostatitis, chronic includes the palpation of the breast, the study of secretion of the prostate, ultrasound, uroflowmetry, in, puncture biopsy of the prostate. In chronic prostatitis shows integrated medication, physiotherapy, massage prostate, instillation the back of the urethra. Surgical treatment is appropriate when complicated forms of prostatitis chronic.
Chronic prostatitis
Chronic prostatitis the most frequent male illness: about 50% of men suffer from some form of inflammation of the prostate. Chronic prostatitis because most strikes men between the ages of 20 and 40 years, are in a period of greater sexual and reproductive labour to the activity. In this context, the identification and treatment of the prostatitis chronic acquires in urology, not only medical, but also socially significant aspect.
Classification of the prostatitis chronic
According to the modern classification of prostatitis, developed in 1995, include 3 categories of disease:
- I. prostatitis Acute.
- II. Prostatitis chronic bacterial genesis.
- III. Prostatitis chronic nonbacterial genesis/Syndrome of chronic pelvic pain – a symptom, not related with evident signs of infection and in the course of 3 months.
- III A chronic prostatitis with the presence of an inflammatory component (discovery in the secret of the prostate white blood cells and agents of infection);
- III B – chronic prostatitis with the lack of an inflammatory component (leukocytes and pathogens in the secret of the prostate gland).
- IV. Asymptomatic chronic prostatitis (the lack of complaints in the detection of leukocytes in prostatic secret).
If there is infection component talk about bacterial (infectious) chronic prostatitis; in case of absence of pathogenic microorganisms – about nonbacterial (non-contagione) prostatitis. It is believed that in 90-95% of all cases takes place non-bacterial chronic prostatitis, and only 10-5% - bacterial.
The cause of prostatitis chronic
The etiology and the pathogenesis of bacterial prostatitis chronic linked by an infection in the prostate following way: a tendency of growth (through the urethra), descending (when the cast infected urine from the bladder), hematogenous (through the vessels highways) or lymphogenous (lymphatic collectors). Most uropathogens defended by e. coli, Klebsiella, proteus, staphylococcus, Enterococcus, CORINE, fungal, parasitic, and viral causative. Along with the flora is argued in the development of prostatitis chronic for the participating agents specific urethritis (chlamydia, mycoplasma, gonococcus, trichomonas, Gardnerella).
However, for the development of prostatitis chronic, it is important is not so much the presence and activity of micro-organisms, as the state of the pelvic organs and of the blood circulation, the presence of co-morbidities, the level of protection mechanisms.
Therefore, the occurrence of prostatitis chronic it can promote a series of factors. First of all, is a urology disease –pyelonephritis, cystitis, urethritis, urethral stenosis, increatos until the end of the prostatitis acute, orchitis, epididymitis, and Dr. Microbial etiologist can enter in the prostate distant from the foci of infection, for example, if you have sinusitis, tonsillitis, dental caries, chronic bronchitis, pneumonia, pyoderma, and PR. Predispose to chronic local inflammation and the total of hypothermia, overheating, stay in a humid environment, fatigue, poor nutrition, rare urination, and PR.
Non-bacterial chronic prostatitis is usually associated with congestive (stagnant) phenomena in the prostate, as a result of venous stasis of the blood circulation in the pelvic organs and the violation of drainage acini of the prostate. Local obstructio results in an overload of the vessels of the prostate the blood, the swelling, its incomplete emptying of secrecy, violation of the barrier, secretory, motor, contractile function breast.
The stagnant changes, usually, are due to behavioural factors – the prolonged deprivation of sexual practice to stop or PRolenguruone of sexual acts, excessive sexual activity, physical inactivity, the long-term front seat, chronic intoxications (alcohol, nicotine, drugs), occupational hazard (vibration). For the development of nonbacterial prostatitis and chronic predisposes the pathology of the pelvic structures and nerve, that exert their innervation (for example, spinal cord injury), hypertrophy of the prostate, hemorrhoids, constipation, androgenodeficiency, and Dr. causes.
The symptoms of prostatitis chronic
Chronic prostatitis is manifested in the local and global symptomatology. Place of work refers prostatic triad, characterized by headaches, dysuria, and violation of sexual function. Pain in the chronic prostatitis lead to permanent aching in nature, are located in the perineal region, genitals, about the pubes, in the groin. Pain that is caused intensifies at the beginning and at the end of urination, pain radiating to the head of the penis, the scrotum, sacrum, the rectum. The pain may increase after sexual intercourse or long abstinence; weaken or intensify after an orgasm, becoming more directly at the moment of ejaculation.
The intensity of the starting point of the pain syndrome in chronic prostatitis varies from feelings of discomfort to express, to violate sleep, and performance capability, of its manifestations. Pain limited to the location in the sacrum, many times, are treated as osteocondrose or sciatica, in connection with the that the patient of long duration and can be treated independently, without resorting to the help of the doctor.
Urination in chronic prostatitis learning and painful. When you do this, you may be concluded the difficulty beginning miscet, weak or intermittent stream of urine, feeling of incomplete emptying of the bladder, frequent night urges, burning sensation in the urethra. In the urine in the chronic prostatitis can detect the presence of floating yarns. After defecation or of the physical load of the urethra appear selection , caused by decreased muscle tone of the prostate. In chronic prostatitis may be celebrated the appearance of rash, feelings of cold or of excessive sweating in the groin, local changes of colour of the skin, associated with stasis of blood circulation.
Chronic prostatitis accompanied by severe disorders of sexual function. The phenomenon gipotenzia may result in the deterioration, the pain of erections prolonged and frequent life erections, difficulty or premature ejaculation, loss of sexual desire (reduced libido), erased orgasms, Hematospermias, infertility. Disturbances of sexual always difficult experienced man, resulting in psycho-emotional disorders, to anxiety and depression, further worsening sexual function.
The worsening of prostatitis chronic accompanied by a slight increase in body temperature and deterioration of well-being. The general state in the chronic prostatitis is characterized by increased irritability, apathy, anxiety, rapid fatigue, loss of appetite, sleep disturbances, decreased work capacity, creativity and physical activity.
Almost a quarter of patients with chronic prostatitis the symptoms of the disease for a long time missing, which leads to further conversion to the urologist. Long-term prostatitis chronic can be complicated impotence, vesiculitis, epididymoorchitis, male infertility, urinary incontinence, and the formation of stones and cysts of the prostate gland, sclerosis of the prostate, is the development of an adenoma and prostate cancer.
The diagnosis of prostatitis chronic
Required for the diagnosis of prostatitis chronic information is produced with the help of integrated laboratory-research instrument. The main examination suspicious of chronic prostatitis includes to discover the history and complaints, conducting the exterior inspection of the genitalia in search of secretions, rashes, irritation, a digital rectal examination of the prostate, with the aim of determining the contours, boundaries, consistency, pain breast.
For the definition of the structural and functional changes of the prostate shown holding ultrasound of the prostate (TRUS). Important methods in the diagnosis of prostatitis chronic serve to study the secretions of the prostate, common urine analysis, bacteriological research from a swab of the urethra, and the urine, 3 cups of urine samples, the PCR and the REEF in search scraping the pathogens genital infection, the definition of prostate-specific antigen (PSA).
Clinically significant in chronic prostatitis is used to identify in the analysis of the pathogens chlamydia, mycoplasmosis, herpes, cytomegalovirus, trichomoniasis, gonorrhea, candidiasis, and also nonspecific bacterial flora. Some secretions of the prostate for the search to pass after urination, and the realization of the prostate massage. Symptoms of prostatitis chronic serve to an increase in the number of white blood cells in your field of vision, reducing the amount of lecithin grains, the presence of a pathogenic microflora.
In general, urine analysis in chronic prostatitis can be detected leukocyturia, pyuria, erythrocyturia. Bacteriological seeding of the urine helps identify the degree and nature of bacteriuria. When reproductive rights violations shows a study on the analysis of semen and SEA-test.
The degree and the causes of disorders of urination helps you to determine the urodynamic study (uroflowmetry, cystometry, profilometry, electromyography). Using data from a survey of chronic prostatitis it is possible to differentiate urinary incontinence from effort, neurogenic bladder, and Dr. When hematuria, Hematospermias, obstructive urination shown the endoscopy - urethroscopy, cystoscopy. To delete an adenoma and prostate cancer, requires the definition of PSA, in some cases, the biopsy of the prostate with morphologic research of the tissues.
The treatment of prostatitis chronic
Chronic prostatitis lends itself to healing is not easy, but one must remember that the recovery is still possible and depends a lot on the mood of the patient, the timeliness of their professional conversion, definition of compliance of all the regulations the urologist. The basis of treatment for bacterial prostatitis chronic PRontивonмикрonбная therapy according to antibiotics of duration not less than 2 weeks. To reduce the pain and inflammation are attributed to NSAIDS ; for the relaxation of the musculature of the prostate, recovery urodynamics and outputs the sharepoint secret demonstrates a technique-blockers.
With the aim of improving drainage of prostate, location of the microcirculation and muscle tone is accomplished by the course of therapeutic massage of the prostate. A session of prostate massage should end with the allocation of at least 4 x of droplets of secretions from the prostate. The prostate massage is contraindicated in the acute bacterial prostatitis, abscess of the prostate, hemorrhoids, stones in the prostate, cracks rectum, prostatic hyperplasia and prostate cancer.
To relieve the starting point of the pain syndrome in chronic prostatitis can be recommended paraprostatic lock, acupuncture. Of great importance in the treatment of prostatitis, chronic, is assigned to physiotherapy with the naming of an item with the electrophoresis, ultrasound, phonophoresis, magnetic therapy, laser magneticam illic, inductometer, treatments with mud, SMT, hot sitting in the sun temperature of 40 – 45°c, of enemas with hydrosulphuric and mineral waters, instillation into the urethra.
With the development of complications related to chronic prostatitis, shows the surgical treatment: resolution of stricture of the urethra; TOUR of the prostate or prostatectomy when the multiple sclerosis prostate; transurethral resection of the bladder, when the multiple sclerosis your lap, puncture and drainage of cysts and abscesses of the prostate; circumcisio when phimosis, called recurrent urinary tract infections, and t. d.
The prevention of prostatitis chronic
Warning prostatitis chronic requires compliance with free sex, timely therapy uronгениtpromotion and extRaginitpromotion infections, normalization, regularity sexual life enough physical activity, the prevention of constipation, in a timely manner to empty the bladder.
To the exclusion of recurrence of the prostatitis chronic exams are required dynamic anDronлonга (urologist); prevention courses физиonPRonцеdur, multivitamins, иммунonмondUHLtonрonв, with the exception of a hypothermia, over-temperature, stress, bad habits.