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Prostatitis

Prostatis is the inflammation of the prostate gland (organ of the sexual and reproductive system of a man) and the change as a result of this process of its physiological functions.

Symptoms-prostatitis-u-masal

Extension

According to several sources, prostatitis occurs in 35-40 %, and according to some authors, 70 % of men from 18 to 50 years.The representative gland in the prevalence of the disease and a set of problems that occur at the same time occupies a main place among urological pathology.

Classification

There are many prostatitis classifications, hence a very peculiar terminology.The most common is the classification of prostatitis proposed by the National Institute of Health of the United States (NIH) in 1995:

Category Description
Category I Acute bacterial prostatitis
Category II Chronic bacterial prostatitis
Category III Chronic abacerial prostatitis
Category IIIA Inflammatory Chronic Pelvic Pain Syndrome
Category IIIb Non -inflammatory chronic pelvic pain syndrome (prostatinia)
Category IV Sinimptomatic inflammatory prostatitis

This classification of prostatitis is based on clinical signs, the presence or absence of leukocytes and microorganisms in the secret of the prostate, ejaculate and urine.

Category I

Acute bacterial prostatitisIt is expressed by acute infectious inflammation of the prostate gland with all related signs:

  • greater amount of leukocytes in the urine;
  • the presence of bacteria in the urine;
  • Common infection signs (increased body temperature, poisoning symptoms).

Category II

Chronic bacterial prostatitis- It is accompanied by appropriate symptoms and an increase in the number of leukocytes and bacteria in the secret of prostate, ejaculate and urine obtained after prostate massage.

Category III

Chronic pelvic pain syndrome (KTR)- The leading clinical symptom is pain syndrome for more than 3 months in the absence of pathogenic microorganisms in the secret of the prostate, ejaculate and urine obtained after the prostate massage.The separation of III A and III B is the presence of a greater number of leukocytes.

Category III a

Inflammatory Chronic Pelvic Pain Syndrome- It is characterized by the presence of symptoms of pain and prostatitis, and there is a greater amount of leukocytes in the secretion of the prostate, the ejaculate and the urine portions, after the massage of the prostate, the pathogenic microorganisms are not detected in these samples.

Category III b

Non -inflammatory syndrome of chronic pelvic pain- Characterized by the presence of pain syndrome and prostatitis symptoms, while there is no increase in the number of leukocytes and are not detected by standard methods of pathogenic microorganisms in the secret of the prostate, ejaculation and urine obtained after the prostate massage.

Category IV

Sinimptomatic inflammatory prostatitis- The absence of characteristic symptoms of prostatitis, the disease is detected by accident during a histological examination of prostate tissue samples obtained in relation to the diagnosis for other reasons (for example, performing a prostate biopsy due to an increase in the level of a specific antigen).

Diagnosis of prostatitis

The symptoms of prostatitis are extremely diverse, but can be combined in several groups.

Pain syndrome

As a result of the insufficient blood supply caused by inflammation or spasm of the blood vessels that feed the prostate, the starvation of the oxygen of the tissue of the gland is observed, as a result of which the products of the pathological oxidation that affect the nerve endings of the prostate are formed.Since the innervation of the prostate is associated with the innervation of the pelvic floor, the penis, the scrotum, the testicles, the rectum: the location of pain is variable.The following symptoms of pain are more common:

  • Discomfort or pain in the perineum, basically appears after physical effort, sexual relations, the alcohol that takes in the form of passenger attacks;
  • Feeling hot potatoes in the rectum;
  • Pain (discomfort) in the testicles: patients are described as "pain", "torsion", are also associated with several provocative factors;
  • The discomfort, rubber and pain in the urethra, are mainly associated with the change of the pH of the prostate secret on the acid side.The sour secret of the prostate acts irritably on the mucous membrane of the urethra, so the pain, more often in the form of "burns", occurs after an act of urination or sexual relations, when part of the secret by reducing the muscles of the gland and the pelvis is squeezed in the light of the urethra.

Urine disorders syndrome

Associated with the narrow innervation of the prostate and bladder, as well as the participation of the prostate muscles in the urine act.Dysuria can be accompanied by the following manifestations:

  • Far urine: frequent urination (it occurs up to 3 times per hour) with acute and sudden calls (impossible to support) and quite small portions;
  • An incomplete emptying of the bladder: after the act of urine, he feels that the urine remained on the bladder;
  • A weak or intermittent urine stream, this can also be attributed to the symptom of the "last fall", despite all the patient's efforts after the urine act of the channel, a drop of urine is still released.

Violation of ejaculation and orgasm

It is associated with damage to the prostatitis of the seed tuber (coliculite) on the surface of which they are nervous receptors that send the signal to the brain structures, where the sensation of orgasm is formed.Prostatitis does not directly cause an erection (blood supply to the penis during sexual excitement).

Main disorders:

  • Premature ejaculation or vice versa is excessively prolonged sexual relations, caused by the inflammation of the seminal tuber or its scars due to the inflammatory process;
  • Deleted orgasm: It is also associated with the inflammation of the seed tuber;
  • Pain during ejaculation: associated with the inflammatory process in the exit ducts of the prostate through which sperm is released.

Fertility violation

When changing the properties of the prostate, as a result of inflammation, the following changes in sperm are observed, reducing the man's ability to fertilize (fertility):

  • A decrease in sperm pH on the acid side, since with inflammation of the prostate, the acidic products of pathological oxidation begin to accumulate in secret.The acidic environment is extremely destructive for sperm that cause its immobilization and even death;
  • The anglutination of sperm - attached to sperm mainly with heads - is associated with a change in the physicochemical properties of secretions;
  • Astenospermia, a decrease in sperm mobility, is closely connected with the change of pH on the acid side and with a violation of the production of prostate lecithin cars, which ensure the vital activity of sperm.

Urectostatitis

In some cases, prostatitis is combined with chronic urethritis, which is manifested by a high mucous inflammatory discharge of the urethra (mainly after prolonged urinary retention).

Prostatitis and sexual disorders

The question "Prostatitis cause impotence?"It is the cause of specialist disputes for decades.

Under the influence of sexual stimuli, with the complete saturation of the body androgens in the formations of the cortical and subcortical region of the brain, a nervous signal occurs, transmitted to the center of an erection located in the spinal cord, from where it is the smooth muscles of the formations of the cavernous bodies of the sorrows and veins (veins (veins (veins)(VEINS).

Ejaculation and orgasm occur with sufficient irritation of special receptor cells found in the area of the seminal tuber in which the prostate output ducts flows, the same receptors are responsible for the departure of the nerve impulse to the cerebral cortex where the orgasm sensation is formed.

The inflammatory process in the prostate gland (prostatitis) can lead to the defeat of the seed tuber and, as a result, as violations of the power of a man, so that the premature ejaculation and the echo of the orgasm.Impotence in chronic prostatitis is associated pathogenetically with the degree of damage to the nerve apparatus of the prostate gland.This form of impotence (impotence of the neuroreceptor) is a characteristic example of a repercussive phenomenon, when the presence of pathological impulsation with the organs affected by the inflammatory process leads to the irradiation of the excitation process that controls the sexual function and disorder of the latter.A true role, although it is not leading, performs in the pathogenesis of the impotence of the neuroreceptor, also a certain suppression of the androgenic activity of the testicles and the sensitivity to the androgens of the centers of the hypothalamus and the pituitary gland.

At the same time, there is an opinion that in the Russia Federation there is hyperdiagnosis of prostatitis and the reallocation of its role in the development of erectile dysfunction.

Diagnosis

The doctor's task is to detect the inflammatory process in the prostate, the identification of the possible pathogen of the disease and the evaluation of the deteriorated function of the prostate gland.In 1990, Stamey wrote that prostatitis is a "garbage basket for clinical ignorance" due to the variety of terms used, diagnoses and treatment methods.At the same time, several simple and clinical and laboratory tests allow a diagnosis correctly, which allows it to begin proper therapy.

Rectal prostate gland survey

A very informative form.The inflammatory process can be judged by evaluating the form, contours, the dimensions of the gland, the presence of compaction and (softening, pain.The main signs of prostatitis: increase or decrease in size, heterogeneity of consistency, the presence of compaction and softening spotlights, pastures.The fact that 80% of pancreatic cancer is detected through a rectal study speaks for itself.We can say that this research method will always be used.

Microscopic examination of pancreas secretion

It should be remembered that an increase in the number of leukocytes in secret does not always indicate prostatitis, because the methods to obtain a secret during massage do not guarantee that the content of the urethra and the seed bubbles do not fall into it.At the same time, with obvious signs of prostatitis, the secret of the prostate can be normal.This is explained by the inflammation spotlights, the presence of part of the output or closed output ducts.

Study of the secretion of the prostate gland

EPS of prostate secretions expressed) Secret studies allow you to determine the presence of an inflammatory process in the prostate gland and in part its functional capacity.It is the main method to diagnose and monitor the treatment of chronic prostatitis.The secret of the prostate can be examined using light microscopy without painting or using special staining methods.In addition, the secret of the prostate gland can undergo a bacteriological examination or exam by the polymerase chain reaction method for the detection of pathogens in it.Get a secret with prostate massage.A secret released from the urethra is collected in a sterile test tube or in a clean object glass for research.Sometimes, the secret of the prostate gland of the urethra does not follow.In such cases, the patient is recommended to stand immediately.If, however, it was not possible to obtain a secret, more often this means that it did not enter the urethra, but in the bladder.In this case, the centrifugation of the bladder liberated washing fluid is examined after the massage of the prostate gland.

  • Lipoid grains (lecithin bodies): a specific product of normal physiological secretion of the glandular epithelium of the prostate gland.It gives a secret appearance of milk.Normally, the secret is rich in lecithin grains.A decrease in its number, together with an increase in the number of leukocytes, indicates an inflammatory process, a tumor;
  • Amiloid bodies: in layers (starch), body, which with a lugol solution is stained in purple or blue, such as starch;
  • Amiloid bodies are a condensed secret of the gland, it has an oval shape and a layer structure, which resembles a tree trunk.They are not normal, its detection indicates a stagnation of the secret in the gland, which can be with adenomas, chronic inflammatory processes;
  • Erythrocytes can be single.They fall into a secret as a result of the energy massage of the prostate gland.Its greatest amount is observed in inflammatory processes, neoplasms.
  • The offspring of the epithelium in large quantities is observed at the beginning of inflammatory processes and with tumors, then there is often disabilities with the degeneration of proteins and fats of epithelial cells.Macrophages can be seen with a stagnation of a secret, for a long time of the current inflammatory process;
  • Betthera crystals are a day of crystals formed during cooling and drying of the mixed secret of male gonads (prostate juice with a mixture of sperm) of sperm salt and salt from the phosphoric layer.With azoospermia and oligozospermia expressed sharply, Bettera crystals are formed rapidly and in large quantities;
  • RELED SYNDROME: Stagnation syndrome is observed with gland adenoma.There is an abundance of macrophages, there are multiple film cells, such as foreign bodies and amyloid bodies;
  • The fern symptom is a symptom of crystallization of a secret: a form of crystals that fall from sodium chloride depends on the physicochemical properties of the prostate's secret.The study of the symptom is carried out by adding a fall of a 0.9% sodium chloride solution to the secret resulting from the prostate with a greater visualization after drying under a light microscope.In healthy reproductive men, the crystallization of the prostate secret is characterized by a typical fern leaf phenomenon (3+).Androgenic failure or the presence of prostatitis give several degrees of violation of the crystal structure until its absence.

Bacteriological studies of urine portions and pancreas secretion

Urethra Bridge, including PCR diagnoses

Serological diagnosis of agents (Elisa) that cause urinary tract infections

The reaction of immunofluorescence (reef) is straight and indirect

Identification of antibodies to known antigens.

Determination of the PSA (specific prostate antigen) of blood serum

The American Urological Diseases Foundation recommends the annual approval of a rectal survey of the prostate gland, accompanied by a PSA for all men over 50, and with prostate cancer for blood relatives according to a male line.There is still a discussion about obtaining a dog immediately after an examination of the fingers of the prostate gland by straight.Recent studies could not confirm the presence of a significant increase in the content of the PSA immediately after an examination of the fingers.Therefore, the PSA level can be determined with the reception of reliable results and after the pancreas survey.

Four Wall Test

To diagnose chronic prostatitis, a 4 mirror test was proposed, based on a comparative bacteriological evaluation of urine, approximately equal in terms of urine portion, obtained before and after the massage of the prostate gland, as well as its secret.

The diagnosis of prostatitis is established with an increase of ten times in the concentration of microorganisms in the prostate secret compared to its urine content (1, 2 and 3 portions) and an increase in the number of polymorphic-nuclear leukocytes> 10-16 in the field of vision of the light microscope (increase of 200 times).Or an increase in the number of leukocytes of more than 300x106/L when calculating them in the counting chamber.Lecitin bodies, which are a product of the normal secretion of the glandular epithelium of the prostate gland, must densely cover the microscope vision (5-10 million in 1 ml).The amyloid bodies in the secret of the prostate are in a significantly lower amount.In mature men, 1-2 can be found in the field of vision.

Biochemistry blood analysis

Immune and hormonal profile (as indications).

Ultrasound, Trusie

Diagnosis of ultrasound of prostatitis by the abdominal and transrectal sensor (trust).

Uroofloometry

Prostatitis treatment

The integral treatment of patients with chronic prostatitis should include:

  • Compliance with the general regime, diet, sexual hygiene, as well as attract sexual partners in the presence of an infectious agent;
  • Selection of effective drugs to suppress the infection;
  • Increase the general reactivity of the patient's body and immunobiological tolerance of microorganisms to drugs;
  • Strengthen the exit of secretion and activation of local reparative processes in the inflammation approach;
  • Sanitation of infection spotlights in the previous and remote organs;
  • Improvement of microcirculation in the prostate gland and pelvic organs;
  • the appointment of general strengthening funds, enzymes and vitamins;
  • Correction of hormonal disorders;
  • the appointment of antispasmodics;
  • the appointment of analgesic and anti -inflammatory drugs;
  • taking sedative and transformative drugs;
  • Regulation of neurotrophic disorders due to medicines for local analysts;

Prostate massage

Prostate massage- A medical procedure that is used to diagnose and sometimes treat chronic prostatitis.Posner described the first prostate massage in 1893, and since 1936 was widely introduced into the urological practice of O'Conory.However, in 1968, after the description of MEARES and STAMEY, a stage test for the diagnosis of prostatitis, the opinions about the causes of this disease changed and massaged as a therapeutic procedure were crossed out of the lists of measures in many guidelines for the treatment of prostatitis in developed countries in the world.

But since the mid -90s of the twentieth century, many doctors involved in the diagnosis and treatment of prostatitis began to notice the inefficiency in some cases of proposed antibacterial therapy and the use of alpha blockers, which led them to use in the practice of this forgotten method.

Basically, prostate massage is currently used as a diagnostic procedure to obtain a prostate secretion (prostate secretions expressed -EP), for its microscopic (cultural) study and for the massage testprior and after postpension).massage.Massage is a medical procedure and must do it as a previously trained specialist.The massage is done after the urine, and when the discharge of the urethra after its preliminary washing with an isotonic solution of sodium chloride, which is especially necessary in cases where a bacteriological examination of the secret is supposed to be supposed to.The prostate massage is done through the anus, since the prostate gland is close to the rectum ampoule and is only available for research.First, you massage one, then the other proportion of the prostate gland with the finger movements from the periphery to the central groove along the output ducts, trying not to touch the seed bubbles.The massage is completed by pressing in the central groove area from above.A secret released from the urethra is collected in a sterile test tube or in a clean object glass for research.Sometimes, the secret of the prostate gland of the urethra does not follow.In such cases, the patient is recommended to stand immediately if it was not possible to obtain the secret, this means that it was not in the urethra, but in the bladder.In this case, the centrifugation of the bladder liberated washing fluid is examined after the massage of the prostate gland.

The Federation of the Federation of the Federation of the Russian Federation officially recommends the prostate massage (repeated massage) as the therapeutic procedure for chronic prostatitis.The prostate massage is widely used for the treatment of prostatitis in the countries of Southeast Asia, China and some European countries.Some Severmerican and Canadian urologists also recommend the use of massage in combination with antibiotic therapy in the treatment of some forms of prostatitis.In essence, the evaluation of the effectiveness or inefficiency of the massage of the prostate was practically not carried out.There are several contradictory studies, in one, carried out by Egyptian doctors, there were no differences in groups of patients, some of which were massages in combination with antibiotic therapy and simply antibiotic therapy, in another, conducted by US and Filipinos researchers, in the group of patients with prostatitis, which received a combination of antibiotic significant therapy.

Supporters of the use of massage for therapeutic purposes believe that the main effect of their use is the drainage of prostate ducts, that is, their release of purulent and dead cells.Another effect is an increase in blood flow in the prostate gland, which improves the penetration of antibiotics in it and activates local immunological processes.

In world literature there are few data on complications related to prostate massage.In 1990, Japanese doctors described the genital organs (Fournier), and in 2003, German doctors were permanent bleeding after a prostate massage with the development of stroke (hemorrhage) of the lungs.There is a study that after massage, PSA level (prostate -specific antigen) temporarily increases.The massage is contraindicated in the acute inflammation of the prostate gland (acute prostatitis), with acute urethritis, orchitis, prostate cancer.The massage for prostate and prostate adenoma massage is not recommended.It is generally recommended that the prostate massage is recommended 2 or 3 times per week.

Physiotherapeutic procedures

Any physiotherapeutic procedure (prostate massage, heating, etc.) in acute prostatitis is contraindicated.

The use of physiotherapeutic procedures in the complex treatment of prostatitis aims to directly affect the prostate gland of physical agents to normalize functional and pathological changes, as well as the electrophoretic administration of drugs in the prostate tissue.

The use of physiotherapeutic methods in the context of pharmacological therapy gives a much better result than in separate treatment.The following methods to influence the prostate gland have been generalized and their effectiveness has demonstrated:

  • shock wave therapy;
  • Electrical stimulation of the pancreas with currents modulated with tid or rectal electrodes;
  • Thermotherapy in several versions (including high frequency thermotherapy);
  • Magnetotherapy;
  • Microwave microwave technology;
  • Laser therapy.
  • transrectal ultrasonic therapy and phonoforesis;
  • Microclisms.