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prostatitis

Prostatitis is inflammation of the prostate (an organ of the male reproductive and reproductive system), the process of which leads to changes in physiological functions.

Symptoms of male prostatitis

spread

According to various sources, the incidence of prostatitis is between 35-40%, and some authors say that it occurs in 70% of men between 18 and 50 years old. Occupy a leading position in urological pathology.

classification

There are many classifications of prostatitis, so the terminology is very special. The most common is the classification of prostatitis, which was proposed by the National Institutes of Health (NIH) in 1995:

category description
the first sort Acute bacterial prostatitis
Second category Chronic bacterial prostatitis
The third category Chronic nonbacterial prostatitis
Class IIIA Inflammatory chronic pelvic pain syndrome
Class IIIB Non-inflammatory chronic pelvic pain syndrome (prostate pain)
The fourth category Asymptomatic inflammatory prostatitis

This classification of prostatitis is based on clinical signs, the presence of white blood cells and microorganisms in the prostate, ejaculation and urine secretions.

the first sort

Acute bacterial prostatitisIt is expressed by acute infectious inflammation of the prostate with all accompanying symptoms:

  • Increased number of white blood cells in urine;
  • Whether there are bacteria in the urine;
  • General signs of infection (fever, symptoms of poisoning).

Second category

Chronic bacterial prostatitis-With the corresponding symptoms, the number of white blood cells and bacteria in the prostate, ejaculation and urine secretions obtained after prostate massage increases.

The third category

Chronic Pelvic Pain Syndrome (CPPS)-The main clinical symptom is that the pain syndrome lasts for more than 3 months, and no pathogenic microorganisms are secreted after prostate massage. There are no pathogenic microorganisms in the prostate, ejaculation and urine. The standard for isolation of III A and III B is the presence of increased white blood cell count.

III Class A

Chronic pelvic pain inflammation syndrome-It is characterized by the symptoms of pain syndrome and prostatitis, while the number of white blood cells secreted by prostate massage, ejaculation and urine increases. After prostate massage, these samples cannot detect pathogenic microorganisms by standard methods.

III Class B

Non-inflammatory chronic pelvic pain syndrome-It is characterized by the symptoms of pain syndrome and prostatitis, while the number of white blood cells and pathogenic microorganisms in the prostate secretion does not increase, while the ejaculation and urine obtained after prostate massage cannot be detected by standard methods.

The fourth category

Asymptomatic inflammatory prostatitis-Since there are no symptoms of prostatitis, the disease was accidentally discovered during histological examination of prostate tissue samples related to other diagnoses due to other reasons (for example, prostate biopsy due to elevated prostate-specific levels)Antigen-PSA).

Diagnosis of prostatitis

The symptoms of prostatitis vary widely, but they can be divided into several categories.

Pain syndrome

Inflammation or spasm of the blood vessels supplying the prostate leads to insufficient blood supply. It is noted that the glandular tissue is hypoxic. As a result, a by-product of pathological oxidation is formed, which affects the nerve endings of the nerves. prostate. Since the innervation of the prostate is related to the innervation of the pelvic floor, penis, scrotum, testis, and rectum, the location of pain is variable. The following are the most common pain symptoms:

  • Discomfort or pain in the perineum-mainly in the form of seizures after exertion, sexual intercourse, and drinking;
  • The sensation of hot potatoes in the rectum;
  • Testicular pain (discomfort)-the patient is described as "pain", "distortion", which is also related to various predisposing factors;
  • Urethral discomfort, cramps and pain are mainly related to the shift of the pH value of the prostate secretion to the acidic side. The acidic secretion of the prostate stimulates the urethral mucosa, so after urination or sexual intercourse, when part of the secretion is squeezed into the urethral cavity during contraction, pain will appear in the form of "burning". The glands and pelvic muscles.

Urinary System Disease Syndrome

It is related to the tight innervation of the prostate and bladder and the involvement of the prostate muscles during urination. Difficulty urinating can be accompanied by the following manifestations:

  • Frequent urination-frequent urination (up to 3 times per hour), and strong and sudden urges (unbearable), and the weight is small;
  • Feeling that the bladder is not completely empty-After urinating, feel that urine remains in the bladder.
  • The urine is weak or intermittent-this may also include symptoms of the "last drop"-despite all the efforts of the patient, the urine is still released from the tube after urination.

Ejaculation and orgasm disorders

It is related to the damage to the seminal vesicle node (colitis) during prostatitis. There are nerve receptors on the surface of prostatitis that send signals to the nerve structure, and the sensation of orgasm is formed in the brain structure. Prostatitis does not directly cause erectile dysfunction (sexual arousal makes the penis congested).

Major violation:

  • Premature ejaculation, or vice versa, too long intercourse time-scarring caused by inflammation or inflammatory process of inflamed nodules;
  • Loss of orgasm-also related to seminal vesiculitis;
  • Pain during ejaculation-is related to the inflammatory process in the excretory duct of the prostate through which sperm is released.

Decreased fertility

When the characteristics of prostate secretions change due to inflammation, the following changes in sperm are observed, which reduces the man's fertility (fertility):

  • The pH of the sperm on the acidic side decreases-due to inflammation of the prostate, acidic products of pathological oxidation begin to accumulate in the secret. The acidic environment is extremely destructive to sperm, making them unable to move or even die.
  • Sperm agglutination-sperm sticking together mainly from the head-is related to the change in the physical and chemical properties of the secret;
  • Asthenospermia-the decline of sperm motility-is closely related to the shift of pH to the acidic side and the destruction of prostaglandin on the production of lecithin cells, thereby ensuring the vitality of sperm.

Urethral prostatitis

In some cases, prostatitis is combined with chronic urethritis, which is manifested by little urine excretion of urethral mucus (mainly after long-term urine retention).

Prostatitis and sexual diseases

The question "Does prostatitis cause yang ot? " has been a cause of professional controversy for decades.

Under the influence of sexual stimulation, in the formation of the cerebral cortex-subcortical area, androgens are completely saturated, and nerve signals are generated. The nerve signals are transmitted from there to the erection center located in the spinal cord. It reaches the sinusoidal curve formed by the cavernous body of the penis. Smooth muscle, while relaxation or relaxation (arteries and sinusoids) or narrowing (veins). The prostate has no role in this process.

Ejaculation and orgasm are fully stimulated by special receptor cells located in the area where the prostatic gland excretory ducts of the semen nodules are located. These same receptors are responsible for transmitting nerve impulses to the neurocortex. The formation of climax.

The inflammatory process of the prostate (prostatitis) can cause damage to the nodules of the seminal vesicles, and thus lead to the invasion of men’s strength and the elimination of premature ejaculation and orgasm. The etiology of chronic prostatitis is related to the degree of damage to the nerve apparatus of the prostate. This form of Yang ence (neuroreceptor yang ot) is a typical example of repercussions, when the presence of pathological impulses from organs affected by the inflammatory process causes the excitation process to radiate to the center that controls sexual function and the latter. The androgen activity of the testis is inhibited to a certain extent, and the sensitivity of the hypothalamus and pituitary gland to androgen also plays a certain role, although not the leading role.

At the same time, there is a view that in the Russian Federation, there is both overdiagnosis of prostatitis and overestimation of the role of prostatitis in the development of erectile dysfunction.

Diagnostic procedure

The task of the doctor is to detect the inflammatory process of the prostate, determine the possible cause of the disease, and evaluate the dysfunction of the prostate. Stamey wrote in 1990 that prostatitis is a "clinical ignorance dumpster" due to the variety of terms used, diagnostic methods and treatment methods. At the same time, some simple clinical and laboratory tests make it possible to make a correct diagnosis so that appropriate treatment can be initiated.

Prostate digital rectal examination

A very useful method. The inflammatory process can be judged by evaluating the shape, contour, size of the gland, the presence of compression and/or softening foci, and pain. The main symptoms of prostatitis: increase or decrease in size, uniform heterogeneity, the presence of compacted and softened lesions, stickiness, and soreness. It goes without saying that 80% of pancreatic cancers are found through rectal examination. It is safe to say that this research method will always be used.

Objective microscopic examination of pancreatic secretions

It should be remembered that the increase in the number of white blood cells in the secret does not always indicate prostatitis, because the method of obtaining the secret during the massage cannot guarantee that the contents of the urethra and seminal vesicles will not enter it. At the same time, there are obvious signs of prostatitis, and the secret of the prostate may be normal. This is due to focal inflammation, partially occluded or closed excretory ducts.

Study of prostate secretion

The study of prostate secretions (expressed prostate secretions-EPS) allows you to determine the presence of inflammatory processes in the prostate and some of its functions. It is the main method to diagnose and monitor the treatment of chronic prostatitis. You can use an optical microscope without staining or use a special staining method to check the secrets of the prostate. In addition, bacteriological examination or research on the secrets of the prostate can be carried out by polymerase chain reaction to detect the infectious agent. Get the secret through prostate massage. The secretions released from the urethra are collected in a sterile test tube or on a clean glass slide for inspection. Sometimes, secretions from the prostate will not flow out of the urethra. In this case, the patient is advised to stand up immediately. However, if the secret is still not available, it usually means that it is not entering the urethra, but the bladder. In this case, check the centrifugation of the lavage fluid released from the bladder after prostate massage.

  • Lipid particles (lecithin bodies) are specific products of normal physiological secretion by the glandular epithelium of the prostate. Give this secret a creamy appearance. Usually, the secret is the lecithin-rich particles. The decrease in their number and the increase in the number of white blood cells indicate that the inflammatory process is a kind of tumor;
  • Amyloid bodies are stratified (amyloid) bodies that turn purple or blue in Lugol's solutions such as starch.
  • Amyloid bodies are thickened secretions of glands, which have an oval shape and layered structure, similar to a tree trunk. Normally, they do not occur, and their tests show that glandular secretions are stagnant, which may be related to adenomas and chronic inflammatory processes.
  • Red blood cells can be single cells. Because of the vigorous massage of the prostate, they entered a secret. During the inflammatory process, an increase in their number is observed in tumors.
  • A large amount of epithelial peeling is observed at the beginning of the inflammatory process and in tumors, and at the same time, peeling often occurs with protein and fatty degeneration of epithelial cells. Macrophages can see the secretion stagnation, which is the current long-term inflammatory process.
  • Bettcher crystals are long crystals that are formed by mixing spermine and phosphate in the male glands (prostate juice mixed with sperm), then cooling and drying. Accompanied by azoospermia and severe oligospermia, Bettcher crystals are rapidly formed in large numbers.
  • Retention Syndrome-Stagnation syndrome is observed in glandular adenomas. There are a large number of macrophages, there are multinucleated cells, such as foreign bodies and amyloid.
  • Fern symptoms-symptoms of secretion of crystals-the form of sodium chloride precipitated crystals depends on the physicochemical properties of prostate secretions. The study of symptoms was carried out by adding a drop of 0. 9% sodium chloride solution to the obtained prostate secretion and further observation after drying under an optical microscope. In healthy men of childbearing age, the crystalline feature of prostate secretion is a typical fern leaf phenomenon (3+). Insufficiency of androgens or the presence of prostatitis can cause various degrees of destruction of the crystal structure until it is missing.

Bacteriological study of urine and pancreatic secretions

Urethral swab, including PCR diagnosis

Serological diagnosis of reagents that cause urinary tract infections (ELISA)

Direct and indirect immunofluorescence reaction (RIF)

Detect antibodies to known antigens.

Determination of serum PSA (prostate specific antigen)

The American Urological Disease Foundation recommends that men who are over 50 years old and have prostate cancer in male ancestry undergo an annual prostate and rectal cancer examination, accompanied by PSA. After the digital examination of the prostate in each rectum, there is still discussion about obtaining PSA immediately. Recent studies failed to confirm a significant increase in PSA content immediately after the digital check. Therefore, the PSA level can be determined by obtaining reliable results and after examining the pancreas.

Four cup samples

In order to diagnose chronic prostatitis, a 4-cup test was proposed based on the comparative bacteriological evaluation of the approximately equal proportion of urine before and after prostate massage and its secretion.

The diagnosis of prostatitis is determined by increasing the concentration of microorganisms in prostate secretions by a factor of ten compared to the content in urine (parts 1, 2, and 3), and the number of polymorphonuclear white blood cells increases. In the field of view of the optical microscope, it is 10-16 (magnification 200 times). Or when counting white blood cells in the counting room, the number of white blood cells increases by more than 300x106/l. Lecithin bodies are the products normally secreted by the normal glandular epithelium of the prostate and should cover the field of the microscope densely (5 ml-10, 000, 000 in 1 ml). It was found that the amount of amyloid in the prostate secretion was significantly less. In adult males, 1-2 can be found in the field of vision.

Biochemical blood test

Immune and hormonal characteristics (according to indications).

Ultrasound, TRUS

Ultrasound diagnosis of prostatitis by abdominal and transrectal transducer (TRUS).

Urine flow method

Treatment of prostatitis

Comprehensive treatment of patients with chronic prostatitis should include:

  • Observe general therapy, diet, sexual hygiene, and participation of sexual partners in treatment if there is an infectious agent;
  • Choose effective drugs to inhibit infection;
  • Increase the general responsiveness of the patient's body and the immunobiological tolerance of microorganisms to drugs;
  • Increased secretion outflow at the focal point of inflammation and activation of local repair process;
  • Hygienic treatment of infection foci of major organs and distant organs;
  • Improve the microcirculation of prostate and pelvic organs;
  • Appoint fortifiers, enzymes and vitamins;
  • Correction of hormonal imbalance;
  • Appoint an antispasmodic;
  • Appoint painkillers and anti-inflammatory drugs;
  • Take sedatives and tranquilizers;
  • Use local analgesics to regulate neurotrophic diseases;

Prostate massage

Prostate massagePosner described the first prostate massage method in 1893, which can be used to diagnose and treat chronic prostatitis. Since 1936, it has been widely introduced into O'Conory Urology. However, in 1968, after Meares and Stamey described the landmark test for diagnosing prostatitis, people's perceptions of the cause of the disease changed, and massage as a treatment was removed from many manuals. Developed countries.

However, since the mid-1990s, many doctors engaged in the diagnosis and treatment of prostatitis began to notice that, in some cases, the recommended antibiotic treatment and the use of alpha-blockers were ineffective, which led them to use this type of treatment. The method of forgetting is in practice.

Basically, prostate massage is currently used as a diagnostic procedure for obtaining prostate secretions (expressed prostate secretions-EPS)-for microscopic (cultural) examinations and pre- and post-massage tests (pre- and post-massage tests-PPMT). Secrete to perform her massage. Massage is a medical procedure that must be performed by a pre-trained expert. Massage after urination, and discharge from the urethra after preliminary washing with isotonic sodium chloride solution, especially necessary in the case of bacteriological examination. Prostate massage is performed through the anus, because the prostate is adjacent to the ampulla of the rectum and can only be examined here. Move your fingers along the excretion tube from the periphery of the prostate to the central groove. Massage the prostate first, and then massage the other gland to avoid touching the seminal vesicle. Press the area of the central sulcus from above to complete the massage. The secretions released from the urethra are collected in a sterile test tube or on a clean glass slide for inspection. Sometimes, secretions from the prostate will not flow out of the urethra. In this case, the patient is advised to stand up immediately, but if the secret is still not available, it means that it does not enter the urethra, but into the bladder. In this case, check the centrifugation of the lavage fluid released from the bladder after prostate massage.

The Ministry of Health of the Russian Federation officially recommends the use of prostate massage agents for therapeutic purposes (repetitive prostate massage) as a treatment for chronic prostatitis. In Southeast Asia, China and some European countries, prostate massage is widely used to treat prostatitis. Some urologists in North America and Canada also recommend combining massage with antibiotic therapy to treat some forms of prostatitis. In fact, few people evaluate the effectiveness or ineffectiveness of prostate massage. On the contrary, there are several conflicting studies, one of which was conducted by Egyptian doctors and found no differences between the patient groups. Some of the patients received a study combining massage with antibiotic therapy and antibiotic therapy alone, and the otherA study conducted by researchers from the United States and the Philippines is the opposite. , Showed significant improvement in a group of prostatitis patients who received a combination of massage and antibiotic therapy.

Proponents of the use of massage for therapeutic purposes believe that the main function of massage is to drain the ducts of the prostate-even if they get rid of purulent and dead cells. It is believed that another effect is to increase blood flow in the prostate, thereby increasing the penetration of antibiotics and activating local protective immune processes.

There is very little literature on the complications related to prostate massage in the world. In 1990, Japanese doctors described genital gangrene (Fournier), and in 2003, German doctors described enlarged prostate with pulmonary embolic stroke (bleeding) after prostate massage. Studies have shown that the level of PSA (Prostate Specific Antigen) temporarily increases after massage. Massage is not suitable for acute inflammation of the prostate (acute prostatitis), acute urethritis, orchitis, and prostate cancer. It is not recommended to massage the prostate and prostate adenoma calcification, usually 2 to 3 times a week.

Physiotherapy procedures

It is forbidden to perform any physical therapy procedures (prostate massage, warm-up, etc. ) for acute prostatitis.

The purpose of using physical therapy procedures in the comprehensive treatment of prostatitis is not only to directly act on physical preparations to normalize the function and pathological changes of the prostate, but also to apply drugs to the prostate tissue by electrophoresis.

Using physical therapy in the context of drug therapy is much better than using therapy alone. The following methods of affecting the prostate have been widely used and have proven their effectiveness:

  • Shock wave therapy;
  • Electrical stimulation of the pancreas with the modulated current of the skin or rectal electrodes;
  • Various versions of hyperthermia (including high-frequency hyperthermia);
  • Magnetic therapy;
  • Microwave microwave therapy;
  • Laser therapy.
  • Transrectal ultrasound therapy and sound therapy;
  • Microcells.