Prostatitis of this category occurs rarely, in approximately 10% of all cases of prostatitis. It is being discussed whether atypical pathogens, such as ureaplasma urealyticum, can provoke inflammation of the prostate. They can be present in a man's body without any sign of inflammation or complaint.
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 the reflux of urine in the channels of the prostate gland (intraprostatic reflux of urine).
Chronic bacterial prostatitis develops as a result of inadequate treatment or a short course of treatment for acute bacterial prostatitis.
Symptoms
- Discomfort or pain - in the perineum, lower abdomen, groin, scrotum, penis, during ejaculation
- Changes in urination - difficulty urinating, 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. The increase in body temperature is uncharacteristic (or insignificant).
Important:
Many men associate erectile dysfunction with prostatitis. This is often facilitated by unprofessional media releases and advertisements of dubious drugs. The fact that an erection can continue even with the complete removal of the prostate (due to the presence of a malignant tumor of the organ) suggests that it itself does not play a role in maintaining the erection.
According to many authoritative urologists, erectile dysfunction in patients with chronic prostatitis is caused by psychogenic and neurotic problems.
Diagnosing
The NIH-CPSI - Chronic Prostatitis Symptom Index questionnaire is used for the initial assessment. It can be used to objectify patient complaints.
The standard method for diagnosing prostatitis is to perform a 4-cup Meares-Stamey test. This is a microscopic and bacteriological study of urine samples taken from different parts of the genitourinary tract and prostate secretions. However, the 4-glass sample method is quite labor-intensive, and currently modifications of Meares-Stamey samples are more often used: 3-glass or 2-glass samples. A possible alternative is to send the ejaculate (sperm) for microscopic and bacteriological examination, since the ejaculate partially (at least 1/3) consists of prostate secretion. This method is more comfortable for patients, especially if they categorically refuse a rectal examination or diagnostic massage of the prostate gland to obtain prostate secretions. However, ejaculate donation has lower information content and reliability compared to a 3- or 2-cup sample.
Submission of ejaculate for bacteriological examination is included in the diagnostic algorithm for infections of the male genital organs and during the examination of a man for infertility.
The results of laboratory tests (general urine test, general blood test, biochemical blood analysis, 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. This means, it is impossible to rely on the result of a rectal examination to diagnose chronic prostatitis.
The same applies to ultrasound diagnostics: it is wrong to diagnose chronic prostatitis based on ultrasound data alone.The European and American Association of Urology does not recommend ultrasound to diagnose prostatitis. The type of execution in this case is not important - transabdominal (through the front abdominal wall - lower abdomen) or transrectal (TRUS - through the rectum). It is wrong to write "chronic prostatitis", "ultrasound signs of chronic prostatitis", "signs of congestive prostatitis" at the conclusion of an ultrasound examination. Only a urologist has the prerogative to make this diagnosis, who determines it on the basis of complaints, history, laboratory tests and - only after - ultrasound.
The most common ultrasound sign with which the diagnosis of chronic prostatitis is established are the so-called diffuse changes in the prostate gland associated with an inflammatory process or other changes in the prostate parenchyma. This is a type of fibrotic process, the replacement of normal prostate parenchyma with scar tissue. STILLthere is no correlation between the number of fibrotic changes in the prostate and the presence of complaints. With age, the chances of the appearance of such "scars" on the organ increase, but a man can live his whole life without feeling any 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 begin to listen to themselves and feel all the symptoms described on the Internet.
In many men over 30, ultrasound may show diffuse changes in the prostate gland. However, the fibrotic process does not indicate the presence of prostatitis.
The diagnosis of chronic prostatitis is established based on the exclusion of other diseases of the genitourinary system - mainly urethritis, prostatic hyperplasia, urethral stricture, neurogenic urination disorders, prostate cancer, bladder cancer.
There is no specific overview of chronic prostatitis based on routine examination results.
Treatment of chronic prostatitis
Antibiotics from the fluoroquinolone group are the 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 show a decrease in the likelihood of the disease returning.
For 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 in the prostatic ducts into the urethra and causes inflammation of the prostate tissue and pain. For such patients, alpha-blockers are recommended.
During the treatment of chronic prostatitis, it is advised that patients refrain from tempting offers to use herbal medicines. A feature of dietary supplements and herbal supplements is the instability of plant components in a part of the substance, they can differ even in the preparation of the same manufacturer. Moreover, from the point of view of evidence-based medicine, the benefits of herbal medicine do not stand up to criticism.
Prostate massage, which in the middle of the 20th century was used as the basis of therapy, today, thanks to new scientific approaches and the Meares-Stamey classification, remains an important tool for diagnosing prostatitis, but not for its treatment.There is no need to use prostate massage as a therapeutic procedure (the effect has not been proven).There are suggestions that frequent ejaculation is similar in nature to therapeutic prostate massage sessions.
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 special exercises for reducing the symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- acupuncture - a small number of studies show a 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 under study;
- behavioral therapy and psychological support - since chronic prostatitis is associated with low quality of life and the development of depression, these methods can improve the psychological state of the patient and help reduce some symptoms of the disease.
It is worth mentioning separatelyasymptomatic chronic prostatitis (asymptomatic).. The diagnosis is most often made on the basis of the results of a histological report - after a biopsy of the prostate gland or after surgical treatment of the prostate. The frequency of detection of inflammation in 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 an age-related physiological feature. 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 on the part of the doctor or the patient.
How is chronic prostatitis treated in a specialized clinic?
During the last 10 years in our country, 47 monographs have been published and 64 master's and doctoral dissertations on prostatitis have been defended. Not to mention the various "popular" publications, which colorfully describe the causes, diagnosis and various methods of treatment of the disease. What does this mean? The fact that the topic of prostatitis raises many questions, and some, unfortunately, still do not have a clear answer. There is a large number of modern drugs, the effect of which has been proven. However, the number of patients diagnosed with chronic prostatitis is not decreasing.
That is why, during the diagnosis and treatment of prostatitis, urologists try to get the most complete picture. They question 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 - as this can provokethe appearance of characteristic manifestations. At the same time, unnecessary tests and studies are not prescribed.