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Prostatitis

Prostates is an inflammation of the prostate gland (a gender organ and the reproductive system of a person) and the change as a result of this process of its physiological functions.

Symptoms-Postatite-U-man

Distribution

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

Classification

There are many classifications of prostatitis, hence very special terminology.Most often is the classification of prostatitis proposed by the US National Institute of Health (NIH) in 1995:

Category Description
Category I. Acute bacterial prostatitis
Category II Chronic bacterial prostatitis
Category III Chronic abacus prostatitis
IIIA Category Inflammatory chronic pelvic pain syndrome
IIIB Category Non -inflammatory chronic pelvic pain syndrome (prostatia)
Category IV Synomptomatic inflammatory prostatitis

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

Category I.

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

  • increased amount of leukocytes in the urine;
  • The presence of bacteria in the urine;
  • Frequent signs of infection (fever, symptoms of intoxication).

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, ejaculation 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 prostate, ejaculation and urine obtained after prostate massage.The division of III A and III B is the presence of an increased number of leukocytes.

Category III a

Inflammatory chronic pelvic pain syndrome- It is characterized by the presence of symptoms of pain and prostatitis and is noted an increased amount of leukocytes in prostate secretion, ejaculation and portions of the urine, after prostate massage, pathogenic microorganisms are not detected in these samples.

Category III B

Non -inflammation syndrome of chronic pelvic pain- It is characterized by the presence of pain syndrome and the symptoms of prostatitis until there is no increase in the number of leukocytes and are not detected by standard methods of pathogenic microorganisms in the secret of prostate, ejaculate and urine obtained after prostate massage.

Category IV

Synomptomatic inflammatory prostatitis- Lack of symptoms characteristic of prostatitis, the disease is detected accidentally during the histological examination of prostate prostate samples obtained in connection with diagnosis for other reasons (for example, a prostate biopsy due to increased levels of specific antigen - PSA).

Prostatitis diagnosis

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

Pain syndrome

As a result of insufficient supply of blood caused by inflammation or spasm of the blood vessels feeding, oxygen fasting of the gland tissue is indicated, resulting in a form of pathological oxidation, which affect the nerve ends of the prostate.Because prostate innervation is related to the innervation of the pelvic floor, penis, scrotum, testes, rectum - the localization of pain is variable.The following symptoms of pain are most common:

  • Discomfort or pain in the perineum - mainly occurs after exercise, sexual contact, alcohol, which is taken in the form of passing attacks;
  • Feeling of hot potatoes in the rectum;
  • Pain (discomfort) in the testes - patients are described as "pain", "twisting", are also associated with various provocative factors;
  • The discomfort, rubber and pain in the urethra - are mainly associated with the shift of the pH of the secret of the prostate in the acidic side.The acidic secret of the prostate is irritating to act on the mucous membrane of the urethra, so the pain, more often in the form of "burning", occurs after an act of urination or sexual contact when part of the secret when reducing the muscles of the gland and pelvis is pressed into the lumen of the urethra.

Urination Disorders Syndrome

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

  • Long urination - frequent urination (occurs up to 3 times an hour) with sharp and sudden calls (impossible to withstand) and more short portions;
  • Feeling of incomplete emptying of the bladder - after the act of urination feels that the urine remains in the bladder;
  • Weak or periodic flow of urine - this can also be due to the symptom of the "last drop" - despite all the patient's effort after the act of urination from 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 tuberculus (coliculite) on the surface of which are nerve receptors, which send the signal to the structures of the brain where the sensation of orgasm is formed.Prostatitis does not directly cause erection (blood supply to the penis during sexual arousal).

Basic Disorders:

  • Premature ejaculation or conversely excessively prolonged sexual contact - caused by inflammation of the seminal tubular or its mark due to the inflammatory process;
  • Deleted orgasm - is also associated with inflammation of the seed tuberculus;
  • Pain during ejaculation - associated with the inflammatory process in the output channels of the prostate, through which sperm is released.

Violation of fertility

When the prostate properties change as a result of inflammation, the following changes in semen are observed, reducing the ability of the person to fertilize (fertility):

  • Reducing the sperm pH in the acidic side - as the inflammation of the prostate acidic products of pathological oxidation begin to accumulate secretly.The acidic environment is extremely destructive to sperm that cause their immobilization and even death;
  • Sperm anglutination - sperm adhesion mainly with heads - is associated with a change in the physicochemical properties of secretions;
  • Asthenospermia - a decrease in sperm mobility - is closely linked to the displacement of pH in the acidic side and to a violation of the production of prostate lecithin carts that guarantee the vital activity of sperm.

Urethropostatitis

In some cases, prostatitis is combined with chronic urethritis, which is manifested by scarce rejection of the mucosa from the urethra (mainly after prolonged retention of the urine).

Prostatitis and sexual disorders

Does "prostatitis cause impotence?"This is the reason for the disputes of specialists for decades.

Under the influence of sexual stimuli, with the complete saturation of the body androgens in the formations of the cortical and subcortical regions of the brain, a nerve signal transmitted in the center of the erection, located in the spinal herd, from the place where the smooth muscles of the caveri) relax.In this process, there is no role of the prostate gland.

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

The inflammatory process in the prostate gland (prostatitis) can lead to the damage of the tuberculus of the seeds and, as a result, as disorders of the potency of the person, so that premature ejaculation and echoing orgasm.Impotence in chronic prostatitis is pathogenetically related to the degree of damage to the prostate nerve.This form of impotence (impotence of the neuroreceptor) is a characteristic example of a reusual phenomenon, when the presence of pathological impulse with the organs affected by the inflammatory process leads to the radiation of the excitation process that controls the sexual function and to the disorder of the latter.Defined, although not leading, plays a role in the pathogenesis of the impotence of the neurorecepter, also the suppression of androgenic activity of the testes and the sensitivity to the androgens of the centers of the hypothalamus and pituitary gland.

At the same time, it is believed that the Russian Federation has both the hyperdiagnosis of prostatitis and the re -appointment of its role in the development of erectile dysfunction.

Diagnostics

The doctor's task is to detect the inflammatory process in the prostate, identifying the possible pathogen of the disease and the evaluation of impaired prostate gland function.In 1990, Stamey wrote that prostatitis was a "garbage basket for clinical ignorance" due to the variety of used, diagnostic and healing methods.At the same time, a few simple and clinical and laboratory tests allow you to properly diagnose, allowing you to start the right therapy.

Putic rectal examination of the prostate gland

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

A microscopic examination of pancreatic secretion

It should be remembered that the increase in the number of leukocytes in a secret does not always show prostatitis, since the methods of obtaining a secret during a massage do not guarantee that the content of the urethra and bubbles will 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 foci of inflammation, the presence of some of the exhibited or closed output channels.

Study of prostate secretion

Expressed prostate secretions-EPS) secret studies allow you to determine the presence of an inflammatory process in the prostate gland and partly its functional ability.This is the main method of diagnosing and monitoring the treatment of chronic prostatitis.The secret of the prostate can be examined with the help of mild microscopy without drawing or using special methods of coloring.Also, the secret of the prostate gland can be subjected to a bacteriological examination or examination by the method of polymerase chain reaction to detect pathogens in it.Take a secret with prostate massage.A secret released from the urethra is collected in a sterile tube or on purely subject glass for examination.Sometimes the secret of the prostate gland from the urethra does not follow.In such cases, the patient is recommended to stand on his feet immediately.However, if it was not possible to get a secret, more often it means that it did not enter the urethra, but in the bladder.In this case, the centrifugation of the flushing fluid released from the bladder after massage of the prostate gland is examined.

  • Lipoid grains (lecithin bodies) - a specific product of normal physiological secretion of the glandular epithelium of the prostate gland.It gives a secret kind of milk.Usually the secret is rich in lecithine grains.The decrease in their number, along with the increase in the number of leukocytes, indicates an inflammatory process, a tumor;
  • Amyloid bodies - layered (starch), a body that is colored in purple or blue, like starch with a solution of Lugol;
  • Amyloid bodies are a condensed secret of the gland, has an oval shape and a layer structure that resembles a tree trunk.They are not normal, their detection shows a stagnation of the secret in the gland, which can be adenomas, chronic inflammatory processes;
  • Erythrocytes can be single.They are secret as a result of a vigorous massage of the prostate gland.Their increased amount is observed in inflammatory processes, neoplasms.
  • The lowering of the epithelium in large quantities is observed at the beginning of inflammatory processes and with tumors, then there is often damage to protein and fat degeneration of epithelial cells.Macrophages can be seen with stagnation of a secret for a long time of the present inflammatory process;
  • Bethera crystals are daily crystals formed during cooling and drying of the mixed secret of the male glands (prostatic juice with sperm impurities) of spermine and phosphorus salt.With azoospermia and sharply expressed oligospermia, Bethera crystals are formed quickly and in large quantities;
  • Reduction syndrome - stagnation syndrome is observed in glandular adenoma.There is an abundance of macrophages, there are multi -core cells such as foreign bodies and amyloid bodies;
  • The symptom of fern is a symptom of crystallization of a secret -form of falling crystals of sodium chloride depends on the physicochemical properties of the secret of the prostate.The symptom examination is performed by adding a decrease of 0.9% sodium chloride solution to the resulting prostate secret with a further viewing after drying under a light microscope.In healthy men of reproductive age, crystallization of the secret of the prostate is characterized by a typical phenomenon of fern leaves (3+).Androgen deficiency or the presence of prostatitis give different degrees of disturbance of the structure of crystals until their absence.

Bacteriological tests of parts of urine and secretion of the pancreas

Urethra spread, including PCR diagnostics

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

The immunofluorescence reaction (reef) is straight and indirect

Identification of antibodies to well -known antigens.

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

The American Foundation for Urological Diseases recommends the annual passage of a rectal prostate gland, accompanied by PSA for all men over 50 and with prostate cancer in blood relatives according to the male line.There is still a discussion about receiving a dog immediately after examining the prostate finger of the rectum.Recent studies could not confirm the presence of a significant increase in PSA content immediately after examination of the finger.In this way, the level of the PSA can be determined by obtaining reliable results after the pancreas study.

Four tests

In order to diagnose chronic prostatitis, a 4-crow test based on a comparative bacteriological evaluation of the urine is proposed, approximately equal to part of the urine obtained before and after prostate massage, as well as its secret.

The diagnosis of prostatitis was detected with a tenfold increase in the concentration of microorganisms in the secret of the prostate compared to their content in the urine (1, 2 and 3 parts) and an increase in the number of polymorphic nuclear leukocytes> 10-16 in the visual field of the light microscope (increase to 200 times).Or increasing the number of leukocytes above 300x106/l when calculated in the counting chamber.Lecitine bodies, which are the product of the normal secretion of the glandular epithelium of the prostate gland, should cover the dense field of the visual field of the microscope (5-10 million in 1 ml).The amyloid bodies in the secret of the prostate are in a much smaller amount.In adulthood men, they can be found 1-2 in the field of view.

Biochemical blood test

Immunological and hormonal profile (according to indications).

Ultrasound, Trusters

Ultrasound diagnostics of prostatitis from the abdominal and transrectal sensor (trust).

Uroflometry

Prostatitis

The overall treatment of patients with chronic prostatitis should include:

  • Compliance with the general regimen, diet, sexual hygiene, and attracting sexual partners in the presence of an infectious agent;
  • selection of effective drugs to suppress infection;
  • Increasing the overall reactivity of the patient's body and the immunobiological tolerance of microorganisms to drugs;
  • Strengthening the leakage of secretion and activation of local reparative processes in the focus of inflammation;
  • Sanitary of the foci of infection in previous and distant organs;
  • improving microcirculation in the prostate and pelvic organs;
  • the appointment of common 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 from local analyzing drugs;

Prostate massage

Prostate massage- a medical procedure used for diagnosing and sometimes treating chronic prostatitis.The first prostate massage was described by Dueer in 1893, and since 1936 it has been widely introduced into the urological practice of O'Conory.However, in 1968, following the description of Mires and Stami, the stage test for the diagnosis of prostatitis, the views on the causes of this disease change and massage as a therapeutic procedure are crossed by measures in many directions for the treatment of prostatitis in developed countries around the world.

But since the mid-1990s, many doctors involved in the diagnosis and treatment of prostatitis began to note inefficiencies in some cases of proposed antibacterial therapy and the use of alpha blockers, which made them use in the practice of this forgotten method.

In general, prostate massage is currently used as a diagnostic procedure for obtaining prostate secretion (pronounced prostatic secretions -epic) -for its microscopic (cultural) examination and for the test before and after the massage test (before and after the massage test -PPMT).Massage.Massage is a medical procedure and should perform a pre -trained specialist.The massage is performed after urination and when disposed of the urethra after its pre -washing with isotonic sodium chloride solution, which is especially necessary in cases where a bacteriological examination of the secret is taken.Prostate massage is performed through the anus, as the prostate gland is close to the rectum ampoule and is only available for examination.First, they massage one, then the other part of the prostate gland with the finger movements from the periphery to the central groove along the outlet ducts, trying not to touch the bubbles of the seeds.The massage is completed by pressing the area of the central groove from above.A secret released from the urethra is collected in a sterile tube or on purely subject glass for examination.Sometimes the secret of the prostate gland from the urethra does not follow.In such cases, the patient is advised to immediately stand on his feet, if it is not possible to obtain the secret, this means that he was not in the urethra but in the bladder.In this case, the centrifugation of the flushing fluid released from the bladder after massage of the prostate gland is examined.

Prostate massage for medical purposes (recurrent massage) is officially recommended by the Russian Federation of the Russian Federation as a therapeutic procedure for chronic prostatitis.Prostate massage is widely used to treat prostatitis in Southeast Asia, China and some countries in Europe.Some North Merical 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 assessment of the effectiveness or ineffectiveness of prostate massage is not practically not done.There are several controversial studies, in one conducted by Egyptian doctors, there are no differences in groups of patients, some of which are massage in combination with antibiotic therapy and simply antibiotic therapy, in another, performed by American and Philippine researchers, in a group of prostatitis patients who have received explosiveprostatitis.

Proponents of the use of a massage for therapeutic purposes believe that the main effect of its use is the drainage of prostate ducts - ie.Their release from purulent and dead cells.Another effect is to increase blood flow to the prostate gland, which improves the penetration of antibiotics into it and activates local protective immunological processes.

There is little evidence of prostate massage complications in world literature.In 1990, Japanese doctors described the genital organs (Funny), and in 2003 German doctors were constant hemorrhage after prostate massage with the development of embolistic stroke (hemorrhage) of the lungs.There is a study that after the massage, the level of PSA (prostate -specific antigen) is temporarily increased.Massage is contraindicated in acute inflammation of the prostate gland (acute prostatitis), with acute urethritis, orchitis, prostate cancer.Massage is not recommended for the prostate to calculate the prostate adenoma.It is usually recommended that prostate massage be recommended 2 or 3 times a week.

Physiotherapy procedures

Any physiotherapy procedures (prostate massage, warming, etc.) in acute prostatitis are contraindicated.

The use of physiotherapy procedures in complex treatment of prostatitis is intended, as well as directly affecting the prostate gland of physical remedies, to normalize the functional and pathological changes, as well as on the electroporetic administration of medicines in the prostate tissue.

The use of physiotherapy methods against the background of drug therapy produces a much better result than in treatment individually.The following methods of influencing the prostate gland have become widespread and have proven their effectiveness:

  • shock wave therapy;
  • electrical stimulation of the pancreas with modulated currents with TID or rectal electrodes;
  • thermotherapy in various versions (including high frequency thermotherapy);
  • magnetotherapy;
  • Microwave microwave technology;
  • Laser therapy.
  • Tractal ultrasound therapy and phonophoresis;
  • Microylisms.