A diagnosis of chronic prostatitis" (XN) is put in the presence of soft tissue inflammation of the prostate, which lasts from 3 months and more. Under the influence of triggering factors of remission is replaced by exacerbations. The disease occurs in all the five men. 30% of patients with a diagnosis at the age of 20 to 50 years. Completely heal the chronic form of prostatitis is almost impossible, but in most cases, impossible to achieve remission stable, provided you comply with the recommendations of a physician (a doctor is engaged in the treatment of prostatitis).
Types of chronic prostatitis
The universal is considered as the classification, according to which several types of chronic prostatitis:
- Acute bacterial (during relapse).
- Chronic bacterial.
- Chronic aseptic (abacterial) prostatitis, which is divided into 2 sub-types: the syndrome of chronic pelvic pain inflammatory or non-inflammatory nature (prostatodynia).
- Asymptomatic flows (latent) in chronic prostatitis.
Data the symptoms of chronic prostatitis in men are not always appear in a strict order. The degree of severity depends on the characteristics of the organism.
Prostatitis chronic bacterial
The bacteria are the cause of the inflammation of the prostate is 6% to 10% of cases. The form of the chronic prostatitis is usually caused specific infections (escherichia coli, staphylococcus aureus, streptococcus hemolytic), penetrating into the prostate to other organs or the external environment. The inflammation caused by this type of bacteria grows slowly with a cleared symptomatology, therefore, chronic infection of the prostate gland is often exacerbated, since they are already running. Sometimes the inflammation manifests the weakness of the itching, burning, and even pain in the urethra, micturition disorders. Active development of the infection as evidenced by pain in the lower belly and fever. What are the first signs of which began with the defeat of the other pelvic organs. Formation of abscesses.
The reasons
Non-specific infection penetrate generally into the prostate during a damage of the genital mucous membranes due to inflammation, sores, debris, tools, urological manipulation. On the surface of the skin of the perineum is constantly a number of intestinal bacteria, it is important, therefore, that hygiene of the procedure before the sexual act. If, in the neighbourhood of the anus, the groin and the scrotum are present, excessive moisture and irritation, then the pathogens are developing actively implemented in the thickness of the epidermis. Non-specific pathogens of chronic prostatitis fall into the gland tissue of the ureter during the oral sexual contact, because in the throat often detected streptococci, certain gram-negative bacteria. Often, the contamination is done by the hands of the men. Most of the men with chronic prostatitis bacterial, belong to the age group of 20 to 40 years, as this period is maximum for sexual activity. Ignore the means of contraception barrier leads to frequent infection-specific caused by the inflammation of the prostate. The most dangerous are the following:
- Mycoplasma;
- Ureaplazmi;
- Trichomonas;
- Chlamydia.
Erectile dysfunction on the background of prostatitis chronic bacterial is often adjusted from neurosis, in consequence of which the man becomes irritable, aggressive.
Treatment
Modern methods of treatment of prostatitis bacterial suggest the intake of antibiotics active against detected during the diagnosis of the pathogen. As aid prescribed anti-spasmodics, analgesics class NSAIDS, diuretics. Antibacterial drugs of the first series are: antibiotics of the second row of macrolides. In the schema may also contain sulfonamides. Quickly cure the chronic prostatitis is impossible. Depending on the nature of the inflammation of the therapy lasts for 2 to 12 weeks. If, within a period of 2 weeks of the positive dynamics is absent, this medication will vary. The negative result of the antibiotic treatment in chronic prostatitis due to the following reasons:
- The short-term courses;
- A low concentration of the substance;
- Education in the openings of the ducts, acinus of the prostate (botryoidal bags, which constitute the tissue of the prostate) the colonies of resistant bacteria.
The antibiotics are introduced not only orally, but also intraprostatically and endolymphatic by the injections imposed, or lymph nodes).
Fungal prostatitis
Fungal (mycotic) prostatitis is a sub-species of a chronic form of the disease. The pathogens penetrate as during unprotected sexual contact, and limfatica other organs. The symptoms of injury of the tissue of the prostate is often blurred, therefore, the inflammation becomes chronic. In normal immunity fungal colony do not reproduce any more sure of the standard. The risk of development of candida prostatitis is increased in diabetic men positive with HIV, and people with a systemic disease.
Abakterialniy prostatit
Chronic pelvic pain, taking the coccyx and the perineum is a sign of abacterial prostatitis (the prevalence is 80 to 90%, including prostatodynia 20% to 30%). Other events may not be at all. At the time of diagnosis of the pathogen is not detected neither in the juice of the prostate or in the urine or in the ejaculate. When the character inflammatory pelvic pain in biological fluids increases the number of white blood cells. In addition to the pain of chronic abacterial prostatitis periodically, there are symptoms such as blood in the ejaculate, the discomfort of ejaculation and defecation, difficulty urinating. Some men significantly decreases libido, deterioration of erectile function, there is of the weakness and muscle pain.
Causes and treatment
The probable causes of the chronic non-bacterial prostatitis:
- The systemic diseases.
- Pathology of blood vessels, the circulation of the blood.
- Autoimmune diseases of the offence.
- Process stagnant.
The exact cause of developing chronic, non-infectious (non-specific) of the prostatitis is not always possible to identify, therefore, the drug therapy is often unsuccessful. For the derivations purulent lesion of the prostate stands catheterization of the urinary bladder. If the effectiveness of the treatment apply surgical in the form of a transurethral fine-needle or laser ablation of the prostate (minimally invasive methods of destruction overgrown tissue).
Chronic prostatitis calculous
Chronic calculous form of the prostatitis also is abacterial. The stones (practicality) in the prostate are formed due to the flow of secretions. They consist of products of inflammatory reactions, salts, masses of necrotic. The pathology usually develops in the stagnant (congestive) of the chronic prostatitis, the kidney stones (stones may migrate from the kidneys and the bladder), metabolic, adenoma of the.
Symptoms of chronic prostatitis with calcification:
- A violation of urination.
- The pain in the groin, coccyx.
- The blood in the semen.
- The deterioration of erection.
For dissolution of stones in the prostate are introducing products and produce rectal massage. If the conservative methods do not work, then resort to surgery. Launched the form of the chronic calculous prostatitis can lead to an abscess of the gland or atrophy of the authority.
Asymptomatic prostatitis
When the chronic prostatitis signs missing. The only thing that manifests at the time of diagnosis, it leukocytosis secret of the prostate and the likely increase in the PSA level. Manifests asymptomatic prostatitis by chance: when the project of the investigation, or at another occasion.
The consequences of the chronic prostatitis
Itself chronic prostatitis the life of a man is not dangerous. Threatening may be its consequences, if the time did not appeal to his coming. The complications most often develop in younger patients. When the chronic prostatitis the protective function of the breast is disrupted, reduces the number of zinc, lysozyme required for normal operation. As a consequence, authority becomes a source of permanent infection. Pathogens often migrate into the testes, the colon, causing epididymitis, abscess. During the movement of the infection through channels may be the development of pyelonephritis, of the renal failure. As the prostate takes an active part in the formation of the ejaculate, his constant inflammation can lead to infertility. Often, a woman cannot get pregnant is not because of the poor quality of the sperm of the partner, but because of a defect in the seminal fluid. The attempts to conceive a child naturally long fail (for more details on the impact of prostatitis on the conception of the child). A severe complication is scarring of the lining of the bladder, prostate, urethra. Long inflammatory deform the fabric, they the face of economic non-functional. Also, the chances of developing prostatic hypertrophy (BPH), which can serve as a catalyst for cancer of the process.
The diagnosis of chronic prostatitis
Consultation with a doctor in detail discover the history of the patient's illness, it is particularly important to describe any violation of privacy. The range of complaints in men with chronic prostatitis can be extremely broad: from sexual dysfunction up to neurosis. ¼ Of all patients in general do not fall within the scope of symptoms of the pathology detected by chance. Important part of the story. Features predecessors of different types of chronic prostatitis: infection is bacterial or urethritis gonococcal, non-infectious hemorrhoids, varicocele, varicose veins defeat of the veins of the legs. Of paramount importance in the diagnosis of chronic prostatitis were palpation of the gland, the analysis of its secret (more info on the sowing of the secret of the prostate). During an exacerbation of the size of the prostate is slightly increased, and in periods of remission bounces, it is possible that a small swelling. The secret is extracted by a massage of the prostate. If the inflammatory process, door of the nature, then the consistency of the authority unequal: alternate areas Zapadni, VitaScene, razmagcheniu. In such cases, the juice of the prostate receive separately of each part. The changes of the secretions of the gland, which are indicators of chronic prostatitis:
- Change of acidity in the direction of the alkalization;
- An increase in the activity of the lysozyme;
- The reduction in the volume of the acid phosphatase.
High informative different fluorescent-cytology prostatic juice, as well as tests of its crystallization. Men in good health, the juice crystallizes in the form of a fern leaf. The violation of the geometry, the drawing bears witness to the pathologies of the endocrine glands, because of which is a lack of androgens. In some cases, when the diagnosis-infectious chronic prostatitis applied nutrition of the provocation – the patient deliberately uses spicy foods or alcohol, and as a result are driven by causative agents of gonorrhea and trichomoniasis. Persistent inflammatory processes are manifested in the introduction of pirogenala or prednisolone. Among the research laboratories of the most informative is considered to be a test, called trehstakannoy break. The patient urinates first into one glass, then a second, after which it is proceeded with a prostate massage. The remains in the bladder, the urine is collected in a third glass. It with the ejaculate exposed to bacteriological study. Among the analyses required is also taken from the urethra for the presence of an STD. A ridge of all the pathogens that have grown up in the cultures, automatically considered agents of chronic prostatitis. In the microbiocenosis their presence is a variant of the standard. Important the title of growth (concentration). If the rate exceeds 10 to 4 degrees, it is considered as an important tool. In the contrary case, the patient shows dynamic observation, and not the treatment. Informative method of diagnosis is TRUE, or ULTRASOUND of the study. By ultrasound characteristics, you can determine the duration and the severity of the inflammation. The main exeprince in chronic prostatitis:
- The volume of the prostate increases up to 20 cm3, and more;
- Sclerotic and fibrous transformation of the tissues;
- Stones;
- Pockets.
The speed of the flow of urine and obstructive changes in the ureter and allows you to follow the flow. For the differentiation of chronic prostatitis from cancer and hyperplasia, where appropriate, biopsy of the prostate. The rates of PSA during the chronic prostatitis in the period of remission is normal or slightly increased. On the bottom of the assets of the inflammatory process may go up to 8 to 10 ng/ml for Diagnosis of non-bacterial chronic prostatitis a little more difficult. It is necessary to pass a number of tests to exclude bacterial infection in the form of inflammation, abnormalities of other pelvic organs. The microscopy of the urine and the semen shows an excess of white blood cells, but the ULTRASOUND, cystoscopy, CT co-morbidities do not reveal.
General methods of therapy of chronic prostatitis
In addition to the specific methods of treatment of various types of chronic prostatitis are of a general nature, applicable in all types of inflammations. An effective way of healing effects on the prostate massage is. It has a direct impact on the fabric of the gland, improves blood and lymphatic circulation, eliminates the products of inflammatory reactions. During the exacerbation of a prostate massage is not carried out.