chronic prostatitis

This type of prostatitis occurs rarely, accounting for approximately 10% of all prostatitis cases. The question of whether atypical pathogens, such as Ureaplasma urealyticum, can cause prostate inflammation is under discussion. They can be present in the male body without any signs of inflammation or discomfort.

Causes of chronic prostatitis

The causes of chronic prostatitis are basically similar to those of acute bacterial prostatitis. In most cases, microorganisms enter the prostate through the urethra as a result of backflow of urine into the prostate ducts (intraprostatic urine reflux).

Chronic bacterial prostatitis is caused by inadequate or short-term treatment of acute bacterial prostatitis.

symptom

• Discomfort or pain - perineum, lower abdomen, groin, scrotum, penis, during ejaculation
• Urinary changes - difficulty urinating, frequent urination, small urine output, feeling of incomplete bladder emptying.

Patients may complain of a combination of symptoms, or any symptom individually. The increase in body temperature is unusual (or not significant).important:Many men associate erectile dysfunction with prostatitis. This is often facilitated by lay publications and advertisements of questionable drugs in the media. The fact that erections persist even when the prostate is completely removed (due to the presence of malignancy in this organ) suggests that the prostate itself plays no role in maintaining an erection.

Many leading urologists believe that erectile dysfunction in patients with chronic prostatitis is caused by psychogenic and neurological problems.

diagnosis

For initial assessment, the NIH-CPSI questionnaire-Chronic Prostatitis Symptom Index was used. It can be used to objectify patient complaints.The standard way to diagnose prostatitis is to perform a 4-cup Meares-Stamey test. This is a microscopic and bacteriological study of urine samples obtained from different parts of the urogenital tract and prostate secretions. However, the 4-glass sample method is quite labor-intensive and modifications of the Meares-Stamey sample are currently more commonly used: 3-glass or 2-glass samples. A possible alternative is to subject the semen (sperm) to microscopic and bacteriological examination, since the semen portion (at least 1/3) consists of prostate secretions. This approach is more comfortable for the patient, especially if they flatly refuse a rectal examination or diagnostic prostate massage to obtain prostate secretions. However, the information content and reliability of donated semen is lower than that of 3-cup or 2-cup samples.

Submission of semen for bacteriological examination is included in the diagnostic algorithm for male genital infections and investigation of male infertility.

In chronic prostatitis, the results of laboratory tests (general urine tests, general blood tests, biochemical blood tests, semen tests and other general clinical tests) are not informative. These tests will most likely show "OK".During rectal examination, changes indicating an inflammatory process in the prostate are not always observed in patients with chronic prostatitis. In other words, it is impossible to rely on the results of a rectal examination to diagnose chronic prostatitis.The same is true for ultrasound diagnosis: it is incorrect to diagnose chronic prostatitis based on ultrasound data alone.The European and American Urology Association does not recommend ultrasound for the diagnosis of prostatitis. In this case, the type of execution does not matter - transabdominal (through the anterior abdominal wall - lower abdomen) or transrectal (TRUS - through the rectum). It is incorrect to write "chronic prostatitis", "ultrasound signs of chronic prostatitis", and "signs of congestive prostatitis" in the conclusion of ultrasound examination. Only a urologist is authorized to make this diagnosis, which he bases on the chief complaint, past medical history, laboratory tests, and ultrasonography.The most common ultrasound signs for the diagnosis of chronic prostatitis are so-called diffuse changes in the prostate associated with inflammatory processes or other changes in the prostate parenchyma. This is a fibrotic process that replaces normal prostate parenchyma with scar tissue. HoweverThere is no correlation between the number of prostatic fibrous changes and the presence of chief complaints. The chances of developing such "scars" in the organs increase with age, but a man can go his entire life without feeling any discomfort in his perineum or vagina. However, some "experts" diagnose prostatitis once ultrasound detects these changes. And some men will feel like they're really sick and they'll start listening to themselves and they'll feel all the symptoms described online.

In many men over the age of 30, ultrasound may show diffuse changes in the prostate. However, fibrotic processes do not indicate the presence of prostatitis.

The diagnosis of chronic prostatitis is based on the exclusion of other diseases of the urogenital system - mainly urethritis, prostatic hyperplasia, urethral stricture, neurogenic voiding disorders, prostate cancer, and bladder cancer.

According to routine examination results, there is no specific case of chronic prostatitis.

Treatment of chronic prostatitis

Fluoroquinolone antibiotics are the best antibacterial drugs for the treatment of chronic bacterial prostatitis. The recommended course of antibiotic treatment is 4 to 6 weeks. Such a long course of treatment is justified by scientific data, showing a reduced likelihood of disease recurrence.For established sexually transmitted infections (STIs), such as Chlamydia trachomatis , macrolide antibiotics should be prescribed. They are the most effective.There is evidence that patients with chronic prostatitis have reduced bladder neck relaxation, causing urine to flow back into the urethral prostatic duct, causing inflammation and pain in the prostate tissue. For such patients, alpha-blockers are recommended.When treating chronic prostatitis, patients are advised not to use herbal medicine. One of the hallmarks of dietary and herbal supplements is that the botanical ingredients in some substances are unstable; they may vary even among preparations from the same manufacturer. In addition, from the perspective of evidence-based medicine, the benefits of herbal medicine cannot withstand criticism.Prostate massage was used as the basis of treatment in the mid-20th century, and today, thanks to new scientific methods and the Meares-Stamey classification, prostate massage remains an important tool in diagnosing prostatitis, but is no longer an important tool in treating it.There is no need to use prostate massage as a treatment (its effectiveness has not been proven).Some believe that frequent ejaculation is similar in nature to therapeutic prostate massage sessions.Other methods that have only been proven effective in one or a few studies or are still under investigation include:

• Pelvic floor muscle training – There is some evidence that specific exercises are effective in reducing symptoms of chronic prostatitis and chronic pelvic pain syndrome;
• Acupuncture – A few studies have shown benefits of acupuncture compared with placebo in people with chronic prostatitis;
• Extracorporeal shock wave therapy - based on the effect of acoustic pulses of significant amplitude on connective and bone tissue, widely used to treat diseases of the musculoskeletal system and more recently in urology, where its effectiveness is under investigation;
• Behavioral therapy and psychological support - Since chronic prostatitis is associated with poor quality of life and the development of depression, these approaches can improve the patient's psychological state and help reduce some symptoms of the disease.

It is worth mentioning alone thatAsymptomatic (no symptoms) chronic prostatitis. Diagnosis is usually made based on the results of a prostate biopsy or histology report after surgical treatment of the prostate. The frequency of detection of inflammation in prostate tissue ranges from 44% (prostate biopsy) to 98-100% (after surgical treatment of the prostate). Scientists believe that the inflammatory changes found in this way are nothing more than an age-related physiological signature. No one specifically diagnoses this type of prostatitis; it is an incidental finding. It does not require treatment or any further action by the doctor or patient.

How is chronic prostatitis treated in specialist clinics?

In the past 10 years, my country has published 47 monographs on prostatitis and passed 64 master's and doctoral theses on prostatitis. Not to mention various "folk" publications, which vividly describe the cause, diagnosis and various treatments of this disease. What does it mean? In fact, the topic of prostatitis raises many questions, and unfortunately, some of them still don’t have clear answers. There are a large number of modern medicines with proven efficacy. However, the number of patients diagnosed with chronic prostatitis has not decreased.That's why when diagnosing and treating prostatitis, urologists try to gain the most complete understanding possible. They question the patient in detail about their signs and symptoms, study the results of previous examinations, and focus not only on the clinical symptoms of the disease, but also on other aspects of health, including the patient's neurological and psychological state - as this may trigger the development of characteristic manifestations. At the same time, unnecessary testing and research is not performed.