Symptoms of prostatitis and prostate adenoma in men

Prostatitisis an inflammatory disease of the prostate. It is manifested by frequent urination, pain in the penis, scrotum, rectum, sexual disorders (erection disorder, early ejaculation, etc. ), sometimes urinary retention, blood in the urine. The diagnosis of prostatitis is made by a urologist or an andrologist according to the typical clinical picture and the results of a rectal examination. In addition, an ultrasound of the prostate, bakposev of the prostate and urine is performed. Treatment is conservative - antibiotic therapy, immunotherapy, prostate massage, lifestyle correction.

General information

Prostatitis is an inflammation of the seminal (prostate) gland - the prostate. It is the most common disease of the genitourinary system in men. It most often affects patients aged 25-50. According to various data, 30-85% of men over the age of 30 suffer from prostatitis. Possible formation of prostate abscess, inflammation of the testicles and appendages, which threatens infertility. The rise of infection leads to inflammation of the upper genitourinary system (cystitis, pyelonephritis).

The pathology develops through the penetration of an infectious agent that enters the prostate tissue from the organs of the genitourinary system (urethra, bladder) or from a distant focus of inflammation (with pneumonia, flu, tonsillitis, furunculosis).

Prostate adenoma is a benign neoplasm of paraurethral glands located around the urethra in its prostate part. The main symptom of prostate adenoma is a violation of urination due to the gradual compression of the urethra by one or more growing nodules. The pathology is characterized by a benign course.

Only a small part of patients seek medical help, however, a detailed examination reveals symptoms of the disease in every fourth man aged 40-50 and in half of men aged 50-60. The disease is detected in 65% of men aged 60-70 years, 80% of men aged 70-80 and more than 90% of men older than 80 years. The severity of symptoms can vary significantly. Research in the field of clinical andrology suggests that problems with urination occur in about 40% of men with BPH, but only one in five patients of this group seek medical help.

Causes of prostatitis

Staphylococcus aureus (Staphylococcus aureus), Enterococcus (Enterococcus), Enterobacter (Enterobacter), Pseudomonas (Pseudomonas), Proteus (Proteus), Klebsiella (Klebsiella) and Escherichia coli can act as an infectious agent in the acute process. . Most microorganisms belong to conditionally pathogenic flora and cause prostatitis only in the presence of other predisposing factors. Chronic inflammation is usually the result of polymicrobial associations.

The risk of developing the disease increases with hypothermia, a history of specific infections and conditions accompanied by congestion in the prostate tissues. There are the following predisposing factors:

• General hypothermia (single or permanent, related to working conditions).
• Sedentary lifestyle, a specialty that forces a person to be in a sitting position for a long time (computer operator, driver, etc. ).
• Constant constipation.
• Violations of the normal rhythm of sexual activity (excessive sexual activity, prolonged abstinence, incomplete ejaculation during "usual" sexual intercourse devoid of emotional color).
• The presence of chronic diseases (cholecystitis, bronchitis) or chronic infectious foci in the body (chronic osteomyelitis, untreated caries, tonsillitis, etc. ).
• Previous urological diseases (urethritis, cystitis, etc. ) and sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea).
• Conditions that cause suppression of the immune system (chronic stress, irregular and malnutrition, regular lack of sleep, overtraining of athletes).

It is assumed that the risk of developing pathology increases with chronic intoxication (alcohol, nicotine, morphine). Some research in the field of modern andrology proves that chronic perineal trauma (vibration, concussion) in drivers, motorcyclists and cyclists is a provoking factor. However, the vast majority of experts believe that all these circumstances are not the real causes of the disease, but only contribute to the worsening of the latent inflammatory process in the prostate tissues.

Congestion in prostate tissues plays a decisive role in the development of prostatitis. Violation of capillary blood flow causes an increase in lipid peroxidation, edema, excretion of prostate tissue and creates conditions for the development of an infectious process.

The mechanism of prostate adenoma development has not yet been fully determined. Despite the widespread opinion that links the pathology with chronic prostatitis, there is no data to confirm the connection between these two diseases. The researchers did not find any relationship between the development of prostate adenoma and the use of alcohol and tobacco, sexual orientation, sexual activity, sexually transmitted and inflammatory diseases.

There is a pronounced dependence of the incidence of prostate adenoma on the age of the patient. Scientists believe that adenoma develops as a result of hormonal imbalance in men during andropause (male menopause). This theory is also supported by the fact that men who are castrated before puberty never suffer from pathology, and men who are castrated after it are extremely rare.

Symptoms of prostatitis

Acute prostatitis

There are three stages of acute prostatitis, characterized by the presence of a certain clinical picture and morphological changes:

• Acute catarrhal. Patients complain of frequent, often painful urination, pain in the sacrum and perineum.
• Acute follicular. The pain becomes more intense, sometimes spreads to the anus, aggravated by defecation. Urination is difficult, urine flows in a thin stream. In some cases, urine retention occurs. A subfebrile state or moderate hyperthermia is typical.
• Acute parenchyma. Severe general intoxication, hyperthermia up to 38-40°C, chills. Dysuric disorders, often - acute retention of urine. Sharp, throbbing pains in the perineum. Difficulty in defecation.

Chronic prostatitis

In rare cases, chronic prostatitis becomes the result of an acute process, however, as a rule, a primary chronic course is observed. The temperature occasionally rises to subfebrile values. The patient notices slight pain in the perineum, discomfort during urination and defecation. The most characteristic symptom is scanty discharge from the urethra during defecation. The primary chronic form of the disease develops over a long period of time. It is preceded by prostatosis (stagnation of blood in the capillaries), which gradually turns into abacterial prostatitis.

Chronic prostatitis is often a complication of the inflammatory process caused by the causative agent of a certain infection (chlamydia, trichomonas, ureaplasma, gonococcus). Symptoms of a specific inflammatory process in many cases mask the manifestations of prostate damage. Perhaps a slight increase in pain during urination, slight pain in the perineum, scanty discharge from the urethra during defecation. A slight change in the clinical picture often goes unnoticed by the patient.

Chronic inflammation of the prostate can be manifested by a burning sensation in the urethra and perineum, dysuria, sexual disorders, increased general fatigue. Mental depression, anxiety and irritability are often the result of impairment of potency (or fear of these impairments). The clinical picture does not always include all the listed groups of symptoms, it differs in different patients and changes over time. There are three main syndromes characteristic of chronic prostatitis: pain, dysuric, sexual disorders.

There are no pain receptors in prostate tissue. The cause of pain in chronic prostatitis becomes almost inevitable due to abundant innervation of pelvic organs, involvement in the inflammatory process of nerve pathways. Patients complain of pain of varying intensity - from weak, painful to intense, disturbing sleep. There is a change in the nature of pain (increasing or weakening) during ejaculation, excessive sexual activity or sexual abstinence. The pain spreads to the scrotum, sacrum, perineum, sometimes to the lumbar region.

As a result of inflammation in chronic prostatitis, the volume of the prostate increases, squeezing the urethra. The lumen of the ureter is reduced. The patient has a frequent need to urinate, a feeling of incomplete emptying of the bladder. As a rule, dysuric phenomena are expressed in the early stages. Compensatory hypertrophy of the muscle layer of the bladder and ureter then develops. Symptoms of dysuria during this period weaken, and then increase again with the decompensation of adaptive mechanisms.

In the initial stages, dyspotency can develop, which manifests itself differently in different patients. Patients may complain of frequent nocturnal erections, blurred orgasm or worsening erection. Accelerated ejaculation is associated with a decrease in the threshold level of orgasmic center excitation. Painful sensations during ejaculation can cause rejection of sexual activity. In the future, sexual dysfunctions become more pronounced. In the advanced stage, impotence develops.

The degree of sexual disorder is determined by many factors, including the sexual constitution and psychological state of the patient. Potency disorders and dysuria can be caused both by changes in the prostate and by the suggestibility of the patient, who, if he has chronic prostatitis, expects the inevitable development of sexual disorders and urination disorders. Especially often, psychogenic dyspotency and dysuria develop in suggestible, anxious patients.

Impotence, and sometimes the very danger of possible sexual disorders, is hard for patients to bear. Often there is a change in character, irritability, discomfort, excessive concern for one's own health, and even "worry about illness".

There are two groups of disease symptoms: irritative and obstructive. The first group of symptoms includes increased urination, persistent (imperative) need to urinate, nocturia, urinary incontinence. The group of obstructive symptoms includes difficulty urinating, delayed onset and prolonged time of urination, feeling of incomplete emptying, urination with an intermittent slow stream, need to strain. There are three stages of prostate adenoma: compensated, subcompensated and decompensated.

Compensated phase

In the compensation phase, the dynamics of the act of urination changes. It becomes more frequent, less intense and less free. There is a need to urinate 1-2 times a night. As a rule, nocturia in stage I prostate adenoma does not cause concern in patients who associate constant night awakenings with the development of age-related insomnia. Normal frequency of urination can be maintained during the day, however, patients with stage I prostate adenoma note a waiting period, especially pronounced after a night's sleep.

Then the frequency of daily urination increases, and the volume of urine released after urination decreases. There are imperative urges. The stream of urine, which previously formed a parabolic curve, is released slowly and falls almost vertically. Bladder muscle hypertrophy develops, due to which the efficiency of its emptying is maintained. At this stage, there is little or no residual urine in the bladder (less than 50 ml). The functional state of the kidneys and upper urinary tract is preserved.

Subcompensated phase

In stage II prostate adenoma, the bladder increases in volume, dystrophic changes develop in its walls. The amount of remaining urine is over 50 ml and continues to increase. During the entire act of urination, the patient is forced to intensely strain the abdominal muscles and diaphragm, which leads to an even greater increase in intravesical pressure.

The act of urinating becomes multiphase, intermittent, wavy. The passage of urine along the upper urinary tract is gradually obstructed. Muscular structures lose their elasticity, the urinary tract expands. Kidney function is impaired. Patients are concerned about thirst, polyuria and other symptoms of progressive chronic renal failure. When compensatory mechanisms fail, the third stage begins.

Decompensated phase

The urinary bladder in patients with stage III prostate adenoma is stretched, filled with urine, easily determined by palpation and visually. The upper edge of the bladder can reach the level of the navel and above. Emptying is impossible even with intense abdominal muscle tension. The urge to empty the bladder becomes continuous. There may be severe pain in the lower abdomen. Urine is excreted often, in drops or very small portions. In the future, the pain and the urge to urinate gradually weaken.

Characteristic paradoxical retention of urine, or paradoxical ischuria, develops (bladder is full, urine is constantly excreted drop by drop). The upper urinary tracts are enlarged, the functions of the renal parenchyma are disturbed due to the constant obstruction of the urinary tracts, which leads to an increase in the pressure in the pelvicceal system. The chronic kidney failure clinic is growing. If medical care is not provided, patients die from progressive CRF.

Complications

In the absence of timely treatment of acute prostatitis, there is a significant risk of developing a prostate abscess. With the formation of a purulent focus, the patient's body temperature rises to 39-40 ° C and can become hectic. Periods of heat alternate with strong winters. Sharp pains in the perineum make it difficult to urinate and prevent defecation.

An increase in prostate edema leads to acute retention of urine. Rarely, an abscess spontaneously ruptures in the urethra or rectum. When it opens, purulent, cloudy urine with an unpleasant pungent odor appears in the urethra; when opened, the stool contains pus and mucus in the rectum.

Chronic prostatitis is characterized by an undulating course with periods of long-term remissions, during which the inflammation in the prostate is latent or manifests itself with extremely bad symptoms. Patients who don't mind often stop treatment and only turn around when complications develop.

The spread of infection through the urinary tract causes pyelonephritis and cystitis. The most common complication of the chronic process is inflammation of the testicles and epididymis (epdidymo-orchitis) and inflammation of the seminal vesicles (vesiculitis). The outcome of these diseases is often infertility.

Diagnostics

In order to assess the severity of prostate adenoma symptoms, the patient is asked to fill in a voiding diary. During the consultation, the urologist performs a digital examination of the prostate. In order to rule out infectious complications, samples are taken and prostate secretions and smears from the urethra are examined. Additional testing includes:

• Echography.In the prostate ultrasound process, the volume of the prostate is determined, stones and blocked areas are detected, the amount of remaining urine, the condition of the kidneys and urinary tract are assessed.
• Urodynamic study.Uroflowmetry allows you to reliably assess the degree of urine retention (urinating time and urine flow rate are determined by a special device).
• Definition of tumor markers.To rule out prostate cancer, it is necessary to evaluate the level of PSA (prostate-specific antigen), whose value should not normally exceed 4 ng/ml. In controversial cases, a prostate biopsy is performed.

Cystography and excretory urography of prostate adenoma have been performed less frequently in recent years due to the emergence of new, less invasive and safer research methods (ultrasound). Sometimes cystoscopy is done to exclude diseases with similar symptoms or in preparation for surgical treatment.

Treatment of prostatitis

Treatment of acute prostatitis

Patients with an uncomplicated acute process are treated by a urologist on an outpatient basis. In case of severe intoxication, suspected purulent process, hospitalization is indicated. Antibacterial therapy is administered. Preparations are chosen taking into account the sensitivity of the infectious agent. Antibiotics are widely used and can penetrate the prostate tissue well.

With the development of acute urinary retention due to prostatitis, they resort to the installation of a cystostomy rather than a urethral catheter, because there is a risk of prostate abscess formation. With the development of an abscess, endoscopic transrectal or transurethral opening of the abscess is performed.

Treatment of chronic prostatitis

Treatment of chronic prostatitis should be complex, including etiotropic therapy, physiotherapy, correction of immunity:

• Antibiotic therapy. The patient is prescribed long courses of antibacterial drugs (within 4-8 weeks). The selection of the type and dose of antibacterial drugs, as well as the determination of the duration of the course of treatment, is carried out individually. The drug is selected based on the sensitivity of the microflora according to the results of urine culture and prostate secretion.
• Prostate massage.Massage of the gland has a complex effect on the affected organ. During the massage, the inflammatory secret accumulated in the prostate is squeezed into the channels, then enters the urethra and is removed from the body. The procedure improves blood circulation in the prostate, which minimizes clogging and ensures better penetration of antibacterial drugs into the tissue of the affected organ.
• Physiotherapy.Laser exposure, ultrasound waves and electromagnetic vibrations are used to improve blood circulation. If it is impossible to carry out physiotherapeutic procedures, the patient is prescribed warm medicinal microclysters.

In the case of chronic, long-term inflammation, a consultation with an immunologist is indicated for the selection of immunocorrective therapy tactics. The patient is given advice on lifestyle changes. Certain changes in the lifestyle of patients with chronic prostatitis are both curative and preventive. Normalization of sleep and wakefulness, establishment of diet, moderate physical activity are recommended to the patient.

Conservative therapy

Conservative therapy is carried out in the early stages and in the presence of absolute contraindications for surgery. Alpha-blockers, 5-alpha reductase inhibitors, herbal preparations (African plum bark extract or sabal fruit) are used to reduce the severity of disease symptoms.

Antibiotics are prescribed to fight the infection that often accompanies prostate adenoma. At the end of the course of antibiotic therapy, probiotics are used to restore the normal intestinal microflora. Perform an immunity correction. Atherosclerotic vascular changes that develop in most elderly patients prevent the flow of drugs to the prostate, so special drugs are prescribed to normalize blood circulation.

Operation

There are the following surgical methods for the treatment of prostate adenoma:

1. TOUR(transurethral resection). Minimally invasive endoscopic technique. The operation is performed with an adenoma volume of less than 80 cm3. Not applicable for renal failure.
2. Adenomectomy.It is carried out in the presence of complications, the mass of the adenoma is greater than 80 cm3. Currently, laparoscopic adenomectomy is widely used.
3. Laser vaporization of the prostate.It allows you to operate with a tumor mass smaller than 30-40 cm3. It is the method of choice for young patients with prostate adenoma, as it allows you to preserve sexual function.
4. Laser enucleation(holmium - HoLEP, thulium - ThuLEP). The method is recognized as the "gold standard" of surgical treatment of prostate adenoma. It allows you to remove an adenoma with a volume greater than 80 cm3 without open intervention.

There are a number of absolute contraindications for surgical treatment of prostate adenoma (decompensated diseases of the respiratory and cardiovascular system, etc. ). If surgical treatment is not possible, catheterization of the bladder or palliative surgery is performed - cystostomy, insertion of a urethral stent.

Prognosis and prevention

Acute prostatitis is a disease that has a pronounced tendency to become chronic. Even with timely and adequate treatment, more than half of patients end up with chronic prostatitis. Recovery is far from always achieved, however, with proper consistent therapy and adherence to the doctor's recommendations, it is possible to eliminate unpleasant symptoms and achieve long-term stable remission in a chronic process.

Prevention is the removal of risk factors. It is necessary to avoid hypothermia, alternating sedentary work and periods of physical activity, eating regularly and fully. Laxatives should be used for constipation. One of the preventive measures is the normalization of sexual life, because both excessive sexual activity and sexual abstinence are risk factors for the development of prostatitis. If symptoms of a urological or sexually transmitted disease appear, it is necessary to consult a doctor in a timely manner.