Chronic (bacterial) prostatitis is characterized by persistent or recurrent symptoms with confirmed bacterial infection in the prostate.
Prostatitis of this category occurs rarely, in approximately 10% of all cases of prostatitis.Whether atypical pathogens, such as ureaplasma urealyticum, can cause prostatitis is debated.They can be present in a man's body without any signs of inflammation or discomfort.
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 urine reflux into the prostate ducts.
Chronic bacterial prostatitis occurs as a result of inadequate treatment or short treatment of acute bacterial prostatitis.
Symptoms
- Discomfort or pain - in the perineum, lower abdomen, groin, scrotum, penis, during ejaculation
- Changes in urination - difficult urination, 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.An increase in body temperature is uncharacteristic (or insignificant).
Important:
Many men associate erectile dysfunction with prostatitis.Unprofessional announcements in the media and advertising of suspicious drugs often contribute to this.The fact that an erection can persist even after complete removal of the prostate (due to the presence of a malignant tumor of the organ) suggests that it does not play a role in maintaining an erection by itself.
According to many authoritative urologists, erectile dysfunction in patients with chronic prostatitis is caused by psychogenic and neurotic problems.
Diagnostics
For the initial assessment, a questionnaire is used - the symptom index of chronic prostatitis.It can be used to objectify patient complaints.
The standard method for diagnosing prostatitis is to conduct a test.This is a microscopic and bacteriological study of urine samples obtained from different parts of the genitourinary tract and prostate secretions.However, the pattern method is quite labor intensive, and pattern modifications are now more commonly used.A possible alternative is to submit the ejaculate (sperm) for microscopic and bacteriological examination, because the ejaculate partially (at least 1/3) consists of prostate secretions.This method is more comfortable for patients, especially if they categorically refuse rectal examination or diagnostic prostate massage to obtain prostate secretions.However, ejaculate donation has less content and reliability compared to a sample.
Giving ejaculate for bacteriological examination is included in the diagnostic algorithm for infections of the male genital organs and when examining a man for infertility.
The results of laboratory tests (general urine test, general blood test, biochemical blood test, spermogram and other general clinical tests) in 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.That is, it is impossible to rely on the result of a rectal examination to diagnose chronic prostatitis.
The same applies to ultrasound diagnostics: it is incorrect to diagnose chronic prostatitis only on the basis of ultrasound data.The European and American Association of Urologists does not recommend ultrasound for diagnosing prostatitis.The type of performance in this case is not important through the front abdominal wall - lower abdomen or TRUS - through the rectum.It is incorrect to write "chronic prostatitis", "ultrasound signs of chronic prostatitis", "signs of prostatitis" in the conclusion of the ultrasound examination.Only a urologist has the prerogative to make this diagnosis, who determines it based on complaints, medical history, laboratory tests and - only after - ultrasound.
The most common ultrasound sign used to diagnose chronic prostatitis is the so-called diffuse changes on the prostate associated with the inflammatory process or other changes in the prostate parenchyma.This is a type of fibrotic process, the replacement of normal prostate parenchyma by scar tissue.However, there is no correlation between the number of fibrotic changes in the prostate and the presence of complaints.With age, the chances of such "scars" on the organ to appear increase, but a person can live a whole life without feeling discomfort in the perineum or pubic area.However, as soon as these changes are detected on ultrasound, some "experts" will diagnose prostatitis.And some men will have the feeling that they are really seriously ill, they will start listening to themselves, they will feel all the symptoms described on the Internet.
In many men over the age of 30, ultrasound can show diffuse changes in the prostate.However, the fibrous process does not indicate the presence of prostatitis.
The diagnosis of chronic prostatitis is based on the exclusion of other diseases of the genitourinary system - primarily urethritis, prostatic hyperplasia, urethral stricture, neurogenic urination disorders, prostate cancer, bladder cancer.
There is no specific picture for chronic prostatitis based on the results of a routine examination.
Treatment of chronic prostatitis
Antibiotics of the fluoroquinolone group are 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 indicate a reduction in the likelihood of disease recurrence.
For detected sexually transmitted infections (STIs), such as chlamydia, a macrolide antibiotic is prescribed.
There is evidence of decreased relaxation of the bladder neck in patients with chronic prostatitis, which leads to reflux of urine into the urethral channels and causes inflammation of the prostate tissue and pain.Alpha-blockers are recommended for such patients.
When treating chronic prostatitis, patients are advised to refrain from tempting offers to use herbal remedies.A characteristic of dietary supplements and herbal supplements is the instability of herbal components in part of the substance;they can differ even in the preparation of the same manufacturer.In addition, from the point of view of evidence-based medicine, the benefits of herbal medicine are beyond criticism.
Prostate massage, which was used as the basis of therapy in the middle of the 20th century, today, thanks to new scientific approaches and classifications, 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 is not proven).There are suggestions that frequent ejaculation is similar in properties to therapeutic prostate massage.
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 specific exercises to reduce symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- acupuncture - a small number of studies indicate the 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 being studied;
- 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 patient's psychological state and help reduce some symptoms of the disease.
It is especially worth mentioningasymptomatic (asymptomatic) chronic prostatitis.The diagnosis is most often made based on the results of histological findings - after prostate biopsy 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 a physiological feature associated with age.No one specifically diagnoses this category of prostatitis;it's kind of a serendipitous discovery.It does not require treatment and does not require any further action by the doctor or the patient.