Chronic (bacterial) prostatitis is characterized by constant or recurring symptoms with a bacterial infection confirmed in the prostate gland.
The prostatitis of this category is infrequent, in about 10% of cases of all cases of prostatitis.The question - if atypical pathogens can, such as the ualiticum ureaplasma), cause inflammation of the prostate - is discussed.They can be present in the body of a man and without any sign of inflammation and complaints.
The causes of chronic prostatitis
The causes of chronic prostatitis are mainly similar to the causes of the development of acute bacterial prostatitis.In most cases, the entry of microorganisms into the prostate occurs by the urethra - due to the flow of urine in the duct of the prostate gland.
Chronic bacterial prostatitis is developing due to inadequate treatment or short treatment for acute bacterial prostatitis.
Symptoms
- Discomfort or pain - in the crotch, the bottom of the abdomen, in the groin, the scrotum, the penis, during ejaculation
- Changes in urination - Mining difficulty, rapidly urgently in small portions, a feeling of incomplete emptying of the bladder.
The patient can complain about a number of symptoms and any symptoms separately.An increase in body temperature is not characteristic (or slightly).
Important:
Many men combine erectile dysfunction with prostatitis.Often this is facilitated by non -professional publications in the media and the advertising of dubious drugs.The fact that an erection can remain even with a complete elimination of a prostate (due to the presence of a tumor of malignant organ) suggests that she does not play a role in maintaining an erection.
According to many authority urologists, erectile dysfunction in patients with chronic prostatitis is due to psychogenic and neurotic problems.
Diagnosis
For the main evaluation, a questionnaire is used - an index of the symptoms of chronic prostatitis.Above, you can objectify the patient complaints.
The standard method to diagnose prostatitis is the performance of the sample.It is a microscopic and bacteriological study of urine samples obtained from different parts of the genitorerinary tract and the secretion of the prostatic gland.However, the test method is fairly laborious and for the moment the samples are more often used.A possible alternative is the delivery of ejaculat (sperm) for a microscopic and bacteriological examination, because the ejaculate is partially (at least 1/3) consists of a secretion of the prostate gland.This method is more comfortable for patients, especially if they categorically refuse a rectal exam or carry out a diagnostic massage of the prostate in order to obtain a secret of the prostate.However, the surrender of the ejaculate has lower information and reliability compared to the rupture.
The administration of ejaculates for a bacteriological examination is included in the diagnostic algorithm for infections of the male genitals and during the examination of a man on infertility.
The results of laboratory tests (general analysis of urine, a general blood test, a biochemical blood test, a spermogram and other general clinical tests) in the case of chronic prostatitis are not informative.Most likely, these tests will show the "standard".
During a rectal examination of the changes indicating the inflammatory process in the prostate, in patients with chronic prostatitis, far from always observed.In other words, it is impossible to count on the result of a rectal study for the diagnosis of chronic prostatitis.
The same goes for UZ diagnoses: Diagnosing chronic prostatitis, focusing only on ultrasound data, is incorrect.The European and American Association of Urologists is not recommended for an ultrasound for the diagnosis of prostatitis.The type of execution in this case is not important through the anterior abdominal wall - the bottom of the abdomen or confidence - through the rectum.To write in the conclusion of the ultrasound "chronic prostatitis", "ultrasonic signs of chronic prostatitis", "signs of prostatitis" is wrong.The prerogative of the installation of this diagnosis has only one urologist who determines it on the basis of complaints, anamnesis, laboratory tests and - only after - ultrasound.
The most common ultrasonic sign, according to which the diagnosis of chronic prostatitis is established - the diffuse changes if called in the prostate gland associated with the transferred inflammatory process or other changes in the parenchyma of the prostate.It is a kind of fibrous process, replacing the normal parenchyma of the prostate with a scar tissue.However, there are no correlations of the number of fibrous changes in the prostate with the presence of complaints.With age, the chances of the appearance of such "scars" in the organ increase, but a man can live his whole life, without feeling any discomfort in the crotch or the pubis.However, as soon as these changes are found on an ultrasound, some "specialists" diagnose prostatitis.And some men will have the feeling that they are really seriously sick, begin to listen to each other, feel all the symptoms described on the Internet.
For many men over 30, ultrasound can show diffuse changes in the prostate gland.However, the fibrous process does not indicate the presence of prostatitis.
The diagnosis of chronic prostatitis is established on the basis of the exclusion of other diseases of the genito -first system - mainly uretrite, prostate hyperplasia, stemoiseria, neurogenic urogen disorders, prostate cancer and bladder cancer.
There is no specific image for chronic prostatitis based on the results of a routine exam.
Treatment of chronic prostatitis
The antibiotics of the Phthikinolone group are optimal antimicrobial drugs for the treatment of chronic bacterial prostatitis.The recommended course in antibacterial therapy is 4 to 6 weeks.One as long is justified by scientific data indicating a decrease in the probability of relapse of the disease.
If sexually transmitted infections (IST), such as chlamydia, are prescribed an antibiotic group of macrolide groups.
There are data on a decrease in the bladder of the bladder in patients with chronic prostatitis, which leads to a reflux of urine in the urethra ducts and causes inflammation of the fabric of the prostate and pain.These patients are recommended by the appointment of alpha-blockers.
In the treatment of chronic prostatitis, patients are advised to abstain from temptation of sentences for the use of plant -based medicine.A characteristic of food supplements and plant additives is the instability of the factory components in a part of the material, they can differ even in the drug of the same manufacturer.In addition, from the point of view of medicine based on evidence, the advantages of plant medicine do not resist criticism.
Prostate massage, which in the middle of the 20th century was used as the basis of therapy today, thanks to new scientific approaches and classification, remains an important tool for diagnosing prostatitis, but not its treatment.You do not need to use prostate massage as therapeutic procedure (the effect is not proven).There are hypotheses according to which frequent ejaculation in its properties is similar to the sessions of therapeutic prostate massage.
To other methods whose efficiency has been proven following one or more studies or is still under study: Report:
- Pilling Muscle training at the bottom - Some data indicate the effectiveness of special exercises to reduce the symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- Acupuncture - A small amount of studies indicates the advantage of acupuncture compared to placebo in patients with chronic prostatitis;
- Therapy with extracorporeal shock waves based on the effects of acoustic impulses of a significant amplitude on connective and bone tissue, is widely used in the treatment of diseases of the musculoskeletal system, recently used in urology, its effectiveness is studying;
- Behavioral therapy and psychological support - since chronic prostatitis is associated with a low quality of life and the development of depression, these methods can improve the patient's psychological condition and help reduce certain symptoms of the disease.
Separately, mention should be mentionedAsymptomatic chronic prostatitis (asymptomatic).The diagnosis is most often established according to the results of the histological conclusion - after the biopsy carried out of the prostate gland or after surgical prostate treatment.The frequency of detection of inflammation in prostate tissues varies from 44% (with prostate biopsy) to 98 to 100% (after surgical treatment of the prostate).Scientists have suggested that the inflammatory changes revealed in this way are nothing more than age -related physiological characteristic.No one is engaged in diagnoses especially of this category of prostatitis, it is a kind of random discovery.It does not need treatment, it does not require any other action by the doctor and the patient.