Prostatitis in this category occurs infrequently, in approximately 10% of all cases of prostatitis. The question of whether atypical pathogens such as ureaplasma urealiticum can provoke prostate inflammation is being discussed. They can be present in a man's body without any signs of inflammation or complaints.
Causes of chronic prostatitis
The causes of chronic prostatitis are basically similar to the causes of acute bacterial prostatitis. The entry of microorganisms into the prostate, in most cases, occurs through the urethra - as a result of the reflux of urine into the prostate ducts (intraprostatic urine reflux).
Chronic bacterial prostatitis develops as a result of inadequate treatment or a short course of treatment for acute bacterial prostatitis.
Symptoms
- Discomfort or pain – in the perineum, lower abdomen, groin, scrotum, penis, during ejaculation
- Changes in urination - difficulty urinating, frequent urination in small portions, feeling of incomplete emptying of the bladder.
The patient may complain of several symptoms or any symptom individually. An increase in body temperature is uncharacteristic (or insignificant).
Important:
Many men associate erectile dysfunction with prostatitis. This is often facilitated by unprofessional publications in the media and advertising of dubious medicines. The fact that an erection can persist even with complete removal of the prostate gland (due to the presence of a malignant tumor in the organ) suggests that it itself does not play a role in maintaining an erection.
According to many renowned urologists, erectile dysfunction in patients with chronic prostatitis is caused by psychogenic and neurotic problems.
Diagnosis
For the initial assessment, the NIH-CPSI questionnaire - Chronic Prostatitis Symptom Index is used. Can be used to objectify patient complaints.
The standard method for diagnosing 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 genitourinary tract and prostate secretions. However, the 4-glass sampling method is quite laborious, and at present, modifications of the Meares-Stamey samples are most often used: 3-glass or 2-glass sampling. A possible alternative is to submit the ejaculate (sperm) for microscopic and bacteriological examination, since the ejaculate is partially (at least 1/3) made up of prostatic secretion. This method is more comfortable for patients, especially if they categorically refuse rectal examination or diagnostic prostate massage to obtain prostate secretions. However, donating ejaculate has lower information content and reliability compared to a 3 or 2 cup sample.
Sending ejaculate for bacteriological examination is included in the diagnostic algorithm for infections of the male genital organs and examination for infertility in a man.
The results of laboratory tests (general urine test, general blood test, biochemical blood test, spermogram and other general clinical tests) in the case of chronic prostatitis are not informative. Most likely, these tests will show "normal".
During a rectal examination, changes that indicate 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 applies to ultrasound diagnosis: it is incorrect to diagnose chronic prostatitis based on ultrasound data alone.The European and American Urological Association does not recommend ultrasound to diagnose prostatitis. The type of execution in this case is not important - 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", "signs of congestive prostatitis" at the conclusion of an ultrasound examination. Only the urologist has the prerogative to establish this diagnosis, who determines it based on complaints, anamnesis, laboratory tests and - only after - ultrasound.
The most common ultrasound sign by which the diagnosis of chronic prostatitis is made are the so-called diffuse changes in the prostate associated with an inflammatory process or other changes in the prostate parenchyma. This is a type of fibrotic process, the replacement of normal prostate parenchyma with scar tissue. Howeverthere is no correlation between the number of fibrous changes in the prostate and the presence of complaints. With age, the chances of these "scars" appearing on the organ increase, but a man can live his entire life without feeling any discomfort in the perineum or pubic area. However, as soon as these changes are detected on ultrasound, some "experts" diagnose prostatitis. And some men will have the feeling that they are really seriously ill, they will begin to listen to themselves and feel all the symptoms described on the Internet.
In many men over 30, ultrasound may show diffuse changes in the prostate. However, the fibrotic process does not indicate the presence of prostatitis.
The diagnosis of chronic prostatitis is established on the basis of excluding other diseases of the genitourinary system - mainly 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 routine exams.
Treatment of chronic prostatitis
Antibiotics from the fluoroquinolone group are ideal antimicrobial medications 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 indicating a decrease in the likelihood of disease relapse.
For identified sexually transmitted infections (STIs), such as Chlamydia trachomatis, a macrolide antibiotic is prescribed. They are the most effective.
There is evidence of decreased relaxation of the bladder neck in patients with chronic prostatitis, which leads to reflux of urine into the prostatic urethral ducts and causes inflammation of the prostate tissue and pain. For these patients, alpha-blockers are recommended.
When treating chronic prostatitis, it is advisable for patients to avoid tempting offers to use herbal medicines. A feature of dietary and herbal supplements is the instability of plant components in a portion of the substance, which may differ even when prepared by the same manufacturer. Furthermore, from the point of view of evidence-based medicine, the benefits of herbal medicine do not stand up to criticism.
Prostate massage, which in the mid-20th century served as the basis of therapy, today, thanks to new scientific approaches and the Meares-Stamey classification, continues to be 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 has not been proven).There are suggestions that frequent ejaculation has similar properties to therapeutic prostate massage sessions.
Other methods that have proven effective in just one or a few studies or that are still being investigated include:
- pelvic floor muscle training – some evidence suggests the effectiveness of special exercises to reduce the symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- acupuncture – a small number of studies indicate a benefit from 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 - as 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.
Separately worth mentioningasymptomatic (asymptomatic) chronic prostatitis. The diagnosis is most often made based on the results of a histological report - after a prostate biopsy or after surgical treatment of the prostate. The frequency of detection of inflammation in prostate tissue ranges 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 an age-related physiological feature. No one specifically diagnoses this category of prostatitis, it is a kind of accidental discovery. It does not require treatment and does not require any additional action on the part of the doctor or the patient.
How is chronic prostatitis treated in a specialized clinic?
In the last 10 years, 47 monographs have been published in our country and 64 master's and doctoral dissertations on prostatitis have been defended. Not to mention the many "popular" publications, which colorfully describe the causes, diagnosis and various methods of treating the disease. What this means? The fact that the topic of prostatitis raises many questions, and some, unfortunately, still do not have a clear answer. There are a large number of modern medicines whose effect has been proven. However, the number of patients diagnosed with chronic prostatitis is not decreasing.
That's why, when diagnosing and treating prostatitis, urologists try to get the most complete picture. They question the patient in detail about signs and symptoms, study the results of previous tests, and pay attention not only to the clinical signs of the disease, but also to other aspects of health, including the patient's neurological and psychological status - as this can provoke the occurrence of characteristic manifestations. At the same time, unnecessary tests and studies are not prescribed.