Chronic (bacterial) prostatitis is characterized by constant or recurrent symptoms with bacterial infection confirmed in the prostate gland.
The prostatitis of this category is rare, in about 10% of cases from all cases of prostatitis.Question is discussed - if atypical pathogens can, like urealsma urealiticum), causes inflammation of the prostate.They can be present in the body of a man and without signs 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 through the urethra, following the merger of the urine in the conduct of the prostate gland.
Chronic bacterial prostatitis develops due to inadequate treatment or a short cycle of acute bacterial prostatitis treatment.
Symptoms
- Discomfort or pain - In the horse, lower abdomen, in the groin, scrotum, in the penis, during ejaculation
- Changes in urination - difficulty of urination, rapid urination in small portions, a sense of incomplete emptying of the bladder.
The patient can complain of a series of symptoms and any symptoms separately.An increase in body temperature is unusual (or slightly).
Important:
Many men associate erectile prostatitis dysfunction.Often this is facilitated by non -professional publications in the media and in the advertising of Dubbie drugs.The fact that an erection can even remain with a complete removal of a prostate (due to the presence of a tumor of malignant organs), suggests that it does not have a role in maintaining an erection.
According to many authoritative urologists, erectile dysfunction in patients with chronic prostatitis is due to psychogenic and neurotic problems.
Diagnostics
For primary evaluation, a questionnaire is used: an index of chronic prostatitis symptoms.On it, you can object the patient's complaints.
The standard method for diagnosis of prostatitis is the performance of the sample.This is a microscopic and bacteriological study of the urine champions obtained from different parts of the parental tract and the secretion of the prostate gland.However, the test method is rather laborious and champions are currently used more often.A possible alternative is the delivery of ejaculate (sperm) for a microscopic and bacteriological examination, since partially ejaculate (at least 1/3) is made up of a secretion of the prostate gland.This method is more convenient for patients, especially if they categorically refuse a rectal examination or perform a diagnostic prostate massage in order to obtain a secret of the prostate.However, the rendering of ejaculate has inferior information and reliability compared to the rupture.
The delivery of ejaculating for a bacteriological examination is included in the diagnostic algorithm for infections of the male genital organs and when examining a man on infertility.
The results of laboratory tests (general urine analysis, a general blood test, a biochemical blood test, a spermogram and other general clinical tests) in case of chronic prostatitis are not information.Most likely, these tests will show the "standard".
During a rectal examination of the changes that indicate the inflammatory process in the prostate, in patients with chronic prostatitis, far from always observed.That is, it is impossible to rely on the result of a rectal study for the diagnosis of chronic prostatitis.
The same goes for Uz-Diagnostic: making a diagnosis of chronic prostatitis, focusing only on ultrasound data, is not correct.The European and American Urologists Association is not recommended to perform an ultrasound for the diagnosis of prostatitis.The type of execution in this case is not important through the front abdominal wall - the abdomen or lower trust - through the rectum.To write in the conclusion of the study on ultrasound "chronic prostatitis", "ultrasound signs of chronic prostatitis", "signs of prostatitis" is wrong.The prerogative of the installation of this diagnosis has only a urologist that determines it on the basis of complaints, anamnesis, laboratory tests and - only after - ultrasound.
The most frequent ultrasonic sign, according to which the diagnosis of chronic prostatitis is established: the widespread changes thus called in the prostate gland associated with the transferred inflammatory process or other changes in the parenchyma of the prostate.This is a kind of fibrous process, which replaces 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 the age, the chances of appearing in such "scars" in the organ are increasing, but a man can live throughout his life, without feeling any discomfort in the horse or in the pubic area.However, as soon as these changes are found on an ultrasound, some "specialists" will diagnose prostatitis.And some men will have the feeling of being really seriously ill, they will start listening to themselves, feeling all the symptoms described on the internet.
For many men over the age of 30, ultrasound can show widespread 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 parent system - urinary - mainly urethritis, prostate hyperplasia, urethra stenosis, neurogenic urban disorders, prostate cancer and bladder cancer.
There is no specific picture for chronic prostatitis based on the results of a routine exam.
Treatment of chronic prostatitis
The antibiotics of the Fthikinolone group are optimal antimicrobial drugs for the treatment of chronic bacterial prostatitis.The recommended antibacterial therapy course is between 4 and 6 weeks.Such long course is justified by scientific data that indicate a decrease in the probability of recurrence of the disease.
If sexual transmission infections (IST), such as clamidia, are prescribed an antibiotic group of macrolid groups.
There are data on a decrease in the relaxation of the bladder neck in patients with chronic prostatitis, which leads to the urine of reflux in the ducts in the urethra and causes inflammation of the tissue of the prostate and pain.These patients are recommended by the appointment of alpha-blockers.
In the treatment of chronic prostatitis, it is advisable that patients refrain from attractive phrases for the use of herbal medicine.A characteristic of food supplements and plants additives is the instability of the plant components in a part of the matter, they can also differ in the drug of the same manufacturer.Furthermore, from the point of view of medicine based on evidence, the benefits of herbal medicine do not resist criticism.
Prostate massage, which in the mid -20th century was used as the base of therapy, today, thanks to new scientific approaches and classification, remains an important tool to diagnose prostatitis, but not its treatment.It is not necessary to use prostate massage as the therapeutic procedure (the effect is not demonstrated).There are hypotheses that frequently ejaculation in its properties is similar to prostate therapeutic massage sessions.
To other methods whose effectiveness has been demonstrated following only one or more studies or is still being studied: report:
- Pilling Altivo Muscle Bottore - 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 the agpuncture compared to placebo in patients with chronic prostatitis;
- Extracorporeal therapy of shock waves based on the effects of the acoustic impulses of significant amplitude on the connective and bone tissue, it is widely used in the treatment of diseases of the musculoskeletal system, recently used in urology, its effectiveness is in the studio;
- 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.
Separately, it is worth mentioningChronic asymptomatic prostatitis (asymptomatic).The diagnosis is often established on the basis of the results of the histological conclusion - after the biopsy performed of the prostate gland or after the surgical treatment of the prostate.The frequency of detecting the inflammation in prostate fabrics varies from 44% (with prostate biopsy) to 98-100% (after the surgical treatment of the prostate).Scientists suggested that inflammatory changes revealed in this way are nothing more than a physiological characteristic related to age.Nobody is engaged in particular diagnostics of this category of prostatitis, this is a kind of random discovery.It does not need treatment, it does not require further actions from the doctor and the patient.