About 40 - 60% of clinic urological patients are patients with chronic prostatitis.Symptoms of prostatitis in men are often the cause of depressive conditions and changes in the psyche.
The disease that every third man suffers over 25 to 30 years does not threaten life, but the difficulties of his diagnosis and treatment determine a long chronic course and usually lead to disability.
The idea of prostate functions, mechanisms and causes of inflammation development allow us to correctly understand symptoms and the need for timely treatment.
The functional value of the prostate
Its main function is the secretion of a specific fluid (secret) 40 - 50 glands that form the entire glandular tissue of the organ.The secret of 90 - 95% consists of water and the main elements, phospholipids, sperm amino acids, which gives sperm a specific smell, enzymes, proteins, citric acid and fructose.All components have their own purpose and are strictly balanced.
The secret of the prostate provides:
- The formation and maintenance of a neutral or slightly alkaline environment in the urethra and sperm.This environment provides sperm for the life of sperm.
- Sperm thinning, necessary to avoid sperm connection with each other and ensure their promotion.In the process of sexual intercourse, the sperm mixed with prostate juice.
- The viability of sperm: The substances contained in the secret are a nutrient medium for germ cells, thanks to which they may be located for several days in the female genitals to egg fertilization.
- Protection of the genitourinary system against infection using zinc, sperm, polyamines and immunoglobulin A. The concentration of zinc in the prostate is 100 times larger than in other organs.It has a pronounced antimicrobial activity, accumulates in iron in the form of protein complexes and is in sperm in free state;Sperminine and polyamines also have high anti -bacterial activity, and immunoglobulins are involved in the immune protection of the prostate and urethra.
Prostate iron also participates:
- in hormonal metabolism through the transformation of testosterone from blood into active hydrotastosterone;The latter regulates the secreting activity of the gland;This process continues with the participation of the same zinc;
- In the act of urination using smooth muscle fibers contained in the gland capsule;
- In the ejaculation process, along with the muscles of the bottom of the pelvis and the part of the prostate urethra;
- in the formation of the sensation of orgasm due to the vasion of the ducts that pass along the lateral surface of the seed tuber;It contains receptors that transmit impulses to the brain during ejaculation.
Thus, the prostate, along with participation in a man's general hormone status and ensuring its possibility of reproduction, protects the urogenital organs from the aggression from conditionally pathogenic and pathogenic microorganisms.
TAXTING CAUSES AND FACTORS
The main cause of prostate inflammation is to enter it, pathogenic and conditionally pathogenic microbes.By 60%, this is an E. coli.In recent studies, the role of the participation of gonococcal infections and trichomonna in inflammation is confirmed.In case of violation of the protective barrier of the gland and a decrease in local immune defense, the penetration of an infection such as yeast, mycoplasm and urepaplasma, herpes viruses and cytomegalinus.
For tuberculosis diseases, mycobacteria is possible through the bloodstream in the prostate.Isolated cases of tuberculosis prostatitis are found, but rarely.
Ways of penetrating the infection in the gland:
- Hematogenic - with blood from other outbreaks of infection;This occurs through the venous vessels of the prostate, communicating with the veins of the penis, testis, straight, bladder and kidney (including tuberculosis injury)
- Lymphogen - through lymphatic vessels
- urethrogen - through the urethra
Contributing factors:
- In particular violation of the hormonal background, a decrease in testosterone level as a result of which the antimicrobial prostate barrier is reduced.
- Varicocele (expansion of seed veins), hemorrhoids, varicose veins of the lower ends.These diseases are the result of a genetic defect in venous valves, which leads to blood microcirculation disorders in organs located in the pelvis, an increase in local temperature, reduced to normal (compared to total body temperature) and the creation of favorable conditions for vital microorganisms.
- Osteochondrosis, lumbar spine hernia and other innervation disorders, a sedentary lifestyle.They can lead to prolonged (narrowing) spasm of the prostate vessels or, conversely, to their long -term expansion.The first leads to impaired blood supply, the second - stagnant blood phenomena.
- Intoxication is alcohol, leading to paralysis of small vessels and nicotine, contributing to their extended spasm.
- Several infectious diseases, diabetes mellitus, frequent mental effects and long negatives, stress states, sleep disorders - all helps reduce general immunity.
Types of prostatitis
Basically, the first symptoms of prostatitis are explained by the deterioration of blood supply to the gland as a result of inflammation or vascular spasm, leading to oxygen deficiency, impaired metabolic processes with the formation of underrated decay products.They cause powerful irritation of a large number of nerve receptors associated with the extremities of the nerves of the testicles, bladder, rectum, penis, pelvis bottom muscles.
According to the classification proposed by the National Health Institute (depending on the course of the inflammatory process), acute bacterial prostatitis is distinguished, which is rare (about 5% of all cases) and chronic prostatitis.The latter can develop after acute, but in 90% - 98% of cases is primary.It is supposed to lead to sexual disorders and infertility.
The chronic form is divided into:
- Bacterial.
- Pelvic pain abacterial or chronic (in the absence of bacteria in studies).In turn, it is divided into inflammatory and not -inflammatory.
- Asymptomatic inflammatory (in the absence of obvious symptoms).
Clinical manifestations
Acute prostatitis
The acute course is caused by any microorganisms and is characterized by damage almost simultaneous to all glandular lobes.The most common cause is gonococcus.The inflammatory process may be in the form of an abscess or diffuse non -inflammation.The most characteristic symptoms of acute prostatitis are as follows:
- Chills and high body temperature (up to 38.5THE and above).
- Severe intoxication - weakness, joint pain, headache, increased pulse frequency, lack of appetite, etc.
- Severe pain in the perineum, in the inguinal and lumbar areas.
- Disturbance of urination - frequent and false image, pain and difficulty in urination, acute urinary retention.
- Belovoy or transparent discharge of the urethra.
An examination of the prostate fingers through the rectum is impossible due to intense pain.In addition, it is against -indicated due to the possibility of dissemination (dissemination) of blood infection and the development of a septic state.
Chronic prostatitis
The recommended classification reflects the fact that signs of chronic prostatitis in men are very diverse, and doctors' opinions on the causes and mechanisms of disease development are widely different.The diagnosis is based on the patient's complaints, clinical examination in a gland finger examination through rectal (rectal) and ultrasound examination.At the same time, the degree of pain, size and volume, contours, uniformity of consistency and presence of softening or sealing areas are evaluated.
Partially the functional capacity of the organ and, most importantly, the presence or absence of inflammation processes, as well as the form of the disease, allows to evaluate the study of prostatic secretion.It is obtained as a result of a finger massage of a prostate with subsequent bacteriological analysis of material (secret), PCR (polymerase chain reaction) conduct to detect conditionally pathogenic microorganisms and pathogens of sexual infections and a sperm analysis.
General symptoms of various forms of chronic prostatitis:
- Discomfort or moderate pain in the form of "pain" and gravity in the perineum, which occur or intensify after drinking alcohol, physical activity, sexual contact.Sometimes they are going through a paroxysmal nature.
- A sense of discomfort and crushes in the urethra during urination or sexual contact, the smaller serous free discharge of the urethra (especially after a long term delay in the urine).
- Frequent sudden impetus of urinating (sometimes up to 3 times in 1 hour) and a feeling of insufficient bladder emptying, which is explained by a violation of nerve regulation of the prostate, its muscle fibers and the bladder.
- Reducing the ability to fertilize, which is caused by an increase in secrecy acidity, a decrease or absence of sperm mobility, their bumping (collage) with heads.
- Pain for orgasm or erased sensations of orgasm, ejaculation disorders, expressed in their premature or, inversely, in the excessive duration of sexual intercourse.These phenomena are associated with the inflammatory process in the field of seminal tuber or its scars as a result of inflammation.
The information presented allows us to understand the need and importance of the opportune appeal to a qualified specialist in the case of certain symptoms and abandon various non -traditional self -medication methods.Treatment is prescribed only after a complete and complete examination in order to establish the cause and form of the disease.
Differential diagnosis
The differential diagnosis of acute prostatitis and distinct signs of chronic prostatitis in men are reflected in the table:
| The form of prostatitis | The main symptoms | Laboratory data |
| Acute bacterial |
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| Chronic bacterial |
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| Chronic pelvic pain syndrome (chronic pelvic pain syndrome): |
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| inflammatory |
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| no -inflammatory or stagnant (40% of patients with prostatitis) |
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| Asymptomatic inflammatory prostatitis |
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