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Prostatitis

Prostatis is inflammation of the prostate gland (organ of sex and the reproductive system of a man) and change following this process of its physiological functions.

Symptoms-prostatitis-u-mascile

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According to various sources, prostatitis occurs in 35-40 % and, according to some authors, 70 % of men aged between 18 and 50 years.The representative gland in the prevalence of the disease and a series of problems that occur simultaneously occupies a leading place between the urological pathology.

Classification

There are many classifications of prostatitis, therefore a very peculiar terminology.The most common is the classification of prostatitis proposed by the National Institute of Health (NiH) of the United States in 1995:

Category Description
Category I. Acute bacterial prostatitis
Category II Chronic bacterial prostatitis
Category III Chronic abacterial prostatitis
Category IIIA Chronic inflammatory pelvic pain syndrome
Category IIIB Non -inflammatory chronic pelvic pain syndrome (Prostatinia)
Category IV Inflammatory Spectomatic prostatitis

This classification of prostatitis is based on clinical signs, presence or absence of leukocytes and microorganisms in the secret of prostate, ejaculate and urine.

Category I.

Acute bacterial prostatitisIt is expressed by the acute infectious inflammation of the prostate gland with all related signs:

  • increase in the amount of leukocytes in the urine;
  • the presence of bacteria in the urine;
  • Common signs of infection (increase in body temperature, symptoms of intoxication).

Category II

Chronic bacterial prostatitis- is accompanied by appropriate symptoms and an increase in the number of leukocytes and bacteria in the secret of the prostate, ejaculate and urine obtained after prostate massage.

Category III

Chronic pelvic pain syndrome (KTR)- The leader clinical symptom is pain syndrome for more than 3 months in the absence of pathogenic microorganisms in the secret of the prostate, ejaculate and urine obtained after prostate massage.The separation of III A and III B is the presence of a greater number of leukocytes.

Category III A

Chronic inflammatory pelvic pain syndrome- It is characterized by the presence of symptoms of pain and prostatitis and a greater quantity of leukocytes is noted in the secretion of the prostate, ejaculate and portions of urine, after the prostate massage, in these samples no pathogenic microorganisms are noted.

Category III B

Non -inflammatory chronic pelvic pain syndrome- characterized by the presence of pain syndrome and prostatitis symptoms, while there is no increase in the number of leukocytes and are not detected with standard methods of pathogenic microorganisms in the secret of the prostate, ejaculate and urine obtained after prostate massage.

Category IV

Inflammatory Spectomatic prostatitis- The absence of characteristic symptoms of prostatitis, the disease is detected by chance during an histological examination of the prostate tissue samples obtained in relation to the diagnosis for other reasons (for example, leading a prostate biopsy due to an increase in the level of a specific antigen - PSA).

Diagnosis of prostatitis

The symptoms of prostatitis are extremely different, but can be combined in different groups.

Pain syndrome

Due to an insufficient supply of blood caused by the inflammation or inflammation of the blood vessels that feed the prostate, the hunger for oxygen of the tissue of the glands are noted, following which the pathological oxidation products that affect the nerve finances of the prostate are formed.Since the innervation of the prostate is associated with the innervation of the pelvic floor, the penis, the scrotum, the testicles, the rectum: the location of the pain is variable.The following symptoms of pain are more common:

  • Discomfort or pain in the perineum - apparently appears after physical effort, sexual intercourse, alcohol that take on passage attacks;
  • Feeling of hot potatoes in the rectum;
  • The pain (discomfort) in the testicles - patients are described as "pain", "twist", are also associated with various provocative factors;
  • Discomfort, rubber and pain in the urethra - are mainly associated with the movement of the pH of the secret of the prostate on the acid side.The harsh secret of the prostate acts irritably on the mucous membrane of the urethra, so pain, more often in the form of a "burning", occurs after an act of urination or sexual intercourse, when part of the secret when reducing the muscles of the gland and the pelvis is crushed in the lumen of the urete.

Minting disorders syndrome

Associated with the close innervation of the prostate and the bladder, as well as in the participation of the prostate muscles in the act of urination.Dysuria can be accompanied by the following events:

  • Distant ureation - frequent urination (takes place up to 3 times per hour) with sharp and sudden calls (impossible to bear) and rather small portions;
  • A sense of incomplete emptying of the bladder - after the act of urination, believes that the urine remained in the bladder;
  • A weak or intermittent flow of urine - this can also be attributed to the symptom of the "last fall" - despite all the patient's efforts after the act of urination from the channel, a drop of urine is still released.

Violation of ejaculation and orgasm

It is associated with damage to the prostatitis of the tubercle of seeds (hops) on the surface of which are nerve receptors that send the signal to the brain structures, where the sensation of orgasm is formed.Prostatitis does not directly cause an erection (flow of blood to the penis during sexual excitement).

Main ailments:

  • Premature ejaculation or excessively prolonged sexual sexual - caused by the inflammation of the seminal tubercle or by its scars due to the inflammatory process;
  • The canceled orgasm - is also associated with the inflammation of the seed tubercle;
  • Pain during ejaculation - associated with the inflammatory process in the prostate exit ducts through which the sperm is released.

Violation of fertility

When changing the properties of the prostate, following the inflammation, the following changes are observed in the sperm, reducing the man's ability to fertilize (fertility):

  • A decrease in the pH of sperm on the acid side - since with inflammation of the prostate, the acid products of pathological oxidation begin to accumulate in secret.The acid environment is extremely destructive for the sperm that causes their immobilization and even death;
  • The Anglutination of the sperm - glue the sperm mainly with the heads - is associated with a change in the physical -chimic properties of the secretions;
  • Asthenospermia - a decrease in sperm mobility - is closely connected to the movement of the pH to the acid side and with a violation of the production of prostate lecithin trolleys, which guarantee the vital activity of the spermatozoa.

Urethropostatitis

In some cases, prostatitis is combined with chronic urethritis, which is manifested by a poor inframatory mucosa discharge from the urethra (mainly after a prolonged urinary retention).

Prostatitis and sexual disorders

The question "prostatitis causes helplessness?"It is the cause of the disputes of specialists for decades.

Under the influence of sexual stimuli, with the fully saturation of the body's androgens in the formations of the cortical and subcortical region of the brain, a nervous signal occurs, transmitted to the center of an erection located in the spinal cord, from where it is located to the smooth muscles.In this process there is no role of the prostate gland.

Ejaculation and orgasm occur with sufficient irritation of cells of special receptors found in the seminal tuberculum area in which the pride exit ducts flow, the same receptors are responsible for the departure of the nervous impulse to the cerebral cortex in which the sensation of orgasm is formed.

The inflammatory process in the prostate gland (prostatitis) can lead to the defeat of the tubercle of the seeds and, consequently, as violations of the power of a man, therefore premature ejaculation and echo orgasm.The impotence in chronic prostatitis is pathogenetically associated with the degree of damage to the nervous system of the prostate gland.This form of helplessness (impotence of the neurorecector) is a characteristic example of a repercrussual phenomenon, when the presence of pathological impulsion with the organs affected by the inflammatory process leads to the irradiation of the excitement process that controls the sexual function and the latter disorder.A certain role, although not leader, takes place in the pathogenesis of the impotence of neurorecerators, also a certain suppression of the androgenic activity of the testicles and the sensitivity to the androgens of the centers of the hypothalamus and the pituitary gland.

At the same time, there is an opinion that in the Russian Federation exists both hyperdiagnosis of prostatitis and reassigning its role in the development of erectile dysfunction.

Diagnostics

The doctor's task is to detect the inflammatory process in the prostate, the identification of the possible pathogenic agent of the disease and the evaluation of the compromised function of the prostate gland.In 1990, Stamey wrote that prostatitis is a "garbage basket for clinical ignorance" due to the variety of terms used, diagnostics and treatment methods.At the same time, several simple and clinical and laboratory tests allow you to correctly make a diagnosis, which allows you to start the appropriate therapy.

Rectal Puttic survey on the prostate gland

A very instructive way.The inflammatory process can be judged by evaluating the shape, contours, the dimensions of the gland, the presence of compaction outbreaks and (or) softening, pain.The main signs of prostatitis: increase or reduction in size, heterogeneity of consistency, presence of compaction and softening outbreaks, pastability, pain.The fact that 80% of pancreatic cancer is detected through a rectal study speaks alone.We can safely say that this research method will always be used.

Microscopic examination of pancreas secretion

It should be remembered that an increase in the number of leukocytes in secret does not always indicate prostatitis, since the methods for obtaining a secret during massage do not guarantee that the content of the urethra and seed bubbles will not fall.At the same time, with evident signs of prostatitis, the secret of the prostate can be normal.This is explained by the outbreaks of inflammation, by the presence of part of the exposed or closed ducts.

Study of the secretion of the prostate gland

Prostatic secretions expressed EPS) secret studies allow to determine the presence of an inflammatory process in the prostate gland and partly its functional ability.It is the main method for diagnosing and monitoring the treatment of chronic prostatitis.The secret of the prostate can be examined using optical microscopy without painting or using special coloring methods.In addition, the secret of the prostate gland can be subjected to a bacteriological exam or exam with the method of the polymerase chain reaction for the detection of pathogens in it.Get a secret with prostate massage.A secret released by the urethra is collected in a sterile test tube or on a glass with clean objects for research.Sometimes the secret of the prostate gland of the ureter does not follow.In such cases, the patient is recommended to set up immediately.If, however, it was not possible to get a secret, more often this means that it has not entered the urethra, but in the bladder.In this case, the centrifuge of the washing fluid issued by the bladder is examined after the prostate gland massage.

  • Lipoid grains (Lecitin bodies) - A specific product of the normal physiological secretion of the glandular epithelium of the prostate gland.It gives a secret aspect of milk.Normally, the secret is rich in lecithin cereals.A decrease in their number, together with an increase in the number of leukocytes, indicates an inflammatory process, a tumor;
  • Hamiloids - Strati (strati), body, which with a lugol solution are colored in purple or blue, such as starch;
  • The amyloid bodies are a condensed secret of the gland, they have an oval shape and a layered structure, which looks like a tree trunk.They are not normal, their detection indicates a stagnation of the secret in the gland, which can be with adenomas, chronic inflammatory processes;
  • Erythrocytes can be single.They fall into a secret due to the energy massage of the prostate gland.Their greater quantity is observed in inflammatory processes, in neoplasms.
  • The descent of epithelium in large quantities is observed at the beginning of the inflammatory processes and with tumors, therefore there is often disability with the protein and fat degeneration of epithelial cells.The macrophages can be seen with a stagnation of a secret, for a long time of the current inflammatory process;
  • Betthera crystals are one day crystals formed during the cooling and drying of the mixed secret of the male gonads (prostate juice with cum blend) of spermo and phosphoric layer salt.With azoospermia and abruptly expressed oligozoospermia, Betthera crystals form quickly and in large quantities;
  • RETEED SYNDROME - Stagnation syndrome is observed with adenoma of the gland.There is an abundance of macrophages, there are multi -core cells as foreign bodies and amyloid bodies;
  • The symptom of the fern is a symptom of the crystallization of a secret form -of falling sodium chloride crystals falls depends on the physical -chimic properties of the secret of the prostate.The study of the symptom is conducted by adding a drop of sodium solution to 0.9% chloride to the resulting secret of the prostate with further vision after drying out at the optical microscope.In healthy men in reproductive age, the crystallization of the secret of the prostate is characterized by a typical phenomenon of the fern leaf (3+).Androgenic insufficiency or the presence of prostatitis give various degrees of violation of the structure of the crystals until their absence.

Bacteriological studies on the portions of urine and secretion of pancreas

Striscia urethra, including PCR diagnostics

Serological diagnosis of agents (Elisa) who cause urinary tract infections

The reaction of immunofluorescence (reef) is straight and indirect

Identification of antibodies in well -known antigens.

Determination of the PSA antigen (prostate -Specific) of the blood serum

The American Foundation for Urological Diseases recommends the annual passage of a rectal investigation of the prostate gland, accompanied by a PSA for all men over the age of 50 and with prostate cancer for blood relatives according to a male line.There is still a discussion on obtaining a dog immediately after an examination of the fingers of the prostate gland per right.Recent studies have not been able to confirm the presence of a significant increase in the content of the PSA immediately after an examination of the fingers.Therefore, the PSA level can be determined with the reception of reliable results and after the pancreas investigation.

Four wall test

In order to diagnose chronic prostatitis, a 4 -glass test has been proposed, based on a comparative bacteriological evaluation of the urine, approximately equal in terms of the portion of urine, obtained before and after the massage of the prostate gland, as well as its secret.

The diagnosis of prostatitis is established with an increase of ten times of the concentration of microorganisms in the secret of the prostate compared to their content in the urine (1, 2 and 3 portions) and an increase in the number of polymorphic-nuclear leukocytes> 10-16 in the field of view of the microscope in light (increase of 200 times).Or an increase in the number of leukocytes of over 300x106/l when calculating them in the counting chamber.The bodies of lecithin, which are a product of the normal secretion of the glandular epithelium of the prostate gland, should densely cover the field of viewing of the microscope (5-10 million in 1 ml).The amyloid bodies in the secret of the prostate are found in a significantly smaller quantity.In men of mature age, 1-2 can be found in the visual field.

Biochemical blood test

Immunological and hormonal profile (according to the indications).

Ultrasound, trusts

Ultrasound diagnosis of prostatitis by the abdominal and transrettical sensor (trust).

Uroflooma

Treatment of prostatitis

The complete treatment of patients with chronic prostatitis should include:

  • compliance with the general regime, diet, sexual sexual hygiene and the attraction of sexual partners in the presence of an infectious agent;
  • selection of effective drugs to suppress the infection;
  • By increasing the general reactivity of the patient's body and the immunobiological tolerance of drugs to drugs;
  • strengthen the outflow of secretion and activation of local reparative processes at the center of inflammation;
  • hygiene of outbreaks of infection in the previous and remote organs;
  • improvement of microcirculation in the organs of the prostate gland and pelvic;
  • the appointment of general strengthening funds, enzymes and vitamins;
  • Correction of hormonal disorders;
  • the appointment of antispasmodic;
  • the appointment of analgesic and anti -inflammatory drugs;
  • take sedative and transformed drugs;
  • regulation of neurotrophical disorders by local analysis drugs;

Prostate massage

Prostate massage- A medical procedure used to diagnose and sometimes treat chronic prostatitis.The first prostate massage was described by Posner in 1893 and since 1936 it was widely introduced in O'Conory's urological practice.However, in 1968, after the description of Meares and Stamey, a test stage for the diagnosis of prostatitis, the opinions on the causes of this disease have changed and the massage as a therapeutic procedure has been deleted from the lists of measures in many guidelines for the treatment of prostatitis in the developed countries of the world.

But since the mid-90s of the 20th century, many doctors involved in the diagnosis and treatment of prostatitis have started to notice the inefficiency in some cases of proposed antibacterial therapy and the use of alpha-blockers, which led them to use in the practice of this forgotten method.

Basically, prostate massage is currently used as a diagnostic procedure to obtain a prostate secretion (expressed prostate secretions -eps) - for its microscopic (cultural) study and for the pre and after the test ofMassage (pre and post -mage -ppm test).massage.The massage is a medical procedure and a previously trained specialist must perform it.The massage is performed after urination and when you unload it from the urethra after its preliminary washing with an isotonic sodium chloride solution, which is particularly necessary in cases where a bacteriological examination of the secret is taken.Prostate massage is performed through the anus, since the prostate gland is close to the row's ampouel and only is available for research.First of all, they massage one, then the other percentage of the prostate gland with the movements of the finger from the suburbs to the central groove along the output ducts, trying not to touch the seed bubbles.The massage is completed by pressing the central furrow area from above.A secret released by the urethra is collected in a sterile test tube or on a glass with clean objects for research.Sometimes the secret of the prostate gland of the ureter does not follow.In such cases, the patient is recommended to stand up immediately if it was not possible to get the secret, this means that it was not in the urethra, but in the bladder.In this case, the centrifuge of the washing fluid issued by the bladder is examined after the prostate gland massage.

Prostate massage for medical purposes (repetitive massage) is officially recommended by the Russian Federation of the Russian Federation as the therapeutic procedure for chronic prostatitis.Prostate massage is widely used for the treatment of prostatitis in Southern countries -East Asia, China and in some European countries.Some Semenmerican and Canadian urologists also recommend the use of massage in combination with antibiotic therapy in the treatment of some forms of prostatitis.In essence, the evaluation of the effectiveness or inefficiency of the prostate massage has not been practically carried out.There are several contradictory studies, in one, conducted by Egyptian doctors, there have been no differences in the groups of patients, some of whom have been massage in combination with antibiotic therapy and simply antibiotic therapy, in another, conducted by American researchers and Filipine, on the contrary, in a group of patients with prostatitis prostatitis, which has received a combination of antibiotics.

Supporters of the use of the massage for therapeutic purposes believe that the main effect of its use is the drainage of the ducts of the prostate, that is, their release from purulent cells and death.Another effect is an increase in blood flow in the prostate gland, which improves the penetration of antibiotics and activates local protective immunological processes.

In world literature there are few data on complications relating to prostate massage.In 1990, Japanese doctors described the genital organs (Fournier) and in 2003 German doctors were permanent hemorrhages after a prostate massage with the development of embolism stroke (hemorrhage) of the lungs.There is a study that after the massage the level of PSA (prostatospecific antigen) increases temporarily.The massage is contraindicated in the acute inflammation of the prostate gland (acute prostatitis), with acute urethritis, orcite, prostate carcinoma.The massage is not recommended for the prostate calculates and prostate adenoma.Prostate massage is generally recommended to be recommended 2 or 3 times a week.

Physiotherapy procedures

Any physiotherapy procedures (prostate massage, heating, etc.) in acute prostatitis are contraindicated.

The use of physiotherapy procedures in the complex treatment of prostatitis aims to directly carry out the prostate gland of physical agents in order to normalize functional and pathological changes, as well as the electrophoretic administration of drugs in the tissue of the prostate.

The use of physiotherapy methods against the background of drug therapy gives a much better result than the treatment separately.The following methods to influence the prostate gland have become widespread and have shown their effectiveness:

  • shock wave therapy;
  • Electric stimulation of the pancreas with modulated currents with TID or rectal electrodes;
  • Thermotherapy in various versions (including high frequency therapy);
  • magnetotherapy;
  • microwave microwave technology;
  • Laser therapy.
  • transrectal ultrasonic therapy and phonoforesis;
  • Microclisms.