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Prostatitis

Prostatis is the inflammation of the prostate gland (sex and a man's reproductive system) and change as a result of this process of its physiological functions.

-Prostatitis-male symptoms

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According to various sources, prostatitis occurs in 35 to 40% and, according to some authors, 70% of men aged 18 to 50.The gland representative in the prevalence of the disease and a set of problems that occur at the same time occupy a leading place among urological pathology.

Classification

There are many classifications of prostatitis, hence a very special terminology.The most common is the classification of prostatitis proposed by the American National Institute of Health (NIH) 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 prostatitis otherwise

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

Category I

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

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

Category II

Chronic bacterial prostatitis- It 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 the massage of the prostate.

Category III

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

Category III A

Chronic inflammatory pelvic pain syndrome- is characterized by the presence of symptoms of pain and prostatitis, and an increased quantity of leukocytes is noted in the secretion of prostate, ejaculate and parts of urine, after massage of prostate, pathogenic microorganisms are not detected in these samples.

Category III B

Chronic pelvic pain syndrome- Characterized by the presence of pain syndrome and symptoms of prostatitis, while there is no increase in the number of leukocytes and are not detected by standard methods of pathogenic microorganisms in the secret of prostate, ejaculation and urine obtained after massage of the prostate.

Category IV

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

Prostatitis diagnosis

Symptoms of prostatitis are extremely diverse, but they can be combined in several groups.

Pain syndrome

Due to the insufficiency of the blood supply caused by inflammation or blood vessel spasms supplying prostate, oxygen famine of the acorns of the acorns is noted, because of which pathological oxidation products are formed which affect the nerve endings of the prostate.Since the innervation of the prostate is associated with the innervation of the pelvic floor, penis, scrotum, testicles, rectum - the location of pain is variable.The following pain symptoms are the most common:

  • Discomfort or pain in the perineum - appears essentially after physical effort, sexual intercourse, an alcohol in the form of attacks that pass;
  • Sensation of hot potatoes in the rectum;
  • Pain (discomfort) in the testicles - Patients are described as "ACH", "torsion", are also associated with various provocative factors;
  • Disfect, rubber and pain in the urethra - are mainly associated with the pH lag of the prostate secrecy on the acid side.The prostate's sour secret acts irritably on the mucous membrane of the urethra, so pain, more often in the form of a "burn", occurs after an act of urination or sexual intercourse, when it is a part of the secret when reducing the muscles of the gland and the pelvis in urethra lights.

Until urination syndrome

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

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

Violation of ejaculation and orgasm

It is associated with damage to prostatitis of the seed tuber (colliculitis) on the surface of the nervous receptors which send the signal to the structures of the brain, where the feeling of orgasm is formed.Prostatitis does not directly cause an erection (blood supply to penis during sexual excitement).

Main disorders:

  • Premature ejaculation or vice versa excessively prolonged of sexual intercourse - caused by the inflammation of the seminal tuber or its scars due to the inflammatory process;
  • Erased orgasm - is also associated with inflammation of the seed tuberculum;
  • Pain during ejaculation - Associated with the inflammatory process in the prostate exit channels through which sperm is released.

Fertility violation

When you modify the properties of the prostate, following inflammation, the following changes in the sperm are observed, which reduces the capacity of humans to fertilize (fertility):

  • A decrease in the pH of sperm on the acid side - because with the inflammation of the prostate, acid products of pathological oxidation begin to accumulate in secret.The acid environment is extremely destructive for sperm causing their immobilization and even death;
  • The anglutination of sperm - the collage of sperm mainly with the heads - is associated with a change in the physicochemical properties of secretions;
  • Asthenospermia - a decrease in the mobility of sperm - is closely linked to the pH lag on the acid side and to a violation of the production of prostate lecitin trolleys, which ensure the vital activity of sperm.

Urethropostatitis

In some cases, prostatitis is combined with chronic urethritis, which manifests itself by a meager mucous-inflammatory discharge of the urethra (mainly after prolonged urinary retention).

Prostatitis and sexual disorders

Does the question "prostatitis cause helplessness?"This is the cause of disputes of specialists for decades.

Under the influence of sexual stimuli, with the full full saturation of body 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 which the smooth muscles of cave formations are relaxed).In this process, there is no role in the prostate gland.

Ejaculation and orgasm occur with sufficient irritation of special receptor cells which are located in the area of the seminal tuber in which the exit spreads out of the prostate flows, the same receptors are responsible for the departure of the nerve impulse in the cerebral cortex where the feeling of the orgasm is formed.

The inflammatory process of the prostate gland (prostatitis) can lead to the defeat of the seed tuber and, therefore, as violations of the power of a man, therefore a premature ejaculation and an echo of orgasm.Helplessness in chronic prostatitis is pathogenetically associated with the degree of damage to the nervous apparatus of the prostate gland.This form of helplessness (helplessness of neuroreceptors) is a characteristic example of a repercussian phenomenon, when the presence of pathological impulse with the organs affected by the inflammatory process leads to the irradiation of the process of excitement which controls the sexual function and the disorder of the latter.A role, although not directed, is played in the pathogenesis of the helplessness of the neuroreceptors, also a certain suppression of the androgen 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, there is both the hyperdiagnosis of prostatitis and the reallocation of its role in the development of an erectile dysfunction.

Diagnosis

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

Rectual Rectual Survey on the prostate gland

In a very informative way.The inflammatory process can be judged by evaluating the shape, the contours, the dimensions of the gland, the presence of compacting foci and or the softening, the pain.The main signs of prostatitis: increase or decrease in size, heterogeneity of coherence, presence of compacting and softening foci, pastability.The fact that 80% of pancreatic cancer is detected through a rectal study speaks of itself.We can safely say that this research method will always be used.

Microscopic examination of pancreatic secretion

It should be remembered that an increase in the number of leukocytes in secret does not always indicate prostatitis, because the methods of obtaining a secret during the massage do not guarantee that the content of the ureth and the seed bubbles will not fall inside.At the same time, with obvious signs of prostatitis, the secret of the prostate can be normal.This is explained by the foci of inflammation, the presence of part of the output channels exposed or closed.

Study of the secretion of the prostate gland

Secret studies of expressed prostatics) Secret Studies allows you to determine the presence of an inflammatory process in the prostate gland and partly its functional capacity.This is the main method of diagnosing and monitoring chronic prostatitis treatment.The secret of 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 examination or to an examination by the chain reaction method by polymerase for the detection of pathogens.Get a secret with prostate massage.A secret released from the urethra is collected in a sterile test tube or on a glass of clean object for research.Sometimes the secret of the urethra prostate gland does not follow.In such cases, the patient is recommended to get up immediately.If, however, it was not possible to obtain a secret, most often, it means that he did not enter the urethra, but in the bladder.In this case, the centrifugal of washing liquid released from the bladder after massage of the prostate gland is examined.

  • Lipoid grains (lecitin body) - specific product of normal physiological secretion of the glandular epithelium of the prostate gland.Gives a look of secret milk.Normally, the secret is rich in Licitine grains.A decrease in their number, as well as an increase in the number of leukocytes, indicates an inflammatory process, a tumor;
  • Amyloid body - in layers (starchy foods), body, which with a lugol solution are colored in purple or blue, like starch;
  • Amyloid bodies are a condensed secret of the gland, have an oval shape and a layer structure, resembling a tree trunk.They are not normal, their detection indicates a stagnation of secrecy in the gland, which can be with adenomas, chronic inflammatory processes;
  • Erythrocytes can be single.They fall into a secret following an energy massage of the prostate gland.Their increase is observed in inflammatory processes, neoplasms.
  • The descent of the epithelium in large quantities is observed at the beginning of the inflammatory processes and with tumors, so there is often a handicap with the protein and the fatty degeneration of the epithelial cells.Macrophages can be seen with stagnation of a secret, for a long period of current inflammatory process;
  • Betthera crystals are day crystals formed during cooling and drying the mixed secret of male gonads (prostate juice with a mixture of sperm) of spermine and salt with phosphoric layers.With azoospermia and the oligozoospermia strongly expressed, Betthera crystals are formed quickly and in large quantities;
  • REDEATITIONAL SYNDOME - Stagnation syndrome is observed with the gland adenoma.There is an abundance of macrophages, there are multi-kind cells such as foreign bodies and amyloid bodies;
  • The symptom of fern is a symptom of crystallization of a secret form-a form of sodium chloride crystals depends on the physicochemical properties of the prostate secrecy.The study of the symptom is carried out by adding a decrease of 0.9% of sodium solution of chloride to the secret which results from the prostate with an additional vision after drying under the optical microscope.In men in good health of reproductive age, the crystallization of the secret of the prostate is characterized by a phenomenon typical of the fern sheet (3+).The androgen failure or the presence of prostatitis give various degrees of violation of the structure of the crystals until their absence.

Bacteriological studies of parts of urine and the secretion of pancreas

Cames of the urethra, including PCR diagnostics

Serological diagnosis of agents (ELISA) which cause urinary tract infections

The reaction of the immunofluorescence (reef) is straight and indirect

Identification of antibodies with well -known antigens.

Determination of the PSA (specific antigen of prostate) of blood serum

The American Foundation for Urological Diseases recommends the annual passage of a rectal survey of the prostate gland, accompanied by a PSA for all men over 50, and with prostate cancer for blood parents according to a male line.There is still a discussion on obtaining a dog immediately after examining the finger of the prostate gland by rectum.Recent studies have not been able to confirm the presence of a significant increase in the content of the PSA immediately after examining the finger.Thus, the PSA level can be determined with the receipt of reliable results and after studying the pancreas.

Test of four parasites

In order to diagnose chronic prostatitis, a 4 glass test was proposed, based on a comparative bacteriological assessment of urine, approximately equal in terms of urine, obtained before and after massage of the prostatic gland, as well as its secret.

The diagnosis of prostatitis is established with an increase ten times of the concentration of microorganisms in the secrecy of the prostate compared to their content in urine portions (1, 2 and 3) and an increase in the number of polymorphic and nuclear leukocytes> 10-16 in the field of view of the microscope microscope (increase per 200 times).Or an increase in the number of leukocytes of more than 300x106 / L during calculations in the counting chamber.The bodies of the Lélicite, which are a product of the normal secretion of the glandular epithelium of the prostate gland, should densely cover the field of vision of the microscope (5-10 million in 1 ml).The amyloid bodies in the secret of the prostate are found in significantly smaller quantities.In mature men, there are 1-2 in the field of vision.

Biochemical blood test

Immunological and hormonal profile (according to the indications).

Ultrasound, trusia

Ultrasound diagnosis of prostatitis by the abdominal and transrectal sensor (confidence).

Urofloometry

Prostatitic treatment

The complete treatment of patients with chronic prostatitis should include:

  • Respect for the general regime, the diet, the sexual sexual hygiene, as well as to attract sexual partners in the presence of an infectious agent;
  • Selection of effective drugs to remove the infection;
  • Increase the general reactivity of the patient's body and the immunobiological tolerance of microorganisms to drugs;
  • Strengthen the flow of secretion and activation of local distribution processes in the focus of inflammation;
  • sanitation of infection foci in previous and distant organs;
  • Improved microcirculation in the prostate gland and pelvic organs;
  • the appointment of general reinforcement funds, enzymes and vitamins;
  • Correction of hormonal disorders;
  • the appointment of antipasmodics;
  • the appointment of analgesic and anti-inflammatory drugs;
  • Take sedative and processed medication;
  • Regulation of neurotrophic disorders by local analysis drugs;

Prostate massage

Prostate massage- A medical procedure used to diagnose and sometimes treat chronic prostatitis.The first massage of the prostate was described by Posner in 1893, and since 1936, it has been largely introduced into the urological practice of O'Conory.However, in 1968, after the description of Meares and Stamey, a scene test for the diagnosis of prostatitis, the views of the causes of this disease have changed and massage as therapeutic procedure were eliminated lists of measurements in many directives for the treatment of prostatitis in developed countries in the world.

But from the mid-90s of the 20th century, many doctors involved in the diagnosis and treatment of prostatitis began to note the ineffectiveness in certain cases of proposed antibacterial therapy and the use of alpha-blockers, which led them to use it in the practice of this forgotten method.

Basically, prostate massage is currently used as a diagnostic procedure to secure prostate secretion (prostatic secretions expressed -eps) - for its microscopic (cultural) study and for pre- andAfter the massage test (pre- and postmasse-ppmt test).massage.Massage is a medical procedure and must perform a previously trained specialist.The massage is carried out after urination and when the urethra is released after its preliminary washing with an isotonic solution of sodium chloride, which is particularly necessary in cases where a bacteriological examination of the secret is supposed.The prostate massage is carried out by the anus, because the gland of the prostate is close to the bulb of rectum and only it is available for research.First of all, they massaged one, then the other proportion of the gland of the prostate with the movements of the finger from the periphery to the central groove along the output ducts, trying not to touch the bubbles of the seeds.The massage is completed by pressing the area of the central furrow from above.A secret released from the urethra is collected in a sterile test tube or on a glass of clean object for research.Sometimes the secret of the urethra prostate gland does not follow.In such cases, the patient is recommended to get up immediately if it was not possible to get the secret, it means that it was not in the urethra, but in the bladder.In this case, the centrifugal of washing liquid released from the bladder after massage of the prostate gland is examined.

Prostate massage for medical purposes (repetitive massage) is officially recommended by the Russian Federation of the Russian Federation as therapeutic procedure for chronic prostatitis.Prostate massage is widely used for the treatment of prostatitis in the countries of Southeast Asia, China and certain European countries.Some urologists of the Record and Canadian Semets also recommend the use of massage in combination with antibiotic therapy in the treatment of certain forms of prostatitis.Essentially, the evaluation of the efficiency or ineffectiveness of the prostate massage has practically not been carried out.There are several contradictory studies, in one, of one of the Egyptian doctors, there was no difference in the groups of patients, some of which were massacred in combination with antibiotics and simply antibiotics, in another, led by American and phillipine researchers, on the contrary, in a significant improvement group.

Supporters of the use of massage for therapeutic purposes believe that the main effect of its use is the drainage of the prostate channels-that is to say their release from purulent and dead cells.Another effect is an increase in blood circulation in the prostate gland, which improves antibiotic penetration and activates local protective immunological processes.

In the world literature, there is little data on complications related to prostate massage.In 1990, Japanese doctors described the genitals (Fournier) and, in 2003, German doctors were a permanent hemorrhage after a massage of the prostate with the development of an embolic (hemorrhage) of the lungs.There is a study which, after massage, the level of PSA (prostatospecific antigen) temporarily increases.Massage is contraindicated in the acute inflammation of the prostate gland (acute prostatitis), with acute urethritis, orchitis, prostate cancer.Massage is not recommended for the Calcine prostate and the adenoma of the prostate.It is generally recommended that prostate massage be recommended 2 or 3 times a week.

Physiotherapeutic procedures

All physiotherapeutic procedures (prostate massage, warming, etc.) in acute prostatitis are contraindicated.

The use of physiotherapeutic procedures in the complex treatment of prostatitis aims to both effect directly on the prostatic gland of physical agents in order to normalize functional and pathological changes, as well as the electrophoretic administration of drugs in the fabric of prostate.

The use of physiotherapeutic methods in the context of pharmacotherapy gives a much better result than in the treatment separately.The following methods to influence the prostate gland have become generalized and have proven their effectiveness:

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