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Prostatitis

Prostatis is an inflammation of the prostate gland (sex organs and reproductive system of a man) and changes as a result of its physiological function.

Symptoms-Prostatitis-U-Male

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

Classification

There are many classifications of prostatitis, so a very strange term.The most common is the classification of prostatitis proposed by the US National Institute of Health (NIH) in 1995:

Category Information
Category i Acute bacterial prostatitis
Category II Chronic bacterial prostatitis
Category III Chronic abacterial prostatitis
Category IIIA Chronic pelvic pain syndrome Inflammatory
Category IIIB Chronic pelvic pain syndrome (prostatinia)
Category IV Prostatitis inflammation of hereimmtomatic

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

Category i

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

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

Category II

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

Category III

Chronic pelvic pain syndrome (KTR)- The leading clinical symptoms are pain syndrome for more than 3 months without pathogenic microorganisms in prostate secrets, ejaculation and urine obtained after the prostate massage.Separation III A and III B is the presence of increased number of leukocytes.

Category III A

Chronic pelvic pain syndrome Inflammatory- characterized by the presence of pain and symptoms of prostatitis, and an increase in the amount of leukocytes is recorded in the secretion of prostate, ejaculation and urine, after the prostate massage, pathogenic microorganisms are not detected in this sample.

Category III B

Non -inflammatory syndrome of chronic pelvic pain- Characterized by the presence of pain syndrome and symptoms of prostatitis, while there is no increase in the number of leukocytes and not detected by the standard method of pathogenic microorganisms in prostate secrets, ejaculation and urine obtained after the prostate massage.

Category IV

Prostatitis inflammation of hereimmtomatic- The absence of symptoms of prostatitis characteristics, the disease was detected by accident during histological examination of prostate tissue samples obtained by diagnosis for other causes (for example, performing prostate biopsy due to increased levels of antigen - PSA).

Diagnosis of prostatitis

Symptoms of prostatitis are very diverse, but they can be combined into several groups.

The sick syndrome

Due to inadequate blood supply caused by inflammation or cramps of the blood vessels that feed the prostate, the hunger of the oxygen glands is observed, as a result by the pathological oxidation product is formed affecting the prostate nerve end.Because prostate conservation is associated with the preservation of pelvic floors, penis, scrotum, penis, rectum - the localization of pain is changing.Symptoms of the following pain are the most common:

  • Discomfort or pain in the perineum - basically appear after work - physical work, sex, alcohol consumption in the form of passing attacks;
  • Hot potato sensation in the rectum;
  • Pain (discomfort) in the penis - the patient is described as "pain", "twisted", is also associated with a variety of provocative factors;
  • Discomfort, rubber and pain in the urethra - are mainly associated with the transition of the prostate secret pH in the acidic area.The secret of the prostate is shocked to act on the mucous membranes of the urethra, so the pain, more often in the form of "burning", occurs after urinary tract or sexual intercourse, when a secret when reducing the muscles of the gland and pelvis is felt into the lumen of the urethra.

Urinary tract syndrome

It is associated with close prostate and bladder preservation, as well as the participation of the prostate muscles in urinary tract.Dysuria can be accompanied by the following manifestations:

  • Frequent urination - frequent urine (occurs up to 3 times per hour) with sharp and sudden calls (impossible to survive) and relatively small parts;
  • Incomplete emptying of the bladder - after urination, it is likely that urine remains in the bladder;
  • Weak or instant urine flow - this can also be associated with the symptoms of "final fall" - despite all the efforts of the patient after the urinary tract, a drop of urine is still released.

Violations of ejaculation and orgasm

It is associated with damage to the tubercle prostatitis (colliculite) on the surface of a nerve receptor that sends a signal to the brain structure, where the orgasm is formed.Prostatitis indirectly causes erection (blood supply to the penis during sexual stimulation).

The main disorder:

  • Premature ejaculation or vice versa compared to persistent sexual intercourse - due to inflammation of the seminal tubercle or scars due to the inflammation process;
  • Deleted orgasm - also associated with tubercle seed inflammation;
  • Pain during ejaculation - is associated with inflammation in the prostate output channel where the sperm is released.

A violation of fertility

When changing the properties of the prostate, as a result of inflammation, the following changes in the sperm are observed, reducing human ability to nourish (fertility):

  • Decreased in the sperm pH in the acidic section - due to prostate inflammation, pathological oxidation acid products begin to accumulate in secret.The acidic environment is very damaging to the sperm that causes their immobilization and death;
  • Sperm Anglutation - spermatozoa adhesive mainly with the head - associated with changes in secretion physicochemical properties;
  • Asthenospermia - a decrease in sperm movement - is closely related to pH shifts in the acidic section and with violations of the production of prostate lecitin cars, which ensures important spermatozoa activity.

Urethropostatitis

In some cases, prostatitis is combined with chronic uretritis, indicated by the release of inflammation of the urethra (especially after prolonged urinary retention).

Prostatitis and sexual harassment

The question "Does prostatitis cause impotence?"It is the cause of expert disputes for decades.

Under the influence of sexual stimulation, with saturation and androgen tension in the formation of cortical and subcortical areas of the brain, nerve signals occur, sent to the center of erection located in the spinal cord, from which it comes to smooth muscles.In this process there is no role of the prostate gland.

Ejaculation and orgasm occur with cell irritation of special receptors located in the seminal tubercle area where the prostate flow tract, the same receptor is responsible for departing from the nerve to the cerebral cortex where the sensation of orgasm is formed.

The process of inflammation in the prostate gland (prostatitis) can lead to tubercle defeat and, as a result, as a violation of human potential, so premature ejaculation and echoing orgasm.Impotence in chronic prostatitis is pathogenetic associated with the degree of damage to the prostate gland nerve.This form of impotence (neuroreceptor impotence) is an example of the feature of the repercussive phenomenon, when the presence of pathological impulsation with the organs affected by the inflammatory process leads to the radiation of excitation processes that control the last sexual function and disruption.Sure role, despite not leading, is played in the pathogenesis of neuroreceptor impotence, as well as some suppression of androgenic activity from the penis and the sensitivity to the central androgen of hypothalamus and the pituitary gland.

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

Diagnostics

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

Putic's rectal review of the prostate gland

A very informative way.The process of inflammation can be judged by assessing the form, contour, gland dimensions, presence of compaction focus and (or) softening, pain.The main signs of prostatitis: an increase or decrease in size, heterogeneity of consistency, presence of compaction and softness focus, ability, pain.The fact that 80% of pancreatic cancer is detected through rectal studies speaking for itself.We can safely say that this research method will always be used.

Microscopic examination of the pancreas secretion

Keep in mind that increasing the number of leukocytes secretly does not always indicate prostatitis, as the method of getting a secret during the massage does not guarantee that the content of the urethra and the seed bubble will not fall into it.At the same time, with clear signs of prostatitis, the secret of the prostate can be normal.This is explained by the focus of the inflammation, the presence of part of the closed channel, or closed, output.

A secret study of the prostate gland

Prostate-EPS Secret Studies) allow you to determine the presence of inflammation in the prostate gland and partially its functionality.It is a major method for diagnosing and monitoring the treatment of chronic prostatitis.Prostate secrets can be checked using light microscopy without drawing or using special coloring methods.Also, the secret of the prostate gland can be subject to bacteriological examination or examination by the polymerase chain reaction method to detect pathogens in it.Get secrets with prostate massage.The secret removed from the urethra is collected in a sterile test tube or on the clean object of the object for research.Sometimes the secret of the prostate gland from the urethra does not follow.In such cases, the patient is recommended to stand immediately.If, however, it is not possible to get a secret, more often it means he does not enter the urethra, but in the bladder.In this case, the centrifugation of washing fluid removed from the bladder after the prostate gland massage is examined.

  • Lipoids (body lecitin) - a special product of the common physiological secretion of the epithelium of the prostate gland.Provides the secret of milk.Usually, the secret is rich in lecitin cereals.Decreases in their numbers, together with increasing number of leukocytes, indicating inflammation, tumors;
  • Amyloid body - layered (starch), body, which with lugol solution in purple or blue, such as starch;
  • The amyloid body is a secreted gland, with oval shape and layer structure, resembling a tree trunk.They are abnormal, their detection shows a secret stagnation in the gland, which can be with adenoma, chronic inflammation process;
  • Erythrocytes can be single.They fall into the secret due to the energetic order of the prostate gland.The amount of their increase is observed in the inflammation process, neoplasms.
  • Decreased epithelial in large quantities at the beginning of the inflammatory process and with tumors, there are often defects with protein and degeneration of epithelial cell fat.Macrophages can be seen with secret stagnation, for a long time in the current inflammation process;
  • Betthera crystal is a day crystal formed during cooling and drying the male gonad mixture (prostatic juice with sperm mixture) from the sperm and -layer phosphoric salts.With azoospermia and suddenly stated oligozoospermia, Betthera crystals form quickly and in large quantities;
  • Redational Syndrome - Stagnation syndrome is observed with gland adenoma.There are many macrophages, there are various cells such as foreign bodies and amyloid bodies;
  • Symptoms of ferns are symptoms of secret crystallization -the form of sodium chloride crystals that fall depends on the physical properties of the prostate secret.Symptom studies are conducted by adding a drop of 0.9% sodium chloride solution to the prostate secret produced by further viewing after drying under a light microscope.In healthy reproductive men, prostate's secret crystallization is characterized by a typical phenomenon of fern (3+).Androgenic failure or the presence of prostatitis provides various degrees of violation of crystal structure until their absence.

Bacteriological study of urine parts and pancreatic secretions

Smear urethra, including PCR diagnostics

The diagnosis of the Serological Agent (ELISA) that causes urinary tract infection

Immunofluorescence (reef) reactions straight and indirect

Identification of antibodies to well -known antigens.

Determination of PSA (prostate -Specific antigen) blood serum

The American Foundation for Urological Disease recommends the annual route of the prostate gland rectal review, accompanied by PSA for all 50 -year -olds, and with prostate cancer for blood clots according to the male line.There is still a discussion on getting the dog shortly after the prostate gland's finger examination of each rectum.This new study has not been able to confirm the presence of a significant increase in the PSA content immediately after finger examination.Therefore, the PSA level can be determined by the receipt of reliable results and after the pancreatic review.

Four -walled test

To diagnose chronic prostatitis, a 4-read test is suggested, based on the assessment of bacterial comparison of urine, about the same in terms of urine, obtained before and after the prostate gland massage, and its secret.

The diagnosis of prostatitis is established with a tenfold increase in the concentration of microorganisms in prostate secrets compared to their contents in the urine (1, 2 and 3 parts) and an increase in the number of polymorphic-nuclear leukocytes> 10-16 in the field of light microscope (increased by 200 times).Or an increase in the number of leukocytes more than 300x106/l when calculating them in the calculation space.Lecitine bodies, which are the result of the usual secretion of the epithelial glands of the prostate gland, should be compact covering the field of microscope (5-10 million in 1 ml).The amyloid body in the secret of the prostate is found in smaller quantities.In mature men, they can be found 1-2 in the field of view.

Biochemical blood test

Immunological and hormone profiles (according to guidance).

Ultrasound, trusie

Diagnosis of ultrasound prostatitis by abdominal and transmission (trust) sensors.

Urofloometry

Treatment of prostatitis

Comprehensive treatment of patients with chronic prostatitis should include:

  • compliance with general regime, diet, sex hygiene, and attract sexual partners with the presence of infectious agents;
  • selection of effective drugs to suppress infection;
  • increase general reactivity of the patient's body and immunobiological tolerance of microorganisms to drugs;
  • Strengthen the outflow of secretion and activation of local reparrative processes in the focus of inflammation;
  • sanitation of the focus of infection in the previous and remote organs;
  • increased micro -circulation in the prostate gland and pelvic organs;
  • Appointment of general reinforcement funds, enzymes and vitamins;
  • Correction of hormone disorders;
  • appointment of antispasmodics;
  • Appointment of analgesic and anti -anti -anti -anti -anticipation drugs;
  • take sedative and change medicine;
  • Neurotropic Disorders Rules by Local Analyst Medicines;

Prostate massage

Prostate massage- Medical procedures 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 widely introduced into the practice of urology o'conory.However, in 1968, after the description of Meeles and Stamey, the stage test for the diagnosis of prostatitis, views on the causes of the disease change and massages as a therapeutic procedure has been released from the list of steps in many guidelines for the treatment of prostatitis in the world of developed countries.

But from the mid-90s of the 20th century, many doctors involved in the diagnosis and treatment of prostatitis began to notice inefficiencies in some cases of suggested antibacterial therapy and the use of alpha barriers, which caused them to use in this forgotten method.

Basically, the prostate massage is now used as a diagnostic procedure for prostate secretion (expressing prostate secretion -EPS) -for microscopic (cultural) studies and for massage tests (pre -and postmassage -pmt).Massage.Massage is a medical procedure and must perform a trained specialist.Massage is performed after urination, and when the release of the urethra after washing early with the isotonic solution of sodium chloride, which is essential in cases where the secret bacteriological examination is assumed.The prostate massage is done through the anus, as the prostate gland is close to the rectum ampoule and is only available for research.First, they massage one, then the other part of the prostate gland with the movement of the finger from the edge to the middle groove along the output channel, trying not to touch the seed bubble.Massage is prepared by pressing in the central furrow area from above.The secret removed from the urethra is collected in a sterile test tube or on the clean object of the object for research.Sometimes the secret of the prostate gland from the urethra does not follow.In such cases, the patient is recommended to reach his feet immediately if it is not possible to get a secret, which means that he is not in the urethra, but in the bladder.In this case, the centrifugation of washing fluid removed from the bladder after the prostate gland massage is examined.

Prostate massage for medical purposes (recurrent massage) is officially recommended by the Russian Federation as a therapeutic procedure for chronic prostatitis.Prostate massage is widely used for the treatment of prostatitis in Southeast Asian countries, China, and several European countries.Some urologists Severmerican and Canada also recommend the use of massage in combination with antibiotic therapy in the treatment of several forms of prostatitis.Basically, the effectiveness of the effectiveness or inefficiency of practical prostate massage is not performed.There are several contradictory studies, in one, conducted by Egyptian doctors, there is no difference in patients, which is partly in combination with antibiotic therapy and only antibiotic therapy, others carried out by American and phillipine researchers, on the contrary, in a group of patients with prostatitis, which receives a combination of antibiotic therapy as an important improvement.

Supporters of the use of massage for therapeutic purposes believe that the main effect of its use is the drainage of the prostate tract - that is, their release from purulent and dead cells.Another effect is an increase in blood flow in the prostate gland, which increases the penetration of antibiotics into it and activates the local protective immunological process.

In world literature there is little data on complications related to prostate massage.In 1990, Japanese doctors described the genital organs, and in 2003, the German doctor was a permanent bleeding after the prostate massage with the development of emboli stroke (bleeding) lungs.There is a study that after the PSA level (antigen prostatospecific).Massage is contraindicated in acute inflammation of the prostate gland (acute prostatitis), with acute uretritis, orchitis, prostate cancer.Massage is not recommended for prostate calcinates and prostate adenomas.It is generally recommended that prostate massage is recommended 2 or 3 times a week.

Physiotherapy procedure

Any physiotherapy procedure (prostate massage, heating, etc.) in acute prostatitis is contraindicated.

The use of physiotherapeutic procedures in the treatment of complex prostatitis is intended for both to have a direct impact on the prostate gland of the physical agent to normalize functional and pathological changes, as well as the electropopic administration of the drug into the prostate tissue.

The use of physiotherapy methods to the background of drug therapy provides better results than treatment separately.The following methods affecting the prostate gland have become extensive and prove its effectiveness:

  • shock wave therapy;
  • Electrical stimulation of the pancreas with current modulated with Tid or rectal electrodes;
  • Thermotherapy in various versions (including high -frekuency) thermotherapy);
  • magnetotherapy;
  • microwave technology;
  • Laser therapy.
  • Transprectal ultrasonic therapy and phonophyesis;
  • Microclisms.