Chronic prostatitis

According to many experts, chronic prostatitis is an inflammatory disease, which is the cause of the infection with possible accession of autoimmune disorders, characterized by damage to the parenchymatic and interstitial organ tissue.The disease has known medicine from 1850. years, but today remains insufficiently studied and faintless.Chronic bacterial (6 - 10%) and non-pointing (80 - 90%) prostatitis are the most common and socially significant inflammatory diseases in men who significantly reduce their quality of life.The disease is recorded mainly in people of young and medium age and is often complicated by damaged copulation and generative functions (reduction of potency, infertility, etc.).The disease is recorded in men in 8 - 35% of cases aged 20 to 40.

The cause of bacterial prostatitis is a pigene flora that penetrates iron from urethra, or lymphogenic and hematogenic trails.The etiology of chronic non-hard prostatitis and its pathogenesis remain unknown.Mostly men suffer from 50 years of age.

Causes of disease development

Chronic prostatitis is currently considered a polyethological disease.There is an opinion that the disease continues as a result of the penetration in the prostate, and then the pathological process continues without its participation.This facilitates numerous non-Nephina factors.

Infectious factors in the development of chronic prostatitis

In 90% of cases, pathogens enter the gland from the urethra, which results in acute or chronic prostatitis.There were cases of asymptomatic carriage.On the course of the disease affects the state of defending the human body and the biological characteristics of pathogens.It is assumed that the transition from acute to chronic prostatitis arises due to the loss of tissue elasticity due to excess production of fibrous tissue.

The following pathogens are located among choral chronic prostatitis agents:

• In 90% of cases, the disease reveals gram-negative bacteria such as Escherichia Coli, Enterococcus Faecalis (fekalan enterococcus), and somewhat more often - psebsiella spp., Pseudomonas aeruginosa, enterobacter Aerogenes and Acinetober spp.Gram-positive bacteria Enterorococci, streptococci and staphylococci are rare.
• The role of coagulase-negative staphylococci, ureplasm, chlamydia, trichomon, gardnerel, anaerobic bacteria and fungi of the genus Candida are not fully completed.

Infection enters the prostate in several ways:

• Ascending path is most likely, how to testify a common combination of prostatitis and urethritis.
• Hematogenic prostatitis develops when the infection penetrates the gland through the bloodstream, which is observed in chronic tonsilitis, sinusitis, periodontitis, pneumonia, cholecystitis and collegities, gnody diseases of the skin, etc.
• Contacted chronic prostatitis is developing with urethritis and strict urethrates, when the infection penetrates the gland in the urinary current, with pure infections, duct and therapeutic urological manipulations (catheterization, hitting, instructions), including transurukran.
• The lymphogenic infection penetrates the prostate with chase, thrombophlebit of hemorrhoid veins, etc.

Non-effective factors in the development of chronic prostatitis

Chemical factors

According to experts, the leading role in the development of chronic prostatitis belongs to an intristrust reflux urinary urine when urine throws the urethra to iron, leading to breaches of prostate and seeds.

In addition to the disease, vascular reactions are developed by the edema of organ, nerve and humeral regulation of the tone of smooth muscle tissues of the urethra, and activating the alpha are disturbed₁-Adroreeceptors cause the development of dynamic obstruction and contributes to the development of new intraffer reflux.

Urine contained in urine, with refluxes, lead to the development of "chemical inflammatory response".

Hemodynamic disorders

Support chronic inflammation of circulatory disorders in pelvic authorities and scrotum.The stagnation develops in people who lead the sedentary lifestyle, for example, for drivers, office officers, etc., with obesity, sexual withdrawal, sexually sexually, mental and physical overload.Maintaining the inflammatory process, taking spicy and spicy food, alcohol and smoking, etc.

Other factors

There are many other factors that support chronic inflammation in the prostate.They include:

• Hormonal.
• Biochemical.
• Immune response disorders.
• Autoimmic mechanisms.
• Contagious and allergic processes.
• Features of the prostate structure of the gland, which leads to difficulties in proper drainage.

The causes of the development of chronic prostatitis cannot be determined.

Classification of prostatitis

According to the classification that in 1995. proposed by American National Health Institutes, prostatitis was divided into:

• Acute (category I).Is 5 - 10%.
• Chronic bacterial (category II).Is 6 - 10%.
• Chronic non-bacterial inflammatory (category IIIA).That is 80 - 90%.
• Chronic non-bacterial non-inflammatory (category IIIB) or chronic pelvic pain syndrome.
• Chronic prostatitis detected by accident (category IV).

Signs and symptoms of chronic prostatitis

The course of chronic prostatitis is long, but not monotonous.Determination periods are monitored by periods of relative peace, which occur after complex anti-inflammatory and antibacterial therapy.

The development of chronic bacterial prostatitis has often preceded urethritis of bacterial or gonorreal nature, non-bacterial - circulatory disorders in pelvic and scrotal organs (hemorrhoids, varicocellus, etc.), sexual surplus.

Patients with chronic prostatitis represent many complaints.They go to doctors for years, but they are very rarely examined for prostate disease.About a quarter of patients has no complaint or disease occurs with scarce clinical symptoms.

The appeals of patients with chronic prostatitis can be divided into several groups.

Sailor disorders associated with the narrowing of the urethra:

• Difficulties in the beginning of urination.
• Weak up of urine flow.
• Occasional or dribal mokrevine.
• A sense of incomplete bladder discharge.

Symptoms caused by irritation of nerve endings:

• Frequent urination.
• The urination drive is sharp and strong.
• Motroing in small portions.
• Urinary incontinence during urination urine.

Syndrome of pain:

• The intensity and nature of the pain are different.
• Localization of pain: lower abdomen, the area of perineum, rectum, groin and lower back, internal surface of the hips.

Sexual function disorders:

• The pain in the rectum and in urea during ejaculation.
• Dispute erection.
• Loss of orgasm.
• Premature ejaculation, etc.

From the nervous system: neurotic disorders in the form of fixing the attention of patients in the state of their health.

Signs and symptoms of chronic non-hard prostatitis

Chronic pelvic pain in men (CFTB) continue with common symptoms for chronic prostatitis, but in 3. Part of urine and secret prostate in the study of bacteria are not present.Simulation CTB can simulate chronic non-bilateral interstitis, rectal diseases, spastic pelvic floor balm and functional prostate caused by disruptive organic bodies and hemodynamics.

In the event of weakened neurovatical function, the Athonians were recorded and the interior of the gland, which manifests the difficulties of the rapid and complete closure of the Urethra Lumens.At the same time, urine, after urinating, continues to emphasize long falls.In such patients, they are in the study, instability and increased exciting, manifestation of sweating and exciting heart activity, changes in dermigraphy.

Complications of the disease

A long course of chronic prostatitis is complicated by disorders of sexual and reproductive functions, disease development such as wedding and epipidios, as well as the organization of the organ.The organized body deteriorates local microcirculation and urodynamics, as well as the results of surgical interventions.Fibrosis of perihometric tissues leads to development of urination disorders.

Diagnostics

Due to the fact that there are many reasons for the development of chronic prostatitis, the entire complex of diagnostic studies is used to diagnose.Treatment success depends on the correct determination of the cause of the disease.The diagnosis of chronic prostatitis is based on the following data:

• Classic triad symptoms.
• Physical method complex (testing of the rectal finger prostate).
• Laboratory method complex (urine analysis and prostate microscopy, sowing and determination of microflore sensitivity in antibacterial medications, general urine and blood analysis).
• To detect gonococke, bacterioscopy smearing from urethra, PCR and serological methods (to detect ureplasm and chlamydia).
• Urofluometry.
• Prostate biopsy.
• Instrumental method complex (ultrasound).
• Determination of patient's immune status.
• Determination of neurological status.
• With inefficient treatment and suspicion of developing complications, calculate and magnetic resonance imaging, blood sowing, etc.

Prostate palpation glands

The palpation of prostate, which increases in the period of deterioration and reduction in the Podal Process Branch, is of the utmost importance in the diagnosis of the disease.In chronic prostatitis, during the period of deterioration, iron is swollen and painful.

The density of organ consistency may be different: areas of softening and compaction are palpated, the western zones are determined.In palpation, it is possible to assess the shape of the gland, Tuberkla and surrounding tissue seed conditions.

The process of transectal finger examinations is combined with confiscation of glands.Sometimes there is a need for separate performance secrets.

Analysis 3 glasses of urine and secret prostate

The gold standard in the diagnosis of chronic prostatitis is:

• Collecting the first part of the urine.
• Collecting another part of urine.
• Getting a secret gland massage.
• A third part of urine collection.

The microscopic and bacteriological overview of the material is then carried out.

With prostate inflammation:

• Microbial number (CFU) exceeds 10³/ ml (10⁴/ ml for epidermal staphylococci), but it should not be ignored by a small number of microbes calculated by dozens and hundreds.
• The presence of 10-15 leukocytes in the field with a view revealed by microscopy was generally accepted by the criterion for the presence of the inflammatory process.

The secret prostate and 3. the urine portions are subjected to microscopic and bacteriological studies:

• In chronic bacterial prostatitis, an increase in the number of leukocytes in secret glands and the third post-massage part of urine, bacteria (mainly intestinal group) was observed.
• With non-pointing prostatitis, an increase in the number of leukocytes in the secret of gland was observed, but microflora was not detected.
• There are no increased amounts of white blood cells and microflors with CTB.

Normal prostate secret indicator:

• Leucocytes less than 10 in the field of view.
• Lecitine grains are a large number.
• There is no microflora.

In chronic prostatitis in prostate secrecy is:

• The number of leukocytes is great exceeding 10-15 in the field of view.
• The amount of lecita cereal was reduced.
• PH excretion is moved to the alkaline side.
• Sour phosphatase content is reduced.
• Lizose activity increases.

Getting negative results of the secret prostate once does not prove the lack of inflammatory process.

The value of the secret prostate test remains.Normally, during the crystallization, a characteristic sample in the form of plates is formed.In the event of a violation of the prostate aggregation properties, such a form does not make what happens with changes in the Androgenic Hormone background.

Ultrasonic examination

If a prostate suspects, an ultrasonic gland inspection (transectran ultrasound), the kidneys and the bladder is optimal, which allows us to determine:

• Volume and size of gland.
• The presence of stones.
• Sizes of seminal vesicles.
• The state of the walls of the bladder.
• Amount of urine remaining.
• Scrotum structures.
• Another type of pathology.

Other prostate test methods

• The state of urodynamics (urine flow study) is easy and simply determined by a study such as Uroflowetrity.With the help of this study, it is possible to immediately discover the signs of the obstruction bladder and implement dynamic supervision.
• The penetration biopsy is performed if he doubts the formation of abscess, benign hyperplasia and prostate cancer.
• In order to clarify the reasons for the development of infrablesicular obstruction, X-ray and endoscopic examinations are performed.
• In the event of a long-term inflammatory process, the execution of urethrocistoscopy is recommended.

Differential diagnosis

Chronic prostatitis should be distinguished from vesiculoProstatis, vegetative prostatopathy, neuropsychiatric disorders, reflective cute dystrophy, ostertis symphysis pubis, sexual dysfunction, urinary bladder door,urethral strict, tuberculosis, prostate and bladder cancer, urolithiasis, chronic epipiditis, inguinal hernia.

Treatment of chronic prostatitis

The treatment of chronic prostatitis should start changes in the patient's lifestyle and diet.

When treating the disease, medications that affect different parts of pathogenesis are used at the same time.

Chief directions of therapy:

• Elimination of causative microorganisms.
• Counterflower therapy.
• Normalization of blood circulation in prostate and pelvic authority.
• Normalization of the appropriate drainage of prostatic acins.
• Normalization of the hormonal profile.
• The prevention of the sclerosis of an organ.

The following drug groups are used to treat chronic prostatitis:

• Antibacterial.
• Antiholinergic.
• Vasodilators.
• Alpha₁- Adrecergic blockers.
• 5 Alpha Reductase inhibitors.
• Cytokine inhibitors.
• Non-ecoid anti -infalmatory.
• Angiprovers.
• Immunomodulators.
• Preparations that affect the exchange of offices.

Antibiotics in treating bacterial chronic prostatitis

Antibacterial therapy should be performed taking into account the sensitivity of the revealed microorganisms on antibiotics.In case of non-precyers, the pathogenic treatment is used.

The choices of the election are the fluoroquinolons of the generation II - IV.Quickly penetrates the gland tissues with ordinary use methods, they show an activity against a large group of gram -negative microorganisms, as well as ureaplasm and chlamydies and chlamydies.In case of failure of antimicrobial treatment, you should assume:

• Microflora polyureziness,
• Short (less than 4 weeks) Treatment courses,
• Incorrect selection of antibiotics and her dose,
• changes in the type of pathogen,
• The presence of bacteria living in the prostate canals, covered with a protective exterior membrane.

The duration of treatment should be at least 4 weeks with mandatory subsequent bacteriological control.In case of preservation in 3. Part of urine and secret bacteria prostate more than 10³The re -antibacterial therapy for a period of 2 to 4 weeks is prescribed.

Cytokine inhibitors in the treatment of chronic prostatitis

The cytokines are glycoproteins that excrete immune and other cells during inflammatory and immune conditions of the response.They active participate in the development of a chronic inflammatory process.

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs have an anti-inflammatory effect and reduce pain and fever.It is widely used in the treatment of chronic prostatitis in the form of tablets and complaints.The most efficient administration route is rectal.

Immunotherapy

In the treatment of bacterial chronic prostatitis, in addition to antibiotics and anti-inflammatory drugs are used by immunomodulational assets.The most effective is the rectal path of administration.The immunomodulator is widely used, increasing the functional activity of phagocytes, which contributes to the more efficient elimination of pathogens.

Alpha-blockers in treating chronic prostatitis

Alpha-1 adrenergic blockers have been determined to normalize the tone of smooth muscles of the prostatic urethra, seminal vesicles and prostate capsules, which makes medications in this group very effective in treating diseases.ALPHA-1 Adrenergic blockers are used in patients with severe urination disorders in the absence of an active inflammatory process.

For CPPS, the treatment period ranges from 1 to 6 months.

5a-reducative inhibitor in the treatment of ablacterial prostatitis and CPP

It was determined that the influence of enzymes 5A-reductaz Testosterone is converted into the prostatic form of 5A-dihydrotestone, whose testosterone activity is more than the activity of testosterone, which leads to organ enlargement due to epithelial and stromal components.

When taking 5A-reducta inhibitors, the atrophy of stromal tissue is observed for 3 months, a yield atrophy in 6 months, inhibits the secretary, the severity of pain and amount of groices reduced, tension and body swelling have been reduced.

The role of anti-sclerotic drugs in the treatment of chronic prostatitis

With a long-term inflammation in the prostate, fibrosis is developed, which is manifested by disorders in microcirculation and urinative.To prevent the fibrosis process, anticorrotic drugs are used.

Other medications used in the treatment of chronic prostatitis

With the lists described above, the following are used to treat diseases:

• Antihistamines.
• Vasodilators and angipotectors.
• Immunosuppressants.
• Drugs affecting the Domestic metabolism and citric acid of Trisodium.

Herbal products

Effectively in the treatment of prostatitis, the use of candles in the form of candles that contain a complex of biologically active peptides isolated from the prostate glands of cattle.

Under the influence of drugs, ::

• Stimulation of metabolic processes in the tissues of glands.
• Improving microcirculation.
• Reduction of edema, leukocyte infiltration, stagnation and pain.
• Prevention of thrombosis in cheerful prostate glands.
• Increasing activities from the secretary epithelium of acinus.
• Improving sexual function (increased libido, recovery of erectile function and normalization of spermatogenesis).

Prostate finger massage

Numerous researchers say that a finger massage should be used in chronic prostatitis, taking into account known contraindications.

Physiotherapy

The efficiency of physiotherapy procedures in the treatment of prostatitis is not proven today, the mechanism of action is not scientifically established, unwanted reactions should not be studied.

Prevention of chronic prostatitis

Starting the prevention of the development of chronic prostatitis, you should know:

• The risk of developing a disease is increased over the years.
• Representatives of negroid race are more predisposed to disease.
• Family predisposition for disease is not excluded.

People with predisposition to develop chronic prostatitis should be more careful for their health condition.

Disease prevention tips:

• Take a sufficient amount of liquid.Frequent urination promotes the rinsing of microflora from the urethra.
• Prevent diarrhea and prison.
• Adhere to rational diet.They do not eat food saturated with carbohydrates and saturated fats, leading to increasing body weight.
• It should be limited to the use of the substance that irritate the urethra: sharp and spicy dishes, smoked meat, sauces and spices, coffee and alcohol.
• Refuse smoking.Nicotine negatively affects the state of vascular walls.
• Don't overdo.
• Do not hold bladder discharge.
• Take the active lifestyle, play sports.Do exercises to strengthen the muscles of the pelvis, which allows you to remove the stagnation of venous blood, which in turn supports the normal prostate function.
• Lead regular sex life.Avoid extended abstinence.Iron should be delayed in a timely manner.
• Stay reserved monogamic relationships.Illegal sexual relations increases the likelihood of acquiring sexually transmitted diseases.
• If the appeals appear genitourinary authorities, contact the urologist immediately.