Prostatitis

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

Scatter

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

Classification

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

Category	Description
Category I	Acute bacterial prostatitis
Category II	Chronic bacterial prostatitis
Category III	Chronic abactry prostatitis
Category IIia	Chronic inflammatory pelvic pain syndrome
Category IIIB	Chronic Pelvic Syndrome Non -inflammatory (prostatinia)
Category IV	Sympomatic inflammatory prostatitis

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

Category I

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

• increased amount of leukocytes in the urine;
• the presence of bacteria in the urine;
• Common signs of 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 the secrecy of the prostate, ejaculate and urine obtained after prostate massage.

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 secrecy of the prostate, ejaculate 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- It is characterized by the presence of symptoms of pain and prostatitis, and an increase in the amount of leukocytes is observed in prostate secretion, ejaculated and portions of urine, after prostate massage, pathogenic microorganisms are not detected in these samples.

Category III B

Non -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 pathogenic microorganism methods in the secret of prostate, ejacular and urine obtained after prostate massage.

Category IV

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

Prostatitis diagnosis

Prostatitis symptoms are extremely diverse, but can be combined in various groups.

Pain syndrome

As a result of insufficient blood supply caused by inflammation or spasm of blood vessels that feed the prostate, oxygen hunger from the gland tissue is observed as a result of which pathological oxidation producers are formed that affect the nerve ends of the prostate.As prostate innervation is associated with pelvic floor innervation, penis, scrotum, testicles, rectum - the location of the pain is variable.The following symptoms of pain are more common:

• Perineum discomfort or pain - basically appears after physical effort, sexual relationships, alcohol assuming the form of passage attacks;
• Hot potato sensation in the rectum;
• Pain (discomfort) in testicles - patients are described as "pain", "torsion", are also associated with several provocative factors;
• Discomfort, rubber and pain in the urethra - are mainly associated with changing the pH of prostate secret on the acid side.The sour secret of the prostate acts annoyingly on the urethra mucosa membrane, so the 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 pelvis to the urethra lumen.

Urination disorder syndrome

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

• Far Urination - Frequent urination (happens up to 3 times per hour) with clear and sudden calls (impossible to support) and very small portions;
• A feeling of incomplete emptying of the bladder - after the act of urination, feels that the urine remained in the bladder;
• A weak or intermittent urine flow - this can also be attributed to the symptom of the "last drop" - despite all the patient's efforts after the act of urination, a drop of urine is still released.

Violation of ejaculation and orgasm

It is associated with damage to the prostatitis of the seed tuber (coliculita) 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 (blood supply to the penis during sexual arousal).

Main disorders:

• Premature ejaculation or vice -vested excessively prolonged sex - caused by inflammation of the seminal tuber or its scars due to the inflammatory process;
• Orga erased orgasm - is also associated with inflammation of the seed tuber;
• Pain during ejaculation - associated with the inflammatory process in prostate output ducts through which sperm is released.

Fertility Violation

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

• An decrease in the pH of sperm on the acid side - since, with the inflammation of the prostate, the acid products of pathological oxidation begin to accumulate in secret.The acid environment is extremely destructive to sperm, causing its immobilization and even death;
• Anglutination of sperm - gluing sperm mainly with heads - is associated with a change in the physical - chemical properties of secretions;
• Astospermia - a decrease in sperm mobility - is closely linked to the change of pH on the acid side and with a violation of the production of prostate lecithin strollers, which guarantee the vital activity of sperm.

Urethropostitis

In some cases, prostatitis is combined with chronic urethritis, which is manifested by inflammatory scarce of urethra scarce mucosia (especially after prolonged urinary retention).

Prostatitis and sexual disorders

The question "Prostatitis causes impotence?"It is the cause of expert disputes for decades.

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

Ejaculation and orgasm occurs with sufficient irritation of special receptor cells that are located in the area of the seminal tuber in which the output ducts of the prostate flows, the same receptors are responsible for departing the nerve impulse to the cerebral cortex where orgasm sensation is formed.

The inflammatory process in the prostate gland (prostatitis) can lead to the defeat of the seed tuber and, as a result, as a violations of a man's power, so premature ejaculation and echoing orgasm.Impotence in chronic prostatitis is pathogenically associated with the degree of damage to the nervous apparatus of the prostate gland.This form of impotence (neuroreceptor impotence) is a characteristic example of a repercussive phenomenon, when the presence of pathological impulses with organs affected by the inflammatory process leads to the irradiation of the arousal process that controls sexual function and the disorder of the latter.A certain role, although not leading, is played in the pathogenesis of neuroreceptors impotence, also some suppression of androgenic activity of the testicles and sensitivity to androgens of the hypothalamus and pituitary gland centers.

At the same time, there is an opinion that in the Russian Federation, there are hyperdiagnosis of prostatitis and the rearubulation of its role in the development of 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 impaired 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, diagnostic and treatment methods.At the same time, several simple and clinical and laboratory tests correctly enable a diagnosis, which allows appropriate therapy to initiate.

Prostate Putic Retal Research

A very informative way.The inflammatory process can be judged evaluating the shape, contours, dimensions of the gland, the presence of compaction foci and (or) softening, pain.The main signs of prostatitis: increase or decrease in size, heterogeneity of consistency, presence of compaction and softening outbreaks, pasture, pain.The fact that 80% of pancreatic cancer is detected through a rectal study speaks for 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 secret does not always indicate prostatitis, because the methods of obtaining a secret during massage do not guarantee that the contents of the urethra and seed bubbles do not fall into it.At the same time, with obvious signs of prostatitis, the prostate secret can be normal.This is explained by the outbreaks of inflammation, the presence of part of the exit ducts exposed or closed.

Prostate secretion study

Secret studies of express prostatic secretions) allow to determine the presence of an inflammatory process in the prostate gland and partly its functional capacity.It is the main method of diagnosis and monitoring of chronic prostatitis treatment.The secret of the prostate can be examined using light microscopy without painting or using special coloring methods.In addition, the secret of the prostate gland may undergo a bacteriological examination or examination by the polymerase chain reaction method for the detection of pathogens in it.Get a secret with prostate massage.A secret released from the urethra is collected in a sterile test tube or a clean object glass for research.Sometimes the secret of the urethra prostate does not follow.In such cases, it is recommended that the patient take place immediately.If, however, it was not possible to get a secret, more often it means that it did not enter the urethra, but on the bladder.In this case, the centrifuged washing fluid released from the bladder after prostate gland massage is examined.

• Lippoid grains (lecithin bodies) - A specific product of the normal physiological secretion of the glandular epithelium of the prostate gland.It gives a secret appearance to the milk.Usually the secret is rich in lecithin grains.A decrease in its number, along with an increase in the number of leukocytes, indicates an inflammatory process, a tumor;
• Amyloid bodies - in layers (starch), the body, which with a Lugol solution is spotted in purple or blue, such as starch;
• Amyloid bodies are an condensed secret of the gland, have an oval shape and a layer structure, similar to a tree trunk.They are not normal, their detection indicates a stagnation of the secret in the gland, which may have adenomas, chronic inflammatory processes;
• Erythrocytes can be single.They fall secret as a result of the energy massage of the prostate gland.Its increased amount is observed in inflammatory processes, neoplasms.
• The descent of the epithelium in large quantities is observed at the beginning of inflammatory processes and with tumors;Then there is often deficiency with protein and grease degeneration of epithelial cells.Macrophages can be seen with a secret stagnation for a long time of the current inflammatory process;
• Betthera's crystals are a day of crystals formed during cooling and drying the mixed secret of male gonads (prostatic juice with a mixture of sperm) of salt -sparce and phosphoric salt.With azoospermia and sharply expressed oligozoospermia, Betthera's crystals form rapidly and in large quantities;
• Writing syndrome syndrome - Stagnation syndrome is observed with gland adenoma.There is an abundance of macrophages, there are multi -core cells, such as foreign bodies and amyloid bodies;
• The symptom of samambaia is a symptom of crystallization in a secret form -a form of sodium chloride crystals depends on the physical -chemical properties of prostate secret.The study of the symptom is performed by adding a 0.9% sodium chloride solution drop to the secrecy resulting from the prostate, with more visualization after drying under a light microscope.In healthy men of reproductive age, the crystallization of the prostate secret is characterized by a typical phenomenon of fern leaf (3+).Androgenic failure or the presence of prostatitis gives various degrees of violation of the crystal structure to their absence.

Bacteriological studies of urine portions and pancreatic secretion

URETRA SMAAR, including PCR diagnosis

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

The reaction of immunofluorescence (reef) is straight and indirect

Identification of antibodies for well -known antigens.

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

The American Foundation for Urological Diseases recommends the annual approval of a rectal prostate gland research, accompanied by a PSA for all men over 50 and with a prostate cancer for blood relatives according to a men's line.There is still a discussion about obtaining a dog immediately after an examination of the prostate gland fingers by rectum.Recent studies could not confirm the presence of a significant increase in PSA content immediately after an examination of the fingers.Thus, PSA level can be determined by receiving reliable results and after pancreatic research.

Four -wall test

To diagnose chronic prostatitis, a 4 glass test was proposed, based on a comparative bacteriological evaluation of the urine, approximately equal in terms of urine portion, 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 in the concentration of microorganisms in the prostate secret compared to its urine content (1, 2 and 3 portions) and an increase in the number of polymorphic-nuclear leukocytes> 10-16 in the field of microscope light (200 times).Or an increase in the number of leukocytes of more than 300x106/L when calculating them in the counting chamber.Lecithin bodies, which are a product of the normal secretion of the prostate gland gland epithelium, should densely cover the microscope field (5 to 10 million in 1 ml).Amyloid bodies in prostate secret are found in a significantly smaller amount.In mature men, they can be found 1-2 in the field of vision.

Biochemical Blood Examination

Immunological and hormonal profile (according to indications).

Ultrasound, Trusie

Diagnosis of prostatitis ultrasound by abdominal and transrectal sensor (confidence).

Urofloometry

Prostatitis Treatment

Comprehensive treatment of patients with chronic prostatitis should include:

• Compliance with the general regime, diet, sexual hygiene, and attract sexual partners in the presence of an infectious agent;
• Selection of effective medicines to suppress the infection;
• Increase the patient's overall reactivity and immunobiological tolerance of drug microorganisms;
• Strengthen the flow of secretion and activation of local reparative processes in the focus of inflammation;
• Sanitation of infection foci in the previous and remote organs;
• Microcirculation improvement in the prostate gland and pelvic organs;
• 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 transformative drugs;
• Regulation of neurotrophic disturbances by medicines for local analysts;

Prostate massage

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

But from the mid -1990s, many doctors involved in the diagnosis and treatment of prostatitis began to observe 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 (express prostatic secretions) - for its microscopic (cultural) study and pre and massage test(pre and post -Massa -PMT test).massage.Massage is a medical procedure and should perform it an expert previously trained.Massage is performed after urination and when the discharge of the urethra after its preliminary wash with an isotonic sodium chloride solution, which is especially necessary in cases where a bacteriological examination of secret is assumed.Prostate massage is performed through the anus, as the prostate gland is near the rectum ampoule and is only available for research.First, they massage one, then the other proportion of the prostate gland with the finger movements from the periphery to the central groove along the exit ducts, trying not to touch the seed bubbles.The massage is completed by pressing the central groove area from the top.A secret released from the urethra is collected in a sterile test tube or a clean object glass for research.Sometimes the secret of the urethra prostate does not follow.In such cases, it is recommended that the patient immediately take the secret if it was not possible to get the secret, it means that he was not in the urethra, but in the bladder.In this case, the centrifuged washing fluid released from the bladder after prostate gland massage is examined.

Prostate massage for medical purposes (repeated massage) is officially recommended by the Russian Russian Federation as a therapeutic procedure for chronic prostatitis.Prostate massage is widely used to treat prostatitis in Southeast Asia, China and some European countries.Some severe 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 assessment of prostate massage efficacy or inefficiency was not practically performed.There are several contradictory studies, in one, conducted by Egyptian doctors, there were no differences in groups of patients, some of which massage in combination with antibiotic therapy and simply antibiotic therapy, in another, conducted by American and Philippine researchers, on the contrary, in a group of non -prostatis patients, who received a combination of an antibiopiacy combination more, in a group of non -prostatis patients, they receivedA combination of a combination of a combination of a combination of antibiopiotherapy.

Defenders of massage use for therapeutic purposes believe that the main effect of their use is the drainage of prostate ducts - that is, their release of purulent and dead cells.Another effect is an increase in blood flow in the prostate gland, which improves antibiotic penetration in it and activates local protective immunological processes.

In world literature, there are few data on prostate massage complications.In 1990, Japanese doctors described the genitals (Fournier) and, in 2003, German doctors were permanent hemorrhage after a prostate massage with the development of stroke (bleeding) of the lungs.There is a study that, after massage, the level of PSA (prostate antigen) temporarily increases.The massage is against -acute inflammation of the prostate gland (acute prostatitis) with acute urethritis, orchitis, prostate cancer.Massage is not recommended for prostate and prostate adenoma calculation.It is generally recommended that prostate massage be recommended 2 or 3 times a week.

Physiotherapeutic procedures

Any physiotherapeutic procedures (prostate massage, heating, etc.) in acute prostatitis are against -indicated.

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

The use of physiotherapeutic methods against the background of drug therapy provides a much better result than in treatment separately.The following methods for influencing the prostate gland became widespread and proved its effectiveness:

• Shock wave therapy;
• Electrical stimulation of the pancreas with modulated currents with TID or rectal electrodes;
• Thermotherapy in various versions (including high frequency thermotherapy);
• Magnetotherapy;
• Microwave technology of microwave;
• Laser therapy.
• Transreal ultrasonic therapy and phonophoresis;
• Microclisms.