Chronic prostatitis in men: signs and treatment. Chronic prostatitis: symptoms, causes, methods of diagnosis and treatment, prognosis

Prostatitis - inflammation of the prostate gland - can manifest itself in acute and chronic forms.

It is difficult to ignore acute inflammation: its signs are clearly expressed, which cannot be said about the chronic manifestation of the disease. It asymptomatic, but it does its job “excellently”, damaging the tissues of the organ, reducing its functions.

About chronic prostatitis: types and features

Inflammation of the prostate is considered chronic, if its indolent symptoms persist for more than 3 months.

According to statistics, only 5% of cases are acute, the remaining 95% are chronic prostatitis. It affects men of reproductive age, and even young men aged 18-20 years are susceptible to this disease.

There can be two reasons for the development of chronic prostatitis: infection and blood stagnation in the pelvis.

Infection gets into the prostate in several ways:

• with blood flow from infectious foci in the body - carious teeth, pneumonia, inflamed maxillary sinuses, pustular formations;
• with the flow of lymph from nearby organs, for example, from the intestines with hemorrhoids, dysbacteriosis;
• sexually;
• descending or ascending route from infected urinary tract - Bladder or urethra.

Prostate inflammation caused by a sexually transmitted pathogen, such as gonococcus, chlamydia, and treponema pallidum, requires special attention. The symptoms of such prostatitis and genital infections are similar to each other, and they can “hide” behind the signs of these diseases. This kind of prostatitis is easy to trigger.

Reduced immunity and hormonal imbalances especially stimulate the development and spread of infection.

Non-infectious or congestive prostatitis appears as a result of a violation of the outflow of blood and lymph from the pelvis, as well as stagnation of prostate juice in the ducts of the gland.

Provoke such phenomena the following factors:

• disturbances in sexual life - prolonged abstinence, interrupted acts, unfulfilled desire;
• smoking - nicotine spasms blood vessels and interferes with normal blood circulation;
• sedentary lifestyle;
• tight clothes;
• alcohol abuse. Alcoholic drinks irritate the walls of the gland ducts, causing their inflammation;
• constipation

Congestive prostatitis occurs 8 times more often than infectious prostatitis and very rarely develops as a complication of acute inflammation of the prostate.

Abacterial prostatitis

This type of disease is also called chronic pelvic pain syndrome (CPPS). The main symptom is pain in the pelvic area, but the absence of pathogenic microorganisms in microbiological examination of urine and prostate secretions.

Painful sensations acquire different severity and localization. They spread to the perineum or bladder, genitals. The process of ejaculation is also painful. Problems with urine excretion and in the sexual sphere are also present, but they are secondary.

The diagnosis is made if the pain persists for 3 months or more.

There are 2 types of CPPS:

1. Inflammatory CPPS- an increased number of leukocytes is detected in the urine and secretions of the prostate, which indicates inflammation. Microorganisms are not detected. There are several reasons for the appearance of this type of inflammation. On the one hand, this is possible with reflux (reflux) of clean urine from the urethra into the gland. Anatomical defects or disruption contribute to this muscle contractions bladder, prostate organ, perineum. Urine, or rather the urates in it, cause inflammation of the prostate. On the other hand, it is believed that the culprit of this process is still bacteria that are not determined by the classical method. To identify them, molecular diagnostics should be used. The 3rd reason is autoimmune processes in the body.

1. Non-inflammatory CPPS— the analyzes do not contain leukocytosis and microorganisms. To establish a diagnosis, instrumental diagnostics are used. It allows you to identify innervation problems or muscle changes in the prostate and other organs:
   • cervical part of the bladder - stenosis or proliferation;
   • pelvic area – myalgia, muscle tension, disruption of the passage of nerve impulses;
   • urethra - narrowing, increased pressure;
   • prostate – reflux of urine, increased pressure.

Often Nervous disorders are observed in patients with CPPS: anxiety, irritability, depressive tendencies.

Bacterial prostatitis

Chronic inflammation of the prostate of bacterial etiology begins to manifest itself with slight discomfort when urinating. This includes minor pain, itching or burning, and a decrease in the flow of the stream. The color of the urine changes and it acquires an unpleasant odor. Unpleasant sensations can also disturb you during bowel movements. A weak, dull pain appears in the perineum.

arise problems in sex life . At the beginning of the disease, they are situational: weakening of erection or increased frequency of its occurrence at night, acceleration of ejaculation, disturbances in orgasmic sensations.

A characteristic symptom for this stage– the appearance of discharge from the urethra during defecation.

Such sluggish symptoms can persist for quite a long time. A man may not pay attention to them, attributing everything to other reasons. If there is no treatment, they progress and an exacerbation of the chronic process occurs. the intensity of sensations increases.

Urination becomes sharply painful, the urge to go to the toilet becomes more frequent. At a certain point, these manifestations weaken due to compensatory growth of the bladder muscles, and then resume again, with greater force.

The pain in the perineum also intensifies. It radiates to the lower back, pubis, leg, scrotum. The nature of the pain also changes: it becomes stronger and sharper, and bothers you at night.

Sexual dysfunction increases and becomes permanent. Ejaculation is accompanied by pain, erection and libido decrease.

Patients are also accompanied by increased sweating, including in the perineum. Body temperature is slightly elevated – 37-37.5°.

Against the background of sexual disorders in men mental disorders develop. They become irritable, nervous, and may become depressed.

Treatment of the disease at this stage reduces the intensity of symptoms, and the exacerbation stage goes into remission.

Other types of chronic prostatitis

There is a concept calculous prostatitis. This disease is extremely rare and affects older men. It is characterized by the formation of stones consisting of prostatic juice, inflammatory effusion, as well as phosphates and calcium.

Signs of this type of disease are pain, which has a localization typical for prostatitis. They intensify with movement, after sexual intercourse. Blood appears in the ejaculate. There are other signs of inflammation of the gland.

Stones are a consequence of long-term prostatitis or adenoma.

Congestive prostatitis There are bacterial and non-bacterial. Its peculiarity is mild symptoms:

• low-grade fever;
• uncomfortable sensations in the groin;
• problems with urination;
• irritability;
• sexual disorders.

There are also such types of chronic prostatitis:

• autoimmune– develops with immune diseases, for example, rheumatoid arthritis, systemic lupus erythematosus;
• hormonal-dystrophic– appears due to hormonal imbalances, with hormonal diseases ( diabetes), as a result of physiological aging of the body;
• vegetovascular– formed against the background of vegetative-vascular dystonia. Causes problems with blood circulation.

How is the disease detected: diagnosis

Chronic prostatitis is diagnosed the same methods as acute.

First thing the doctor interviews and examines the patient. The examination is carried out using a digital rectal examination of the prostate. It may be enlarged, painful, asymmetrical and hardened. In rare cases (non-inflammatory CPPS) it is not changed.

Next doctor will order tests. Laboratory methods include a general blood and urine test and analysis of prostate secretions. They will show an increased white blood cell count. Bacteriological examination of urine and prostate juice reveals the pathogen. Sometimes these indicators may be normal, but the process is still present.

To confirm the fact of the disease, the blood is tested for PSA. Instrumental methods will also help: ultrasound, TRUS, urofluometry.

Very often it turns out that a man does not suspect that he has such a disease, ignoring the symptoms. It is detected by chance, during systematic examinations. Therefore, it is recommended not to disturb the system and not to neglect scheduled inspections.

Pharmacological treatment

First of all, for the treatment of chronic prostatitis antibiotics are prescribed. The course is long - 1-1.5 months. Before prescribing antibacterial agents, the type of pathogen and its sensitivity to the drugs are determined.

Necessarily use immunocorrective drugs, because reduced immunity is a common cause of inflammation. Help from an immunologist is possible.

Therapy for chronic inflammation of the prostate Can't do without anti-inflammatory drugs. To begin with, non-steroidal drugs are prescribed: Diclofenac, Ibuprofen, Meloxicam. They are used in the form of tablets or injections. If they fail to achieve the desired result, hormones are used: Prednisolone, Dexamethasone.

Alpha blockers will help relieve muscle tension from the bladder and perineum. They act symptomatically, reducing pain and improving urination.

If unbearable pain occurs, painkillers are relevant.

It’s worth mentioning separately about the use of such dosage form like candles. They are perfect for treating chronic prostatic processes. Most often, its symptoms are mild, and the mild action of suppositories is quite enough to relieve them.

They are inserted into the rectum. Its close location to the prostate gland allows you to quickly and effectively achieve results. In addition, the harmful effects of tablets on the gastrointestinal tract and difficulties with injections are eliminated. Suppositories have an anti-inflammatory and analgesic effect on the organ.

Physiotherapy and other methods

In addition to medications, other methods of treating chronic prostatitis are used:

• rectal prostate massage– carried out through the rectum. The procedure eliminates stagnation of prostate juice and also enhances the effect of medications. Contraindicated in case of exacerbation of the disease and in the presence of stones in the prostate;
• physiotherapy improves blood circulation in the affected organ and improves its nutrition. Methods used UHF, electrophoresis, darsonvalization and others. They are indicated only in the remission stage;
• Prostatitis involves not only the organs, but also the psyche of a man. He might need help from a psychologist or psychotherapist;
• acupuncture is a common method of treating chronic prostatitis. The procedure affects the organ indirectly, through acupuncture points;
• exercises, such as squats, walking, jumping will increase blood circulation in the pelvis and eliminate congestion;
• actively used balneotherapy– treatment with mineral waters.

Medications are an integral part of the treatment of chronic prostatitis. But they can cause a number of complications. And since the treatment of this type of disease is long-term, people have found ways to partially replace such drugs. Came to the rescue ethnoscience.

Leader among folk remedies treatments for prostatitis are pumpkin seeds. They contain a lot of zinc, which is essential for men's health. The seeds can be consumed separately: 30g will replenish the daily requirement of the essential microelement. You can also grind them in a meat grinder and mix with honey, making balls from the resulting mixture. They need to be stored in the refrigerator and consumed 1 piece before meals.

It is very useful for inflammation of the prostate to drink freshly squeezed juices of beets, carrots, cucumbers and asparagus. The volume per day should be at least 0.5 liters.

Blueberry Perfect for restoring the prostate gland. It contains a lot useful substances, microelements and vitamins.

In rare cases, in the treatment of prostatitis have to resort to surgery. Indications for it include the lack of improvement from conservative treatment, as well as acute processes: abscess and other purulent inflammation of the prostate, acute urinary retention, proliferation of glandular tissue, as well as benign and malignant formations.

Surgical treatment is carried out using several methods: This can be partial resection of an organ, opening of ulcers, excision of the foreskin or removal of the entire gland.

How to prevent the development of chronic prostatitis

Prevention of this disease can be primary or secondary.

Primary prevention is to prevent the occurrence of the disease, and comes down to the following measures:

• maintaining immunity;
• regularity of sexual activity;
• physical exercises and moderate loads. This is especially important for those who lead a sedentary lifestyle;
• avoid hypothermia;
• stopping infectious foci in the body;
• timely treatment of urogenital infections;
• be sure to undergo routine medical examinations;
• do not abuse alcohol and smoking.

Secondary prevention includes measures to prevent relapse of the disease. In the first year after suffering from prostatitis, a man is required to visit a urologist once every 3 months. Then – once every 6 months. If an exacerbation of the disease does not occur, the patient is removed from dispensary observation.

Excellent for the prevention of prostatitis sanatorium-resort treatment is suitable. Modern sanatoriums offer complexes of procedures from physiotherapy and balneotherapy, and other natural resources.

Important monitor your diet as well. Include more vegetables and fruits and a variety of cereals in the menu. You should also enrich your diet with fermented milk products. Eating seafood will compensate for the lack of zinc.

You should avoid salty, spicy and smoked foods, and do not overuse spices. Legumes, fatty food And flour products should be excluded.

Chronic prostatitis is a sluggish but long-term process. He is insidious with complications:

• cystitis, pyelonephritis - urolithiasis;
• vesiculitis - an inflammatory process in the seminal vesicles;
• epididymo-orchitis is an inflammatory process of the testicles;
• gland hypotrophy;
• infertility and impotence.

Treatment of the disease - quite a long process. But it’s worth following this path to the end in order to preserve your health and preserve the chance of having healthy offspring.

Due to inflammation, prostatitis is divided into two groups. The first group includes infectious prostatitis, which can be caused by various bacteria, viruses or fungal diseases.

The second group includes the so-called congestive prostatitis, which is caused by stagnation of fluid (secret) of the prostate gland and blood in the veins of this organ. The development of these symptoms is observed, for example, with irregular sexual activity. Venous congestion can occur with prolonged sedentary work in a sitting position (for example, drivers of motor vehicles, mental workers), when wearing tight underwear, and also with alcohol abuse.

Factors in the development of prostatitis

In addition, factors predisposing to the development of prostatitis are: a decrease in the body's defenses, hormonal disorders, untreated foci of infection, from which microbes penetrate the prostate gland and contribute to the development of inflammation.

The risk of prostatitis as a result of decreased immunity is higher in people who are often ill, against the background of nervous overload, chronic stress, smoking and alcohol. All these factors either facilitate the penetration of infection into the prostate gland, or lead to a deterioration in the blood supply to the pelvic organs, stagnant processes, which contributes to the proliferation of microorganisms and the development of the inflammatory process.

What happens?

Most often, prostatitis develops in a chronic form, over several years, without causing much concern. In this case, mild pain and discomfort may occur in the perineum, radiating to the sacrum, genitals or rectum. Periodically, frequent, painful, and sometimes difficult urination and slight discharge from the urethra are observed.

Unfortunately, most men at this stage do not pay attention to such symptoms, but in vain. The danger of chronic prostatitis is that its spread throughout urinary system can lead to the development of cystitis and pyelonephritis.

In addition, complications of prostatitis are vesiculitis - inflammation of the seminal vesicles, and orchiepididymitis - inflammation of the testicles and their appendages, and this can ultimately lead to male infertility. In addition, inflammatory processes in the prostate gland can subsequently cause the development of prostate adenoma or prostate cancer.

After some time, prostatitis causes erection problems. This is due to the involvement in the inflammatory process of the nerves responsible for erectile function that pass through the prostate gland.

Diagnosis and treatment

So, if you have at least one of the listed symptoms, do not hesitate, do not start the disease - go to a urologist or andrologist. The doctor will ask you to undergo an initial examination, which includes tests for sexually transmitted infections and an ultrasound of the pelvic organs and prostate gland, and will conduct a digital rectal examination of the prostate. There is no need to be afraid of him: an experienced doctor will not hurt you. This study is extremely informative. It allows you to clarify the diagnosis and severity of the disease. By feeling the gland (through the anus), the doctor not only finds out what happened to it, but also gets a sample of its secretion. Before starting treatment, a bacteriological culture of prostate secretion will be carried out in the laboratory to determine the sensitivity of your microflora to various antibacterial drugs. Without this, treatment will not be effective, and may lead not to getting rid of the disease, but to its transition to a new, more severe form.

Drug therapy for prostatitis is complemented by prostate massage, which reduces congestion, improves blood flow and evacuation of gland secretions. Unfortunately, modern medicine still cannot solve the problem of a final cure for prostatitis. The doctor is able to bring the disease to the remission stage (no symptoms) for two to three years. After which the treatment will have to be repeated.

Prevention

It is always much easier to prevent a disease than to cure it. Therefore, try to follow simple preventive measures that can protect you from all the “delights” of prostatitis. Refuse from fashion that forces you to constantly wear tight and tight swimming trunks. Loose cotton panties are much more hygienic and do not interfere with normal blood flow to the prostate.

In addition, avoid hypothermia, move more and, if it is not possible to have regular sexual relations, masturbate - according to doctors, this is both cleansing, self-massage, and the prevention of prostatitis.

If the situation with infectious (or rather, bacterial) prostatitis is more or less clear, then abacterial chronic prostatitis is still a serious urological problem with many unclear questions. Perhaps, under the guise of a disease called chronic prostatitis, a number of diseases are hidden and pathological conditions, characterized by various organic changes in tissue and functional disorders of not only the prostate, organs of the male reproductive system and lower urinary tract, but also other organs and systems in general.

The lack of a uniform definition of chronic prostatitis negatively affects the effectiveness of diagnosis and treatment of this disease.

According to the definition of the US National Institutes of Health, the diagnosis of chronic prostatitis involves the presence of pain (discomfort) in the pelvic area, perineum and organs genitourinary system for at least 3 months. In this case, dysuria, as well as bacterial flora in the prostate secretion, may be absent.

Basic objective sign chronic prostatitis - the presence of an inflammatory process in the prostate, confirmed by histological examination of prostate tissue (obtained as a result of puncture biopsy or surgery), and/or microbiological examination of prostate secretion; or characteristic changes in the prostate detected by ultrasound, symptoms of urination problems.

ICD-10 codes

• N41.1 Chronic prostatitis.
• N41.8 Other inflammatory diseases of the prostate gland.
• N41.9 Inflammatory disease of the prostate gland, unspecified.

ICD-10 code

N41.1 Chronic prostatitis

Epidemiology of chronic prostatitis

Chronic prostatitis ranks first in prevalence among inflammatory diseases of the male reproductive system and one of the first among male diseases in general. This is the most common urological disease in men under 50 years of age. Average age patients suffering from chronic inflammatory process in the prostate - 43 years. By the age of 80, up to 30% of men suffer from chronic or acute prostatitis.

The prevalence of chronic prostatitis in the general population is 9%. In Russia, chronic prostatitis, according to the most approximate estimates, in 35% of cases causes men of working age to consult a urologist. In 7-36% of patients it is complicated by vesiculitis, epididymitis, urination disorders, reproductive and sexual functions.

What causes chronic prostatitis?

Modern medical science considers chronic prostatitis as a polyetiological disease. The occurrence and recurrence of chronic prostatitis, in addition to the action of infectious factors, is caused by neurovegetative and hemodynamic disorders, which are accompanied by a weakening of local and general immunity, autoimmune (exposure to endogenous immunomodulators - cytokines and leukotrienes), hormonal, chemical (reflux of urine into the prostatic ducts) and biochemical (possible the role of citrates) processes, as well as aberrations of peptide growth factors. Risk factors for the development of chronic prostatitis include:

• lifestyle features that cause infection of the genitourinary system (promiscuous sexual intercourse without protection and personal hygiene, the presence of an inflammatory process and/or infections of the urinary and genital organs in a sexual partner):
• carrying out transurethral manipulations (including TURP of the prostate) without prophylactic antibiotic therapy:
• presence of an indwelling urethral catheter:
• chronic hypothermia;
• sedentary lifestyle;
• irregular sex life.

Among the etiopathogenetic risk factors for chronic prostatitis, immunological disorders are important, in particular imbalance between various immunocompetent factors. First of all, this applies to cytokines - low-molecular compounds of a polypeptide nature that are synthesized by lymphoid and non-lymphoid cells and have a direct effect on the functional activity of immunocompetent cells.

Great importance is attached to intraprostatic urinary reflux as one of the main factors in the development of so-called chemical non-bacterial prostatitis.

The development of functional diagnostics has made it possible to further study the activity of the nervous system and diagnose neurogenic disorders of the pelvic organs and prostate. This primarily applies to the pelvic floor muscles and smooth muscle elements of the wall of the bladder, urethra and prostate. Neurogenic dysfunction of the pelvic floor muscles is considered one of the main causes of the non-inflammatory form of chronic abacterial prostatitis.

Chronic pelvic pain syndrome may also be associated with the formation of myofascial trigger points located at the sites of muscle attachment to the bones and fascia of the pelvis. Impact on these trigger points, located in close proximity to the organs of the genitourinary system, causes pain radiating to the suprapubic region, perineum and other areas of projection of the genital organs. As a rule, these points are formed during diseases, injuries and surgical interventions on the pelvic organs.

Symptoms of chronic prostatitis

Symptoms of chronic prostatitis are: pain or discomfort, urinary problems and sexual dysfunction. The main symptom of chronic prostatitis is pain or discomfort in the pelvic area, which lasts 3 months. and more. The most common location of pain is the perineum, but a feeling of discomfort can occur in the suprapubic, groin areas, anus and other areas of the pelvis, on the inner thighs, as well as in the scrotum and lumbosacral region. Unilateral testicular pain is usually not a sign of prostatitis. Pain during and after ejaculation is most specific for chronic prostatitis.

Sexual function is impaired, including suppressed libido and deterioration in the quality of spontaneous and/or adequate erections, although most patients do not develop severe impotence. Chronic prostatitis is one of the causes of premature ejaculation (PE), but late stages diseases ejaculation may be slow. There may be a change (“erasing”) of the emotional coloring of orgasm.

Urinary disorders are more often manifested by irritative symptoms, less often by symptoms of IVO.

In case of chronic prostatitis, quantitative and qualitative disorders of the ejaculate can also be detected, which are rarely the cause of infertility.

The disease chronic prostatitis has a wavy nature, periodically intensifying and weakening. In general, the symptoms of chronic prostatitis correspond to the stages of the inflammatory process.

The exudative stage is characterized by pain in the scrotum, in the groin and suprapubic areas, frequent urination and discomfort at the end of urination, accelerated ejaculation, pain at the end or after ejaculation, increased and painful erections.

In the alternative stage, the patient may experience pain (unpleasant sensations) in the suprapubic region, less commonly in the scrotum, groin area and sacrum. Urination, as a rule, is not impaired (or increased). Against the background of accelerated, painless ejaculation, a normal erection is observed.

The proliferative stage of the inflammatory process can be manifested by a weakening of the intensity of the urine stream and increased urination (with exacerbations of the inflammatory process). Ejaculation at this stage is not impaired or slightly slowed down, the intensity of adequate erections is normal or moderately reduced.

At the stage of scar changes and sclerosis of the prostate, patients are worried about heaviness in the suprapubic region, in the sacrum, frequent urination day and night (total pollakiuria), a sluggish, intermittent stream of urine and an imperative urge to urinate. Ejaculation is slowed down (even to the point of absence), adequate and sometimes spontaneous erections are weakened. Often at this stage, attention is drawn to the “erasing” of the orgasm.

Of course, the strict staging of the inflammatory process and compliance with it clinical symptoms do not always appear and not in all patients, as well as the variety of symptoms of chronic prostatitis. More often, the presence of one, or less often two, symptoms inherent in different groups is observed, for example, pain in the perineum and frequent urination or imperative urge with accelerated ejaculation.

The impact of chronic prostatitis on the quality of life, according to the unified quality of life assessment scale, is comparable to the impact of myocardial infarction. angina or Crohn's disease.

Classification of chronic prostatitis

There is still no unified classification of chronic prostatitis. The classification of prostatitis proposed in 1995 by the US National Institutes of Health is considered the most convenient for use.

• Type I - acute bacterial prostatitis.
• Type II - chronic bacterial prostatitis, found in 5-1 cases.
• Type III - chronic abacterial prostatitis (chronic pelvic pain syndrome), diagnosed in 90% of cases;
• Type IIIA (inflammatory form) - with an increase in the number of leukocytes in the prostate secretion (more than 60% of the total number of chronic prostatitis;
• Type IIIB (non-inflammatory form) - without increasing the number of leukocytes in the prostate secretion (about 30%);
• Type IV - asymptomatic inflammation of the prostate, detected accidentally during examination for other diseases based on the results of analysis of prostate secretions or its biopsy (histological prostatitis). The frequency of this form of the disease is unknown.

Diagnosis of chronic prostatitis

Diagnosis of manifesting chronic prostatitis is not difficult and is based on the classic triad of symptoms. Considering that the disease is often asymptomatic, it is necessary to use a complex of physical, laboratory and instrumental methods, including determining the state of the immune and neurological status.

When assessing the subjective manifestations of the disease great importance has a survey. Many questionnaires have been developed that are filled out by the patient and that the doctor wants to get an idea of ​​the frequency and intensity of pain, urination disorders and sexual disorders, the patient’s attitude to these clinical manifestations of chronic prostatitis, as well as assess the state of the patient’s psycho-emotional sphere. The most popular currently is the Chronic Prostatitis Symptom Scale (NIH-CPS) questionnaire. The questionnaire was developed by the US National Institutes of Health; it represents an effective tool for identifying the symptoms of chronic prostatitis and determining its impact on the quality of life.

Laboratory diagnosis of chronic prostatitis

It is the laboratory diagnosis of chronic prostatitis that makes it possible to diagnose “chronic prostatitis” (since in 1961, Farman and McDonald established the “gold standard” in the diagnosis of prostate inflammation - 10-15 leukocytes in the field of view) and make a differential diagnosis between its bacterial and nonbacterial forms.

Laboratory diagnostics can also identify possible infection of the prostate with atypical, nonspecific bacterial and fungal flora, as well as viruses. Chronic prostatitis is diagnosed if prostate secretions or 4 urine samples (3-4 glass samples suggested by Meares and Stamey in 1968) contain bacteria or more than 10 leukocytes per field of view. If there is no bacterial growth in the prostate secretion with an increased number of leukocytes, it is necessary to conduct testing for chlamydia and other STIs.

A microscopic examination of the discharged urethra determines the number of leukocytes, mucus, epithelium, as well as trichomonas, gonococci and nonspecific flora.

When examining a scraping of the urethral mucosa using the PCR method, the presence of microorganisms that cause sexually transmitted diseases is determined.

Microscopic examination of prostate secretion determines the number of leukocytes, lecithin grains, amyloid bodies, Trousseau-Lallement bodies and macrophages.

A bacteriological study of prostate secretion or urine obtained after its massage is carried out. Based on the results of these studies, the nature of the disease is determined (bacterial or abacterial prostatitis). Prostatitis can cause an increase in PSA concentration. Blood sampling to determine serum PSA concentration should be carried out no earlier than 10 days after digital rectal examination. Despite this fact, when the PSA concentration is above 4.0 ng/ml, the use of additional diagnostic methods, including prostate biopsy, is indicated to exclude prostate cancer.

Of great importance in the laboratory diagnosis of chronic prostatitis is the study of the immune status (state of humoral and cellular immunity) and the level of nonspecific antibodies (IgA, IgG and IgM) in the prostate secretion. Immunological research helps determine the stage of the process and monitor the effectiveness of treatment.

Instrumental diagnosis of chronic prostatitis

Differential diagnosis of chronic prostatitis

Establishing the nature of the dominant pathological process in the prostate is especially important, since under the “mask” of chronic prostatitis various disorders of the trophism, innervation, contractile, secretory and other functions of this organ manifest themselves. Some of them can be attributed to manifestations of abacterial prostatitis, for example its atonic form.

Chronic abacterial prostatitis should also be differentiated:

• with psychoneurological disorders - depression, neurogenic bladder dysfunction (including detrusor-sphincter dyssynergia), pseudodyssynergia, reflex sympathetic dystrophy;
• with inflammatory diseases of other organs - interstitial cystitis, osteitis of the symphysis pubis;
• with sexual dysfunction;
• with other causes of dysuria - bladder neck hypertrophy, symptomatic prostate adenoma, urethral stricture and urolithiasis;
• with diseases of the rectum.

Treatment of chronic prostatitis

Treatment of chronic prostatitis, like any chronic disease, should be carried out in compliance with the principles of consistency and an integrated approach. First of all, it is necessary to change the patient’s lifestyle, his thinking and psychology. By eliminating the influence of many harmful factors, such as physical inactivity, alcohol, chronic hypothermia and others. By doing so, we not only stop further progression of the disease, but also promote recovery. This, as well as normalization of sex life, diet and much more, is a preparatory stage in treatment. This is followed by the main, basic course, which involves the use of various medications. This step-by-step approach to treating the disease allows you to monitor its effectiveness at each stage, making the necessary changes, and also fight the disease according to the same principle by which it developed. - from predisposing factors to producing ones.

Indications for hospitalization

Chronic prostatitis, as a rule, does not require hospitalization. In severe cases of persistent chronic prostatitis, complex therapy carried out in a hospital is more effective than treatment on an outpatient basis.

Drug treatment of chronic prostatitis

It is necessary to simultaneously use several medications and methods that act on different parts of pathogenesis in order to eliminate the infectious factor, normalize blood circulation in the pelvic organs (including improving microcirculation in the prostate), adequate drainage of prostatic acini, especially in the peripheral zones, normalize the level of essential hormones and immune reactions. Based on this, antibacterial and anticholinergic drugs, immunomodulators, NSAIDs, angioprotectors and vasodilators, as well as prostate massage can be recommended for use in chronic prostatitis. In recent years, treatment of chronic prostatitis has been carried out using drugs that were not previously used for this purpose: alpha1-blockers (terazosin), 5-a-reductase inhibitors (finasteride), cytokine inhibitors, immunosuppressants (cyclosporine), drugs affecting urate metabolism ( allopurinol) and citrates.

The basis for the treatment of chronic prostatitis caused by infectious agents. - antibacterial treatment of chronic prostatitis, carried out taking into account the sensitivity of a particular pathogen to a particular drug. The effectiveness of antibacterial therapy has not been proven for all types of prostatitis. In chronic bacterial prostatitis, antibacterial treatment of chronic prostatitis is effective and leads to the elimination of the pathogen in 90% of cases, provided that drugs are selected taking into account the sensitivity of microorganisms to them, as well as the properties of the drugs themselves. It is necessary to choose the correct daily dose, frequency of administration and duration of treatment.

For chronic abacterial prostatitis and inflammatory syndrome of chronic pelvic pain (in the case when the pathogen was not identified as a result of the use of microscopic, bacteriological and immune diagnostic methods) short course Empirical antibacterial treatment of chronic prostatitis can be carried out and, if clinically effective, continued. The effectiveness of empirical antimicrobial therapy in both patients with bacterial and abacterial prostatitis is about 40%. This indicates the undetectability of the bacterial flora or the positive role of other microbial agents (chlamydia, mycoplasmas, ureaplasmas, fungal flora, Trichomonas, viruses) in the development of the infectious inflammatory process, which is currently not confirmed. Flora that is not detected by standard microscopic or bacteriological examination of prostate secretions can, in some cases, be detected by histological examination of prostate biopsies or other subtle methods.

In non-inflammatory chronic pelvic pain syndrome and asymptomatic chronic prostatitis, the need for antibacterial therapy is controversial. The duration of antibacterial therapy should be no more than 2-4 weeks, after which, if the results are positive, it continues for up to 4-6 weeks. If there is no effect, it is possible to discontinue antibiotics and prescribe drugs of other groups (for example, alpha1-blockers, plant extracts of Serenoa repens).

The drugs of choice for empirical treatment of chronic prostatitis are fluoroquinolones, since they have high bioavailability and penetrate well into the gland tissue (the concentration of some of them in the secretion exceeds that in the blood serum). Another advantage of drugs in this group is their activity against most gram-negative microorganisms, as well as chlamydia and ureaplasma. The results of treatment of chronic prostatitis do not depend on the use of any specific drug from the group of fluoroquinolones.

For chronic prostatitis, the following are most often used:

• norfloxacin at a dose of 400 mg 2 times a day for 10-14 days;
• pefloxacin at a dose of 400 mg 2 times a day for 10-14 days;
• ciprofloxacin at a dose of 250-500 mg 2 times a day for 14-28 days.

If fluoroquinolones are ineffective, combination antibacterial therapy should be prescribed: amoxicillin + clavulanic acid and clindamycin. Tetracyclines (doxycycline) have not lost their importance, especially when a chlamydial infection is suspected.

Recent studies have proven that clarithromycin penetrates well into prostate tissue and is effective against intracellular pathogens of chronic prostatitis, including ureaplasma and chlamydia.

If relapses occur, the previous course of antibacterial drugs in lower single and daily doses may be prescribed. The ineffectiveness of antibacterial therapy is usually due to the wrong choice of drug, its dosage and frequency, or the presence of bacteria that persist in the ducts, acini or calcifications and are covered with a protective extracellular membrane.

Considering the important role of intraprostatic reflux in the pathogenesis of chronic abacterial prostatitis, if obstructive and irritative symptoms of the disease persist after antibiotic therapy (and sometimes together with it), α-blockers are indicated. Their use is due to the fact that in humans up to 50% of intraurethral pressure is maintained due to stimulation of α1-adrenergic receptors. The contractile function of the prostate is also under the control of α1-adrenergic receptors, which are localized mainly in the stromal elements of the gland. Alpha-blockers reduce increased intraurethral pressure and relax the bladder neck and smooth muscles of the prostate, and reduce detrusor tone. A positive effect occurs in 48-80% of cases, regardless of the use of a specific drug from the group of α-blockers.

The following α-blockers are used:

• tamsulosin - 0.2 mg/day,
• terazosin - 1 mg/day, increasing the dose to 20 mg/day;
• alfuzosin - 2.5 mg 1-2 times a day.

At the end of the 90s the first scientific publications about the use of finasteride for prostatodynia. The action of this drug is based on suppressing the activity of the enzyme 5-a-reductase, which converts testosterone into its prostatic form, 5-a-dihydrotestosterone. the activity of which in prostate cells is 5 times or more higher than the activity of testosterone. Androgens play a major role in age-related activation of the proliferation of stromal and epithelial components and other processes leading to prostate enlargement. The use of finasteride leads to atrophy of stromal tissue (after 3 months) and glandular tissue (after 6 months of taking the drug), and the volume of the latter in the prostate decreases by approximately 50%. The epithelial-stromal ratio in the transition zone also decreases. Accordingly, the secretory function is also inhibited. The studies have confirmed a decrease in the severity of pain and irritative symptoms in chronic abacterial prostatitis and chronic pelvic pain syndrome. The positive effect of finasteride may be due to a decrease in prostate volume. accompanied by a decrease in the severity of edema of the interstitial tissue, a decrease in the tension of the gland and, accordingly, a decrease in pressure on its capsule.

Pain and irritative symptoms are indications for the prescription of NPS, which are used both in complex therapy, and also as an alpha-blocker alone if antibacterial therapy is ineffective (diclofenac dose 50-100 mg/day).

Some studies demonstrate the effectiveness of herbal medicine, but this information has not been confirmed by multicenter placebo-controlled studies.

In our country, medicines based on Serenoa repens (Sabal palm) are most widely used. According to modern data, the effectiveness of these drugs is ensured by the presence of phytosterols in their composition, which have a complex anti-inflammatory effect on the inflammatory process in the prostate. This effect of Serenoa repens is due to the ability of the extract to suppress the synthesis of inflammatory mediators (prostaglandins and leukotrienes) by inhibiting phospholipase A2, which is actively involved in the conversion of membrane phospholipids into arachidonic acid, as well as inhibition of cyclooxygenase (responsible for the formation of prostaglandins) and lipoxygenase (responsible for the formation of leukotrienes). In addition, Serenoa repens preparations have a pronounced anti-edematous effect. The recommended duration of treatment for chronic prostatitis with drugs based on Serenoa repens extract is at least 3 months.

If the clinical symptoms of the disease (pain, dysuria) persist after the use of antibiotics, α-blockers and NSAIDs, subsequent treatment should be aimed at either relieving pain, or solving problems with urination, or correcting both of the above symptoms.

For pain, tricyclic antidepressants have an analgesic effect due to blocking histamine H1 receptors and anticholinesterase action. The most commonly prescribed drugs are amitriptyline and imipramine. However, they must be taken with caution. Side effects- drowsiness, dry mouth. In extremely rare cases, narcotic analgesics (tramadol and other drugs) can be used to relieve pain.

If dysuria predominates in the clinical picture of the disease, an ultrasonography (UFM) should be performed before starting drug therapy, and, if possible, a video urodynamic study. Further treatment is prescribed depending on the results obtained. In case of increased sensitivity (hyperactivity) of the bladder neck, treatment is carried out as for interstitial cystitis, they prescribe amitriptyline, antihistamines, and instillation of antiseptic solutions into the bladder. For detrusor hyperreflexia, anticholinesterase drugs are prescribed. For hypertonicity of the external sphincter of the bladder, benzodiazepines (for example, diazepam) are prescribed, and if drug therapy is ineffective, physiotherapy (spasm relief), neuromodulation (for example, sacral stimulation).

Based on the neuromuscular theory of the etiopathogenesis of chronic abacterial prostatitis, antispasmodics and muscle relaxants can be prescribed.

In recent years, based on the theory of the participation of cytokines in the development of a chronic inflammatory process, the possibility of using cytokine inhibitors, such as monoclonal antibodies to tumor necrosis factor (infliximab), leukotriene inhibitors (zafirlukast, which belongs to a new class of NSAIDs) and tumor necrosis factor.

Non-drug treatment of chronic prostatitis

Currently, great importance is attached to the local use of physical methods, which make it possible not to exceed the average therapeutic dose of antibacterial drugs due to stimulation of microcirculation and, as a consequence, increased accumulation of drugs in the prostate.

Most effective physical methods treatment of chronic prostatitis:

• transrectal microwave hyperthermia;
• physiotherapy (laser therapy, mud therapy, phono- and electrophoresis).

Depending on the nature of changes in the prostate tissue, the presence or absence of congestive and proliferative changes, as well as concomitant prostate adenoma, various temperature conditions microwave hyperthermia. At a temperature of 39-40 "The main effects of electromagnetic radiation of the microwave range, in addition to the above, are anticongestive and bacteriostatic effects, as well as activation of the cellular immune system. At a temperature of 40-45 ° C, sclerosing and neuroanalgesic effects prevail, and the analgesic effect is due to the inhibition of sensory nerves endings.

Low-energy magnetic laser therapy has an effect on the prostate that is close to microwave hyperthermia at 39-40 ° C, i.e. stimulates microcirculation, has an anticogestive effect, promotes the accumulation of drugs in prostate tissue and activation of the cellular immune system. In addition, laser therapy has a biostimulating effect. This method is most effective when congestive-infiltrative changes in the organs of the reproductive system predominate and is therefore used for the treatment of acute and chronic prostatovesiculitis and epididymo-orchitis. In the absence of contraindications (prostate stones, adenoma), prostate massage has not lost its therapeutic value. Sanatorium-resort treatment and rational psychotherapy are successfully used in the treatment of chronic prostatitis.

Surgical treatment of chronic prostatitis

Despite its prevalence and known difficulties in diagnosis and treatment, chronic prostatitis is not considered a life-threatening disease. This is proven by cases of long-term and often ineffective therapy, turning the treatment process into a purely commercial enterprise with minimal risk to the patient’s life. A much more serious danger is posed by its complications, which not only disrupt the process of urination and negatively affect the reproductive function of men, but also lead to serious anatomical and functional changes in the bladder - sclerosis of the prostate and bladder neck.

Unfortunately, these complications often occur in young and middle-aged patients. That is why the use of transurethral electrosurgery (as a minimally invasive operation) is becoming increasingly important. In case of severe organic BOO, caused by sclerosis of the bladder neck and sclerosis of the prostate, transurethral incision is performed at 5, 7 and 12 o'clock of the conventional dial, or economical electrical resection of the prostate is performed. In cases where the outcome of chronic prostatitis is prostate sclerosis with severe symptoms that are not amenable to conservative therapy. perform the most radical transurethral electroresection of the prostate. Transurethral electroresection of the prostate can also be used for common calculous prostatitis. Calcifications. localized in the central and transient zones, they disrupt tissue trophism and increase congestion in isolated groups of acini, leading to the development of pain that is difficult to treat conservatively. In such cases, electrical resection must be carried out until the calcifications are removed as completely as possible. In some clinics, TRUS is used to monitor the resection of calcifications in such patients.

Another indication for endoscopic surgery is sclerosis of the seminal tubercle, accompanied by occlusion of the ejaculatory and excretory ducts of the prostate. Such patients, as a rule, go to the doctor with complaints of a sexual nature: pallor of the emotional coloring of orgasm, up to a complete absence of sensations, pain during ejaculation, or absence of sperm (anejaculatory syndrome). Impaired patency of the prostate drainage tract makes it difficult to evacuate prostatic secretions, causing it to stagnate in the acini and thereby impairing not only the secretory function of the gland (production of citric acid, zinc, lytic enzymes and other substances), but also the barrier function. As a result, the synthesis of humoral and cellular defense factors decreases, which affects the state of local immunity. In these cases, in order to restore the patency of the vas deferens and prostatic ducts, one of the options is to perform resection of the seminal tubercle, incision of the ejaculatory ducts and seminal vesicles.

Another problem is the diagnosis and treatment of chronic prostatitis in patients with prostate adenoma undergoing surgery. The course of prostate adenoma is complicated by chronic prostatitis of varying severity in 55.5-73% of patients. Of this entire group of patients, only 18-45% of patients are diagnosed with chronic prostatitis at the pre-hospital stage during outpatient examinations, and another 10-17% - in the hospital as part of a routine preoperative examination. The remaining patients are operated on with previously undiagnosed chronic prostatitis, often in the acute stage, with pronounced inflammatory changes in the parenchyma and acini, which become surgical findings.

Often, during transurethral electroresection of the prostate, the release of contents from the prostatic ducts and sinuses opened during resection is noted, which can have either a thick, viscous consistency (with a purulent process in the prostate) and be released like a “paste from a tube”, or liquid-serous-purulent . And this despite the fact that any transurethral endoscopic manipulations during exacerbation of chronic inflammatory processes in the male organs reproductive system contraindicated due to the risk of developing secondary sclerosis of the prostate and bladder neck in the postoperative period, as well as stricture of the posterior part of the urethra. Solving this problem is complicated by the difficulty of obtaining objective laboratory and instrumental data confirming complete sanitation of the prostate after treatment. In other words, it is not enough to detect the presence of prostate inflammation in the preoperative period; it is also necessary to prove the effectiveness of the subsequent antibacterial and anti-inflammatory therapy, which can be somewhat more difficult to do.

If an exacerbation of a chronic inflammatory process (purulent or serous-purulent discharge from the prostatic sinuses) is diagnosed during transurethral intervention, the operation must be completed by removing the entire remaining gland. The prostate is removed by electroresection, followed by pinpoint coagulation of bleeding vessels with a ball electrode and installation of a trocar cystostomy to reduce intravesical pressure and prevent resorption of infected urine into the prostatic ducts.

It is important to know!

The results of a digital rectal examination (DRE) are the basis for drawing up a plan for further examination of a patient with suspected chronic prostatitis. The method is valuable not only for its simplicity and accessibility, but also for its fairly high information content.

Chr. prostatitis is one of the most pressing problems modern medicine; This ailment is one of the ten diseases for which men most often see a specialist. Despite the fact that inflammation of the prostate gland is not a deadly disease, it is fraught with a number of serious complications, such as sexual dysfunction in the form of impotence and decreased libido, as well as benign prostatic hyperplasia and even infertility.

Treatment of the disease is the prerogative of urologists, since in order to make a correct diagnosis in a timely manner and prescribe the correct therapy, certain knowledge and experience are required.

Causes of the disease

By and large, no man can be immune from the occurrence of chronic disease. prostatitis. The causes and mechanisms of its development are very diverse, but most often the basis of the pathology is a bacterial infection, with E. coli often acting as a microbial agent, and somewhat less frequently - Klebsiella, Pseudomonas aeruginosa, Enterobacter, Proteus, etc. Among the gram-positive pathogenic flora, staphylococci are distinguished, streptococci, sometimes enterococci.

Recently, there has been an increase in the number of patients in whom bacterial prostatitis is associated with pathogens such as chlamydia, mycoplasma, ureaplasma, gonococci, trichomonas, and tubercle bacilli.

If we talk about predisposing factors for the development of chronic disease. prostatitis, then here we can mention:

• previously suffered ARVI, influenza;
• hidden foci of chronic infection (tonsillitis, carious teeth, furunculosis);
• physical and mental stress;
• physical inactivity;
• frequent hypothermia;
• hypo- and vitamin deficiency;
• congenital or acquired immunodeficiency conditions;
• prostate injury;
• urinary system infections (urethritis, pyelonephritis, cystitis, orchitis);
• tight underwear;
• prolonged sexual abstinence or frequent interruption of sexual intercourse;
• stress.

Clinical picture

Symptoms of chronic Prostatitis is often hidden.

Patient complaints may include:

• frequent and/or difficulty urinating;
• sexual disorders (premature ejaculation, erectile dysfunction, decreased sexual sensations, infertility);
• pain and burning in the urethra, increasing during urination and sexual intercourse;
• hyperemia, swelling and itching of the glans penis;
• pain and discomfort in the perineal area;
• pain in the lower abdomen, lumbosacral region with irradiation to the rectum, external genitalia;
• psycho-emotional disorders (depression, apathy).

It is worth noting that in medicine there are atypical clinical forms of chronic disease. prostatitis. They are characterized by pain in places uncharacteristic of the classical variant of the disease, for example, testicles, rectum, lower limbs, lower back and sacrum, which is associated with the complex innervation of the man’s second heart.

Diagnostics

In order to correctly assess the condition of the prostate gland, the activity of the inflammatory process and the stage of the disease, and therefore prescribe adequate treatment, a wide range of diagnostic studies are used in urological practice.

Among the latter are:

• collecting anamnesis and identifying symptoms that bother the patient;
• transrectal digital examination, through which you can determine the size, structure and consistency of the organ, as well as the degree of its pain;
• laboratory analysis of prostate secretion;
• ultrasound scanning, which allows you to get a more accurate picture of the condition of the prostate, conduct differential diagnosis with neoplasms;
• bacterial culture of prostate secretion to identify pathogens, as well as to determine their sensitivity to antibiotics;
• establishing the concentration of prostate-specific antigen, which is necessary to exclude adenoma and organ cancer;
• biopsy with morphological analysis to determine the nature of the tumor process.

Treatment methods

Drug therapy

Treatment of chronic prostatitis requires an individual approach depending on the stage and form of the disease, as well as data from laboratory and instrumental examination methods.

The main areas of drug correction of the disease include:

• carrying out immunocorrective therapy under the control of an immunogram;
• eradication of pathogenic microbial flora using antibiotics;
• prescription of resolving therapy that eliminates cicatricial changes in the prostate gland and reduces pain;
• taking multivitamin complexes that normalize metabolic processes in the body.

Antibiotic therapy

Treatment of bacterial hr. prostatitis involves the use of antibiotics of certain groups that have high penetrating ability into prostate tissue. Among modern drugs, this indicator is maximum for fluoroquinolones, which are also characterized by pronounced bactericidal activity against most microorganisms that cause inflammation of the second heart of a man.

Tetracyclines (Doxycycline), Trimethoprim and macrolides have a slightly lower degree of penetration into prostate secretions and tissue. However, the latter are rarely used in chronic therapy. prostatitis, since they are ineffective against gram-negative pathogenic flora - the most common reason illness. However, in cases of inflammation of the prostate gland associated with specific microorganisms, such as chlamydia, ureaplasma and mycoplasma, treatment with a drug from this group, such as Azithromycin, can be very successful.

The duration of antibiotic use is prescribed by the attending physician. In uncomplicated cases, a ten-day course is sufficient. If necessary, the specialist can extend treatment to 2-3 weeks, and sometimes more, but only if the patient’s condition improves and the result of a microbiological study of prostate secretion is positive.

Alpha blockers

Drugs of this pharmacological group are used as antispasmodics to relax the prostate muscles, improve the outflow of prostate secretions and eliminate difficulty urinating.

Physiotherapy

In the complex treatment of the disease, various physiotherapeutic methods play an indispensable role. They are carried out with the aim of improving the transport of drugs to prostate tissues, stimulating trophic processes and eliminating inflammatory manifestations.

The most popular are low-energy laser therapy and microwave hyperthermia; To better deliver drugs to the prostate gland, ultrasonic phonophoresis, inductothermoelectrophoresis, etc. are used.

Spa treatment using mud baths, as well as enemas with hydrogen sulfide and mineral waters, has a beneficial effect on the course of the disease.

Massage

Prostate massage is used to improve the outflow of prostate secretions and stimulate regional hemodynamics, which speeds up the healing process of patients. True, there are a number of restrictions on its use, in particular acute inflammation or exacerbation of chronic disease. prostatitis, hemorrhoids, fissures, tumors and rectal polyps.

Phytotherapy

Treatment with medicinal herbs not only helps to increase the effectiveness of drug correction, but also to reduce the side effects of chemotherapy drugs.

You can choose from ready-made pharmaceutical products or independently prepared herbal mixtures from plants with bactericidal, anti-inflammatory, diuretic, immunomodulatory and antispasmodic effects, for example, birch leaves and buds, wintergreen, poplar buds, aspen bark, lingonberry, parsley root, St. John's wort, etc.

Surgical methods

Surgical treatment of the disease is carried out in exceptional cases. Indications for surgery are narrowing of the lumen of the urethra, urethral stricture, prostate abscess, various neoplasms, and the presence of stones.

Recently, during operations to remove stones and prostate adenoma, minimally invasive interventions are used, for example, transurethral resection of the organ.

Prevention

• prevention of infection with sexually transmitted infections (ureaplasma, chlamydia, gardnerella, gonococcus, some viruses, etc.);
• timely treatment of tonsillitis, pharyngitis, carious teeth, urogenital infections;
  full sexual life;
• refusal bad habits(smoking, alcohol abuse);
• balanced diet with limited spicy and salty foods;
• for men of sedentary professions - including morning exercises, feasible physical exercises, and walks in the fresh air in your schedule.

Conclusion

Do not forget that advanced stages of chronic disease. Prostatitis is difficult to correct, and therefore, the man’s health, his ability to work and his quality of life in general will largely depend on how timely the patient receives treatment and how carefully he follows the rules for preventing the recurrence of this disease.

Inflammation of the prostate gland, that is, the prostate, regardless of the cause of the disease, usually becomes chronic. In order for effective treatment of chronic prostatitis to be achieved, you need to know for what reasons it appears.

Good health, dear readers. Alexander Burusov is in touch, an expert at the Viva Men men's club, and we continue to understand the problem, its causes, symptoms and treatment options.

In this article we will try to figure out what is the best way to treat this terrible disease, what options are at our disposal. Let's start looking at the latest and greatest effective methods treatment of prostatitis in men.

Inflammatory diseases of the genitourinary system and rectum, due to close contact with the prostate gland, lead to the formation of an inflammatory focus in it. The vessels supplying the prostate are branches of the arteries of the bladder, rectum, posterior sacral artery, and deep femoral artery. Any infectious focus present in these organs can enter the gland.

The presence of a chronic infection of any location, for example, the paranasal sinuses, leads to a weakening of the immune system, and conditionally pathogenic microorganisms present on the skin, in the intestines, and urethra become pathogenic. This leads to the development of a chronic process.

Poor circulation of the prostate gland due to stagnation of blood against the background of reduced physical activity leads to a deterioration in the supply of drugs to the prostate gland and complicates the treatment of chronic prostatitis in men.

Increased blood flow to the organs located in the pelvis occurs not only due to low physical activity, but also from a number of factors:

• irregular sex life;
• interruption of sexual intercourse;
• smoking, drinking alcohol;
• varicose veins of the lower extremities;
• paraproctitis and proctitis;
• thrombophlebitis of hemorrhoidal veins against the background of chronic hemorrhoids;
• fissures and fistulas of the anus;
• the tone of the vascular wall is regulated by the sympathetic and parasympathetic nervous system, in which disease the flow and flow of blood from the organ is disrupted;
• perineal trauma in equestrians, cyclists, and motorcyclists.

With sexually transmitted urogenital infections, the disease cannot always be cured completely - this is the cause of the development of chronic prostatitis. The most common pathogens are:

• Trichomonas;
• mycoplasma;
• gonococci;
• gardnerella;
• ureaplasma;
• chlamydia;
• mushrooms;
• viruses;
• coli;
• streptococci;
• enterococci;
• staphylococci.

These microorganisms are difficult to cure.

After 40 years, a man’s hormonal activity gradually begins to fade away. At first it is asymptomatic.

A decrease in testosterone production over and over again leads to a slight stagnation of prostate secretion in its granules. Little by little this stagnation increases. Substances contained in prostate secretions are not completely removed. The secretory, motor, barrier function of prostate secretion begins to suffer.

Citric acid, found in prostatic juice, performs a bactericidal function and dilutes it. When citric acid stagnates, there is not enough citric acid, and a bacterial infection begins to develop. The level of citric acid in prostatic juice is directly related to the amount of testosterone in the blood.

Clinical picture of the disease

Symptoms of chronic prostatitis in men:

• sensations of discomfort, pain above the pubis;
• pain shoots periodically in the rectum and sacrum;
• increased frequency of urination and pain, especially after hypothermia or stress;
• uncharacteristic discharge;
• disorders of ejaculation, erection;
• premature ejaculation;
• increased sweating;
• sleep disturbance;
• periodic increase in body temperature no more than 37.2-37.3 0 C in the evening.

The treatment of chronic prostatitis in men depends on which symptoms predominate: pain, difficulty urinating or sexual dysfunction.

The main components of disease therapy

Is chronic prostatitis curable?

It is necessary to highlight the main areas of treatment:

• medicines;
• normalization of work and rest regimes;
• balanced diet;
• rejection of bad habits;
• physiotherapy, massage;
• folk remedies.

It is necessary to treat not only with medication, but also with the comprehensive use of all methods. It is impossible to give preference to any one direction of treatment for prostatitis.

Drug treatment

Effective treatment prostatitis should be aimed at eliminating the cause of prostatitis. Medicines are selected individually by a doctor after performing the necessary diagnostic tests. Let's figure it out how and how to treat prostatitis, if it has already acquired a chronic form. Main directions of drug therapy:

• antibiotics;
• anti-inflammatory drugs;
• antispasmodics to improve urine flow;
• uroantiseptics to eliminate urinary tract infections;
• drugs that improve arterial and venous blood flow;
• medications that improve fluidity, reduce blood viscosity;
• vitamins;
• enzymes;
• sedatives, psychotherapeutic effects;
• correction of immune disorders;
• treatment of metabolic diseases and hormonal dysfunction.

Antibacterial therapy

Whether chronic prostatitis can be cured will depend on well-chosen antibacterial therapy. It is important to note that therapy and treatment of prostatitis will be most effective only if the type and stage of the disease is correctly determined.

Antibiotics are selected that penetrate well into the prostate and effectively act on the causative agent of infection. Some causative agents of chronic prostatitis, for example ureaplasma, are not sensitive to such strong drugs as:

• tetracyclines;
• some cephalosporins;
• levofloxacin;
• clarithromycin.

How to treat chronic prostatitis with antibiotics?

Groups of antibacterial drugs used for treatment bacterial prostatitis:

1. Fluoroquinolones (normfloxacin, ofloxacin, ciprofloxacin, lomefloxacin).
2. Macrolides (erythromycin, azithromycin).
3. Tetracyclines (doxycycline, metacycline).
4. 5-nitroimidazole derivatives (metronidazole, tinidazole).
5. Cephalosporins 3-5 generations.
6. Lincosamines (Clindamycin).
7. Sulfonamides.

The course of treatment with one antibiotic is 7-10 days, depending on the test results. During treatment with antibacterial agents, it is mandatory to prescribe antifungal drugs and agents that normalize the microflora of the gastrointestinal tract.

In total, the course of antibacterial therapy takes from 2 to 4 weeks.

Routes of administration of antibiotics:

• orally in tablets;
• intramuscularly;
• intravenously;
• inside the prostate;
• endolymphatic.

The doctor will tell you what to treat and what specific antibiotic to use, based on the examination data:

• general blood analysis;
• examination of prostate secretions;
• TRUSY;
• uroflowmetry.

Nonsteroidal anti-inflammatory drugs

The effect of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with the normalization of the permeability of the vascular wall and the restoration of microcirculation. They reduce the formation and prevent existing inflammatory mediators from being absorbed. We must remember the property of NSAIDs to form ulcers in the stomach and duodenum.

How to cure chronic prostatitis without developing a stomach ulcer? It is necessary to take 1 capsule of omez or omeprazole in the evening for preventive purposes.

It is considered most rational to use rectal suppositories with NPS, for example indomethacin.

Immunomodulators

To correct immune disorders, the following drugs are used:

• metaluracil;
• taktivin;
• imunofan;
• levomisol;
• immunofan.

Drugs are prescribed by a doctor, dosages are selected individually.

Nonspecific resistance of the body is normalized by vitamins and microelements.

Enzymes

Enzyme preparations improve access of antibiotics and NSAIDs to the prostate, destroying adhesions that are always present in a chronic inflammatory process.

In addition, enzymes have a moderately pronounced function of stimulating immunity.

List of drugs:

• lidase;
• vitreous body;
• aloe.

To block adrenergic receptors in the tissues of the prostate, bladder, and urethra, the following are used:

• prazosin;
• alfuzosin:
• doxazosin;
• terazosin;
• tamsulosin.

How to treat chronic prostatitis with alpha-adrenergic receptor blockers?

These drugs are prescribed by a doctor for the purpose of:

1. Eliminate spasm from the neck of the bladder, which develops against the background of edema and inflammation.
2. Improve urine flow, normalize physiological urination.
3. Coordinate the work of the muscles and sphincters of the bladder.

Normalization of blood flow with drugs

Normal blood flow is achieved with an adequate diameter of the arteries, the veins that bring blood, and the outflow of oxygen-depleted blood. It is also necessary to reduce blood viscosity and achieve good fluidity in the capillary bed.

For this purpose, drugs of different groups are used:

• trental;
• Cavinton;
• rheopolyglucin;
• Detralex;
• troxerutin.

To achieve a good result in the treatment of chronic prostate diseases, it is necessary to treat inflammatory diseases of the urethra, bladder and kidneys. For this purpose, the following drugs are used:

• nitroxoline;
• phytolysin;
• canephron.

Prostatitis inevitably reduces potency, weakens libido, and impairs erection. These phenomena are always accompanied by symptoms of dysphoria, low mood, and mood swings. For these symptoms, it is prescribed sedatives, anxiolytics, antidepressants.

Physiotherapeutic methods of influence

The following methods of treating the chronic process are used to influence the prostate:

• ultrasound
• electrophoresis;
• baths with hot water with decoctions of chamomile, linden, sage, thyme;
• warm enemas
• massage of the prostate gland through the rectum;
• hirudotherapy
• inductothermy;
• microwave resonance therapy.

Physiotherapeutic treatment is contraindicated for concomitant prostate adenoma.

The severity of psychological abnormalities and depressive symptoms depends on how long chronic prostatitis is treated. To speed up the process of treatment, in the absence of contraindications, it is necessary to add physiotherapeutic methods of influence.

Standard recommendations for all chronic diseases in the form of avoiding fried, salted, peppered, and smoked foods are not sufficient in this situation. Effective treatment of prostatitis depends on a rational, balanced diet. It is necessary to add foods such as celery, ginger, turmeric, and api products to your food.

• silicon, which normalizes the formation of hormones in the body;
• B vitamins, remove toxins and restore redox processes;
• chromium, germanium, selenium, zinc normalize the functioning of the sympathetic and parasympathetic systems;
• vitamins C and A normalize the permeability of the cell membrane and have antioxidant properties;
• essential amino acids, omega 3, which rejuvenate sexual function.

For apitherapy used: natural honey, bee bread, dead fruit, royal jelly, dead bees, bee pollen.

Beekeeping products have the following effects:

• bactericidal;
• fungicidal;
• bacteriostatic;
• tonic;
• antiviral;
• immunomodulatory effect.

Traditional treatment

The course of treatment for chronic prostatitis must be supplemented with medicinal herbs, which must take into account all of the listed mechanisms for the development of the disease. Then the effect of therapy will be achieved in full.

The following medicinal herbs can be used:

• nettle, sage, bearberry;
• mint, plantain, hernia;
• rosehip, yarrow, wormwood;
• thyme, birch buds, linden flowers;
• marshweed, chamomile, motherwort.

The cure for chronic prostatitis depends on the long-term use of medicinal herbs according to a regimen in combination with anti-relapse courses of drug therapy.

Decoctions and infusions are used for oral administration, for baths, and for microenemas. Use tinctures, that is, alcohol-containing ones medicines Not recommended. This hinders the successful treatment of chronic urogenital diseases.

All of these drugs give a good effect in the treatment of prostatitis of inflammatory, congestive, hormonal etiology.

ATTENTION:

If you want to be guaranteed to cure chronic prostatitis and its complications in short time, get rid of vascular erectile dysfunction and prevent adenoma from developing, be sure to check out our comprehensive, effective at-home recovery program.

It takes approximately 20 minutes a day, and you will receive the first noticeable results within a few weeks. This program is the first program of its kind in the CIS, which has fully proven its effectiveness in the treatment of chronic prostatitis and vascular erectile dysfunction.

Sincerely, Alexander Burusov