Prostatitis

Prostatis is an inflammation of the prostate (organ of a person's gender and reproductive system) and the change as a result of this process of its physiological functions.

spread

According to various sources, prostatitis occurs in 35-40 %, and according to some authors, 70 % of men between the ages of 18 and 50.The representative gland in the prevalence of the disease and a number of problems that occur simultaneously takes up a foreground in urological pathology.

classification

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

category	Description
Category I	Acute bacterial prostatitis
Category II	Chronic bacterial prostatitis
Category III	Chronic abacterial prostatitis
Category IIIA	Inflammatory chronic pelvic pain syndrome
Category IIIB	Syndrome of non -inflammatory chronic pelvic pain (prostate)
Category IV	Sinimtomatic inflammatory prostatitis

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

Category I

Acute bacterial prostatitisIt is expressed by acute infectious inflammation of the prostate with all relatives:

• increased amount of leukocytes in the urine;
• the presence of bacteria in the urine;
• Frequent signs of infection (increase in body temperature, symptoms of poisoning).

Category II

Chronic bacterial prostatitis- It is accompanied by suitable symptoms and an increase in the number of leukocytes and bacteria in the secret of prostate, ejaculate and urine that were preserved according to the prostate massage.

Category III

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

Category III A

Inflammatory chronic pelvic pain syndrome- is characterized by the presence of pain and prostatitis symptoms, and an increased amount of leukocytes is found in the secretion of prostate, ejaculate and parts of the urine according to the prostate massage, pathogenic microorganisms are not demonstrated in these samples.

Category III B

Non -inflammatory syndrome of chronic pelvic pain- characterized by the presence of pain syndrome and symptoms of prostatitis, while the number of leukocytes does not increase and is not proven with standard methods of pathogenic microorganisms in the secret of prostate, ejaculation and urine according to prostate massage.

Category IV

Sinimtomatic inflammatory prostatitis- The lack of symptoms that are characteristic of prostatitis is demonstrated by the disease during a histological examination of prostate tissue samples, which were preserved in connection with the diagnosis for other reasons (e.g. a prostate biopsy, due to an increase in the level of a certain antigen - PSA).

Diagnosis of prostatitis

The symptoms of prostatitis are extremely different, but can be combined into several groups.

Pain syndrome

As a result of the inadequate blood supply due to inflammation or cramp of blood vessels that feed the prostate, the oxygen hunger of the glandular tissue is determined, according to which the BY products of the pathological oxidation are formed that influence the nerve end of the prostate.Since the prostate interior of the pelvic floor, the penis, testicle, the testicle, the testicle, the rectum is associated, the localization of pain is variable.The following pain symptoms are most common:

• Complaints or pain in the perineum - basically after physical exertion, sexual intercourse, alcohol in the form of passing attacks;
• Feeling of hot potatoes in the rectum;
• Pain (complaints) in testicles - patients are described as "pain", "twisting", are also associated with various provocative factors.
• Complaints, rubber and pain in the urethra are mainly connected to the shift of the PH value of the secret of the prostate on the acid side.The acidic secret of the prostate has an irritative effect on the mucous membrane of the urethra, so that pain occurs more often in the form of a "burning" after an act of urinating or sexual intercourse, when part of the secret is pressed into the lumens of the urethra when reducing the muscles of the glands and pelvis.

Urine disorders syndrome

Combined with the close innovation of the prostate and bladder as well as the participation of the prostate muscles in the urine.Dysuria can be accompanied by the following manifestations:

• Wide urination - frequent urination (up to three times an hour) with sharp and sudden calling (impossible to endure) and rather small parts;
• A feeling of incomplete emptying of the bladder - after urination, it is of the opinion that the urine has remained in the bladder;
• A weak or intermittent urine current - this can also be attributed to the symptom of the "last drop" - despite all the patient's efforts after urinating from the canal, a drop of urine is released.

Violation of ejaculation and orgasm

It is associated with damage to the prostatitis of the Samentuberkel (Colliculit) on the surface, the nerve receptors of which send the signal structures of the brain, whereby the feeling of orgasm forms.Prostatitis does not lead directly to an erection (blood supply to the penis during sexual excitement).

Main disorders:

• Early born ejaculation or vice versa overly boring sexual intercourse - caused by inflammation of the seed tuberel or its scars due to the inflammatory process;
• Eleased Orgasm - is also associated with the inflammation of the seed tuberkel;
• Pain during ejaculation - in connection with the inflammatory process in the output channels of the prostate, which released the sperm.

Violation of fertility

When changing the properties of the prostate due to inflammation, the following changes in the sperm are observed, which reduces the man's ability to fertilize fertility (fertility):

• A decrease in the pH value of sperm in the acidic side - since acidic products of the pathological oxidation accumulate in the secret with inflammation of the prostate.The acidic environment is extremely destructive for sperm, which causes your immobilization and even her death.
• The anglutination of sperm - spermatozoen mainly with heads adhesive - is associated with a change in the physical -chemical properties of secretions;
• Asthenospermia -a decrease in sperm mobility -is closely related to the shift of the pH on the acid side and the violation of the production of prostate lecit carts, which ensure the vital activity of spermatozoen.

Urethropostatitis

In some cases, prostatitis is combined with chronic urethritis, which manifests itself from the urethra by lean mucus -like anti -inflammatory discharge (mainly after a longer retention in the urine).

Prostatitis and sexual disorders

The question "Does prostatitis do impotence?"It has been the cause of the specialists' disputes for decades.

Under the influence of sexual stimuli with the full saturation of the body in the formations of the cortical and subcortical region of the brain, there is a nervous signal on the middle of an erection that is in the back murder of the back murder, where it is the smooth muscles of the formations of the caves of the penis, which is on the way of sinusus and sinusy)(Arterus) (arterus) (arterus) (arterus) (arterus) (arterus) (arterus) (arterus) (arterus) (arterus) (arterus) (arterus) (arteries) (arteries) (arteries) (arteries) (arteries) (arteries) (arteries) (arteries)(Arteries) () afes (arterus) () afes (arterus) afes, af (yes) Öafetandahannööh a one a one in this process there is no role in the prostate gland.

Ejaculation and orgasm occur with adequate irritation of special receptor cells that are in the area of the seed tuberkel in which the outlet channels of the prostate flows.

The inflammatory process in the prostate gland (prostatitis) can lead to the defeat of the seed tuberkel and as a result as violations of the effectiveness of a person that thus premature ejaculation and echo of orgasm.Impotence in chronic prostatitis is pathogenetically associated with the degree of damage to the nerve devices of the prostate gland.This form of impotence (neuroreceptor impotence) is a characteristic example of a re -streaked phenomenon if the presence of a pathological impulse with the organs affected by the inflammatory process leads to radiation of the excitation process, which controls the sexual function and to disturb the latter.A certain, although non -leading role, is played with the pathogenesis of the neuroreceptor impotence, also a certain suppression of androgenic activity of the testicles and sensitivity to the androgens of the centers of hypothalamus and the pituitary gland.

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

Diagnosis

The doctor's task is to identify the inflammatory process in the prostate, the identification of the possible illness of the disease and the evaluation of the impaired function of the prostate.In 1990 Stamey wrote that prostatitis was a "garbage basket for clinical ignorance" due to the variety of terms used, diagnosis and treatment methods.At the same time, several simple and clinical and laboratory tests enable the correct diagnosis so that you can start the appropriate therapy.

Putic Rectal Survey of the prostate gland

A very informative way. The inflammatory process can be assessed by the form, contours, dimensions of the gland, the presence of compression locations and (or), there is pain.The main signs of prostatitis: increase or decrease in size, heterogeneity of the consistency, the presence of compression and softening, misusity, pain.The fact that 80% of the pancreatic cancer is detected by a rectal study speaks for itself.We can certainly say that this research method is always used.

Microscopic examination of the secretion of the pancreas

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

Investigation of the secretion of the prostate gland

Expression prostate secrete-eps) Secret Studies enable you to determine the presence of an inflammatory process in the prostate and partly its functionality.It is the main method for diagnosing and monitoring the treatment of chronic prostatitis.The secret of the prostate can be examined using light microscopy without painting or with special color methods.In addition, the secret of the prostate gland of a bacteriological examination or examination using the method of polymerase chain reaction can be subjected to the detection of pathogens.Get a secret with the prostate massage.A secret released by the urethra is collected in a sterile test tube or in a clean object glass for research.Sometimes the secret of the prostate from the urethra does not follow.In such cases, the patient is recommended to get on his feet immediately.If it was still not possible to get a secret, it often means that it did not come into the urethra, but in the bladder.In this case, the centrifugat of the washing fluid, which is released from the bladder after the massage of the prostate gland.

• Lipoid grains (lecit body) -a specific product of the normal physiological secretion of the glandular epithelium of the prostate gland.A secret gives a milk look.Usually the secret is rich in lecitin grains.A decrease in their number together with an increase in the number of leukocytes shows an inflammatory process, a tumor;
• Amyloid body - layered (starchy), body that are colored with a lugollal solution in purple or blue like strength;
• The amyloid bodies are a condensed secret of the gland, has an oval shape and a layer structure that resembles a tree trunk.They are not normal, their proof shows a stagnation of the secret in the gland, which can be with adenomes, chronic inflammatory processes.
• Erythrocytes can be single.As a result of an energetic massage of the prostate, they fall into a secret.Their 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 a disability with protein and fat degeneration of epithelial cells.Macrophages can be seen with stagnation of a secret for a long time of the current inflammatory process;
• Bethera crystals are a daily crystals that is formed during cooling and drying the mixed secret of the male gonades (prostate juice with a sperm mixture) made of sperm and phosphorus -layer salt.With azoospermia and spicy oligozoospermia, Betthera -crystals form quickly and in large quantities;
• Redakteal syndrome - Stagnation syndrome is observed with glandularadenoma.There is an abundance of macrophages, there are multi -cells such as foreign bodies and amyloid body;
• The symptom of FARN is a symptom for the crystallization of a secret form of falling sodium chloride crystals dependent on the physical -chemical properties of prostate home.The symptom is examined by adding a drop of 0.9% sodium solution from chloride to the resulting secret of the prostate with further consideration after drying under a light microscope.In healthy men of reproductive age, the crystallization of prostate nuclear is characterized by a typical phenomenon of Farnblatt (3+).The androgenic failure or the presence of prostatitis results in different degrees of injury to the structure of crystals to their absence.

Bacteriological examinations of parts of the urine and the secretion of the pancreas

Urethra, including PCR diagnostics

Serological diagnosis of active ingredients (ELISA) that cause urinary tract infections

The reaction of the immune fluorescence (reef) is straight and indirect

Identification of antibodies against well -known antigens.

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

The American Foundation for urological diseases recommends the annual passage of a rectal overview of the prostate, accompanied by a PSA for all men over 50 and with prostate cancer for blood relationships in a male line.There is still a discussion about receiving a dog immediately after a finger examination of the prostate per rectum.Recent studies could not confirm the presence of a significant increase in the content of the PSA immediately after a finger examination.Thus, the PSA level can be determined with the preservation of reliable results and after the overview of the pancreas.

Four -Wall test

In order to diagnose chronic prostatitis, a 4-glass test was proposed based on a comparative bacteriological evaluation of the urine, which was roughly the same in terms of the part of the urine, which was obtained before and after the massage of the prostate gland.

The diagnosis of prostatitis with a ten-fold increase in the concentration of microorganisms in the secret of the prostate compared to their content in urine (1, 2 and 3 parts) and an increase in the number of polymorphic nuclear leukocytes> 10-16 in the area of the point of view of the light microscope (increase by 200 times).Or an increase in the number of leukocytes of more than 300 x 106/l when calculating them in the counting chamber.Lecit bodies that are a product of the normal secretion of the glandular epithelium of the prostate gland should cover the eyesight of the microscope (5-10 million in 1 ml).Amyloid bodies in the secret of the prostate are found in a significantly smaller amount.In men from the tire age, they can be found in the field of vision 1-2.

Biochemical blood test

Immunological and hormonal profile (according to indications).

Ultrasound, Trusie

Ultrasound diagnosis of prostatitis through the abdominal and transrectal sensor (trust).

Urofloometry

Treatment of prostatitis

A comprehensive treatment of patients with chronic prostatitis should include:

• Compliance with the general regime, nutrition, sexual sex hygiene as well as the attraction of sexual partners if an infectious agent is present;
• Selection of effective medication to suppress the infection;
• Increasing the patient's general reactivity and the immunobiological tolerance of microorganisms towards medication;
• Strengthening the drainage of secretion and activating local repair processes in focus;
• Sanitary facilities of infection varieties in the previous and remote organs;
• Improvement of microcirculation in the prostate and pelvic organs;
• the appointment of general strengthening of funds, enzymes and vitamins;
• Correction of hormonal disorders;
• the appointment of anti -spas modos;
• the appointment of analgesic and anti -inflammatory medication;
• Seastant and transforming medication;
• Regulation of neurotrophic disorders caused by local analysis media;

Prostate massage

Prostate massage- A medical procedure used for diagnosis and sometimes for the treatment of chronic prostatitis.The first massage of the prostate was described by Posner in 1893 and has been introduced to O'Conory's urological practice since 1936.According to the description of Meares and Stamey, a stage test for the diagnosis of prostatitis, the views on the causes of this disease changed and massaged views on the causes of this disease as a therapeutic procedure from the lists of measures in many guidelines for the treatment of prostatitis in the industrialized countries in the world.

From the mid-90s of the 20th century, many doctors who were involved in the diagnosis and treatment of prostatitis began inefficiency in some cases of proposed antibacterial therapy and the use of alpha blockers, which they used in the practice of this forgotten method to use this forgotten method.

In principle, the prostate massage is currently used as a diagnostic procedure for the preserving of a prostate crime hid (expressed prostate tapes episodes) for its microscopic (cultural) study and for the massage test (pre- and post massage test -PMT).Massage.Massage is a medicalProcess and must carry out it as a specialist trained.The massage takes place after urination and when redeeming from the urethra after preliminary washing with an isotonic solution of sodium chloride, which is particularly necessary in cases in which a bacteriological examination of the secret is assumed.The prostate massage is carried out by the anus because the prostate is located near the rectum amateum and only research is available.First massage one, then the other proportion of the prostate with the movements of the finger from the periphery to the central groove along the output channels and tried not to touch the seed bubbles.The massage is completed by pressing the area of the central furrow from above.A secret released by the urethra is collected in a sterile test tube or in a clean object glass for research.Sometimes the secret of the prostate from the urethra does not follow.In such cases, the patient is recommended to get up immediately if it was not possible to get the secret.This means that he was not in the urethra, but in the bladder.In this case, the centrifugat of the washing fluid, which is released from the bladder after the massage of the prostate gland.

The prostate massage for medical purposes (repeated massage) is officially recommended by the Russian Federation of the Russian Federation as a therapeutic process for chronic prostatitis.The prostate massage is often used to treat prostatitis in the countries of Southeast Asia, China and some European countries.Some Severmerican and Canadian urologists also recommend using massage in combination with antibiotic therapy in the treatment of some forms of prostatitis.Essentially, the evaluation of the effectiveness or inefficiency of the massage of the prostate was practically not carried out.There are several contradictory studies carried out by Egyptian doctors.There were no differences in groups of patients, some of whom were in combination with antibiotic therapy and simply antibiotic therapy in another massage carried out by American and phillipine researchers, on the contrary, on the contrary, in a group of prostatitis who received a combination of antibiotic therapy, there was no significant improvement.

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

In world literature there are only a few data on complications related to the prostate massage.In 1990 Japanese doctors described the genital organs (Fournier), and in 2003 the German doctors were permanent bleeding after a prostate massage with the development of embolical stroke (bleeding).There is a study in which the PSA level (prostate -specific antigen) is temporarily increasing after the massage of the PSA level.The massage is contraindicated in acute inflammation of the prostate (acute prostatitis) with acute urethritis, orchitis, prostate cancer.The massage is not recommended for prostate calculation and prostate -adenom.It is generally recommended to recommend the prostate massage 2 or 3 times a week.

Physiotherapeutic methods

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

The use of physiotherapeutic methods in the complex treatment of prostatitis aims to influence both the prostate gland of physical agents in order to normalize functional and pathological changes as well as the electrophoretic administration of medicinal products in the tissue of the prostate.

The use of physiotherapeutic methods against the background of drug therapy provides a much better result than in the treatment.The following methods for influencing the prostate are widespread and have proven their effectiveness:

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