Prostatitis in this category is rare, occurring in about 10% of all prostatitis. The question of whether atypical pathogens such as ureaplasma urealyticum can trigger prostatitis is debated. They can be present in a man's body without any signs of inflammation or complaints.
Causes of chronic prostatitis
The causes of chronic prostatitis are basically similar to the causes of acute bacterial prostatitis. Microorganisms enter the prostate in most cases through the urethra - as a result of urine reflux into the ducts of the prostate gland (intraprostatic urine reflux).
Chronic bacterial prostatitis develops as a result of inadequate treatment or short treatment of acute bacterial prostatitis.
Symptoms
- Discomfort or pain - in the perineum, lower abdomen, groin, scrotum, penis, during ejaculation
- Changes in urination - difficulty urinating, frequent urination in small amounts, a feeling of incomplete emptying of the bladder.
The patient may complain of several symptoms, or of any individual symptom. An increase in body temperature is not typical (or insignificant).
Important:
Many men associate erectile dysfunction with prostatitis. This is often facilitated by unprofessional publications in the media and the promotion of dubious drugs. The fact that the erection can be maintained even after the complete removal of the prostate (due to a malignant tumor of the organ) suggests that it itself does not play a role in maintaining the erection.
According to many respected urologists, erectile dysfunction in patients with chronic prostatitis is caused by psychogenic and neurotic problems.
Diagnostics
For the initial evaluation, we use the NIH-CPSI questionnaire - Chronic Prostatitis Symptom Index. It can be used to objectify the patient's complaints.
The standard method for diagnosing prostatitis is to perform a 4-cup Meares-Stamey test. This is a microscopic and bacteriological examination of urine samples obtained from different parts of the urogenital tract and prostate secretions. However, the 4-glass sample method is quite labor intensive, and currently modifications of Meares-Stamey samples are more commonly used: 3-glass or 2-glass samples. A possible alternative is to submit the ejaculate (sperm) for microscopic and bacteriological examination, since the ejaculate is partially (at least 1/3) prostate secretion. This method is more convenient for patients, especially if they categorically refuse rectal examination of the prostate gland or diagnostic massage to obtain prostatic secretions. However, ejaculate donation has lower information content and reliability than a 3- or 2-vial sample.
The submission of the ejaculate for bacteriological examination is included in the diagnostic algorithm for infections of the male genital organs and in the examination of male infertility.
The results of laboratory tests (general urine test, general blood test, biochemical blood test, spermogram and other general clinical tests) are not informative in the case of chronic prostatitis. Most likely, these tests will show "normal".
During the rectal examination, changes indicative of the inflammatory process of the prostate are not always observed in patients with chronic prostatitis. In other words, it is impossible to rely on the results of a rectal examination to diagnose chronic prostatitis.
The same is true for ultrasound diagnostics: it is incorrect to diagnose chronic prostatitis based on ultrasound data alone.The European and American Urological Association does not recommend ultrasound for the diagnosis of prostatitis. The type of execution in this case is not important - transabdominal (through the anterior abdominal wall - lower abdomen) or transrectal (TRUS - through the rectum). It is incorrect to write the words "chronic prostatitis", "ultrasound signs of chronic prostatitis", "signs of stagnant prostatitis" at the end of the ultrasound examination. Only a urologist has the right to make this diagnosis, who makes the diagnosis based on complaints, anamnesis, laboratory tests and - only after - ultrasound.
The most common ultrasound sign used to diagnose chronic prostatitis is the so-called diffuse changes in the prostate gland, which are associated with an inflammatory process or other changes in the prostate parenchyma. It is a type of fibrotic process, the replacement of normal prostate parenchyma with scar tissue. Howeverthere is no correlation between the number of fibrous changes in the prostate and the presence of complaints. With age, the chance of such "scars" appearing on the organ increases, but a person can live his whole life without feeling discomfort in the perineum or pubic area. However, as soon as these changes are detected on ultrasound, some "experts" diagnose prostatitis. And some men have the feeling that they are really seriously ill, they will start listening to themselves and will feel all the symptoms described on the Internet.
In many men over the age of 30, ultrasound can show diffuse changes in the prostate gland. However, the fibrotic process does not indicate the presence of prostatitis.
The diagnosis of chronic prostatitis is established based on the exclusion of other diseases of the urogenital system - primarily urethritis, prostatic hyperplasia, urethral stricture, neurogenic urinary disorders, prostate cancer, bladder cancer.
Based on the results of the routine examination, there is no specific picture of chronic prostatitis.
Treatment of chronic prostatitis
Antibiotics belonging to the group of fluoroquinolones are the optimal antimicrobial drugs for the treatment of chronic bacterial prostatitis. The recommended antibiotic therapy is 4-6 weeks. Such a long course is justified by scientific data that indicate a decrease in the likelihood of relapse of the disease.
A macrolide antibiotic is prescribed for identified sexually transmitted infections (STIs), such as chlamydia trachomatis. These are the most effective.
It has been shown that in patients with chronic prostatitis, relaxation of the bladder neck is reduced, which leads to backflow of urine into the prostatic ducts of the urethra and causes inflammation and pain in the prostate tissue. Alpha-blockers are recommended for such patients.
In the treatment of chronic prostatitis, patients are advised to refrain from tempting offers to use herbs. Dietary supplements and herbal supplements are characterized by the instability of plant components in part of the material, even in the same manufacturer's preparation. In addition, from the point of view of evidence-based medicine, the benefits of herbal healing are beyond criticism.
Prostate massage, which was the basis of therapy in the middle of the 20th century, is now, thanks to new scientific approaches and the Meares-Stamey classification, an important tool in the diagnosis of prostatitis, but not in its treatment.It is not necessary to use prostate massage as a therapeutic procedure (the effect is not proven).There are suggestions that frequent ejaculation is similar in properties to therapeutic prostate massage.
Other methods that have been shown to be effective in only one or a few studies or are still being investigated include:
- pelvic floor muscle training - some evidence suggests that specific exercises are effective in reducing symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- acupuncture - some studies indicate that acupuncture is beneficial compared to placebo in patients with chronic prostatitis;
- extracorporeal shock wave therapy - due to the effect of significant amplitude acoustic pulses on connective and bone tissue, widely used in the treatment of locomotor diseases, recently used in urology, its effectiveness is being investigated;
- behavioral therapy and psychological support - since chronic prostatitis is associated with a low quality of life and the development of depression, these methods can improve the patient's psychological state and help reduce some symptoms of the disease.
It is worth mentioning separatelyasymptomatic (asymptomatic) chronic prostatitis. The diagnosis is most often made based on the results of the histological report - after a biopsy of the prostate or surgical treatment of the prostate. The frequency of detection of inflammation in prostate tissue varies from 44% (with prostate biopsy) to 98-100% (after surgical treatment of the prostate). According to scientists, the inflammatory changes identified in this way are nothing more than age-related physiological characteristics. No one specifically diagnoses this category of prostatitis, it is a kind of accidental discovery. It does not require treatment and requires no further intervention by either the doctor or the patient.
How is chronic prostatitis treated in a specialized clinic?
During the last 10 years, 47 monographs were published in Hungary, and 64 master's and doctoral theses dealing with prostatitis were defended. Not to mention the various "popular" publications, which colorfully describe the causes, diagnosis and various methods of treatment of the disease. What does this mean? The fact is that the topic of prostatitis raises many questions, and some of them, unfortunately, still do not have a clear answer. There are many modern drugs with proven effectiveness, but the number of patients diagnosed with chronic prostatitis is not decreasing.
That is why urologists try to get the most complete picture when diagnosing and treating prostatitis. They question the patient in detail about the signs and symptoms, study the results of previous examinations, and pay attention not only to the clinical symptoms of the disease, but also to other aspects of health, including the patient's neurological and psychological state - as this can provoke the occurrence of characteristic manifestations. At the same time, unnecessary examinations and studies are not prescribed.