Urology prostatitis. Prostatitis - many faces of one disease

Chronic prostatitis is an inflammatory disease of an infectious origin of the parenchymal and interstitial tissue of the prostate gland, the result of acute inflammation or a primary chronic course.

Epidemiology. It is detected in 8-35% of men aged 20-40.

Etiology. Infection or congestion with a sedentary lifestyle, alcohol intake, masturbation, disturbed rhythm of sexual intercourse. It is characterized by foci of the lesion, the formation of infiltrates, zones of destruction and scarring.

Gram-negative microbes are the most common cause. Sexual dysfunction negatively affects the course of chronic prostatitis.

Classification(US National Institutes of Health, 1995).

Phases of the course: the phase of active inflammation, latent and remission.

Pathogenesis. Inflammatory process with the addition of autoimmune disorders.

Clinic. Complaints of discomfort in the genital area, pulling pain in the sacrum, above the womb, in the perineum; increased pain at the end of intercourse or subsidence during it, difficult, frequent urination, especially in the morning, prostorrhea that occurs in the morning, while walking, physical exertion. It is characterized by a decrease in the tone of the excretory ducts of the prostate gland. Violation of sexual function - impotence.

Diagnostics. The diagnosis is based on the patient's complaints, digital examination of the prostate gland through the rectum, analysis of the secretion of the prostate gland.

A digital examination reveals a slight increase in the size of the prostate gland, moderate pain, uneven surface of the gland due to depressions or infiltrates; the gland is pasty, at the time of its examination, a secret can be abundantly secreted from the urethra. The secret of the gland contains an increased number of leukocytes (over 6-8 in the field of view) and a decrease in the number of lecithin grains. Great importance is attached to a separate examination of the prostate gland after massage, bacteriological examination with the determination of antibiograms.

For bacteriological diagnosis of prostatitis, the method is usually used. meares And Stamey, which consists in the sequential study of the first and middle portions of urine, prostatic secretion and urine obtained after prostate massage. Analysis of the secret of the prostate, obtained by massage, is not very informative. Only 20% of patients with chronic prostatitis show signs of inflammation in the secret of the prostate gland; In other cases, normal indicators of secretion may indicate obstruction of the excretory ducts of the lobules of the organ. The diagnosis of chronic bacterial prostatitis is established if the microbial count exceeds 103/ml. Ultrasound sonography is limited in information content. Uroflowmetry - a way to determine the state of urodynamics, allows you to determine the signs of infravesical obstruction. With a prolonged inflammatory process, ureteroscopy or urethrocystography is performed. Punch biopsy of the prostate allows to differentiate chronic prostatitis, cancer or benign prostatic hyperplasia. There are no clear diagnostic criteria for chronic abacterial prostatitis.

Treatment. Tasks - stopping the infection, restoring the immune response, prostate function.

Antibiotics are prescribed for chronic bacterial prostatitis, chronic abacterial prostatitis (category III A, if there is clinical, bacteriological, immunological evidence of prostate infection). The nature of the microflora, the sensitivity of microorganisms, side effects, the nature of previous treatment, doses and combinations of antibacterial drugs, combination with other methods of treatment are taken into account. Sufficient concentration in the secretion and prostate tissue creates tetracyclines, macrolides, fluoroquinolones, rifampicin, cotrimoxazole. The drugs of choice are fluoroquinolones (levofloxacin, mofloxacin, sparfloxacin), the duration of antibiotic therapy is 2-4 weeks, if there is no effect, then the therapy continues for another 2-4 weeks. When using cotrimoxazole, the duration of treatment is 1-2 months. In addition to antibacterial drugs, treatment includes the treatment of urethritis, agents aimed at improving microcirculation, immunomodulators, non-steroidal anti-inflammatory drugs, and physiotherapy. A new approach is the use of α1-blockers; it is advisable to prescribe them for chronic prostatitis category III B (prostatodynia), with a pronounced violation of urination and the absence of an active inflammatory process; the duration of treatment is from 1 to 6 months (doxazosin). Prostatilen, diclofenac, wobenzym, enerion, gelarium, citalopram, pentoxifylline (phosphodiesterase inhibitor) reduce inflammation, troxevasin, detralex improve venous outflow. Levitra (vardenafil) - a selective inhibitor of phosphodiesterase-5, concentrated in the tissues of the cavernous bodies of the penis and platelets, improves the blood supply to the organ, sexual function, stimulates the functions of the testicles.

Candles "Vitaprost" of plant origin are also used, containing biologically active peptides isolated from the prostate gland of cattle. The drug contributes to the normalization of microcirculation, spermatogenesis, helps to restore prostate function, increase the activity of the secretory epithelium of the acini, the disappearance of secretion stagnation, normalize the content of leukocytes in the secret, eliminate microorganisms from it, increase immunity, nonspecific resistance of the body, normalize hemostasis; pain syndrome decreases, sexual function improves (increased libido, restoration of erectile function). Mode: 20-30-minute walks before and after sleep, food restriction in the evening, sleeping on a hard bed, physiotherapy exercises (skiing, skating, hiking, swimming). Compliance with the regime of work and rest, active movements and physical activity, sexual and emotional life; psychotherapy. Alcohol, spices, spices are categorically excluded from food. The prostate is 3/4 a muscular organ, therefore its electrical stimulation is justified, which leads to sanitation and improvement of function. The best training of the sexual apparatus is a full sexual life.

Physiotherapy:

1) physiotherapeutic effect daily or every other day (20 sessions);

2) impulse fluctuating stimulation;

3) sinusoidal modulated currents;

4) ultrasound therapy;

5) laser infrared transrectal irradiation;

6) finger massage.

Finger massage of the prostate gland: before the massage, the patient does not completely empty the bladder, but does it after the massage to remove the pathological secret; massage is performed without tension, gradually increasing its intensity, which allows you to normalize the indicators of the secret of the prostate gland, relieve the patient of pain, improve the consistency of the gland. The absence of a secret after a massage is an indication to stop the massage. If pain intensifies after the massage, then this indicates the intensity of the infiltrative-cicatricial process in the prostate gland, in these cases, thermal procedures, anti-sclerotic and provocative therapy are first performed. Thermal procedures are carried out in the form of sitz baths and microclysters with chamomile, antipyrine (1 g per 50 ml of hot water).

Prevention. Treatment of acute prostatitis, adherence to recommendations on the regimen, diet, sexual life; prevention of bowel disease.

Forecast. The prognosis is favorable with persistent long-term treatment.

Chronic prostatitis is quite difficult to treat. Despite this, more and more men are wondering if the disease can be cured? Most doctors are inclined to believe that getting rid of chronic prostatitis forever is almost impossible. Long-term complex treatment is required, including physiotherapy, diet and medication. Read about all these points in the article.

Drug treatment of chronic prostatitis

Men often ask the question, is chronic prostatitis treated? The first thing you need to know is that you won’t be able to choose the necessary drugs on your own. The disease has several forms of flow. With abacterial infection, antibiotics are not prescribed. The exception is a test treatment, when the doctor selects an antibiotic to confirm a non-infectious cause of prostatitis. To cure the disease at home - you need to undergo an examination. Only after that it is possible to select medicines, traditional medicine recipes and medical procedures.

Principles for the use of antibiotics

Knowing the type of bacteria that caused the disease, you can choose an effective drug. The use of antibiotics against various pathogens, see the table.

We are talking about this with the Honored Scientist of the Russian Federation, Doctor of Medical Sciences, Professor, Head of the Department of Urology and Human Reproductive Health of Rostov State Medical University, Honorary Member of the Russian Society of Urologists Mikhail Kogan.

Difficult diagnosis

Elena Nechaenko, AiF Health: Mikhail Iosifovich, please tell us what kind of disease this is and is there any hope of coping with it?

Mikhail Kogan: Prostatitis is a chronic inflammatory disease, mostly of bacterial origin. As a rule, it develops slowly - for months and even years, but the pace of development in all patients is different. And although prostatitis is an incurable disease, it can and should be controlled - that is, to achieve a stable and long-term remission.

Quite difficult in most cases. Today we often have to deal with overdiagnosis. After all, it is believed that this disease is rampant in all men of middle, and even older. Indeed, inflammation in the prostate gland is found in many, and by the age of 70-80 almost all men have it. However, inflammation is not the same as curing the disease. In order for the urologist to be able to make such a diagnosis and treat the patient, it is necessary that, in addition to the inflammatory process, the patient also has an appropriate clinical picture. In addition, the doctor must be able to conduct differential diagnosis. After all, prostatitis is a many-sided disease and, in addition to typical symptoms, it can also manifest itself as pain in the abdomen, as well as in the pelvic area, genital organs and body parts. Therefore, it is sometimes confused with musculoskeletal, vascular, neurological and even mental diseases. The urologist must be highly qualified to understand what the symptoms are associated with.

- What research methods are used to confirm the diagnosis?

Unfortunately, standard methods (special analysis of urine and prostate secretion) are not always informative and sometimes do not allow to identify the causative agent of prostatitis. And without this, it is impossible to adequately select an antibiotic that can suppress the activity of inflammation, and also allow you to remove (or reduce) the symptoms.

Who will benefit from antibiotics?

- Do correctly prescribed antibiotics help everyone?

Alas, not everyone. There are many reasons. One of them is a global problem: the development of resistance of pathogenic bacteria to antibiotics. As a result of this process, microbes develop resistance to drugs, and they do not act on them. Therefore, before prescribing treatment, it is necessary to conduct a study on the sensitivity of bacteria to antibacterial drugs. But this is still, alas, no guarantee that therapy will help. After all, the sensitivity of pathogenic microbes to a drug can be unequal: both strong and medium, and even weak. Or even zero. In addition, microbes can react differently to a drug already in the body. For example, in a test tube they showed high sensitivity to them, but in the body - already weak. And there are very few drugs that meet the clinical standards for the treatment of prostatitis - to count them, the fingers of one hand are literally enough. Therefore, standard treatment is effective only in about one third of patients.

- And what can explain such inequality? And what about the remaining two-thirds of patients?

All organisms are different. For example, a person may have reduced immunity, both general and local (in particular, in the pelvic organs). In this case, the man will be more prone to inflammatory diseases of the genital area. In addition, in addition to prostatitis, there may be other features and diseases that reduce the effectiveness of treatment. The most frequent and significant of them are diabetes mellitus, vascular disorders, metabolic syndrome, hormone deficiency (including the main male hormone - testosterone). Finally, the cause of prostatitis can also be non-bacterial. If laboratory studies did not reveal the causative agent of the disease, it is necessary to continue the diagnosis. Be sure to do an ultrasound of the prostate. It is necessary to exclude other causes of the inflammatory process in this organ - for example, stones, cysts, abscesses. If any of these are found, the first thing the patient will need is surgery. A special ultrasound is also performed, which shows the function of the vessels of the prostate gland - whether the blood flow is disturbed, whether there is an oxygen starvation of the organ. In this case, drugs that improve blood circulation will be needed. Physiotherapy (magnets, heat, electro and laser treatment) can also be used. Despite the fact that the effectiveness of these methods has not yet been proven, but only studied, in some cases they help.

Non-standard approach

- What about patients who have no surgical pathology, but antibiotics are not effective?

Such patients are required to prescribe drugs that are not officially recommended for the treatment of prostatitis, but nevertheless have a general beneficial effect, and thus can indirectly affect the health of the prostate gland - improve its metabolic processes, blood circulation, reduce inflammation. Among these drugs are many herbal preparations. But for such a treatment to be effective, it naturally must be approved by a doctor. Self-medication is unacceptable. With the help of individually selected therapy, another third of patients can be helped. But there are still about one-third of those who are not helped by any of the above. Such people should not give up, but should contact specialized clinics where serious research is being carried out about their disease. The search for a non-standard approach to the treatment of prostatitis may well be crowned with a good result.

- What can be advised in terms of prevention of prostatitis?

Of course, this is a healthy lifestyle, you need to protect yourself from sexually transmitted diseases, try to protect yourself from evidence-based risk factors (smoking, chronic stress, physical inactivity, hypothermia and overheating of the genitals). Also, don't stop having sex. After all, regular sex life improves blood flow in the prostate gland and prevents the development of inflammation.

This is an infectious and inflammatory disease of the prostate gland, an organ in its shape and size similar to a chestnut, located directly under the bladder. The prostate produces seminal fluid, which nourishes and is involved in the transfer of sperm.

At prostatitis the following symptoms may develop: frequent and unbearable urge to urinate, burning and pain during urination, accompanied by pain in the pelvis, groin or lower back.

Classified by the National American Institute of Health into 4 categories.

• Category 1 - acute bacterial prostatitis.
• Category 2 - .
• Category 3 - includes conditions formerly known as abacterial prostatitis, prostatodynia and chronic pelvic pain syndrome.
• Category 4 - asymptomatic prostatitis.

For treatment prostatitis the first, second type, bacterial origin, usually requires the use of anti-inflammatory, analgesic drugs and antibiotics. Also, various methods of treatment are used to alleviate the condition, as well as self-prophylaxis. Treatment prostatitis The third category is varied and mostly symptomatic. Category 4 is usually an incidental finding on routine examination and often does not require specific treatment.

Symptoms of prostatitis

Signs and symptoms prostatitis differ depending on the category.

• Fever and chills
• Flu-like symptoms
• Pain in the prostate, groin, or lower back
• Dysuric phenomena: increased urge to urinate, difficulty and pain during urination, feeling of incomplete emptying of the bladder, blood in the urine.
• painful ejaculation

Acute prostatitis This is a serious disease that requires immediate contact with a urologist for help and treatment. Seek immediate medical attention if you have any of these symptoms.

Chronic bacterial prostatitis(category 2)

With this type prostatitis symptoms develop more gradually and are not as severe as in acute prostatitis. Also, the course of the disease is undulating, and periods of calm are replaced by exacerbations with the manifestation of clinical symptoms.

Symptoms of chronic prostatitis:

• Frequent, intolerable urge to urinate.
• Pain and burning during urination (dysuric phenomena).
• Pain in the pelvis.
• Nighttime urge to urinate (nocturia).
• Pain in the back and genitals.
• Difficulty starting to urinate or weakening the urine stream.
• Occasional blood in semen or urine (hematuria).
• Painful ejaculation.
• Slight rise in body temperature.
• Recurring cystitis.

(category 3)

In general, signs of abacterial prostatitis similar to the symptoms of chronic bacterial prostatitis although this category prostatitis may proceed without fever. The only way to distinguish between bacterial prostatitis from abacterial is to conduct special laboratory tests aimed at identifying an infectious agent in the urine or prostate secretion.

Other conditions similar to prostatitis

Can be difficult to diagnose due to the fact that the symptoms prostatitis similar to signs of other diseases, such as cystitis, bladder cancer, benign prostatic hyperplasia.

Causes of prostatitis

The most common reason prostatitis is a bacterium found in the large intestine. Most often, the infection develops directly in the prostate, but sometimes it spreads to the prostate from the bladder or urethra.

Chronic bacterial prostatitis(category 2)

It is not yet fully understood what causes chronic prostatitis. Sometimes chronic prostatitis is a consequence of acute Bladder catheterization, trauma to the genitourinary system (eg, cycling, equestrianism), or infection of other organs may be the source of infection.

Chronic abacterial prostatitis(category 3)

Cause or causes of this type prostatitis not fully defined. There are several theories on this:

• Other infectious agents: Some experts believe that non-bacterial prostatitis is actually caused by infectious agents that are not detected in laboratory tests.
• Weight lifting. Lifting heavy objects with a full bladder can cause urine to reflux into the prostate, thus causing inflammatory changes.
• Interstitial cystitis. Often diagnosed as a cause of chronic pelvic pain in women, this disease is increasingly occurring in men as well.
• Physical activity. Although regular exercise is very beneficial for the body as a whole, but cycling and horseback riding can cause irritation in the prostate.
• Spasm of the pelvic muscles. Urination with incoordination with the muscles of the pelvic floor, with their spasm, leads to an increase in pressure in the prostate, which can lead to inflammation.
• Anatomical disorders of the urinary tract. Narrowing (stricture) of the urethra leads to increased pressure during urination, which again can lead to prostatitis.

It is not a contact or sexually transmitted disease.

Risk factors for prostatitis

Unlike other prostate diseases, the chances of getting sick prostatitis more in younger men, even younger than 40 years. The risk of disease is also high if:

• Have you had a urethral or bladder infection in the recent past
• Have you recently had a urethral catheter placed?
• You do not empty your bladder on time and do hard work with a full bladder
• Regularly engage in cycling or equestrian sports.

Men with HIV/AIDS are also at high risk of the disease prostatitis. It's not entirely clear why.

Why you need to see a doctor if you suspect prostatitis

See a doctor if you have any of the symptoms prostatitis such as constant discomfort or pain when urinating, blood in the urine or semen, pain during ejaculation, especially if all these symptoms appeared suddenly. Untreated prostatitis leads to more complex complications, such as sepsis. It is also necessary to consult a doctor to rule out conditions that can lead to damage to the kidneys and bladder.

If you are being treated for an acute prostatitis, be sure to visit the doctor at the end of it in order to assess the effectiveness of treatment. You can also discuss with your doctor measures to prevent recurrence of the disease.

It should be mentioned that men should undergo a digital rectal examination of the prostate as part of their routine examination by a doctor.

Research and diagnosis for prostatitis

When diagnosing prostatitis many conditions with similar symptoms should be ruled out and categorized prostatitis.

Diagnosis usually begins with a questioning and a general examination. You will be asked a series of questions about your symptoms and complaints. General examination includes examination and examination of the abdomen, pelvis, digital rectal examination of the prostate.

During this procedure, the urologist palpates the prostate by wearing a glove and carefully inserting a finger into the rectum using some kind of lubricant. Since the prostate is located anterior to the rectum, its posterior surface is accessible to palpation. If on examination it turns out to be enlarged or painful, this may indicate prostatitis.

Analyzes of prostate juice, urine and / or ejaculate for prostatitis

It is necessary to evaluate prostate juice, urine and/or ejaculate for the presence of bacteria and leukocytes responsible for the immune response - all this will help in making a diagnosis of prostatitis.

If bacteria are detected during these studies, then the results of the sensitivity of bacteria to antibacterial drugs are of great help in choosing the treatment of prostatitis.

Ultrasound examination (ultrasound) for prostatitis

If you suspect prostatitis the doctor will prescribe an ultrasound examination (ultrasound) of the urinary system - kidneys, bladder, prostate with the determination of residual urine. Ultrasound is used not only to confirm the diagnosis of prostatitis, but also to exclude other pathologies of the urinary system, which can give similar symptoms. A more informative picture is given by transrectal ultrasound (TRUS) of the prostate gland. In this study, an ultrasound transducer is inserted into the patient's rectum directly to the posterior surface of the prostate gland. Due to the fact that the distance between the ultrasound probe and the prostate is minimal, the picture obtained during the study is more informative.

Signs prostatitis on ultrasound is:

• Enlargement of the prostate.
• The presence of a heterogeneous structure of the prostate.
• The presence of calicinates, stones in the prostate.

But ultrasound of the prostate for prostatitis is not an absolute method for making a diagnosis. prostatitis. Ultrasound gives only ultrasound signs prostatitis. Ultrasound doctor can't make a diagnosis prostatitis- this can only be done by a urologist, who must evaluate all the data obtained during the study.

Test for urogenital infection in prostatitis

Quite often, the cause of bacterial prostatitis is a urogenital infection. Therefore, the doctor prescribes a study for the presence of an infection that is sexually transmitted.

Complications with prostatitis

There is no evidence that acute or chronic prostatitis increase the risk of prostate cancer, but the presence of an inflammatory process in the prostate can affect the increase in the level of prostate-specific antigen (PSA) in the blood. PSA is a substance produced in the prostate gland and may, but not always, be a sign of prostate cancer. Therefore, you should conduct a second study, after the treatment of prostatitis, if you have an elevated PSA level with prostatitis.

Since the prostate is closely related to ejaculation, prostatitis can lead to fertility problems. In addition, untreated prostatitis can lead to difficulty urinating, and in particularly difficult cases can lead to bacteremia, the presence of bacteria in the blood.

The article is informational. For any health problems - do not self-diagnose and consult a doctor!

V.A. Shaderkina - urologist, oncologist, scientific editor

is an inflammatory disease of the prostate gland. Manifested by frequent urination, pain in the penis, scrotum, rectum, sexual disorders (erection dysfunction, early ejaculation, etc.), sometimes urinary retention, blood in the urine. The diagnosis of prostatitis is established by a urologist or andrologist according to a typical clinical picture, the results of a rectal examination. Additionally, an ultrasound of the prostate, bakposev of prostatic secretion and urine is performed. Treatment is conservative - antibiotic therapy, immunotherapy, prostate massage, lifestyle correction.

ICD-10

N41.0 N41.1

General information

Prostatitis is an inflammation of the seminal (prostate) gland - the prostate. It is the most common disease of the genitourinary system in men. Most often affects patients aged 25-50 years. According to various data, 30-85% of men over the age of 30 suffer from prostatitis. Possible abscess formation of the prostate gland, inflammation of the testicles and appendages, which threatens infertility. The ascent of the infection leads to inflammation of the upper genitourinary system (cystitis, pyelonephritis).

Pathology develops when an infectious agent enters the prostate tissue from the organs of the genitourinary system (urethra, bladder) or from a remote inflammatory focus (with pneumonia, influenza, tonsillitis, furunculosis).

Causes of prostatitis

As an infectious agent in an acute process, Staphylococcus aureus (Staphylococcus aureus), Enterococcus (Enterococcus), Enterobacter (Enterobacter), Pseudomonas (Pseudomonas), Proteus (Proteus), Klebsiella (Klebsiella) and Escherichia coli (E. Coli) can act. Most microorganisms belong to conditionally pathogenic flora and cause prostatitis only in the presence of other predisposing factors. Chronic inflammation is usually due to polymicrobial associations.

The risk of developing the disease increases with hypothermia, a history of specific infections and conditions accompanied by congestion in the tissues of the prostate. There are the following predisposing factors:

• General hypothermia (one-time or permanent, associated with working conditions).
• A sedentary lifestyle, a specialty that forces a person to be in a sitting position for a long time (computer operator, driver, etc.).
• Constant constipation.
• Violations of the normal rhythm of sexual activity (excessive sexual activity, prolonged abstinence, incomplete ejaculation during a “habitual” sexual intercourse devoid of emotional coloring).
• The presence of chronic diseases (cholecystitis, bronchitis) or chronic infectious foci in the body (chronic osteomyelitis, untreated caries, tonsillitis, etc.).
• Transferred urological diseases (urethritis, cystitis, etc.) and sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea).
• Conditions that cause suppression of the immune system (chronic stress, irregular and malnutrition, regular lack of sleep, overtraining in athletes).

It is assumed that the risk of developing pathology increases with chronic intoxication (alcohol, nicotine, morphine). Some studies in the field of modern andrology prove that chronic perineal trauma (vibration, concussion) in motorists, motorcyclists and cyclists is a provoking factor. However, the vast majority of experts believe that all of these circumstances are not the real causes of the disease, but only contribute to the exacerbation of the latent inflammatory process in the tissues of the prostate.

A decisive role in the occurrence of prostatitis is played by congestion in the tissues of the prostate. Violation of capillary blood flow causes an increase in lipid peroxidation, edema, exudation of prostate tissues and creates conditions for the development of an infectious process.

Symptoms of prostatitis

Acute prostatitis

The degree of sexual disorder is determined by many factors, including the sexual constitution and the psychological mood of the patient. Violations of potency and dysuria can be due to both changes in the prostate gland and the suggestibility of the patient, who, if chronic prostatitis is detected, expects the inevitable development of sexual disorders and urination disorders. Especially often psychogenic dyspotence and dysuria develops in suggestible, anxious patients.

Impotence, and sometimes the very threat of possible sexual disorders, is hard to tolerate by patients. Often there is a change in character, irritability, obnoxiousness, excessive concern for one's own health, and even "care for the disease."

Complications

In the absence of timely treatment of acute prostatitis, there is a significant risk of developing a prostate abscess. With the formation of a purulent focus, the patient's body temperature rises to 39-40 ° C and can become hectic in nature. Periods of heat alternate with severe chills. Sharp pains in the perineum make it difficult to urinate and make defecation impossible.

The increase in prostatic edema leads to acute urinary retention. Rarely, an abscess spontaneously ruptures into the urethra or rectum. When opened, purulent, cloudy urine with an unpleasant pungent odor appears in the urethra; when opened, the feces contain pus and mucus in the rectum.

Chronic prostatitis is characterized by an undulating course with periods of long-term remissions, during which inflammation in the prostate is latent or manifests itself with extremely poor symptoms. Patients who are not bothered by anything often stop treatment and turn only when complications develop.

The spread of infection through the urinary tract causes the occurrence of pyelonephritis and cystitis. The most common complication of the chronic process is inflammation of the testicles and epididymis (epdidymo-orchitis) and inflammation of the seminal vesicles (vesiculitis). The outcome of these diseases is often infertility.

Diagnostics

The characteristic clinical picture simplifies the process of diagnosis in acute and chronic prostatitis. It is mandatory to:

• collection of prostate secretion to determine the sensitivity of microflora (sowing of prostate secretion and urine culture).
• Ultrasound of the prostate to identify structural changes (tumors, cysts, adenoma) and differentiate prostatitis from other diseases is performed
• spermogram to exclude or confirm the development of infertility.

Treatment of chronic prostatitis

Treatment of chronic prostatitis should be complex, including etiotropic therapy, physiotherapy, immunity correction:

• Antibiotic therapy. The patient is prescribed long courses of antibacterial drugs (within 4-8 weeks). Selection of the type and dosage of antibacterial drugs, as well as determining the duration of the course of treatment is carried out individually. The drug is chosen based on the sensitivity of the microflora according to the results of urine culture and prostate secretion.
• Prostate massage . Massage of the gland has a complex effect on the affected organ. During the massage, the inflammatory secret accumulated in the prostate gland is squeezed out into the ducts, then enters the urethra and is removed from the body. The procedure improves blood circulation in the prostate, which minimizes congestion and ensures better penetration of antibacterial drugs into the tissue of the affected organ.
• Physiotherapy. To improve blood circulation, laser exposure, ultrasonic waves and electromagnetic oscillations are used. If it is impossible to carry out physiotherapeutic procedures, the patient is prescribed warm medicinal microclysters.

In chronic, long-term inflammation, an immunologist's consultation is indicated to select the tactics of immunocorrective therapy. The patient is given advice on lifestyle changes. Making certain changes in the lifestyle of a patient with chronic prostatitis is both a curative and a preventive measure. The patient is recommended to normalize sleep and wakefulness, establish a diet, conduct moderate physical activity.

Forecast and prevention

Acute prostatitis is a disease that has a pronounced tendency to become chronic. Even with timely adequate treatment, more than half of the patients end up with chronic prostatitis. Recovery is far from always achieved, however, with correct consistent therapy and following the doctor's recommendations, it is possible to eliminate unpleasant symptoms and achieve a long-term stable remission in a chronic process.

Prevention is to eliminate risk factors. It is necessary to avoid hypothermia, alternate between sedentary work and periods of physical activity, eat regularly and fully. For constipation, laxatives should be used. One of the preventive measures is the normalization of sexual life, since both excessive sexual activity and sexual abstinence are risk factors in the development of prostatitis. If symptoms of a urological or sexually transmitted disease appear, you should consult a doctor in a timely manner.