- The reasons
- Forms of development
A rapidly developing and pronounced inflammatory process in the prostate gland caused by an infectious agent is called acute prostatitis. The disease codes for ICD-10: 41.0, as well as 41.8 and 41.9 (other and unspecified inflammatory diseases of the prostate). Acute prostatitis is accompanied not only by extremely painful symptoms, but with untimely or illiterate treatment can cause serious complications.
Acute prostatitis is the most common disease of the prostate gland among men under the age of 50 years; in the older group this pathology retreats to the 3rd place after adenoma and prostate cancer. Such statistics is associated with sexual activity, since infectious agents that cause inflammation get into the gland in most cases through sexual contact.
The prostate gland is a vulnerable organ that is easily affected by microorganisms penetrating from the urethra, bladder, intestine. The main contingent of causative agents of acute prostatitis is bacteria:
- E. coli (80% of cases);
- serration, Klebsiel, Proteus (10-15%);
- enterpoxycycline (5-10%);
- Staphylococcus aureus .
Many types of these bacteria can asymptomatically exist in the intestine or on the skin, being part of the human microflora, but when they enter the prostate, their colonies begin to multiply rapidly, causing a bacterial type of acute prostatitis .
There is also an infectious acute prostatitis , which is usually triggered by influenza, tuberculosis, and herpes. There are frequent cases of lesions of the prostate in the presence of diabetes.
The main ways in which microorganisms penetrate the prostate gland:
- canalicular – from the urethra through the connecting ducts. Bacteria can enter the ureter sexually or through households. For example, it is possible to enter E. coli during unprotected intercourse with a woman whose vagina is contaminated with this type of bacterium, as well as with oral and anal types of intimate contact;
- hematogenous – with blood during the mass reproduction of bacteria;
- lymphogenous – with lymph flow (usually in acute urethritis).
Factors provoking acute prostatitis:
- promiscuous sex (penetration of pathogens into the urethra from the mucous membranes of the partners);
- obesity (reduced testosterone production, affecting prostate health, increased estrogen levels (female sex hormones));
- congestive processes in the pelvic region, hemorrhoids (local metabolism is disturbed, prostatic juice stagnates, the prostate nutrition is disturbed due to pressure of hemorrhoids);
- long-term catheterization of the bladder (high risk of infection);
- surgical interventions or instrumental examinations performed on the urethra (probably infection, inflammation);
- phimosis (narrowing of the foreskin, the inability to fully expose the head). In the accumulating secretions, bacteria actively proliferate;
- throwing urine into the prostate tissue due to a bladder sphincter disorder (an infection can enter);
- the presence of stones in the prostate (provoke duct blockage, stagnation of the secret).
Weakening of immunity due to alcoholism, systemic diseases, AIDS also contribute to the occurrence of acute prostatitis.
Forms of development
Acute prostatitis is classified depending on the site of localization of the inflammatory focus, the breadth of its spread and associated symptoms.
If the infection has penetrated only into the ducts of the prostate and does not spread further, then this condition is called catarrhal acute prostatitis (focal prostatitis). The size of the gland increases due to edema, the lumen of the excretory ducts is narrowed. At this stage, the inflammation does not go beyond the mucous and submucosal layers, but due to edema of the ducts, prostate secretion stagnates in them, and the desquamated epithelium accumulates. Since the catarrhal form of the disease is usually provoked by urethritis , the back of the urethra is the source of infection. The release of an altered prostate secretion into it further aggravates the symptoms of primary pathology.
The expansion of the lesion on the follicles leads to inflammation of the lobes of the gland. This form of the disease is called follicular . Pus formed from stagnant prostatic secretions, is excreted into the urethra , probably the appearance of isolated abscesses. Glandular tissue undergoes destructive changes, the prostate enlarges.
In the absence of a competent and timely treatment, inflammation can spread to the second lobe of the gland, encompass connective tissues. Excessive suppuration and tissue melting occurs in the affected areas. This form of prostatitis is called parenchymal . This form can also develop after a prostate biopsy, as a result of surgery. First, isolated foci of purulent inflammation are formed, which then merge to form a prostate abscess (abscess stage). The suppuration, depending on the location, may open up to the rectum, bladder, or the back of the urethra. In such cases, immediate hospitalization is required.
Manifestations of acute prostatitis depend on the nature of the development of the disease, but the inflammatory process usually begins with a 20-30 minute chill, which is replaced by general weakness. In some cases (especially for alcoholics and drug addicts), the symptoms may be blurred, limited to discomfort in the rectum during bowel movements, a feeling of pressure in this area in a sitting position.
Symptoms of catarrhal form :
- heaviness and pain in the lower abdomen;
- frequent urge to urinate , especially at night, the process is accompanied by strong cuttings;
- body temperature may rise slightly.
Intoxication of the body is absent at this stage, urine and blood counts are still within the normative limits.
The follicular form has the following characteristics :
- constant aching pain in the groin;
- pain when urinating;
- dull pain in the rectum during stool;
- increase in total temperature.
In the study of urine observed purulent filament (pyuria), an increased content of bacteria.
Clinical manifestations of parenchymal form :
- high fever; chills;
- severe weakness;
- thirst against lack of appetite;
- frequent, but difficult urination, in severe cases, it stops altogether;
- intense throbbing groin pains;
- flatulence, constipation.
The bladder is often involved in the inflammatory process, hematuria signals this – the appearance of blood in the urine.
Doctors recommend men with a sudden causeless rise in temperature and discomfort during urination to immediately seek a diagnosis, without waiting for the increase of symptoms.
The urologist determines acute prostatitis on the basis of the clinical picture when examining and interviewing the patient, then specifying the diagnosis with a number of studies:
- clinical, biochemical analysis of blood, the study of the first portion of urine;
- urethral smears to identify pathogens and determine their sensitivity to antibiotics;
- palpation of the prostate through the rectum. When inflammation marked increase in the size of the gland, and the groove separating the lobe, lubricated. In severe forms of acute prostatitis, this method is not used, since there is a high risk of provoking the spread of infection;
- Ultrasound prostate. Usually, the procedure is performed through the rectum, but if the pain syndrome is very strong, then the gland is scanned transabdominally, applying the sensor to the skin of the abdomen;
- CT scan, MRI. These types of studies show the prevalence of inflammation;
- uroflowmetry – a method for measuring the flow rate of urine using a special apparatus, in the receiving tank of which the patient urinates, or by means of an ordinary glass and stopwatch;
- a blood test to identify atypical microorganisms using immunological methods and DNA diagnostics.
The above are the main methods that are used to diagnose acute prostatitis, in some cases the doctor may exclude or prescribe additional types of research.
Acute prostatitis in catarrhal form, with timely access to a doctor, is completely cured, provided the patient fulfills all the prescriptions and regimen. After the follicular form in the prostate gland remains clogged with inflammation. They may persist pathogen. Subsequently, with an irregular and insufficient secretion of the secret, the formation of stones is likely, the development of a relapse of acute prostatitis, its transition to a chronic form. Similar especially often occurs after the parenchymal form. To avoid consequences, it is important to approach treatment with the utmost responsibility.
During therapy should follow a number of rules :
- not to engage in sexual relations (sexual rest);
- abstain from alcohol, minimize smoking (it is desirable to completely eliminate bad habits);
- do not eat spicy, salty foods, as well as caffeinated beverages, so as not to irritate the mucous membranes of the ureter;
- drink plenty of warm fluids: water, decoctions (preferably dogrose, chamomile), compotes. Drinking plenty of water and frequent urination will help prevent the advancement of infection along ascending pathways and cause pyelonephritis, as well as reduce the degree of intoxication.
Self-treatment for acute prostatitis is unacceptable. Common broad-spectrum antibiotics can only make things worse. Traditional methods for this disease are not applicable.
The main objective of treatment for acute prostatitis is the relief of the development and destruction of the pathogen. Depending on its type, the following drugs are prescribed:
- antimycotic (antifungal);
From the last group of drugs, preference is given to the following:
- fluoroquinolones ( Ofloxacin, Norfloxacin );
- penicillinyl ( Amoxiclav );
- cephalosporins from the latest development series ( Cefuraxim, Cefaclor, Cefixime );
- macrolides ( azithromycin ).
The total duration of the drug course is about 4 weeks, with uncomplicated forms, it is possible to cure the patient within 10 days. Antibiotic therapy will be longer if the causative agent is, for example, E. coli. Such bacteria are resistant to drugs due to their biofilm and thick protective capsule.
The use of antibiotics requires support of the body in the form of vitamin therapy and restoration of intestinal microflora, for which multivitamin complexes are used (ascorbic acid and B vitamins are especially important), preparations with pre- and probiotics.
In parallel, funds are assigned to alleviate the patient’s condition:
- anesthetic candles;
Vaseline, a mild laxative, is used to reduce discomfort during bowel movements.
You can not use thermal microclysters and heating pads to relieve spasms and pain. This will contribute to the spread of the source of infection.
Relieve muscle spasms of the pelvic floor Pregabalin, Sirdalud, Baclofen . Acceptance of alpha andblockers ( Tamsulosin, Prazosin ) will help ease the process of urination.
In severe forms of acute prostatitis, a patient is required to be hospitalized. In a hospital, high doses of antibiotics are injected into the blood. Intravenous hydration (administration of fluids) is also carried out and diuretics (diuretic) are prescribed to speed up the withdrawal of the infection and prevent its spread.
Complications of acute prostatitis usually occur on the background of other associated diseases, as well as during attempts at self-treatment. The transition of the disease to the chronic form is possible, the development of infertility, recurrent cystitis , the appearance of foci of suppuration in the prostate, pyelonephritis, sepsis.
Of the severe complications, the most frequent cessation of urination occurs. In the case of a prolonged retention of urine, it is discharged by means of a catheterization of the bladder by imposing suprapubic fistula (a through hole through which urine flows out through the tube). This period lasts 1-2 weeks.
If within 1–2 days of antibiotic use, there is no positive dynamics in the patient’s condition, then there is reason to suspect the development of an abscess (suppurative focus in the prostate). For confirmation, transrectal ultrasound and puncture are used. The treatment of an abscess consists in its debridement through surgery or puncture. Drainage is installed in the cleaned cavity for 5-7 days. Bacterial shock is possible, therefore, in the postoperative period, increased doses of antibiotics are prescribed, as well as painkillers.
A purulent lesion may extend beyond the prostatic capsule, in which case paraprostatic phlegmon is diagnosed. In the absence of adequate therapy, the process spreads to the pelvic wall tissue, causing symptoms of peritonitis. An abscess can strike a part of the rectum and open up to the perineal region (paraproctitis). Save the situation is possible only with timely surgical intervention and enhanced antibiotic therapy.
The main measure of prevention of acute prostatitis is an orderly sex life, the use of barrier contraception methods , and intimate hygiene (bacteria actively develop in smegma that accumulates between the foreskin and head).
The more intense the microcirculation of the blood in the prostate, the less chance of inflammation due to stagnation. This requires regular moderate physical activity.
Any diseases of the bladder and urethra ( cystitis , urethritis ) should not be left untreated or undiagnosed . The reason for any discomfort during urination should be identified by a specialist. It is useful to undergo prophylactic examinations at the urologist and be tested for hidden infections so that they do not cause prostatitis by entering the gland with systemic blood flow.