Prostatik is the inflammation of the prostate gland (the organ of human gender and reproductive system) and a change as a result of this process of physiological functions.
Spread
According to various sources, prostatitis occurs in 35-40 %, and some authors say 70 % of men aged 18-50.Representative glands of the disease prevalence and a series of problems arising at the same time occupy one of the leading places in urological pathology.
Classification
There are many classification of prostatitis, so it is a very specific terminology.The most common is the classification of prostatitis recommended by the United States Institute of Health (NIH) in 1995:
| Category | Description |
| Category I | Acute bacterial prostatitis |
| II.Category | Chronic bacterial prostatitis |
| III.Category | Chronic abociral prostatitis |
| IIIA category | Inflammatory chronic pelvic pain syndrome |
| IIIB category | Non -inflammatory chronic pelvic syndrome (prostatinia) |
| ARC.Category | Syimpomatic inflammatory prostatitis |
This classification of prostatitis is based on clinical symptoms, the presence or absence of leukocytes and microorganisms in the secret of prostate, ejaculate and urine.
Category I
Acute bacterial prostatitisThis is expressed with acute infectious inflammation of the prostate with all related indications:
- Increased amount of leukocytes in the urine;
- the presence of bacteria in the urine;
- General signs of infection (increase in body temperature, symptoms of intoxication).
II.Category
Chronic bacterial prostatitis- The adequate symptoms and prostate, ejaculate and urine secret are accompanied by an increase in the number of leukocytes and bacteria obtained after prostate massage.
III.Category
Chronic pelvic pain syndrome (KTR)- The leading clinical symptom of pain syndrome for more than 3 months, if there is no pathogenic microorganism in the prostate secret, ejaculation and urine received after the prostate massage.The presence of an increased number of leukocytes III a and III b.
III.Category in the
Inflammatory chronic pelvic pain syndrome- The presence of pain and prostatitis symptoms and the number of leukocytes in prostate, ejaculate and urine are observed, and after prostate massage, pathogenic microorganisms are not observed in these samples.
III.Category B
Chronic pelvic pain is not an inflammatory syndrome- The presence of pain syndrome and symptoms of prostatitis are characterized, while the number of leukocytes is not increased and prostate, ejaculate and urine are not detected after the standard methods of pathogenic microorganisms.
ARC.Category
Syimpomatic inflammatory prostatitis- lack of symptoms specific to prostatitis, the disease is observed in an accident in histological examination of prostate tissue samples, which is obtained for other reasons for diagnosis (for example, a prostate biopsy is performed due to an increase in a particular antigen).
Diagnosis of prostatitis
The symptoms of prostatitis are extremely varied, but can be combined in several groups.
Pain syndrome
As a result of the blood supply to the prostate nourishing blood inflammation or blood vessel, oxygen starvation of the glandular tissue is observed, resulting in pathological oxidation products that affect the prostate nerve endings.Because the prostate's innervation is accompanied by the penis, the penis, the scrotum, the testicles, the rectum - the localization of pain varies.The following pain symptoms are most common:
- Disomfort or pain in the perineum - basically physical effort, sexual intercourse, alcohol takes over in the form of passing attacks;
- Feeling of hot potatoes in the rectum;
- Pain (discomfort) in the testicles - patients are called "pain", "twist", also associated with various provocative factors;
- Discomfort, rubber and pain in the urethra - primarily related to the pH of the prostate secret on the acidic side.The sour secret of the prostate acts irritably on the mucosal membrane of the urethra, so it occurs in the form of pain, more often in the form of "burning", urination or sexual intercourse, when the secret part is squeezed into the lumen of the urethra when reduced from the pelvis.
Urinary disorders syndrome
It is accompanied by a close innervation of the prostate and bladder and the participation of prostate muscles in urination.Dysuria is accompanied by the following manifestations:
- Remote urination - frequent urination (three times per hour) with sharp and sudden calls (impossible to endure) and quite small doses;
- Feeling of incomplete emptying of the bladder - after urination, you feel that the urine remains in the bladder;
- A weak or intermittent flow of urine - this is also attributed to the symptom of the "last drop" - despite the fact that all the patient's efforts are about urine from the canal, a drop of urine is still released.
Violation of ejaculation and orgasm
This involves damage to the seed tuber (collikulite) prostatitis, which has nervous receptors that transmit the signal to the structure of the brain, where the feeling of orgasm is formed.Prostatitis does not cause erection (blood supply to penis during sexual excitement).
Main disorders:
- Premature ejaculation or vice versa, over -prolonged sexual intercourse - inflammation of the inflammation of the seminar or its scarring due to the inflammatory process;
- Deleted orgasm - is also associated with inflammation of the seed tuber;
- Pain during ejaculation - the inflammatory process is related to the output channels of the prostate through which sperm is released.
A violation of fertility
When changing the properties of the prostate, the following changes in the sperm are observed as a result of inflammation, reducing human ability to fertility (fertility):
- Decrease in the pH of sperm on the acid side - as prostate inflammation of the pathological oxidation is secretly accumulated.The acidic environment is extremely devastating the immobilization of sperm and even death;
- English English - gluing of spermatosoids primarily with heads - a change in the physical -chemical properties of secretions;
- Asthenospermia, a decrease in sperm mobility, is closely linked to the pH shift on the acid side and violates the production of prostate lecithin wagons that ensure vital activity of spermatosoids.
Urethritis
In some cases, prostatitis is combined with chronic urethral grinds, which is declared by a slight reduction in mucositis from the urethra (especially after a longer urinary tract retention).
Prostatitis and sexual disorders
The question: "Prostatitis causes impotence?"This is the reason for decades of disputes between professionals.
Sexual stimuli causes the body's full -value saturation of the body's androgens in the formations of the cortical and subcortical region of the brain, which is distributed to the centersinusoids).There is no role in the prostate gland in this process.
Ejaculation and orgasm occurs with sufficient irritation of special receptor cells, which are located in the seminar tubercle area, in which the output channels of the prostate flows are the same receptors responsible for the start of the nerve impulse, where the orgasm detection develops.
The inflammatory process of prostate (prostatitis) can lead to the defeat of seed tuber and, as a result of a violation of human efficiency, thus echoes premature ejaculation and orgasm.Impotence of chronic prostatitis is pathogenetically associated with the degree of damage to the nerve device of the prostate gland.Such a form of impotence (neuroreceptor impotence) is a typical example of a repercussive phenomenon, when the presence of pathological impulsion with the organs affected by the inflammatory process leads to the irradiation of the excitation process that regulates the sexual function and the latter disorders.It plays a certain, albeit not leading role in the pathogenesis of neuroreceptor impotence, as well as some suppression of the androgenic activity of testicles and the centers of the hypothalamus and the sensitivity of the pituitary gland androgens.
At the same time, there is a opinion that in the Russian Federation, both the role of prostatitis hypergiagnosis and the role of erectile dysfunction.
Diagnosis
It is the responsibility of the doctor to recognize the inflammatory process of the prostate, to identify the possible pathogen of the disease and to evaluate the impaired function of the prostate gland.In 1990, Stamey wrote that prostatitis is a "trash bin of clinical ignorance" because of the terms used, diagnostic and treatment methods.At the same time, many simple, clinical and laboratory tests allow the diagnosis to be properly made, which allows you to start proper treatment.
The Putic rectum of the prostate
A very informative method.The inflammatory process can be judged by evaluating shape, outlines, gland size, compression focus and focus on (or) softening.The main signs of prostatitis are: increase or decrease in size, heterogeneity of consistency, compression and softening focuses, pain, pain.The fact that 80% of the pancreatic cancer is observed through rectal examination and speaks for itself.We can certainly say that this research method is always used.
A microscopic examination of the secretion of the pancreas
It should be remembered that the increase in the secret number of leukocytes does not always indicate prostatitis, as the methods of acquiring a secret during massage do not guarantee that the content of the urethra and seed bubbles does not fall.However, with the obvious signs of prostatitis, the secret of the prostate can be normal.This is explained by the presence of inflammation, the presence of some of the pronounced or closed output channels.
To study the secretion of prostate
Expressed prostate secretion-EPS) secret studies allow you to determine the presence of the inflammatory process in the prostate gland and partly its functional ability.This is the main method of diagnosing and observing chronic prostatitis.The secret of the prostate can be examined using light microscope or using special painting methods.In addition, the secrets of the prostate can be subjected to bacteriological examination or examination using the polymerase chain reaction to detect pathogens.Get a secret with the prostate massage.The secret from the urethra is collected in a sterile test tube or on a clean object for research.Occasionally, the secret of the prostate from the urethra does not follow.In such cases, it is recommended to the patient to take off his leg immediately.However, if a secret could not be made, this means that it was not in the urethra, but in the bladder.In this case, the centrifugation of the washing fluid released after the prostate massage is examined from the bladder.
- Lipoid particles (lecithin bodies) - a specific product of normal physiological secretion of prostate gland glandular epithelium.Gives a secret look.Usually the secret is rich in lecithin particles.Decrease in their number and the increase in leukocytes indicate an inflammatory process and cancer;
- Amyloid bodies - layered (starch), body painted in purple or blue with a lugol solution like starch;
- Amiloid bodies are the condensed secret, oval shape and layer structure of the gland, which reminds me of a tree trunk.They are not normal, their detection indicates the stagnation of the secret in the gland, which can be adenoma and chronic inflammatory processes;
- Erythrocytes can be unique.As a result of the energetic massage of the prostate gland.Increased quantities are observed in inflammatory processes and tumors.
- The decreasing decrease in the epithelium in large quantities is observed at the onset of inflammatory processes and tumors, and then there is often a disability with protein and oily degeneration of epithelial cells.Macrophages can be seen with stagnation of a secret, the current inflammatory process for a long time;
- Betthera crystals are daily crystals that are formed during the formation of mixed secrets of spermin and phosphorus layer (prostate juice) of male gonids (mixture of prostate juice).Azoospermia and sharply expressed oligozoospermia, the Betthera crystals are formed quickly and in large quantities;
- Reduction syndrome - stagnation syndrome can be observed at the adenoma gland.There are plenty of macrophages, multi -core cells such as foreign bodies and amyloid bodies;
- The symptom of fern is a symptom of crystallization of secret sodium chloride crystals, depending on the physical -chemical properties of the prostate secret.The symptom is studied by adding a 0.9% sodium solution of the chloride sodium solution to the resulting secret of the prostate, with further views after dried under a light microscope.In healthy men of reproductive age, crystallization of the prostate secret is characterized by a typical phenomenon of fern letter (3+).The presence of androgenic failure or prostatitis results in varying degrees of violation of the structure of the crystals.
Bacteriological examination of some parts of the urine and selection of the pancreas
Urethra smear including PCR diagnostics
Serological diagnosis of agents (Elisa) that cause urinary tract infections
The reaction of immunofluorescence (reef) is straight and indirect
Identification of antibodies against well -known antigens.
Determination of PSA (prostate -specific antigen) of blood serum
The US Urological Disease Foundation recommends the annual handover of the prostate gland rectum, which is accompanied by PSA to men over 50 years of age and, according to the male line, is the blood relative prostate cancer.There is still a dispute to obtain the dog immediately after examining the prostate gland by the rectal gland.Recent studies have not been able to confirm a significant increase in the contents of the PSA immediately after the finger examination.Thus, the PSA level can be determined by receiving reliable results and after assessing the pancreas.
Four -walled test
4 glass tests have been recommended to diagnose chronic prostatitis, based on comparative bacteriological evaluation of urine, it is approximately the same for urinary water, which was obtained before and after the prostate gland massage.
Diagnosis of prostatitis increases ten times the concentration of microorganisms in the secret of the prostate, compared to their urine content (1, 2 and 3 parts), and increased the number of polymorphic-nuclear leukocytes at 10-16> 10-16 in the field of light microscope (200 times increase).Or the increase in leukocytes is more than 300x106/l when they are calculated in the counter chamber.Lecithin bodies, which are products for normal secretion of the prostate glandular epithelium, must densely cover the microscope's vision (5-10 million 1 ml).In the secret of the prostate, the amyloid bodies are significantly smaller.For men of mature age, you can find 1-2 in the field of vision.
Biochemical blood test
Immunological and hormonal profile (according to indications).
Ultrasound, trusie
Ultrasonic diagnosis of prostatitis with abdominal and tranctal sensors (trust).
Urofloometry
Treatment of prostatitis
It includes comprehensive treatment of patients with chronic prostatitis:
- The general system, diet, sexual sexual hygiene, and attracting sexual partners in the presence of an infectious agent;
- Selection of effective drugs for suppressing infection;
- increases the general reactivity of the patient's body and the immunobiological tolerance of microorganisms against drugs;
- Confirming the outflow of secretion and activation of local reparation processes in the focus of inflammation;
- Sewage treatment of the infection focus in the previous and remote organs;
- Improvement of microcirculation in the prostate gland and pelvic organs;
- appointment of general strengthening bases, enzymes and vitamins;
- Correction of hormonal disorders;
- Appointment of cramping;
- appointment of analgesic and anti -inflammatory drugs;
- Taking sedative and converting drugs;
- Regulation of neurotrophic disorders with local analytical drugs;
Prostate massage
Prostate massage- a medical procedure used to diagnose and sometimes treat chronic prostatitis.The first massage of the prostate was described by Posner in 1893 and has been widely introduced into the urological practice of O'Conory since 1936.In 1968, after the description of Meares and Stamey, the stage test for diagnosing prostatitis, the opinion on the causes of the disease changed, and the massage as a therapeutic procedure, the list of many guidelines for prostatitis, was omitted in developed countries.
But since the mid-1990s, many doctors involved in the diagnosis and treatment of prostatitis have begun the effectiveness of the recommended antibacterial therapy in some cases and the use of alpha blockers, which led them to be used in the practice of forgotten method.
Basically, prostate massage is currently used as a diagnostic procedure to obtain prostate secretion (expressed prostate secretion -eps) for its microscopic (cultural) examination and before and after the massage test(Pre- and post -and -post -Test -PPMT).massage.Massage is a medical procedure and must be performed by a previously trained professional.The massage is performed after urination, and when the urethra is emptied after pre -washing the sodium chloride with isotonic solution, which is especially necessary if the secretiological examination of the secret is assumed.The prostate massage is carried out through the anus because the prostate gland is close to the rectum ampouula and is only available for research.First, one is massaged, then the other proportion of the prostate by moving the finger from the periphery to the central groove along the output channels, trying not to touch the seed bubbles.The massage is completed by pressing the central furrow from above.The secret from the urethra is collected in a sterile test tube or on a clean object for research.Occasionally, the secret of the prostate from the urethra does not follow.In such cases, the patient is advised to get to immediately if it was not possible to get the secret, which means that he was not in the urethra, but in the bladder.In this case, the centrifugation of the washing fluid released after the prostate massage is examined from the bladder.
The prostate massage for medical purposes (Depetic Massage) is officially recommended by the Russian Federation's Russian Federation as the therapeutic procedure of chronic prostatitis.Prostate massage is widely used to treat prostatitis in Southeast Mázia, China and Europe.Some supermers and Canadian urologists also recommend that massage be used in combination with antibiotic therapy to treat certain forms of prostatitis.In essence, the evaluation of the efficiency or efficiency of prostate massage was virtually not implemented.There are many contradictory studies, with Egyptian doctors no difference in patient groups, some of which were combined with antibiotic therapy and simple antibiotic therapy, in another, on the contrary, a combination of prostatitis.
Supporters for the use of massage for therapeutic purposes believe that the main effect of its use is to remove prostate channels - that is, their release from turmoil and dead cells.Another effect is the increase in blood flow in the prostate gland, which improves antibiotics penetration and activates local protective immunological processes.
There is little data available in world literature on the complications related to prostate massage.In 1990, Japanese doctors described the genitals (Fournier), and in 2003 German doctors were constant bleeding after a prostate massage, with the formation of lung embarmic stroke (bleeding).There is a study that after the massage, the level of PSA (prostate -specific antigen) increases temporarily.Massage is contraindicated in acute inflammation of the prostate gland (acute prostatitis), acute uretritis, orchitis, prostate cancer.Massage is not recommended for calcination of prostate and prostate adenoma.We generally recommend that prostate massage are recommended twice or three times a week.
Physiotherapy procedures
Physiotherapy procedures (prostate massage, warming, etc.) have been repaired in acute prostatitis.
The use of physiotherapeutic procedures in the complex treatment of prostatitis is to focus on the prostate gland of physical agents to normalize functional and pathological changes and to electrophoretic drugs into the prostate tissue.
The use of physiotherapy methods in the background of medication results in much better results than separate treatment.The following methods are widespread and proven to influence the prostate gland:
- shock wave therapy;
- Electrical stimulation of the pancreas with modulated currents with TID or rectal electrodes;
- thermotherapy in different versions (including high frequency thermotherapy);
- magnetic therapy;
- Microwave microwave technology;
- Laser therapy.
- Transrectal ultrasonic therapy and phonophoresis;
- Microclisms.