The prostate is an inflammation of the prostate (organ of the human sexual and reproductive system) and changes due to the processes of its physiological function.
spread
According to various sources, prostatitis occurs in 35-40%, and according to some authors, 70% of men aged 18 to 50 years old.The representative glands of disease prevalence and a concurrent range of problems occupies a leading position in urological pathology.
Classification
Prostatitis has many categories and is therefore a very peculiar term.The most common one is the classification of prostatitis proposed by the National Institutes of Health (NIH): 1995:
| category | describe |
| A category | Acute bacterial prostatitis |
| Category II | Chronic bacterial prostatitis |
| Category 3 | Chronic abortion prostatitis |
| Category 3 | Inflammatory chronic pelvic pain syndrome |
| Class IIIB | Syndrome of non-inflammatory chronic pelvic pain (prostaglandin) |
| Class IV | Bactericidal inflammatory prostatitis |
This classification of prostatitis is based on clinical signs, the presence or absence of white blood cells and microorganisms, the secrets of prostate, ejaculation and urine.
A category
Acute bacterial prostatitisIt is expressed by acute infectious inflammation of the prostate and all related signs:
- Increased amount of white blood cells in the urine;
- There are bacteria in the urine;
- Common signs of infection (elevated body temperature, symptoms of poisoning).
Category II
Chronic bacterial prostatitis- The number of white blood cells and bacteria in the prostate, ejaculation and urine obtained after prostate massage increases.
Category 3
Chronic pelvic pain syndrome (KTR)- The leading clinical symptoms are pain syndrome for more than 3 months after prostate massage, in the secret of prostate, ejaculation and urine.III A and III B are isolated from the presence of increased numbers of leukocytes.
Category 3
Inflammatory chronic pelvic pain syndrome- Characterized by the presence of pain and prostatitis symptoms, the number of white blood cells is found in the secretion of the prostate, ejaculation and parts of the secretion after prostate massage, and no pathogenic microorganisms were detected in these samples.
Category 3
Non-inflammatory syndrome of chronic pelvic pain- Characterized by the presence of pain syndrome and symptoms of prostatitis, the number of white blood cells did not increase, and was not detected by standard pathogenic microbial methods in the secrets of prostate, ejaculation and urine after prostate massage.
Class IV
Bactericidal inflammatory prostatitis- Lack of prostatitis characteristics, in the histological examination of prostate tissue samples associated with diagnosis, the disease was detected for other reasons (e.g., prostate biopsy due to increased levels of specific antigen-PSA).
Diagnosis of prostatitis
The symptoms of prostatitis are extremely diverse, but they can be combined into several groups.
Pain syndrome
Due to inflammation or spasm of blood vessels, oxygen hunger in gland tissue is noticed, thus the production of pathological oxidation affects the nerve end of the prostate.Because the prostate nerves are related to the nerves of the pelvic floor, penis, scrotum, testicles, and rectum, the localization of pain is variable.The following pain symptoms are the most common:
- Discomfort or pain in the perineum - basically occur in physical fatigue, sexual intercourse, alcohol in the form of transmission attacks;
- The feeling of hot potatoes in the rectum;
- Pain in the testicles (discomfort) - The patient is described as “pain”, “distortion”, and is also associated with various outrageous factors;
- Discomfort, rubber and pain in the urethra are mainly related to the secret pH of the acidic side prostate.The acid secret of the prostate acts irritably on the mucosa of the urethra, so when the muscles and pelvic muscles of the glands are reduced, the pain occurs in the form of "burning" and the pain is part of the secret.
Urinary disease syndrome
It is related to the tight innervation of the prostate and bladder and the participation of the prostate muscles.Urination can be accompanied by the following symptoms:
- Urinate far - Urinate frequently (up to 3 times per hour) and have sharp and sudden calls (unbearable), while quite small parts;
- The empty discharge of the bladder is incomplete - After urinating, it feels like urine remains in the bladder.
- Weak or intermittent flow of urine - Although all efforts of the patient release urine after urination in the canal, this can also be attributed to the symptoms of "last drip".
Violation of ejaculation and orgasm
It is associated with damage to prostatitis (gluite) in seed nodules, whose surface is neural receptors that send signals to the brain structures that form the sensation of orgasm.Prostatitis does not directly cause an erection (the blood supply to the penis during sexual arousal).
Major diseases:
- Premature ejaculation or vice versa over-excessive intercourse – caused by inflammation caused by inflammatory processes or scars caused by inflammatory processes;
- Erase orgasm - also associated with inflammation of seed nodules;
- Pain during ejaculation - is related to the inflammatory process in the prostate output duct that releases sperm.
Infringement of fertility
When changing the properties of the prostate, the following changes in sperm were observed due to inflammation, thereby reducing the person's fertilization ability (fertility):
- The pH of sperm on the acidic side decreases - because with the inflammation of prostatitis, the acidic products of pathological oxidation begin to accumulate secretly.The acidic environment is extremely destructive to the fixation and even death of sperm.
- Anglo of sperm - sperm bonds to the head - is associated with changes in the physical and chemical properties of the secretions;
- Assistant - a decrease in sperm mobility - is closely related to the pH of the acidic side and violates the production of prostate anapeninone strand carts, which ensures important sperm activity.
Urethritis
In some cases, prostatitis combines with chronic urethritis, which manifests as a inflammatory discharge of the urethra (mainly after prolonged retention in the urine).
Prostatitis and sexual diseases
Question "Can prostatitis cause positivity?" This is the cause of decades of expert disputes.
Under the influence of sexual stimulation, in the formation of the cortical and subcortical regions of the brain, the complete saturation of the body's androgens, and neural signals occur, and are transmitted to the center of the erection located in the spinal cord, from there, from there, from there to the smooth muscles of the penis bone, that is, the smooth muscles on the penis bone, i.e., the relaxed (arteries anteriors and antery and sinores and sinners) and sin.During this process, the prostate has no effect.
Ejaculation and orgasm occur in fully stimulating special receptor cells, which are located in the semen nodule area, in the outlet duct of prostate flow. The same receptor causes nerve pulses to detach the cerebral cortex, forming a sexual neurotic sensation.
The inflammatory process in the prostate (prostatitis) causes the failure of seed nodules, and therefore premature jokes and climaxes due to invasion of the man's efficacy.The pathogenicity of chronic prostatitis is related to the degree of damage to the prostate nerve equipment.This form of yangot (neuroreceptor yangot) is a characteristic example of the phenomenon of opposition when the presence of pathological impulses of organs affected by the inflammatory process leads to the stimulation process of controlling sexual function and the latter obstacles.It plays a certain role in the pathogenesis of neuroreceptor yangot, and also plays a role in inhibiting the androgenic activity of the testicles, as well as sensitivity to the center of the hypothalamus and pituitary glands.
At the same time, there is a view that in the Russian Federation, the overdiagnosis of prostatitis and its role in the development of erectile dysfunction are redistributed.
diagnosis
The doctor's task is to detect the inflammatory process in the prostate, identify the pathogens of the disease, and evaluate the impaired function of the prostate.In 1990, Stamey wrote that prostatitis is a “trash basket of clinical ignorance” due to the use of multiple terms, diagnosis and treatments.Meanwhile, several simple clinical and laboratory tests allow you to diagnose correctly, which allows you to start the proper therapy.
Prostate cleavage and rectal investigation
A very useful way.The inflammatory process can be judged by evaluating the shape, profile, size, compaction and/or softening, focus of pain of the gland.Major signs of prostatitis: increase or decrease in size, consistency of heterogeneity, compaction and softening, stickiness, and pain.The fact that 80% of pancreatic cancers was detected by rectal studies itself.We can say with certainty that this research method will always be used.
Microscopic examination of pancreatic secretion
It should be remembered that the increased number of secret white blood cells does not always indicate prostatitis, as the method of obtaining secrets during massage does not guarantee that the contents of the urethra and seed bubbles will not fall into it.At the same time, there are obvious signs of prostatitis, and the secret of the prostate may be normal.This is explained by the presence of inflammation's focus, partial vulnerabilities, or the closed output pipeline.
Study the secretion of the prostate
Expressed Prostate Secretion - EPS) Secret study allows you to determine the presence of inflammatory processes in the prostate and partly have its functional capabilities.It is the primary method for diagnosing and monitoring the treatment of chronic prostatitis.The secret to the prostate can be examined using optical microscopy without painting or using special staining methods.Similarly, the secrets of the prostate can be bacteriologically tested or examined through polymerase chain reaction to detect pathogens in it.Get secrets with prostate massage.The secret released from the urethra is collected in sterile test tubes or clean object glass.Sometimes, the secret of the urethral glands does not follow.In this case, the patient is advised to stand up immediately.But if it is impossible to obtain a secret, this is more common, meaning that he does not enter the urethra, but enters the bladder.In this case, centrifugal fluid of the washing solution released from the bladder after prostate massage was examined.
- Fat particles (brain proteins) - A specific product of normal physiological secretion of the prostate epithelium.Give a secret milk look.Usually, secrets are filled with granules.The decrease in the number, as well as the increase in the number of white blood cells, indicates the inflammatory process, tumor.
- Amyloid body - layered (starch), body with lugol solution, stained with purple or blue, such as starch;
- Amyloid is the condensation secret of the glands, with an oval shape and layer structure similar to a tree trunk.They are not normal, and their tests indicate a secret stagnation in the glands and can be used with adenomas, chronic inflammatory processes.
- Red blood cells can be single.They fall into a secret thanks to the energy massage of the prostate.During the inflammatory process, their increased amounts were observed in the tumor.
- The decline in epithelials was observed at the beginning of the inflammatory process and at the beginning of the tumor, which was then often associated with protein and steatosis of epithelial cells.During the current inflammation process, macrophages can be seen through secret stagnation.
- Betthera crystals are crystals that form during the secret of mixing in cooled and dried male gonads (prostate juice and sperm mixture).Accompanied by Azoospermia and sharp low-fat plants, Bethela crystals quickly formed a large amount.
- Regeneration syndrome-arrest syndrome is observed in adenoma adenoma.There are many macrophages, polynucleated cells, such as foreign bodies and amyloids.
- Symptoms of ferns are a secret – sodium chloride reduces crystallization symptoms in crystal forms, depending on the physicochemical properties of the secrets of the prostate.The symptom study was performed by adding 0.9% sodium chloride solution to the secret of the production of the prostate and further observed after drying under an optical microscope.In healthy men of healthy age, crystallization of the secret prostate is characterized by a typical phenomenon of fern leaves (3+).The presence of androgen failure or prostatitis can lead to various levels of invasion of the crystal structure.
Bacteriological study on urine and pancreatic secretion
Urethral smear, including PCR diagnosis
Serological diagnosis of drugs causing urinary tract infection (ELISA)
The immunofluorescence (reef) response is direct and indirect
Identify antibodies against good antigens.
Serum determination PSA (prostate-specific antigen)
The American Foundation for Urology Diseases recommends rectal investigation of the prostate, accompanied by PSA in all men over the age of 50 and according to a male series of blood relatives in prostate cancer.There is still discussion about getting dogs immediately after each rectal prostate examination.Recent studies have not confirmed the significant increase in PSA content immediately after finger examination.Therefore, the PSA level can be determined by receiving reliable results and following pancreatic investigation.
Four wall test
To diagnose chronic prostatitis, based on a comparative bacteriological evaluation of urine, 4 glass tests were proposed, and the portion of urine obtained before and after prostate massage was approximately equal to urine, and its secret.
Compared with the content in the urine, the secret microbial concentrations of the prostate (parts 1, 2, and 3) establish the diagnosis of prostatitis, while in the field of view of optical microscopy, the number of polymorphic nucleo-leukocytes is >10-16 (>10-16).Or the number of white blood cells when calculated in the counting chamber exceeds 300x106/L.Inflammasomes are the product of normal secretion of the prostate epithelium and should densely cover the microscope's field of view (1 ml is 500-100 million).The number of amyloids in the secrets of the prostate is significantly smaller.Among people of mature age, 1-2 can be found in the field of view.
Biochemical blood test
Immunology and hormone profile (according to indications).
Ultrasonic, Trussi
Ultrasound diagnosis of prostatitis by abdominal and transrectal sensors (trust).
Urinary method
Treatment of prostatitis
Comprehensive treatment for patients with chronic prostatitis should include:
- Comply with general regimes, diet, sexual hygiene, and attract sexual partners in the presence of infectious diseases;
- Select effective drugs to suppress infection;
- Improve the general responsiveness of the patient's body and the immunobiological tolerance of the drug to the drug;
- Strengthen the secretion of the key inflammation and activate the outflow of local repair processes;
- Hygiene of infection foci in previous and remote organs;
- Improve microcirculation in the prostate and pelvic organs;
- Appoint general strengthening funds, enzymes and vitamins;
- Correct hormone diseases;
- Appoint reflux drugs;
- Appoint painkillers and anti-inflammatory drugs;
- Take sedatives and conversion drugs;
- modulation of neurotrophic diseases by local analysis of drugs;
Prostate massage
Prostate massage- Medical procedures for diagnosing and sometimes treating chronic prostatitis.Posner described the first massage of the prostate in 1893, and since 1936 it has been widely introduced into O'Conory's urology practice.However, in 1968, after describing Meres and Stimmy (a phase test for diagnosis of prostatitis), perceptions of the cause of the disease changed, and massage, along with measures of treatment, were not in many guidelines in developed countries around the world.
But since the mid-1990s, many doctors involved in the diagnosis and treatment of prostatitis have begun to notice the inefficiency of the proposed antibacterial treatment and the use of alpha-blockers in some cases, which has made them efficient in the practice of this forgotten approach.
Basically, prostate massage is currently used as a diagnostic procedure for obtaining microscopic (cultural) studies on prostate secretion (expressed prostate secretion-EPS), as well as pre- and pre- and post-massage (pre- and post-test pre- and post-PPMT).massage.Massage is a medical procedure that must be performed by experts who have previously trained.Massage is performed after urination, which is especially necessary when the urethra is excreted from the urethra with isotonic solution of sodium chloride after its initial washing, in the case of presumed secret bacteriological examination.Prostate massage is performed through the anus, because the prostate is close to rectal amperes and can only be used for research.First, they massage one, and then massage another proportion of the prostate, with the fingers moving from the periphery along the output tube toward the central groove, trying not to touch the seed bubbles.Massage is done by pressing the area of the central furrow from above.The secret released from the urethra is collected in sterile test tubes or clean object glass.Sometimes, the secret of the urethral glands does not follow.In this case, the patient is advised to stand up immediately, if the secret is not available, which means he is not in the urethra, but in the bladder.In this case, centrifugal fluid of the washing solution released from the bladder after prostate massage was examined.
The Russian Federation formally recommends prostate massage (repeated massage) for medical purposes as a treatment procedure for chronic prostatitis.Prostate massage is widely used to treat prostatitis in Southeast Asia, China and certain European countries.Some Severmerican and Canadian urologists also recommend using massage in combination with antibiotic therapy to treat certain forms of prostatitis.Essentially, there is no real assessment of the effectiveness or inefficiency of prostate massage.Egyptian doctors conducted some contradictory studies, with no difference in a group of patients, some of which were massage combined with antibiotic therapy, while only in another antibiotic therapy, another antibiotic therapy performed by researchers in the United States and the Philippines, and in one group of those patients, there was a combination of antibiotic therapy with antitoxic agents.
Proponents of the use of massage for therapeutic purposes believe that the main role of its use is the drainage of the prostate ducts - i.e. they are released from purulent and dead cells.Another effect is the increase in blood flow in the prostate, which can improve the entry of antibiotics into it and activate local protective immune processes.
In the world literature, there are few data on complications related to prostate massage.In 1990, Japanese doctors described the reproductive organs (Fournier), and in 2003, with the development of embolizing stroke (bleeding) in the lung, German doctors had permanent bleeding after prostate massage.There was a study that PSA levels (prostate-specific antigens) were temporarily increased after massage.Massage In acute inflammation of the prostate (acute prostatitis), suffering from acute urethritis, providing fruit inflammation, prostate cancer.Massage is not recommended for prostate calcium and prostate adenomas.It is generally recommended to have a prostate massage 2 or 3 times a week.
Physical Therapy Procedures
Any physical therapy procedure in acute prostatitis (prostate massage, warming, etc.) is contraindicated.
The use of physical therapy procedures in complex treatment of prostatitis is intended to directly affect the prostate of the physical agent to normalize functional and pathological changes, as well as electrophoresis of the drug into prostate tissue.
Using physical therapy in the context of drug therapy is much better than the outcomes of treatment alone.The following methods that affect the prostate have been widely expanded and demonstrated their effectiveness:
- Shockwave therapy;
- Electrical stimulation of the pancreas with TID or rectal electrodes using modulated current;
- Various versions of thermal therapy (including high frequency thermal therapy);
- Magnetic therapy;
- Microwave microwave technology;
- Laser therapy.
- transrectal ultrasound and speech therapy;
- Small career.