Prostate is an inflammation of the prostate gland (the organ of sex and a man's reproductive system) and change as a result of this process of its physiological functions.
Dissemination
According to various sources, the prostate occurs at 35-40 %, and according to some authors, 70 % of men aged 18 to 50 years.The representative gland in the predominance of the disease and a variety of problems that occur at the same time occupy a major place among urological pathology.
ClaSSIFICaTION
There are many prostate classifications, a very special terminology.The most common is the prostate classification proposed by the National Institute of American Health (NIH) in 1995:
| CATEGORY | Description |
| Category of | Acute bacterial prostatitis |
| Category II | Chronic bacterial prostatitis |
| Category III | Chronic abacterial prostatitis |
| Category IIIA | Chronic pelvic pain syndrome |
| Category IIIB | Chronic non -inflammatory pelvic pain syndrome (prostatinia) |
| Category IV | Sinimptic inflammatory prostatitis |
This prostate classification is based on clinical signs, presence or deficiency of leukocytes and microorganisms in the secret of the prostate, ejacula and urine.
Category of
Acute bacterial prostatitisIt is expressed by acute infectious inflammation of the prostate gland with all related signs:
- increased amount of leukocytes in the urine;
- the presence of bacteria in the urine;
- Common signs of infection (increased body temperature, symptoms of intoxication).
Category II
Chronic bacterial prostatitis- It is associated with appropriate symptoms and an increase in the number of leukocytes and bacteria in the secret of the prostate, ejacula and urine obtained after prostate massage.
Category III
Chronic pelvic pain syndrome (KTR)- The main clinical symptom is pain syndrome for more than 3 months in the absence of pathogenic microorganisms in the secret of the prostate, ejacula and urine obtained after prostate massage.Division of III A and III B is the presence of an increased number of leukocytes.
Category III a
Chronic pelvic pain syndrome- It is characterized by the presence of symptoms of pain and prostatitis, and an increased amount of leukocytes is observed in the secretion of the prostate, ejacula and urine parts, after prostate massage, pathogenic microorganisms are not detected in these samples.
Category III B
Non -inflammatory syndrome of chronic pelvic pain- It is characterized by the presence of pain syndrome and prostate symptoms, while there is no increase in the number of leukocytes and are not detected by standard methods of pathogenic microorganisms in the secret of the prostate, ejacula and urine obtained after prostate massage.
Category IV
Sinimptic inflammatory prostatitis- Lack of characteristic prostate symptoms, the disease is detected by the accident during a histological examination of prostate tissue samples taken with regard to other reasons (for example, performing a prostate biopsy due to an increase in the level of a specific antigen - PSA).
Diagnosis of prostatitis
Symptoms of prostatitis are extremely varied, but they can be combined into several groups.
Pain syndrome
As a result of insufficient blood supply caused by inflammation or spasms of the blood vessels that feed the prostate, the hunger of the oxygen of the glandular tissue is observed, as a result of which are formed by -pathological oxidation products affecting the nerve endings of the prostate.Since the internalization of the prostate is associated with the intrigue of the pelvic floor, penis, scrotum, testicles, rectum - the localization of the pain is variable.The following symptoms of pain are more common:
- Discomfort or pain in the perineum - essentially manifested after physical exercise, sexual intercourse, alcohol taking the form of passing attacks;
- Sensation of hot potatoes in the rectum;
- Pain (discomfort) in the testicles - patients are described as "pain", "twist", also associated with various provocative factors;
- Discomfort, tires and pain in the urethra - are mainly associated with the relocation of the pH of the prostate secretion on the acidic side.The sour secret of the prostate acts unclearly on the mucous membrane of the urethra, so the pain, most often in the form of a "burning", occurs after an act of urination or sexual intercourse, when part of the secret when reduces the muscles of the gland and pelvis is squeezed into the river of the ureth.
Urinary Disorders Syndrome
It is associated with the narrow intrigue of the prostate and the bladder, as well as the participation of the prostate muscles in the act of urination.Dysuria may be associated with the following manifestations:
- Distant urination - frequent urination (occurs up to 3 times an hour) with sharp and unexpected calls (impossible to endure) and very small parts;
- A feeling of incomplete bladder emptying - after the act of urination, thinks the urine remained in the bladder;
- A poor or permanent urine flow - this can also be attributed to the symptom of "last fall" - despite all the patient's effort after the act of urination by the canal, a decrease in urine is still released.
Violation of spill and orgasm
It is associated with damage to the prostate of the seed tubercle (colliculitis) on the surface of which are nerve receptors that send the signal to the brain structures, where the feeling of orgasm is formed.Prostatitis does not directly cause an elevation (blood supply to the penis during sexual resurrection).
The main disorders:
- Premature shedding or vice versa extensively prolonged sexual intercourse - caused by inflammation of the seminal tubercle or its toothache due to the inflammatory process;
- Deleted orgasm - is also associated with inflammation of the seed tubercle;
- Pain during spilling - associated with the inflammatory process in the prostate outlet ducts through which sperm is released.
Violation of fertility
When changing the properties of the prostate, as a result of inflammation, the following changes in semen are observed, reducing human ability to fertilize (fertility):
- A decrease in sperm pH on the acidic side - since with prostate inflammation, the acidic products of pathological oxidation begin to accumulate in secret.The acidic environment is extremely devastating for sperm causing their immobilization and even death;
- Sperm Angulation - Adhesion of sperm mainly with heads - is associated with a change in the physico -chemical properties of secretions;
- Athenospermia - a decrease in sperm mobility - is closely linked to pH displacement on the acidic side and to a violation of prostate leciac carriages, which provide the vital activity of sperm.
Uretropostatitis
In some cases, the prostatitis is combined with chronic urethritis, which manifests itself with poor mucosal-inflammatory discharges from the urethra (mainly after prolonged urinary retention).
Prostatitis and sexual disorders
The question "Does prostate impotence cause?"That is why specialists' disagreements for decades.
Under the influence of sexual stimuli, with the complete saturation of the body's androgens in the formations of the cortical and subcortical region of the brain, a nervous signal occurs, transmitted at the center of a lifting located in the spinal cord, where it comes to the smooth muscle of the cave bodies of the penis, which are either relaxed by the arteries (s).There is no role of the prostate gland.
Ejaculation and orgasm occurs with sufficient irritation of the special receptor cells that are located in the area of the seminal tubercle in which the prostate outlet flows flow, the same receptors are responsible for removing the nerve impulse in the cerebral cortex, where the orgasm sensation is formed.
The inflammatory process in the prostate gland (prostatitis) can lead to the loss of seed tubercle and, as a result, as a violation of a man's power, so premature spill and echo orgasm.Impotence in chronic prostatitis is pathogenetically associated with the degree of damage to the nerve apparatus of the prostate gland.This form of impotence (neuroreceptor powerlessness) is a characteristic example of a repert phenomenon, when the presence of pathological impulse with the organs affected by the inflammatory process leads to the radiation of the excitement process that controls sexual function and the latter's disorder.A certain role, though not a leader, is played in the pathogenesis of neuroreceptor impotence, also a suppression of androgenous activity of the testicles and sensitivity to androgens of the hypothalamus centers and the pituitary glands.
At the same time, there is an opinion that in the Russian federation there are both prostate hyperdiagnosis and re -determination of its role in developing erectile dysfunction.
Troubleshooting
The doctor's task is to detect the inflammatory process in the prostate, identify the potential pathogen of the disease and the evaluation of the damaged function of the prostate gland.In 1990, Stamey wrote that prostatitis is a "garbage basket for clinical ignorance" due to the variety of terms used, diagnostics and treatment methods.At the same time, some simple and clinical and laboratory tests make it possible to make a diagnosis correctly, which allows you to start the right therapy.
Putic rectal observation of the prostate gland
A very informative way.The inflammatory process can be judged by evaluating the shape, contours, dimensions of the gland, the presence of compression seals and (or) softening, pain.Main signs of prostatitis: increase or decrease in size, heterogeneity of durability, presence of compression seals and softening, pasactivity, pain.The fact that 80% of pancreatic cancer is detected through a rectal study speaks for itself.We can say for sure that this method of research will always be used.
Microscopic examination of pancreas secretion
It should be remembered that an increase in the number of leukocytes in secret does not always indicate the prostate, because the methods of obtaining a secret during massage do not guarantee that the content of the urethra and seed bubbles will not fall into it.At the same time, with visible signs of prostate, the secret of the prostate can be normal.This is explained by the inflammation seals, the presence of some of the exposed or closed canals.
Studying the secretion of the prostate gland
The secrets of the prostate expressed-EPS) secret studies allow you to determine the presence of an inflammatory process in the prostate gland and partly its functional ability.The main method of diagnosing and monitoring chronic prostatitis treatment is the main method.The secret of the prostate can be examined using light microscopy without painting or using special staining methods.Also, the secret of the prostate gland may undergo a bacteriological examination or examination by the method of polymerase chain reaction to detect pathogens in it.Get a secret with prostate massage.A secret released from the urethra is collected in a sterile exam tube or a glass of clean research object.Sometimes the secret of the prostate gland from the urethra does not follow.In such cases, the patient is recommended to immediately ride on his feet.If, however, it was not possible to get a secret, most often it means that he did not enter the urethra but into the bladder.In this case, the centrifugate of the washing fluid released from the bladder after the massage of the prostate gland is examined.
- Lipoidal grains (lecithin bodies) - a specific product of normal physiological secretion of the epithelial gland of the prostate gland.Gives a secret a mammary look.Normally, the secret is rich in lecithic grains.A decrease in their numbers, along with an increase in the number of leukocytes, indicates an inflammatory process, a tumor;
- Amyloid bodies - starch, body, which with a solution of lugol are stained in purple or blue, such as starch;
- Amiloid bodies are a condensed gland secret, have an oval shape and a layer structure, which resembles a tree baggage.They are not normal, their detection indicates a stagnation of the secret in the glands, which can be with adenoma, chronic inflammatory processes;
- Erythrocytes can be single.They fall into a secret as a result of the energetic massage of the prostate gland.Their increased amount is observed in inflammatory processes, neoplasms.
- The descent of the epithelium in large quantities is observed at the beginning of inflammatory and tumor processes, then there is often a disability with protein and fatty degeneration of epithelial cells.Macrophages can be seen with a stagnation of a secret, for a long time of the current inflammatory process;
- Berthera crystals are a daily crystals formed during cooling and drying the mixed secret of masculine gonads (prostatic juice with a mixture of sperm) from sperm and phosphorus salt.With nitoospermia and oligozoospermia sharply expressed, Batera crystals are formed rapidly and in large quantities;
- Editing Syndrome - Station syndrome is observed with gland adenoma.There are an abundance of macrophages, there are multi -core cells such as foreign bodies and amyloid bodies;
- The symptom of Fern is a symptom of crystallization of a secret form -a form of declining sodium chloride crystals depends on the physico -chemical properties of prostate secret.Symptom study is performed by adding 0.9% sodium solution of chloride to the resulting secretion of prostate with further vision after drying under a mild microscope.In healthy men of reproductive age, crystallization of prostate secret is characterized by a typical phenomenon of Ferni leaves (3+).Androgenic failure or the presence of prostatitis give different degrees of violation of the structure of the crystals up to their absence.
Bacteriological studies of urine parts and pancreas secretion
Staining urera, including PCR Diagnostics
Serological diagnostics of agents (ELISA) that cause urinary tract infections
Immunofluorescence reaction (reef) is straight and indirect
Identification of antibodies to known antigens.
PSA determination (specific prostate antigen) of blood serum
The American Foundation for Urological Diseases recommends the annual passage of a rectal study of the prostate gland, accompanied by a PSA for all men over the age of 50, and with a prostate cancer for blood relatives according to a male line.There is still a discussion about taking a dog immediately after examining the finger of the prostate gland for the rectum.Recent studies cannot confirm the presence of a significant increase in PSA content immediately after a finger examination.Thus, the PSA level can be determined by obtaining reliable results and after studying the pancreas.
Four -trouble test
To diagnose chronic prostatitis, a 4-mosque test was proposed, based on a comparative bacteriological evaluation of the urine, approximately equal to the urine part, taken before and after the massage of the prostate gland, as well as its secret.
Diagnosis of prostatitis is established by a tenfold increase in the concentration of microorganisms in the secret of the prostate compared to their urine content (1, 2 and 3 portions) and an increase in the number of polymorphic-nuclear leukocytes> 10-16 in the area of light microscope (200 times increase).Or an increase in the number of leukocytes of more than 300x106/l when you calculate them in the counting room.Lecitine bodies, which are a product of normal secretion of the epithelium of the prostate gland, should dense the field of vision of the microscope (5-10 million in 1 ml).Amiloid bodies in the secret of the prostate are found in a significantly smaller amount.In men of mature age, they can be found 1-2 in the field of viewing.
Biochemical blood test
Immunological and hormonal profile (according to indications).
Ultrasound, Trusni
Ultrasound diagnostics of prostatitis by the abdominal and transchectal sensor (Trust).
Urofloometry
Treatment of prostatitis
Comprehensive treatment of patients with chronic prostate should include:
- Compliance with the general regime, diet, sexual sex hygiene, and attracting sexual partners in the presence of an infectious agent;
- the choice of effective medicines to suppress the infection;
- increasing the overall reactivity of the patient's body and immunobiological tolerance of microorganisms to medication;
- strengthening the course of secretion and activation of local reparative processes in the focus of inflammation;
- Sewers of infection focuses in previous and distant organs;
- improving microcirulation in the prostate gland and pelvic organs;
- the appointment of general strengthening funds, enzymes and vitamins;
- Correction of hormonal disorders;
- appointment of antispasmodics;
- appointment of analgesic and anti -inflammatory drugs;
- taking soothing and transformative medicines;
- regulation of neurotrophic disorders by local analysis drugs;
Prostate massage
Prostate massage- a medical procedure used to diagnose and sometimes treat chronic prostatitis.The first prostate massage was described by Posner in 1893, and since 1936 was widely presented in O'Conory's urological practice.However, in 1968, after the description of Meares and Stamey, a phase test for prostatitis diagnosis, views on the causes of this disease changed and massage as a therapeutic procedure was crucified by lists of measures in many prostate treatment in developed countries of the world.
But by the mid-90s of the 20th century, many doctors involved in prostate diagnosis and treatment began to mark inefficiency in some cases of proposed antibacterial therapy and the use of alpha blockers, which made them use in the practice of this forgotten method.
Basically, prostate massage is currently used as a diagnostic procedure for obtaining a prostate secretion (prostate -expressed secretions) - for its microscopic (cultural) study and for pre -and post -test test (premium test-Ppmt).Massage massage is a medical procedure and should perform it a previously trained specialist.Massage is performed after urination, and when discharged from the urethra after its preliminary washing with an isotonic solution of sodium chloride, which is particularly necessary in cases where a bacteriological examination of the secret is assumed.The prostate massage is performed through the anus, as the prostate gland is close to the rectum ampoule and only has available research.First, they massage one, then the other proportion of the prostate gland with the finger movements from the periphery to the central furrow along the output ducts, trying not to touch the seed bubbles.The massage ends by pressing on the area of the central groove from above.A secret released from the urethra is collected in a sterile exam tube or a glass of clean research object.Sometimes the secret of the prostate gland from the urethra does not follow.In such cases, the patient is recommended to immediately reach his feet if it were not possible to get the secret, which means he was not in the urethra but in the bladder.In this case, the centrifugate of the washing fluid released from the bladder after the massage of the prostate gland is examined.
Prostate massage for medical purposes (repetition massage) is officially recommended by the Russian Federation of the Russian Federation as a therapeutic procedure for chronic prostatitis.Prostate massage is widely used for the treatment of prostate in the countries of Southeast Asia, China and some European countries.Some Severmermerican and Canadian urologists also recommend using massage in combination with antibiotics therapy in the treatment of some forms of prostatitis.In essence, the evaluation of the effectiveness or inefficiency of the prostate massage was practically not performed.There are some contradictory studies, in one, conducted by Egyptian doctors, there were no differences in groups of patients, some of which were massage in combination with antibiotics therapy and simply antibiotic therapy, performed by American and Phillipine researchers, otherwise in a group of prostate patients.
Proponents of using massage for therapeutic purposes believe that the main effect of its use is drainage of the prostate channels - ie.Their release from purulent and dead cells.Another effect is an increase in blood flow to the prostate gland, which improves the penetration of antibiotics into it and activates local immunological processes.
In the world literature there is little data on complications related to prostate massage.In 1990, Japanese doctors prescribed the genitals (Fournier), and in 2003, German doctors were permanent hemorrhage after a prostate massage with the development of embolic shock (hemorrhage) of the lungs.There is a study that after massage the PSA level (antigen prostatospecific) increases temporarily.Massage is contraindicated in acute inflammation of the prostate gland (acute prostatitis), with acute urethritis, orchitis, prostate cancer.Massage is not recommended for prostate calcins and prostate adenoma.It is generally recommended that the prostate massage be recommended 2 or 3 times a week.
Physiotherapeutic procedures
Anydo physiotherapeutic procedure (prostate massage, heating, etc.) in acute prostatitis are contraindicated.
The use of physiotherapeutic procedures in the complex treatment of prostatitis aims to both directly affect the prostate gland of physical agents in order to normalize functional and pathological changes, as well as electrophoretic administration of drugs in the prostate tissue.
The use of physiotherapeutic methods on the background of medication therapy gives a much better result than in treatment separately.The following methods to influence the prostate gland have become widespread and prove their effectiveness:
- shock wave therapy;
- electrical stimulation of pancreas with electrodes modulated with TID or rectal electrodes;
- thermotherapy in different versions (including high -frequency therapy);
- magnetotherapy;
- Microwave microwave technology;
- Laser therapy.
- Translectal umbrella therapy and phonophoresis;
- Microclies.