Prostitis is a prostate inflammation by the prostate (the body of sex and the reproductive system of man) and changes as a result of this process of its physiological functions.
Spread
According to various sources, prostatitis occurs in 35-40%, and according to some authors, 70% of men aged 18 to 50 years.Representative gland in overcoming diseases and setup problems that occur at the same time occupies a leading place among urological pathology.
Classification
There is a lot of classification of prostatitis, hence the very distinctive terminology.The most common is the classification of prostatitis proposed by the American National Institute of Health (NIH) in 1995. years:
| Category | Description |
| Category and | Acute bacterial prostatitis |
| Category II | Chronic bacterial prostatitis |
| Category III | Chronic ablacterial prostatitis |
| Category IIIA | Inflammatory chronic pelvic pain syndrome |
| Category IIIB | Non-coal chronic pelvis syndrome (probative) |
| Category IV | Synomptomatic inflammatory prostatitis |
This classification of prostatitis is based on clinical signs, presence or absence of leukocytes and microorganisms in prostate, ejaculation and urine.
Category and
Acute bacterial prostatitisIt is expressed by an acute contagious inflammatory praise with all related signs:
- increased amount of leukocytes in urine;
- the presence of urine bacteria;
- Common signs of infection (increase in body temperature, symptoms of intoxication).
Category II
Chronic bacterial prostatitis- It is signed by appropriate symptoms and increasing the number of leukocytes and bacteria in the secrecy of prostate, ejaculate and urine obtained after the prostate massage.
Category III
Chronic Syndrome Pager's Heels (KTR)- The leading clinical symptom is the syndrome of pain for more than 3 months in the absence of pathogenic microorganisms in prostate, ejaculation and urine obtained after the prostate massage.Separation of III A and III B The presence of the increased number of leukocytes.
Category III a
Inflammatory chronic pelvic pain syndrome- Characterized by the presence of pain and prostatitis, and the increased amount of leukocytes in the excretion of prostate, ejaculate and parts of the prostate, pathogenic microorganisms were not detected in these samples.
Category III B
No-coating syndrome of chronic pelvic pain- Characterized by the presence of prostatitis syndrome, until there is an increase in the number of leukocytes and are not detected by standard methods of pathogenic microorganisms in prostate, ejaculation and urine obtained after the prostate massage.
Category IV
Synomptomatic inflammatory prostatitis- Lack of symptoms characteristic of prostatitis, the disease was discovered during the histological examination of the prostate samples obtained in relation to the diagnosis for other reasons (for example, the implementation of the prostate biopsy due to increasing the level of specific antigen - PSA).
Diagnosis of prostatitis
Prostatitis symptoms are extremely diverse, but can be combined in several groups.
The syndrome of pain
As a result of insufficient blood supply caused by inflammation of blood vessels, prostate, consent of oxygen of glandular tissue, as a result of which are formed by pathological oxidation that affect the nerve endings of the prostate.Since the prostate of the internal is associated with the innervation of the pelvic floor, penis, scrotum, testicles, rectum - the localization of pain is a variable.The following symptoms of pain are the most common:
- Discomfort or pain in the perineum - basically appear after physical effort, sexual intercourse, alcohol in the form of passing attacks;
- A feeling of hot potatoes in the rectum;
- Pain (discomfort) in the testicles - patients are described as "pain", "twisting", are also connected to different provocative factors;
- Uneasiness, rubber and urethra pain - are mainly related to the mentioned pH secrets of the acid side.The acidic secret prostate irritates at the mucosa of the urethra, and in the form of "ignition," appears after the act of urinating or sexual intercourse, when entering the muscles of glands and pelvis, clenched in lumen urethra.
Urenity Disorder Syndrome
Associated with close innervation of prostate and bladder, as well as the participation of the prostate muscles in the act of urinating.Dysuria can be accompanied by the following manifestations:
- Furious urination - frequent urination (happens up to 3 times per hour) with sharp and sudden calls (impossible to endure) and quite small portions;
- A sense of incomplete bladder discharge - after the urination act, he feels that urine remained in the bladder;
- Weak or occasional flow of urine - This can be attributed to the symptom of the "last fall" - despite all patient efforts after the act of urinating from the canal, a drop in urine is still released.
Breach of ejaculation and orgasm
It is associated with damage to the prostatitis of the seed tuberkla (columnity) on the surface, of which the nervous receptors sending the brain structures, where a sense of orgasm is formed.Prostatitis does not directly cause an erection (blood supply to the penis during sexual excitement).
Main disorders:
- Premature ejaculation or reverse excessively long-lasting sexual intercourse - caused by inflammation of the seminar tuberket or its scar due to the inflammatory process;
- Deleted orgasm - is also connected to the inflammation of Tuberkla;
- Pain during ejaculation - associated with the inflammatory process in the exit channels of the prostate through which sperm is released.
Breach of fertility
When changing prostate properties, as a result of inflammation, the following changes in sperm were observed, reducing man's abilities to fertilize (fertility):
- Reduction of pH sperm on the sour side - from the inflammation of the prostate, the acidic products of pathological oxidation begin to accumulate in secret.The sour environment is extremely destructive for sperm that causes their immobilization, and even death;
- Sperm Anglutination - Bonding of spermation mainly with the heads - is associated with the change in the physicochemical properties of the secretary;
- AsthenosPermia - Reduction of sperm mobility - is closely linked to the pH in the acid and with a breach of prostate production of lecithin trolleys, which ensure the vital sperm activity.
Urethropostatitis
In some cases, prostatitis combines with chronic urethritis, which manifests mild mucosa-inflammatory exhaust from the urethra (mainly after extended urinary restraint).
Prostatitis and sexual disorders
Question "Does prostatitis cause infirm?"This is the cause of disputes of experts for decades.
Under the influence of sexual stimuli, with full saturated bodies in the forms of the cortical and support area, a nervous signal is submitted in the center of the Elek, from the place in the smooth muscles of the penis cavernous bodies (arteries and sinusoids) (veins).There is no role of the prostate gland in this process.
Ejaculation and orgasm occur with enough irritation of receptor cells in the field of seminar tubercles in which the prostate output channels are responsible for the departure of the nerve impulse on the cerebral cortex where a sense of orgasm is formed.
The inflammatory process in the expensive gland (prostatitis) can lead to defeat tubercles for seeds and, as a result, as a violation of man's potency, such a premature ejaculation and echo orgasm.Impotence in chronic prostatitis is pathogenically linked to the degree of damage to the prostate nerve device.This form of impotence is a characteristic example of a rapid phenomenon, when the presence of pathological impulsion with bodies affected by the inflammatory process leads to the irradiation of the excitement procedure and the sexual function and disorder.Safe, although not leading, the role is played in the pathogenesis of neuroreceptor, also some control of androgen testicles and sensitivity to androgenic centers of hypothalamus and pituitary.
At the same time, there is an opinion that there is also the hyperdialness of prostatitis and redistribution of its role in the development of erectile dysfunction in the Russian Federation.
Diagnostics
The task of the doctor is to discover the inflammatory process in the prostate, identifying possible pathogenic disease and assessment of the damaged prostate function.In 1990. Stamey wrote that prostatitis was "garbage basket for clinical ignorance" due to different concepts of used, diagnostic and treatment methods.At the same time, several simple and clinical and laboratory tests allow you to make a diagnosis correctly, allowing you to start the appropriate therapy.
PUTIC RECTAL RESEARCH PROSTATE
A very informative way.The inflammatory process can be judged by evaluating shapes, contours, dimensions of the gland, the presence of foci of compaction and (or) softening, pain.Main signs of prostatitis: increase or decrease in size, heterogeneity of consistency, presence of focus of compaction and softening, pallets, pain.The fact that 80% of the pancreas cancer reveals through a rectal study speaking for themselves.We can safely say that this research method will always be used.
Microscopic examination of the Secretary of the pancreas
It should be borne in mind that increasing the number of leukocytes is not indicated always on prostatitis, because the methods of obtaining a secret during the massage do not guarantee that the content of the seeds and bubbles will not fall into it.At the same time, with obvious signs of prostatitis, the secret prostate can be normal.This explains the foci of the inflammation, the presence of part exposed or closed, output channels.
Prostate excretion study
Expressed prostatic secretions) Secret studios provide you with determining the presence of inflammatory process in prostate and partially its functional ability.It is the main method of diagnosing and supervision of the treatment of chronic prostatitis.The secret prostate can be tested using a slight microscopy without painting or using special coloring methods.Also, the secret prostate by the prostate can be subjected to bacteriological examination or examination method of the chain reaction of the polymerase for the detection of pathogens in it.Get a secret with a prostate massage.The secret that is released from the urethra is collected in a sterile test pipe or on a clean glass of the research facility.Sometimes the secret of the prostate gland from the urethra is not followed.In such cases, the patient is recommended to return to his feet immediately.If, however, it was not possible to get a secret, it is more often that he did not enter the urethra, but in the bladder.In this case, the centrifugate washing fluids were released from the bladder after examining the massage of the prostate gland.
- Lipoid grains (lecithin bodies) - a specific product of normal physiological excretion of a glandular epithelium prostate gland.Gives secret milk.It is usually a secret rich in legitimate cereals.Reduction of their number, along with increasing the number of leukocytes, indicates the inflammatory process, tumor;
- Amyloid bodies - layered (Storchy), body, which are with a solution of Lugola colored in purple or blue, like starch;
- Amyloid bodies are condensed secret glands, has an oval shape and a layer structure, like a wooden luggage.They are not normal, their detection points to stagnation of secret in the gland, which can be in adenomas, chronic inflammatory processes;
- Erythrocytes can be alone.They fall into a secret as a result of the prostate energy massage.Their increased amount was observed in inflammatory processes, neoplasms.
- It will remove the descending epithelium in large quantities at the beginning of inflammatory processes and tumors, and then there is often a disability with protein and greasy degeneration of epithelial cells.Macrofage can be seen by stagnation of the secret, longer time of the current inflammatory process;
- The crystals of the Betthera on the day are the crystals formed during cooling and mixed secret of male gonads (prostatic juice with sperm plumage) from sperm and phosphora-lanice salt.With azoospermia and sharply expressed Oligozoospermia, Betthera Crystalis form quickly and in large quantities;
- Redaetional syndrome - stagnation syndrome is observed with Gland Adeno.There is an abundance of macrophages, there are multi-use cells such as foreign bodies and amyloid bodies;
- The symptom of FERN is the symptom of crystallization of the secret - in the form of falling sodium chloride crystals depends on the physicochemical properties of the secret prostate.The symptom study is made by adding a decline in 0.9% of chloride sodium solutions to the resulting secret prostate with further viewing after drying under the light microscope.In healthy male reproductive age, the crystallization of the secret prostate is characterized by a typical FERN list phenomenon (3+).Androgen failure or presence of prostatitis give different degrees of violations of the structure of crystals to their absence.
Bacteriological studies of urine parts and excretion pancreas
Urethra smear, including PCR diagnostics
Serological diagnosis of agents (elisa) that cause urinary tract infections
Immunofluorescence (reef) reaction is flat and indirect
Identification of antibodies for good knowledge of antigens.
Determination of a dog (prostate -specific antigen) blood serum
The American Foundation for Urological Diseases recommends the annual passage of the Rectal Prostate Research, accompanied by a dog for all men over 50 years, and with prostate cancer for blood cousins towards the male line.There is still a discussion about getting a dog immediately after examining the prostate glands of the rectum.Recent studies could not confirm the presence of a significant increase in the dog content immediately after the finger view.Thus, the level of the dog can be determined by receiving reliable results and after the pancreatic survey.
Four-lived test
In order to diagnose chronic prostatitis, a 4-glass test was proposed, based on a comparative bacteriological urine estimate, approximately equal to the part of the urine, obtained before and after the massage of the prostate, as well as its secret.
The diagnosis of prostatitis was established by ten-drugs by increasing the concentration of prostate compared to their content in the urine (1, 2 and 3 portions) and increasing the number of polymorphic-nuclear leukocytes> 10-16 in the light microscope field (increase by 200 times).Or increase in the number of leukocytes more than 300x106 / l when calculating them in the counting chamber.LECITY BODIES, which are the product of normal excretion of the prostate epithelium, should be densely covered by the field of microscope vision (5-10 million in 1 ml).Amyloid bodies in prostate secrecy are in a much lesser quantity.In men, ripe times can be found 1-2 in the field of view.
Biochemical blood test
Immunological and hormonal profile (according to indication).
Ultrasound, Trusie
Ultrasonic diagnosis of prostatitis by the abdominal and transhrectane sensor (trust).
Urofloomery
Prostatitis treatment
A comprehensive treatment of patients with chronic prostatitis should contain:
- Respect for general regime, diet, sexual sex hygiene, as well as attracting sexual partners in the presence of an infectious agent;
- Selection of effective drugs to combat infection;
- Increasing the general reactivity of the patient's body and immunobiological tolerance of microorganisms in drugs;
- Strengthening the outflow of excretion and activation of local reparative processes in the focus of inflammation;
- Rehabilitation of the foci of infection in previous and remote bodies;
- Improving microcirculation in prostate glands and pelvic authorities;
- Appointment of general strengthening of funds, enzymes and vitamins;
- Correction of hormonal disorders;
- Appointment of antispasmodics;
- Appointment of analgesic and anti-inflammatory drugs;
- taking a sedative and transforming drugs;
- Regulation of neurotrophic disorders by local drug drug drugs;
Prostate massage
Prostate massage- Medical procedure used in order to diagnose and sometimes treat chronic prostatitis.The first massage of the prostate described Posner in 1893. years, and since 1936. was widely introduced in the Urological practice of O'Condoria.However, in 1968. year, after the description of Meary and Stamey, prostatitis, were covered in the causes of this disease and massage as therapeutic proceedings in many prostatitis treatment guidelines in developed countries around the world.
But since the mid-90s 20. Centuries, many doctors involved in diagnosis and prostatitis have begun inefficiency in some cases proposed antibacterial therapies and the use of alpha-blockers, which has led to use in the practice of this forgotten method.
Basically, the prostate massage is currently used as a diagnostic procedure for the excretion of the prostate - for its microscopic (cultural) study (before and postmassage test) and must perform a previously trained specialist. The massage is performed after urination, and when it is released from the urethra after preliminaryLaunding isotonic sodium chloride solution, which is especially needed when a bacteriological review is assumed. The prostate is near the rectum of the prostate from the prostate movement from the periphery to the central groove along the output channels, trying not totouching the seed bubbles. The massage is completed from the central furrow from the urethra is collected in a sterile examination of the object to the leg if it was not possible to obtain a secret, it means that it was not in the bubble. In thisThe case, the centrifugate washing liquids were released from the bladder after the prostate massage is examined.
Massage prostate for medical purposes (repetitive massage) officially recommends Russian Federation of the Russian Federation as a therapeutic process of chronic prostatitis.Prostate massage is widely used to treat prostatitis in the countries of Southeast Asia, China and some countries in Europe.Some Severic and Canadian urologists also recommend using massage combined with antibiotic therapy in the treatment of some forms of prostatitis.In essence, assessment of efficiency or inefficiency of the prostate massage is practically not implemented.There are several contradictory studies, in one, which conducted Egyptian doctors, some of which were massages combined with antibiotic therapy and simply antibiotic therapy, on the contrary, received a combination of antibiotic therapy, significant improvement was observed.
Fans of using therapeutic massage Massage believe that the main effect of its use of the Denial Channel Prostate - I.E.their release from gnow and dead cells.Another effect is to increase blood flow in the spending gland, which improves the penetration of antibiotics in it and activates local protective immune processes.
In the world literature, there are small data on complications related to prostate massage.1990. Japanese doctors described the genital bodies (four-earlier), and in 2003. German doctors were permanent bleeding after a prostate massage with the development of the epbolic walking (bleeding) lungs.There is a study that after massage the level of the dog (prostathospecific antigen) temporarily increases.The massage is contraindicated in the acute inflammation of the prostate (acute prostatitis), with acute urethritis, orchitis, prostate cancer.Massage is not recommended for calcinating the prostate and adenome prostate.It is generally recommended that the prostate massage is recommended 2 or 3 times a week.
Physiotherapy procedures
All physiotherapy procedures (prostate massage, heating, etc.) in acute prostatitis are contraindicated.
The use of physiotherapy procedures in complex treatment of prostatitis has direct action on the prostate of physical funds to normalize functional and pathological changes, as well as the electrophoretic administration of the prostate tissue.
The use of physiotherapy methods against the background of drug therapy gives medicines much better than in treatment separately.The following methods of influence on the prostate glend have become widespread and showed their efficiency:
- shock therapy-wave;
- Electrical stimulation of pancreas with modulated currents with TID or rectal electrodes;
- Thermotherapy in different versions (including high-quatering thermotherapy);
- Magnetotherapy;
- Microwave microwave technology;
- Laser therapy.
- Transtral ultrasonic therapy and phonoporesis;
- Microcrism.