Prostatitis: how to recognize the disease

Prostatitis is one of the main urinary problems in men under 50 years of age. Ten to twelve percent of all representatives of the stronger sex have experienced symptoms of prostatitis at least once in their lives. The disease can occur in acute and chronic forms, which directly depends on its signs and symptoms.

What is prostatic disease

Prostatitis is a term that means inflammation of the prostate gland.The prostate or prostate is an organ of the male reproductive system. Its normal size does not exceed the size of a walnut. The gland is located below the bladder, in front of the rectum. The prostate surrounds the urethra, the tube that carries urine and semen out of the body. Its main function is to produce secretions (prostatic fluid), which supports the vital activity of sperm after ejaculation.

The inflammatory process in the prostate can be caused by infection, as well as many other reasons.

Types and first signs of the disease

The first signs and subsequent symptoms will depend on the type of prostatitis. In total, clinicians distinguish 4 types.

1. Acute bacterial prostatitis: Caused by a bacterial infection, which often has a sudden onset and may resemble flu-like symptoms. This is the least common of the four types of prostatitis.
2. Chronic bacterial prostatitis: Characterized by recurrent bacterial infections in the prostate. There may be few or no symptoms between attacks, which is also why it is difficult to treat successfully.
3. Chronic prostatitis/chronic pelvic pain syndrome: Most cases of prostatitis fall into this category, but at the same time this category is the least well understood. It can be described as inflammatory or non-inflammatory, depending on the presence or absence of infection-fighting cells - antibodies in urine, semen and prostatic secretions. It is often not possible to identify a specific cause. Symptoms may come and go or be intermittent.
4. Asymptomatic prostatitis: This disease is often diagnosed incidentally during treatment for infertility or prostate cancer. People with this form of prostatitis do not complain of symptoms or discomfort, however, tests show the presence of infectious cells in prostatic secretions.

Main symptoms

Symptoms associated with prostatitis can vary depending on the underlying cause of the disease.Common, progressive symptoms include:

• pain or burning when urinating (dysuria);
• difficulty urinating, such as a thin urine stream or slow, intermittent urine;
• frequent urination, especially at night (nocturia - going to the toilet more than 2 times a night);
• urgent urge to urinate.

An important symptom is pain, which can occur or spread to different areas of the lower body. She can:

• in the rectum (rectum), sometimes associated with constipation;
• in the abdomen and/or lower back;
• in the perineum - between the scrotum and the rectum.

Patients often report penile and testicular discomfort. Painful ejaculation is characteristic, and in addition, prostatitis may be accompanied by sexual dysfunction.

A rapid and severe onset often characterizes the acute bacterial form, which is distinguished by an additional complex of symptoms similar to that occurring with influenza viruses.This:

• fever and chills;
• general malaise and body aches;
• enlarged lymph nodes;
• sore throat.

If the patient ignores the first signs of the disease and does not seek help from a urologist-endocrinologist, there will be cases of dangerous purulent complications. Acute infectious prostatitis can develop into a serious form of the disease, when prostate tissue becomes covered with pustules or abscesses. Symptoms include:

• cloudy urine or blood in the urine;
• discharge from the urethra;
• foul odor of urine and secretions.

If early signs of infection are detected, a man should immediately consult a doctor for further diagnosis.

Diagnostic method

Prostatitis is usually diagnosed through laboratory testing of a urine sample and examination of the prostate by a urologist.This examination involves palpating the prostate through the rectum to check for any abnormalities. Sometimes the doctor collects and tests a sample of prostate secretions. To get at it, the urologist will massage the gland during a rectal examination. Because there is concern that this procedure may release bacteria into the bloodstream, this test is contraindicated in cases of acute bacterial prostatitis.

The urologist also measures body temperature in the armpit and rectum, then compares the results. When suffering from acute prostatitis, the temperature in the anus will vary by about 0. 5 degrees.

Test

Laboratory tests that may be ordered include:

• clinical blood and urine analysis;
• bacterioscopy and culture of urine sediments and prostatic secretions - examining samples under a microscope for the presence of bacteria;
• a trace of discharge from the urethra (if there is any discharge);
• determine prostate-specific antigen (PSA) levels.

If a clinical blood test shows an increased leukocyte level (between 10–12 per field of view), this will indicate the presence of inflammation. Acute infectious prostatitis is characterized by an increase in neutrophils, a type of white blood cell whose main function is to destroy disease-causing bacteria. There is also a decrease in the level of eosinophils (less than 1% of total white blood cells), another group of white blood cells responsible for protecting the body from proteins of foreign origin. The erythrocyte sedimentation reaction, or red blood cells, is another indicator of a general clinical blood test and also indicates the presence of a pathological process in the body if its value exceeds 10 mm/H. The rate of deposition of these blood cells increases with increasing plasma concentrations of markers of the inflammatory process: fibrinogen and immunoglobulin proteins, as well as C-reactive protein.

Bacterioscopy of urine sediment and prostatic secretions will reveal the presence and number of pathogenic microorganisms in these biological fluids, and by culture for antibiotic sensitivity, the type of bacteria will be determined. determined to choose the next treatment method. Pathogenic microorganisms can be identified, among other things, by taking samples of secretions from the urethra for microscopic examination.

The prostate-specific antigen test is a screening test in the form of an intravenous blood test for a protein produced exclusively by prostate cells. Protein levels depend on the age of men and range from 2. 5 ng/ml for ages 41–50 to 6. 5 ng/ml for men over 70 years old. An increase in the level of this protein above age means that a biopsy - tissue analysis - is needed to treat cancer. However, excess protein content can also be observed due to prostatitis.

PSA levels can also be slightly increased by benign enlargement (adenoma) of the prostate and by urinary tract infections.

Age-related PSA norms - table

Age category	PSA norms
Under 40 years old	less than 2. 5 ng/ml
40–49 years old	2. 5 ng/ml
50–59 years old	3. 5 ng/ml
60–69 years old	4, 5 ng/ml
Over 70 years old	6. 5 ng/ml

Study musical instruments

Since no single test or analysis completely guarantees an accurate diagnosis, other methods - instrumental methods - can be used as part of a comprehensive diagnosis. Including:

1. Urological study of the bladder- a complex instrumental method using special equipment that allows you to determine whether the bladder is completely empty, the urine flow rate, pressure inside the bladder and urethra, and also evaluate the photoEffects of prostatitis on normal urination. This study is recommended for people with chronic urinary problems: intermittent or thin urine stream, urinary incontinence, frequent urination, etc. v. It is also indicated for patients with persistent prostatitis, especially when standard therapy is ineffective. Before the examination, a special catheter sensor is inserted into the patient's urethra in a horizontal position, which is also connected to the measuring device. Next, he is asked to drink a certain amount of clean water, while recording the feeling of a full bladder, the first urge to urinate, urine leakage, etc. v. After that, the patient is transferred to a specially equipped chair, on which he will need to go to the toilet while remaining under the control of sensors and equipment that carry out the necessary measurements. The procedure includes several stages, each taking about half an hour. The results of the hemodynamic study are provided to the patient immediately upon completion.

2. Ultrasound images (USA)- this method is used to diagnose existing disorders and is also prescribed annually to men after 45 years of age to prevent prostatitis and other glandular diseases. The study was performed in the morning on an empty stomach using an ultrasound machine through the anterior abdominal wall with a bladder filled with clean water, as well as by inserting a special sensor 5–7 cm deep into the rectum (rectal method) or transurethral method. This procedure is absolutely safe and allows you to determine the contour, size and condition of each area of the prostate. The volume of a healthy prostate is about 20–25 cm³. The maximum length, width and thickness are 3. 5 cm, 4 cm and 2 cm respectively.
3. Magnetic resonance imaging (MRI)- the method allows you to study in detail the structure, density, condition and even blood flow of the prostate; Sometimes, for a better overview, an additional contrast agent is injected into the vein. Examination is also done to differentiate prostatitis from cancer. The MRI machine is a large cylinder surrounded by a magnet, into which a medical table with the patient slides inside, like a tunnel. The person should wear loose-fitting clothing without metal accessories and avoid eating heavy foods 10–12 hours before the procedure. Before inspection, it is mandatory to remove watches, jewelry and any other metal objects. If the patient has an implant or cardiac device that contains metal in the body, MRI diagnostic methods are contraindicated. To carry out the procedure, a transrectal sensor is most often used (although it is possible without it), having previously cleaned the rectum with an enema. The nurse inserts the sensor and secures it with a special disposable cuff. During the entire examination, about 30 minutes, the patient should lie as still as possible. This procedure is not painful.

4. Cystoscopy- examination of the mucous membrane of the urethra and bladder with a cystoscope - a long narrow catheter with a bulb and camera at the end under local anesthesia. The procedure is performed after the bladder is full. Cystoscopy time is about 15 minutes. This method allows you to evaluate the condition of the urinary tract, excluding other possible diseases that cause problems with urination.
5. Prostate biopsy- is a necessary procedure if, after a comprehensive examination, the doctor suspects a malignant process in the prostate. It must be ruled out or confirmed to choose treatment tactics. This procedure is performed on an outpatient basis by inserting a needle through the patient's rectum and taking a sample of prostate tissue. A local anesthetic is injected into the anus, then, when the medication takes effect, an ultrasound probe with a needle attached is inserted into the intestines. Under ultrasound guidance, the surgeon will determine the necessary locations to "split" the material for analysis. Usually there are up to 18 different spots on the organ. Biopsy is not painful; After the anesthetic wears off, you may only feel a little uncomfortable.

If the patient has recurrent urinary tract infections and prostatitis, the specialist will prescribe a comprehensive examination of the genitourinary system to identify anatomical abnormalities.

Differential diagnosis

Symptoms of acute prostatitis may resemble those of cystitis or urethritis. In all cases, symptoms include painful and frequent urination. But acute prostatitis is distinguished by clear symptoms of general intoxication and pus in urine and secretions. Examination of the prostate will be painful and will detect an increase in the size of the gland, which will not occur with cystitis or urethritis.

Doctors say prostatitis does not increase the risk of prostate cancer.

Chronic prostatitis should be distinguished in young men with complex genitourinary symptoms from vegetative genital syndrome. These diseases can only be distinguished by analyzing prostatic secretions for the presence of bacteria. In men over 45 years old, it is necessary to rule out cancer and prostate adenoma, which in the early stages are often asymptomatic, unlike prostatitis. For a more detailed analysis, the urologist will prescribe a PSA test and then, if necessary, a biopsy.

Prostatitis can be an acute bacterial disease, often easily treated with antibiotics, or a chronic, relapsing disease that requires ongoing medical monitoring and control. In each case, only a urologist and andrologist can accurately diagnose the disease.