Acute prostatitis is an infectious inflammation of the prostate gland, accompanied with swelling and the formation of purulent foci in the prostate. Manifestations of acute prostatitis depends on the phase (catarrhal, follicular, parenchymatous, abscessed) and may include dysuric disorders, pain in the perineum, fever, intoxication. The diagnosis is based on palpation of the prostate, ultrasound and Doppler studium prostate, a study of the discharge of the urethra and prostate secretion. Treatment of acute prostatitis includes the administration of antimicrobial therapy, Nsaids, antispasmodics, analgesics, immunomodulators, physiotherapy.
Acute and chronic prostatitis are the most common and socially significant diseases of the male. In clinical urology, prostatitis is diagnosed in 30-58% of women in the reproductive and working age (30-50 years). For acute prostatitis is accompanied by disorders of sexual function and fertility, disorders of psychoemotional state and social disadaptation.
Causes of acute prostatitis
The causative agents of acute prostatitis are mainly non-specific infectious agents that penetrate into the tissues of the prostate, of the gram-negative (Escherichia coli, Klebsiella, Proteus) or gram-positive (staphylococci, enterococci, streptococci)
Often acute prostatitis may be caused by pathogens urogenital infections:
- chlamydia
- trichomoniasis,
- Ureaplasma,
- gonorrhea,
- mycoplasmosis,
- candidiasis etc.
Most often, the penetration of microbial agents in the prostate tissue are going transcanalicular way – through the excretory ducts of the glands in the wall of the posterior urethra. Therefore, the urethritis of any origin is very often complicated with acute prostatitis. Less microbial flora gets into the prostate from the bladder in acute cystitis. The introduction of pathogens in the gland is significantly facilitated by the increased intraurethral pressure (reprehenderat, stones in the urethra), the implementation of the endourethral manipulation (bougienage of the urethra, urinary catheterization, ureteroscopy, cystoscopy, etc.).
Additionally, acute prostatitis may result from hematogenous infection, facilitated by the conditions of the blood supply of the prostate with a well-developed system of arterial and venous anastomoses. When called hematogenous drift bacteria can get into the prostate tissue from distant foci in purulent tonsillitis, sinusitis, caries, cholecystitis, bronchitis, pyoderma, etc. Can lymphogenous infection of the prostate from the bowel with anal fissures, proctitis, colitis.
Of non-infectious factors that contribute to the development of acute prostatitis include persistent congestion in the veins of the pelvis and postural drainage acini of the prostate. Stagnation can be caused by disritmia sexuality and sexual violations – a practice interrupted intercourse, lack of or improper sexual activity, excessive sexual activity, etc. The pathological deposition of blood in the venous line of the pelvis can be noticed when sedentary lifestyle, frequent constipation, colds, chronic (most often alcohol) intoxication, varicose veins of the pelvis.
Forms of acute prostatitis
In the development of acute prostatitis distinguish the following forms, which are its stages:
- catarrhal,
- follicular,
- parenchymal,
- abscessed.
Acute prostatitis begins with a catarrhal inflammation of the mucous and submucous layer of the excretory ducts of individual lobules of the gland. In the enlarging of the walls of the channels contributes to the stagnation of the Muco-purulent secret in the follicles of the prostate and progression of inflammation, in connection with what may develop central suppuration of lobules acute follicular prostatitis. When multiple lesions of the lobules, and diffuse involvement of the parenchyma and interstitial tissue of the prostate in suppurative inflammation, acute prostatitis goes into its next phase – parenchymal. In the case of the merger of small ulcers in the large hearth the formation of an abscess of the prostate, which can be opened in the urethra, the perineum, the rectum or the bladder.
Symptoms of acute prostatitis
Clinical manifestations of acute prostatitis correspond to the stages of the process. Common manifestations are pain, disorders of urination and drunkenness.
In the acute catarrhal stage of prostatitis feel the weight and pain in the perineum. Dysuric disorders are characterized by painful frequent urination, especially at night. The temperature of the body is maintained in the normal range, may be slightly elevated; intoxication missing. Palpation examination of the prostate is not changed or slightly increased, little painful. The study of prostate detect the secretion increase of white blood cells, the accumulation of Muco-purulent themes. In the urine during the emptying of the excretory ducts of the acini appear white blood cells. Prostate massage is usually impossible, because of the pain. The treatment started in the catarrhal stage of acute prostatitis, leads to a recovery of 7-10 days.
The follicular form of acute prostatitis occurs more light, accompanied by a dull pain in the perineum, irradiating in the penis, rectum or sacrum. Against this background, the urination painful and difficult, until the development of acute urinary retention. The act of defecation in the acute follicular prostatitis is also difficult, because of expressed pain. Due to the increase of body temperature up to 38°C, impaired General condition. Palpation per rectum is determined is enlarged, dense, intense, asymmetric, enlarged, sharply painful in some areas when the digital review. Urine is collected after the palpation of the gland, contains a large number of leukocytes and purulent filaments, forming a turbid precipitate. Massage to get the cancer of secretion in the follicular phase of acute prostatitis is contraindicated. With intensive treatment of acute follicular prostatitis can be positively determined; otherwise, it passes to the next, the parenchymal phase.
Clinic of acute parenchymatous prostatitis develops rapidly. Characterized by severe hyperthermia (up to 39-39,5°C and more) accompanied by fever, General weakness, depression of appetite, thirst. The first urination edged learning and complicated, then may stop completely. Attempts to empty the bladder or bowel are accompanied by intense pain. The development of the painful tenesmus, constipation, flatulence. The pain extends to the rectum, is a tedious character, forcing the patient to take a forced position – lying down with crossed legs. With the development of reactive inflammation of the rectum from the anus of mucus.
Determined by palpation diffusely enlarged, with an unclear outline of the gland, extremely painful at the slightest touch. Prostate massage in the parenchymal phase of acute prostatitis is contraindicated strongly. Sometimes, because of the pararectal tissue swelling and tenderness, rectal examination is not possible to lead. In the urine – pronounced album sanguinem cellam, pyuria. The outcome of acute parenchymatous prostatitis can serve as resolution of the disease, the formation of an abscess of the prostate or chronic prostatitis.
The diagnosis of acute prostatitis
The recognition and identification of the stage of acute prostatitis is performed by a urologist and is on the basis of a comprehensive physical examination, laboratory and instrumental examination. Examination of the prostate through the rectum, allows to determine the size, consistency, homogeneity, symmetry, cancer; pain reaction, foci of destruction, signs of purulent fusion of tissues. Palpation of the prostate in acute prostatitis is carried out very carefully without rough pressure and massage movements. Obtained in the prostate secretion revealed an increased number of leucocytes and amyloid Taurus, reducing the number of lecithin granules.
In acute prostatitis, there is an increased leukocyturia in the third part of the urine and urine collected after palpation of the prostate. For the allocation of the causative agent of acute prostatitis is necessary to conduct a bacterial analysis of urine and urethral discharge with antibiotics, PCR studies of scrapings, blood cultures of sanguinem cultura. The nature and severity dysuric disorders in acute prostatitis is estimated by using the uroflowmetries.
Ultrasound of the prostate with moderate pain syndrome can be performed transrectal; in the case of pronounced pain reaction – transabdominal. Anoscopically estimated the shape, the size of the tumor, the presence of focal or diffuse changes, it sets the stage of acute prostatitis. The use of Doppler studium allows a detailed and differentiated to evaluate the vascularization of the prostate.
When planning the surgical tactics in terms of destructive forms of acute prostatitis are appropriate, CT or MRI of the pelvis.
Treatment of acute prostatitis
The leading role in the treatment of acute prostatitis belongs to the causal therapy. You need the earliest appointment antimicrobial (antibacterial, antiviral, antitrichomonal, antimycotic) drugs to suppress the propagation of microorganisms in the gland and the tissues of the urethra. To reduce cramps and painful urination prescribe analgesics, spasmolytics, and rectal candles with Anaesthesinum or belladonna, hot microclysters. In the complex therapy of acute prostatitis are used Nsaids, enzymes, immunomodulators, vitamins, infusion solutions.
Physical therapy in acute prostatitis is carried out after the reduction of acute symptoms. In order to anti-inflammatory, decongestant, analgesic actions, improving microcirculation and local immunity applied rectal electrophoresis, UHF-therapy, microwave therapy, prostate massage. In acute prostatitis shown to comply with bed rest, sparing diet, sexual peace.
When urinary retention on the background of acute prostatitis avoid carrying out catheterization of the bladder, preferring trocar cystostomy. When abscess of the prostate occurs in need of surgery - opening and drainage of the abscess cavity.
The treatment of acute prostatitis is judged by the restoration of the structure of the tissue glands and its functions, the normalization of the composition of the juice of the prostate gland, the removal of the pathogens causing the inflammation of the body liquids.
Prediction and prevention
As a rule, in a timely manner and reasonable causal therapy leads to cupping of the signs of acute prostatitis. Of an abscess of the prostate or chronic inflammation occurs in advanced cases.
Prevention of acute prostatitis should include debridement of infectious foci in the body, the carrying value and the endourethral endovesical manipulations in accordance with the rules of asepsis, timely treatment of Stds and urethritis, the normalization of sexual activity and physical activity.