The relevance of studying the mechanism of development of chronic prostatitis increases in direct proportion to the increase in the number of diagnosed cases of the disease. It is known that chronic prostatitis (CP) occupies a leading place among urological diseases and is the result of many factors that are an integral part of modern life (social environment, ecology, increased resistance of pathogens to antibacterial drugs).
Since the disease not only covers an increasing percentage of the male population, but is also diagnosed at an ever younger age, there is often a rather dismissive attitude towards the problem on the part of doctors who use template regimens for treatment that are unable to lead to recovery.
What is chronic prostatitis
The diagnosis of chronic prostatitis (CP) combines a fairly wide range of pathological processes in the prostate gland, manifested in the form of a chronic inflammatory process of tissues. However, one cannot speak of CP only as a result of the penetration of pathogens into the prostate, since such a view justifies attempts to treat prostatitis exclusively with antibiotics, which almost never brings lasting positive results.
The main factors underlying the development of pathology can be considered complex changes in tissues and, accordingly, the functional abilities of the gland, which are the main cause of the development of infectious microflora. Chronic prostatitis, to a certain extent, is a collective diagnosis that combines several factors:
- Decreased immunity.
- Stagnant processes in the pelvic organs.
- Urodynamic disorder.
- Degenerative processes in the prostate parenchyma.
- trophic disturbance.
- inflammatory processes.
Development mechanism
The penetration of pathogenic microflora into a healthy prostate gland is practically unable to cause an inflammatory process, since the microflora of the prostate has a certain resistance to pathogens present in the urethra. However, the presence of one or more of the above provoking factors leads to the development of persistent inflammation, accompanied by the appearance of scar formations (fibrotization) or areas of necrosis.
The proliferation of connective tissue in the process of scar formation causes congestive processes in the acini (ducts that ensure the excretion of secretions), which aggravate the course of the disease. Necrotization of tissues leads to the formation of a cavernous cavity, in which, in addition to dead epithelium, a prostatic secret accumulates.
Thus, the main cause of the development of CP is not an infection, but various physiological disorders that allow the inflammatory process to become chronic.
Another distinguishing feature of the disease, which makes diagnosis difficult, isflow periodicity. As a rule, under the influence of external factors or the internal state of the body, there is a periodic change in the intensity of the pathology, during which acute conditions are replaced by periods of remission.
Often there is not only a complete absence of symptoms, but also the absence of laboratory indicators indicating the presence of infection (for example, leukocytes). Despite the positive results, this condition cannot be considered a recovery, since all physiological disorders in the gland remained unchanged.
The reasons
The main causes of circulatory disorders in the pelvic organs and stagnation of venous blood in the prostate gland are:
- Constant stay in a sitting position.
- Hypothermia of the whole body or directly in the pelvic region.
- Systematic constipation.
- Prolonged abstinence from sexual activity or excessive sexual activity.
- The presence in the body of a chronic infection of any localization (sinusitis, bronchitis).
- Excessive physical activity, accompanied by a lack of sleep or rest, causes immune suppression.
- A history of urogenital infections (gonorrhea, trichomoniasis).
- Toxic effects on the body due to the systematic use of alcoholic beverages.
The presence of any of these causes leads to the appearance of stagnant processes, deterioration of the excretory function of the glands, a decrease in cellular resistance to diseases, which contribute to the creation of optimal conditions for the reproduction of pathogenic microorganisms in the prostate gland.
Can chronic prostatitis be cured?
Despite the availability of a large amount of systematized information on the mechanism of development of CP,its treatment is extremely difficultand is one of the leading problems in modern urological practice.
Due to the fact that the disease proceeds in each individual patient according to an individual scheme, accordingly, the approach to treatment should also be individual, taking into account all the physiological changes that have occurred in the prostate gland.
The anatomical features of the prostate, which can be accessed either through the urethra or through the rectum, significantly reduce the effectiveness of the applied therapeutic effect. In this regard, to achieve a relatively stable result, a long course of therapy (usually several months) is required, during which the patient must strictly comply with all the doctor's requirements.
Unfortunately, a complete cure can only be achievedin 30 cases out of 100. This is mainly due to untimely seeking medical help, due to a long absence of severe symptoms or a conscious avoidance of unpleasant diagnostic and then therapeutic procedures. As a rule, at the time of treatment, atrophic processes in the prostate are irreversible, and even with long-term treatment, it is only possible to completely eliminate the symptoms and achieve a stable remission, the duration of which depends on the patient's compliance with the doctor's recommendations.
Treatment
The complex of measures used in the treatment of CP includes:
Antibacterial therapy
Suppression of the activity of bacterial microflora with the help of antibiotics should be carried out only after a complex of laboratory tests, according to the results of which the most effective drug is prescribed.
As a rule, the duration of antibiotics is determined by the severity of the disease and is at least 30 days. It is unacceptable to interrupt treatment, as the remaining microorganisms will become resistant to this group of drugs, and subsequently, they will need to be replaced and an even longer course. In the treatment of prostatitis, preference is given to antibiotics that have a bactericidal effect:
- Fluoroquinolones;
- Azalides;
- Aminoglycosides;
- Tetracyclines.
If laboratory tests reveal a specific nature of infection, for example, trichomoniasis or the viral origin of prostatitis, nitroimidazoles or an antiviral drug are prescribed in parallel with antibiotics.
The use of antispasmodics and α-blockers
The main purpose of the use of drugs of this series is to relieve spasm in the pelvic floor, which helps to increase blood supply, improve urine outflow and reduce pain.
Laxatives
In order to avoid excessive stress on the pelvic muscles that occur during the act of defecation, it is advisable to use laxatives, since attempts during constipation can aggravate the patient's condition.
Physiotherapy
One of the most common methods of physiotherapy is rectal massage of the prostate gland. The therapeutic effect of the impact of a finger on the prostate, carried out through the anus, is to squeeze out the infected secret, which is subsequently excreted through the urethra.
In addition, during the massage, the blood supply to the tissues increases, which has a positive effect on antibiotic therapy. To perform rectal prostate massage, the following physiotherapeutic methods are also used:
- Electrical simulation.
- High frequency thermotherapy.
- Infrared laser therapy.
Prevention
After stabilization of the condition, the patient is required to follow the rules that impose some restrictions on the usual way of life:
- Avoid water procedures in open reservoirs and pools.
- Get checked out by a doctor regularly.
- Completely refrain from drinking alcohol.
- Have regular sex life with one partner.
Compliance with the rules will allow you to be in remission as long as possible and avoid exacerbations of the disease.