Causes of chronic prostatitis
The causes of chronic prostatitis are basically similar to the causes of acute bacterial prostatitis. The entry of microorganisms into the prostate in most cases occurs through the urethra — as a result of throwing urine into the ducts of the prostate gland (intraprostatic reflux of urine).
- Discomfort or pain — in the perineum, lower abdomen, groin, scrotum, penis, during ejaculation
- Changes in urination-difficulty urinating, frequent urination in small portions, feeling of incomplete emptying of the bladder.
- The patient may complain of a number of symptoms, or of a single symptom. The increase in body temperature is uncharacteristic (or insignificant).
The standard method for diagnosing prostatitis is to perform a 4-cup Meares-Stamey test. This is a microscopic and bacteriological study of urine samples obtained from different parts of the genitourinary tract and prostate secretions. A possible alternative is to donate the ejaculate (sperm) for microscopic and bacteriological examination, since the ejaculate partially (at least 1/3) consists of the prostate gland. This method is more comfortable for patients, especially if they categorically refuse to perform a rectal examination or diagnostic massage of the prostate gland in order to obtain prostate secretions.
During rectal examination, changes that indicate an inflammatory process in the prostate are not always observed in patients with chronic prostatitis. That is, it is impossible to rely on the result of a rectal examination for the diagnosis of chronic prostatitis.
Treatment of chronic prostatitis
Fluoroquinolone antibiotics are the optimal antimicrobial agents for the treatment of chronic bacterial prostatitis. The recommended course of antibacterial therapy is from 4 to 6 weeks. Such a long course is justified by scientific data indicating a decrease in the likelihood of relapses of the disease.
If sexually transmitted infections are detected, such as chlamydia trachomatis, a macrolide group antibiotic is prescribed.
There is evidence of decreased relaxation of the bladder neck in patients with chronic prostatitis, which leads to reflux of urine into the prostatic ducts in the urethra and causes inflammation of the prostate tissue and pain. Such patients are recommended to use alpha-blockers.
Other methods that have been proven effective in just one or several studies, or are still being investigated, include:
- pelvic floor muscle training-some evidence suggests the effectiveness of special exercises to reduce the symptoms of chronic prostatitis and chronic pelvic pain syndrome;
- acupuncture-a small number of studies indicate an advantage of acupuncture over placebo in patients with chronic prostatitis;
- extracorporeal shock wave therapy-based on the effect of acoustic pulses of significant amplitude on connective and bone tissue, is widely used in the treatment of diseases of the musculoskeletal system, has recently been used in urology, its effectiveness is under study;
- behavioral therapy and psychological support-since chronic prostatitis is associated with poor quality of life and the development of depression, these methods can improve the psychological state of the patient and help reduce some of the symptoms of the disease.