The relevance of the study of 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).
As the disease not only covers a growing percentage of the male population, but is also diagnosed at an increasingly younger age, there is often a rather dismissive attitude towards the problem by doctors who use treatment schemes for treatment that are not capable of leading to recovery.
What is chronic prostatitis
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 the attempts to treat prostatitis exclusively with antibiotics, which almost never bring lasting positive results.
The main factors underlying the development of pathology can be considered complex changes in the tissues and, consequently, the functional abilities of the gland, which are the main cause of the development of infectious microflora. Chronic prostatitis, to some extent, is a collective diagnosis that combines several factors:
- Reduced 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 not able to provoke 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. Tissue necrotization leads to the formation of a cavernous cavity, in which, in addition to the dead epithelium, a prostatic secret accumulates.
Therefore, the main cause of the development of PC 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, isperiodicity of the flow. As a rule, under the influence of external factors or the internal state of the body, a periodic change in the intensity of the pathology occurs, 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 that indicate the presence of infection (for example, leukocytes). Despite the positive results, this condition cannot be considered a cure, as 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:
- Permanent stay in a sitting position.
- Whole body hypothermia 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 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 cell 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 treated?
Despite the availability of a large amount of systematized information on the development mechanism of the PC,its treatment is extremely difficultand it is one of the main 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 both through the urethra and through the rectum, significantly reduce the effectiveness of the applied therapeutic effect. In this regard, in order to obtain a relatively stable result, a long course of therapy (usually several months) is required, during which the patient must strictly adhere to all the requests of the doctor.
Unfortunately, a complete cure can only be achievedin 30 out of 100 cases. This is mainly due to the premature request for medical assistance, 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 advice of the doctor.
Treatment
The set of measures used in the treatment of CP includes:
Antibacterial therapy
The suppression of the activity of bacterial microflora with the help of antibiotics should be carried out only after a complex of laboratory tests, based on 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 stop treatment, as the remaining microorganisms will become resistant to this group of drugs, and subsequently they will have 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 the 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 using drugs from this series is to relieve spasm in the pelvic floor, which helps to increase blood supply, improve urine outflow and reduce pain.
Laxatives
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 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 the stabilization of the condition, the patient is required to follow the rules that impose certain restrictions on the usual way of life:
- Avoid water procedures in open basins and pools.
- Get checked regularly by a doctor.
- Completely refrain from drinking alcohol.
- Having a regular sex life with a partner.
Compliance with the rules will allow you to stay in remission for as long as possible and avoid exacerbations of the disease.