Prostatitis: how to recognize the disease

Prostate inflammation is one of the main urological problems in men under 50 years old. Ten to twelve percent of all representatives of the stronger sex have experienced symptoms of prostatitis at least once in their life. The disease can occur in acute and chronic form, on which its signs and symptoms directly depend.

What is prostatitis

Prostatitis is a term for inflammation of the prostate.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 under the bladder, in front of the rectum. The prostate surrounds the urethra, the tube through which urine and semen exit the body. Its main function is the production of secretion (prostatic juice), which supports the vital activity of spermatozoa after ejaculation.

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

Types and first signs of the disease

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

1. Acute bacterial prostatitis: Caused by a bacterial infection, it usually appears suddenly and may resemble flu-like symptoms. It is the least common of the four types of prostatitis.
2. Chronic bacterial prostatitis: Characterized by recurrent bacterial infections of the prostate. There may be few or no symptoms between attacks, which is also why it can be 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 type is the least understood. It can be characterized as inflammatory or non-inflammatory, depending on the presence or absence of infection-fighting cells - antibodies in urine, semen and prostate secretions. It is often impossible to determine a single specific cause. Symptoms may come and go or remain intermittent.
4. Asymptomatic inflammatory 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 the prostate secretion.

Main symptoms

Symptoms associated with prostatitis can vary depending on the underlying cause of the condition.Common symptoms, which gradually increase, include:

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

An important symptom is pain, which may occur or radiate to various areas of the lower body. She may be :

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

Patients often report discomfort in the penis and testicles. Painful ejaculation is characteristic, and in addition, prostatitis can be accompanied by sexual dysfunction.

A rapid and severe onset is usually characteristic of the acute bacterial form, which is distinguished by an additional symptom complex similar to that which appears during the influenza virus.This:

• fever and chills;
• general discomfort and aches;
• enlarged lymph nodes;
• a sore throat.

If the patient ignores the first signs of the disease and does not seek help from a urologist-andrologist, then there are dangerous cases of purulent complications. Acute infectious prostatitis can progress to a serious form of pathology, when the prostate tissue becomes covered with pustules or abscesses. The symptoms are:

• cloudy urine or blood in the urine;
• discharge from the urethra;
• bad urine smell and discharge.

If the first signs of inflammation are detected, a man should immediately consult a doctor for further diagnosis.

Diagnostic methods

Prostatitis is usually diagnosed by laboratory testing of a urine sample and an examination of the prostate by a urologist.This exam involves palpating the prostate through the rectum to examine for any abnormalities. Sometimes the doctor takes and tests a sample of prostate secretions. To obtain it, the urologist massages the gland during a rectal exam. Because there is concern that the 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 armpits and rectally, then compares the results. During acute prostatitis, the temperature in the anus will vary by approximately 0. 5 degrees.

Laboratory tests

Laboratory tests that may be ordered include:

• clinical blood and urine tests;
• bacterioscopy and culture of urinary sediment and prostate secretions - examination of samples under a microscope for the presence of bacteria;
• a smear of urethral discharge (if there is any discharge);
• determination of the level of prostate specific antigen (PSA).

If a clinical blood test shows an increase in the level of leukocytes (from 10 to 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 pathogenic bacteria. There is also a decrease in the level of eosinophils (less than 1% of all leukocytes), another group of leukocytes responsible for protecting the body against proteins of foreign origin. The sedimentation reaction of erythrocytes, 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 sedimentation rate of these blood cells increases with an increase in the concentration in the blood plasma of markers of the inflammatory process: fibrinogen and immunoglobulin proteins, as well as C-reactive protein.

Bacterioscopy of urinary sediment and prostatic secretions will indicate the presence and number of pathological microorganisms in these biological fluids, and through the culture of antibiotic sensitivity, the type of bacteria will be established for subsequent selection of treatment. The causative microorganism can be determined, among other things, by taking a smear of discharge 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. The protein norm depends on the age of the man and ranges from 2. 5 ng/ml for 41-50 year olds to 6. 5 ng/ml for men over 70 years old. An increase in the level of this protein above the age norm means the need for a biopsy - tissue analysis for oncology. However, excessive protein content can also be observed due to inflammation of the prostate.

PSA levels may also increase slightly in cases of benign enlargement (adenoma) of the prostate and urinary tract infections.

Age-related PSA norms - table

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

Instrumental studies

Since none of the tests or analyzes individually provide a complete guarantee of a correct diagnosis, other - instrumental - methods can be used as part of a comprehensive diagnosis. These include:

1. Urodynamic study of the bladder- a complex instrumental method using special equipment makes it possible to determine whether the bladder is completely emptied, urine output, pressure inside the bladder and urethra, and also to assess the effect of prostatitis onnormal urination. This study is recommended for people suffering from chronic urinary problems: intermittent or thin stream, incontinence, frequent urination, etc. It is also indicated for patients with prolonged inflammation of the prostate, particularly when standard treatment is ineffective. Before the examination, a special sensor catheter is inserted into the patient's urethra in a horizontal position, which is also connected to measuring equipment. Then he is asked to drink a certain amount of clean water, simultaneously recording the feeling of a full bladder, the first urge to urinate, the presence of urinary leakage, etc. Then, the patient is transferred to a specially equipped chair, on which he will have to relieve himself while remaining under the control of sensors and equipment that carry out the necessary measurements. The procedure consists of several stages, each of which lasts about half an hour. The results of the urodynamic study are given to the patient immediately after its completion.

2. Ultrasound Imaging (United States)- the method is used for the diagnosis of existing disorders and it is also indicated annually for men after 45 years as prevention of prostatitis and other gland diseases. The study is carried out in the morning on an empty stomach using an ultrasound device through the anterior abdominal wall with a bladder filled with clean water, as well as by inserting a special sensor 5-7 cm deep intothe rectum (rectal method) or through the urethra. The procedure is absolutely safe and allows you to determine the contour, size and condition of certain areas of the prostate. The volume of a healthy prostate is approximately 20 to 25 cm³. The maximum length, width and thickness are 3. 5cm, 4cm and 2cm 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 intravenously. The examination is also carried out to differentiate prostatitis from oncology. An MRI machine is a large cylinder surrounded by a magnet, into which a medical table with a patient inside slides, like a tunnel. The person should wear loose clothing without metal accessories and refrain from eating heavy foods 10 to 12 hours before the procedure. Before the examination, it is imperative to remove watches, jewelry and any other metal objects. If the patient has implants or cardiac devices containing metal in the patient's body, the MRI diagnostic method is contraindicated. To carry out the procedure, a transrectal sensor is most often used (although it is possible without it), after previously cleaning the rectum with an enema. The nurse inserts the sensor and fixes it with a special disposable cuff. During the entire examination, approximately 30 minutes, the patient must remain as still as possible. The procedure is painless.

4. Cystoscopy- examination of the mucous membranes of the urethra and bladder using a cystoscope - a long, narrow catheter with a bulb and a camera at the end under local anesthesia. The procedure is performed once the bladder is full. The duration of the cystoscopy is approximately 15 minutes. The method allows you to assess the condition of the urinary tract, excluding other possible diseases causing 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 excluded or confirmed to select treatment tactics. The procedure is performed on an outpatient basis by inserting a puncture needle into the patient's rectum and taking a sample of prostate tissue. A local anesthetic is injected into the anus and, once it has taken effect, an ultrasound probe with a needle is inserted into the intestine. Under ultrasound guidance, the surgeon determines the locations from which it is necessary to "pinch" the material for analysis. There are usually up to 18 different points on the organ. The biopsy does not cause pain; after the end of anesthesia, only slight discomfort is possible.

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

Differential diagnosis

Acute symptoms of prostatitis may resemble inflammation of the bladder or urethra. In all cases, symptoms include painful and frequent urination. But acute prostatitis is distinguished by sharp symptoms of general intoxication and an admixture of pus in urine and secretions. Palpatory examination of the prostate will be painful and will reveal an increase in the size of the gland, which will not occur in cases of cystitis or urethritis.

Doctors say that inflammation of the prostate does not increase the risk of prostate cancer.

Chronic inflammation of the prostate should be differentiated in young men with anogenital symptom complex and vegetative urogenital syndrome. These diseases can only be distinguished by analyzing prostate secretions for the presence of bacteria. In men over 45 years old, it is necessary to exclude oncology and adenoma of the prostate, which at first are most often asymptomatic, unlike inflammation of the prostate. 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, recurring condition that requires constant medical monitoring and control. In each case, only a specialist in the field of urology and andrology can correctly diagnose the disease.