Acute prostatitis – infectious-inflammatory of the defeat of the prostate gland, accompanied by swelling and the formation of the avant-garde in the tissues of the prostate. The manifestation of acute prostatitis depend on the stage (catarrhal, follicular, parenchyma, abscessed) and may include dysuric disorders of pain in the groin, fever, poisoning. The diagnosis is based on the data of the palpation of the prostate, ultrasound and Doppler studies of the prostate, separate study of the urethra and the prostate secretion. The treatment of the acute prostatitis consists in the appointment of antimicrobial therapy, nsaids, antispasmodics, analgesics, immune modulators, physiotherapy.
Acute and chronic prostatitis are the most common and socially significant kinds of diseases. In the clinic of urology of the prostate is diagnosed 30-58% of men in reproductive health and of working age (between 30 and 50 years). The term acute prostatitis is accompanied by disorders of the sexual function and fertility, disorders of psycho-emotional state and social disadaptation.
The cause of acute prostatitis
Agents of acute prostatitis mainly act nonspecific infectious agents, penetration into the tissue of the prostate - gram-negative (e. coli, klebsiella, protey) or gram-positive bacteria (staphylococci, enterococci, streptococci)
Often, the acute prostatitis may be caused by pathogens complex of infections:
- chlamydia,
- trichomoniasis,
- ureaplazmoza,
- gonorrhea,
- mycoplasmosis,
- candidiasis and other
More often, the penetration of microbial agents in the tissue of the prostate is performed transcanalicular using – a through the outlet of the ducts of the breast, opening into the posterior wall of the urethra. Therefore, urethritis any genesis very often complicated by acute prostatitis. Less of the microbial flora found in the prostate, bladder in acute cystitis. The introduction of pathogens in the gland is much easier with a higher intraurethral pressure (reprehenderat, the stones of the urethra), the realization of endourethral manipulation (bougienage of the urethra, catheterization of the bladder, uretroskopii, cystoscopy, etc).
Additionally, acute prostatitis may be the result of hematogenous penetration of the infection, which contribute to the conditions of blood supply of the prostate widely with the developed system of arterial and venous anastomoses. When hematogenous drift the germs can get into the prostate tissue away from the foci of tonsillitis, sinusitis, caries, cholecystitis, bronchitis, gangrenous and other, it is Possible lymphogenous infection of the prostate gland of the bowel when anal, fissures and cracks, proctitis, colitis.
To non-communicable of the factors that contribute to the development of acute prostatitis, lead to persistent fenmenos stuck in the veins of the pelvis and the violation of drainage acini of the prostate. The stagnation can be called dysrhythmia sexual life, rape and the practice of the interruption of the sexual relationship, or the lack of irregular sexual life, excessive sexual activity and other Pathological compost from the blood in the venous bed of the pelvis may be detected when sedentary lifestyle, frequent constipation, hypothermia, chronic (mainly alcohol) poisoning, varicose veins of the veins of the pelvis.
The acute form of prostatitis
In the development of acute prostatitis distinguish the following forms, at the same time are its stages:
- catarrhal,
- follicular,
- parenchyma,
- abscess.
Acute prostatitis begins with a catarrhal inflammation of the changes of the mucous and the submucosa of the output layer of the ducts to individual sections breast. In the future, the inflammation of the walls of the ducts favors the stagnation situation-purulent secret in the follicles of the prostate, and the progression of inflammation, which may develop focal, the resentment of wedges – follicular acute prostatitis. When plural of the defeat of wedges and diffuse involvement of the parenchyma and interstitial tissue of the prostate in gnoyno is an acute inflammatory process of prostatitis, which it passes to its next stage – parenchyma. In the case of the merger of small pustules on an important focus is an abscess of the prostate gland, which may open into the urethra, the perineum, the rectum or the bladder.
The symptoms of acute prostatitis
The clinical manifestations of acute prostatitis correspond with the stages of the process. General of the demonstrations serve pain, disorders of urination and intoxication.
In the acute catarrhal stage of prostatitis feels the weight and pain in the groin. Dysuric disorder is characterized by a painful increase of urination, especially at night. The body temperature is kept within the standard, may be slightly elevated; the intoxication of lack. When the palpation examination of the prostate not modified or slightly increased, some painful. The study of the secretion of the prostate detects an increase of the leukocytes, the accumulation situation of the strands. In the urine during the emptying-out of the ducts, the acini appear leukocytes. Prostate massage, as a general rule, it is not possible due to pain. The treatment, which started in the catarrhal the acute phase of prostatitis, which leads to the recovery of 7 to 10 days.
Follicular acute prostatitis is more bright, accompanied by awkward pain pain in the groin, irradiating in the penis, the anus, or the sacrum. In this context, the urination painful and difficult, until the development of the acute urine retention. The act of defecation acute follicular prostatitis is also difficult to express the pain. Given the increase in body temperature to 38°c alters the general state. Palpation per rectum is defined augmented, heavy, intense, asymmetric, and prostate, sharply painful in certain areas of the Paltseva study. The collected urine after palpation of the breast, in the great number it contains leukocytes and purulent of the strings that form the sediment muddy. The implementation of massage to get the secret of the prostate gland in the follicular phase acute prostatitis is contraindicated. When aggressive treatment of acute follicular prostatitis can be resolved favorably; otherwise, it goes to the next, parenchyma stage.
The clinical acute parenchymatous prostatitis develops rapidly. Is feature expressed hyperthermia (up to 39-39,5°c or above) with chills, general weakness, oppression, of appetite, thirst. At the beginning of urination, abruptly learning and difficult, and then may cease entirely. The attempt of emptying the bladder or of the intestine accompanied by severe pain. Develop intense tenesmus, constipation, flatulence. The pain extends into the rectum, it is of throbbing nature, makes that the patient is obliged to take a position lying down with pursed of the feet. During the development of the propulsion of the inflammation of the rectum of the anus stands out the mucus.
Palpation is defined diffuse increased, the fuzzy contours of iron, it is very painful when the slightest touch. Prostate massage in parenchyma in the acute phase of prostatitis is contraindicated categorically. Sometimes, due to a strong edema pararectal fiber and the pain of rectal examination cannot be performed. In the urine – is expressed album sanguinem-this [cellam, pyuria. Result 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 definition of the acute phase of prostatitis is performed by the urologist and is based on a holistic approach to the physical examination, laboratory and instrumental survey. The study of the prostate through the rectum to determine the size, consistency, homogeneity, symmetry of the breast; the pain reaction, the foci of degradation, evidence of suppurative fusion of the tissues. Palpation of the gland acute prostatitis is performed with much care, without any bad pressure and massaging movements. In the secret of the prostate is detected an increase in the number of leucocytes and amyloid taurus, decreasing the amount of lecithin from the beans.
Acute prostatitis there is a heightened pyuria in the third portion of urine and in the urine, collected after the palpation of the prostate. For the selection of excitation of the acute prostatitis should be carried out the bacterial inoculation of the test of the urine and separated from the urethra with cialis, pcr-scaling of the research, the planting of blood in sanguinem-this [culture. The nature and severity of the dysuric disorders of the acute prostatitis is estimated using the uroflowmetries.
Ultrasound of the prostate with a modest syndrome painful you can run transrectal; in the case of express pain reaction – transabdominal. Anoscopically evaluates the form, the value of the breast, the presence of focal or diffuse changes, you set the acute phase of prostatitis. The use of Doppler studium allows you to detail and in a differentiated way to estimate the vascularization of the prostate.
When planning surgical tactics against the destructive ways of the forms of acute prostatitis, it is advisable to the realization of a ct scan or an mri of the pelvis.
The treatment of acute prostatitis
The main role in the treatment of acute prostatitis belongs etiotropnoy therapies. It is the earliest of the allocation of antimicrobial (antibacterial, antiviral and antitrichomonal, antimycotic) drugs to suppress the multiplication of microorganisms in the prostate and the tissue of the urethra. In order to reduce the spasms and the pain of urination will prescribe painkillers, anti-spasmodic, rectal candles with Anaesthesinum or beladona, microclysters. In the therapy of acute prostatitis are used nsaids, enzymes, immunomodulatory agents, vitamins, infusion of solutions.
Physical therapy of the acute prostatitis occurs after the recall of acute symptoms. In order to anti-inflammatory, a decongestant, an analgesic action, improve the local microcirculation and immunity apply rectal electrophoresis, uhf-therapy, microwave therapy, prostate massage. Acute prostatitis is shown the compliance of the bed, careful diet, peace.
During the delay of urine in the background of the acute prostatitis avoid the conclusion of the catheterization of the bladder, giving the preference to trocar cystostomy. When abscess of the prostate occurs the need for surgery performance of the autopsy and drainage of the abscess cavity.
Of the cure of the acute prostatitis is judged by the recovery of the structure of the tissues of the glands and their functions, the normalization of the composition of the juice of the prostate, the elimination of the pathogens that cause the inflammation of the biological fluids.
Prediction and prevention of the
As a general rule, timely, and reasonable causal therapy leads to cupping of the signs of acute prostatitis. The formation of abscesses in the prostate or the chronic inflammation happens in the cases.
The prevention of acute prostatitis should include the sanitation of the foci of infection in the body, the realization of endovesical and endourethral on the manipulation in accordance with the rules of asepsis, the timely treatment of sexually transmitted diseases and urethritis, the normalization of the sexual life and physical activity.