Bacterial chronic prostatitis
Last reviewed: 23.04.2024
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It is believed that bacterial chronic prostatitis is a rare enough pathology: thus, according to one of the studies, among 656 patients with symptoms of prostatitis only 7% had data confirming the second category of the disease. The data obtained by us, in contrast to this opinion, indicate that the majority of patients with bacterial chronic prostatitis remain undiagnosed for one reason or another; the use of various provocative tests (massage, adrenoceptor blocking, enzyme installation, RT, pyrogenal administration, allergens, bacteria (tuberculin), etc.) significantly improves the diagnosis of chronic prostatitis.
The persistence of a pathogenic microorganism in the prostate can be due to the poor permeability of antimicrobial agents to the tissue and secretion of the prostate gland; in this case, a low concentration is created in the inflammatory focus, sufficient to inhibit the development of bacterial microflora, but not bactericidal. Under the influence of treatment, urine is sterilized, pain and dysuria disappear, but soon after the termination of the course of therapy the symptomatology resumes. In addition, starting as an infectious-inflammatory process, further persistent disease progression can be supported by autoimmune mechanisms.
Clinical symptoms of chronic prostatitis of infectious form are variable. Despite the fact that chronic prostatitis can be a consequence of the acute form, many men suffering from bacterial chronic prostatitis do not have any indication of a previous acute prostatitis. In some, bacterial chronic prostatitis is less than symptomatic, but the majority of patients complain of irritation of the urinary tract (dysuria, frequent urination, imperative urges, nocturia), as well as pain that is usually localized in the pelvis and / or perineum. Sometimes there is pain after ejaculation and the presence of blood in the sperm. Chills, fever and other manifestations of intoxication are not typical.
Physical examination and palpation of the prostate through the rectum, as well as cystoscopy and urography do not allow to reveal any changes specific for chronic prostatitis. With microscopy of the prostate secret, a large number of leukocytes is found, but this is not pathognomonic for chronic prostatitis.
The main diagnostic criterion is repeated infection of the urinary tract caused by the same pathogen, and the detection of the same pathogen in the bacteriological culture of the secretion of the prostate. Once again, we emphasize - rectal examination, and even more so that prostate massage should be performed after urine analysis in order to avoid its contamination. The diagnostic titer is a microbial number, or colony-forming unit (CFU), exceeding 103 / ml. Convincing is also the content of bacteria in the secretion of the prostate and in the third portion of urine, 10 times or more exceeding it in the second portion. When there are difficulties in obtaining the secretion of the prostate, you can use a microscopic and bacteriological study of the ejaculate, in which the secret of the prostate is 30-40%.
Microorganisms counted in only tens and hundreds (KOE, 10 1 -10 2 / ml), also can not be ignored, especially considering multidrug-resistant forms. However, it should be remembered that not every microorganism sown from the secretion of the prostate can be considered as an etiological factor of prostatitis due to contamination of the material by the microflora of the urethra. Therefore, the main focus is on the clinical symptoms of chronic prostatitis: if there is no history of recurrent urinary infection, then the diagnosis of bacterial chronic prostatitis, according to leading experts in this field, is questionable.
One of the potential causes of persistence of the bacterial agent and recurring infections is prostate stones. Prostate stones are detected by transrectal sonography in 75% of middle-aged men and almost 100% of the elderly. It is believed that the factors contributing to their formation are obstruction of the prostate ducts with its adenomatous hyperplasia and urine reflux into the prostate. Infected prostate stones can not be sterilized by medication alone, so when persistent bacterial chronic prostatitis with the presence of stones in the prostate is sometimes resorted to surgical treatment - transurethral resection of the prostate. It should be borne in mind that the probability of developing tuberculosis of the prostate, which can occur under the mask of nonspecific prostatitis, is great. In this case, prostatolytiasis can be mistaken for calcified centers of tuberculous inflammation in the prostate parenchyma.
It is necessary to remember about such forms as gonococcal prostatitis (causative agent - N. Gonorrhoeae), as well as even more rare variants - fungus (associated with systemic mycoses) and parasitic prostatitis. Bacteriological and immunological methods of diagnostics help to exclude these forms of prostatitis, although with gonococcal prostatitis, which developed as a result of ascending urethral infection, after seed treatment the secretion of the prostate secretion may be negative (N. Gonorrhoeae culture can not be sown). However, patients with a history of gonorrheal urethritis, which preceded the development of prostatitis, even if it is impossible to detect the causative agent of the latter, should undergo a course of treatment with tetracyclines [doxycycline (unidox solute)] for 3-4 weeks.
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