How much does it cost to cure prostatitis

A survey of residents of different countries showed that 2-10% of adult men experience symptoms that suggest prostate problems during their lifetime.

Any urinary disorder is a wake-up call, and self-medication in this case should be ruled out. However, problems are not always associated with the prostate.

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Our articles are written with a passion for evidence-based medicine. We refer to reputable sources and seek reviews from reputable physicians. But remember: the responsibility for your health falls on you and your doctor. We do not write recipes, we make recommendations. It is up to you to rely on our point of view or not.

How the prostate works

The prostate, or prostate gland, is a nut-like organ located just below the bladder. Between the halves of the "nut" passes the urethra - a tube through which urine is excreted from the bladder, and sperm from the testicles.

The main task of the prostateconsists in producing a secretion that is part of the sperm. Thanks to this secret, sperm are able to move. The second task of the prostate is to contract, allowing ejaculation, i. e. ejaculation.

Near the prostate are the seminal vesicles connected to the vas deferens, through which semen leaves the genitals. The seminal vesicles produce the liquid part of the sperm and maintain prostatic secretion.

Prostate secretion is a mixture of citric acid and enzymes. This fluid dilutes the sperm, which flows into the urethra from the testes vas deferens.

Prostate problems do not always lead to erection problems

In the vast majority of cases, sexual dysfunction is not associated with prostate problems because there is no physical connection between the prostate and the erection mechanism.

But upset urination, discomfort from incomplete bladder emptying, pain or discomfort accompanied by inflammation, lead to the fact that a person begins to feel nervous and shy. Because of this, psychological problems arise - as a rule, they are the ones that negatively affect the erection.

What is prostatitis

Prostatitis is an inflammation of the prostate gland that is associated with pathogenic microbes or other non-infectious causes. Sometimes inflammation also affects the seminal vesicles - this is called a vesicle.

At the same time, inflammation of the prostate gland does not always lead to pain and problems with urination, and the presence of unpleasant symptoms is not necessarily associated with inflammation of the gland.

To avoid confusion, urologists around the world use the classification proposed by the American National Institute for the Study of Diabetes Mellitus, Digestive and Kidney Diseases or NIDDK.

To simplify a bit, the classification divides prostatitis into bacterial and abacterial, that is, it is not associated with bacteria. This approach helps doctors make an important decision - whether to prescribe additional antibiotics and medications. Giving antibiotics to all patients with suspected prostate is wrong because non-microbial forms of prostatitis are more common than bacterial. Taking unnecessary antibiotics is harmful to your health.

The NIDDK classification identifies five forms of prostatitis.

Acute bacterial prostatitis.A disease most often caused by pathogens typical of urinary tract infections: for example, E. coli, Klebsiella and Enterobacter.

As a rule, the disease starts suddenly and is accompanied by a general deterioration of well-being. The temperature rises to 38-39 ° C, with some people feeling weak, severe pain or burning in the perineum, scrotum or anus, in the lower abdomen and sometimes in the muscles. Some people experience pain during ejaculation. Sometimes with bacterial prostatitis, there is frequent, difficult and painful urination.

Chronic bacterial prostatitis.This disease can also be caused by microbes typical of acute prostatitis. The disease is considered chronic if the symptoms last for at least three months.

The symptoms of chronic bacterial prostatitis are similar to those of acute, but may be less severe or less severe. Fever and weakness are usually absent, the pain in the lower abdomen is more painful than sharp, but it is difficult to start urinating and empty the bladder completely. Moreover, the unpleasant symptoms may disappear temporarily and, after a while, reappear.

Any man can get acute and chronic bacterial prostate. But those who are most at risk are those who have a higher risk of exposure to germs: those who have sex, especially anal sex, without a condom, patients with a urinary tract infection, and people who have recently had surgery ora prostate biopsy.

Chronic abacterial prostatitis associated with inflammation.The symptoms of non-bacterial inflammatory prostatitis are very similar to acute and chronic bacterial prostatitis. At the same time, there are no pathogenic bacteria in the semen, prostate skeleton and urine, but the leukocyte concentration will be high - this indicates inflammation of the prostate gland.

Chronic abacterial prostatitis, or chronic pelvic pain syndrome, that is not associated with inflammation.The symptoms also mimic acute and chronic bacterial prostatitis. At the same time, there are no pathogenic bacteria and a high concentration of leukocytes in semen, prostate skeleton and urine - this indicates that the prostate gland is not inflamed.

In the case of non-bacterial forms of prostatitis, it is far from always possible to understand which cause leads to the development of the disease. Risk groups are also difficult to identify.

Asymptomatic inflammatory prostatitis.This form of the disease does not cause any concern. Most often, inflammation is discovered accidentally when the patient is examined for other problems, such as infertility.

How does prostatitis differ from prostate adenoma

In about 8% of men after the age of 40, the prostate begins to grow in size - this is called prostate adenoma, or benign prostatic hyperplasia. An enlarged prostate narrows the urethra, and because of this, problems with urination can begin: too frequent request to use the toilet or urine leaks. When faced with adenoma symptoms, some patients may assume they have developed prostate.

While some of the symptoms of prostate hyperplasia may actually resemble prostatitis, they are not the same thing. Prostatitis is an inflammation of the prostate gland. And an adenoma is an uncontrolled age-related proliferation of prostate cells that is not associated with inflammation.

Adenoma can cause serious concerns, so if you have trouble urinating, it is important to see a urologist as soon as possible. However, an adenoma is still not as dangerous as prostatitis because it does not increase the risk of cancer.

How often is chronic bacterial prostatitis diagnosed?

According to the data of the generalized literature, worldwide, acute bacterial prostatitis occurs in 5-10% of cases, and chronic bacterial prostatitis - in 6-10% of cases. Moreover, both variants of chronic abacterial prostatitis occupy 80-90% of all cases of the disease.

If we perform a massive microscopic examination of the prostate gland, we will find certain signs of its inflammation in all men without exception after 40 years. But it has nothing to do with the diagnosis of chronic bacterial prostatitis.

There are many urological diseases that can be hidden behind the mask of chronic prostatitis, some of them are quite serious and require immediate treatment. Therefore, I recommend that all patients with prostatitis-like symptoms undergo a more detailed examination, which will clarify the diagnosis.

How is prostatitis diagnosed?

From the patient's point of view, the symptoms of bacterial and non-bacterial prostatitis are very similar. Without consultation with a urologist and special tests, it is impossible to distinguish one form of prostatitis from another and get a quality treatment. You can make an appointment with a urologist for free under the compulsory medical insurance policy or make an appointment with a doctor at a private clinic.

The main task of a urologist, to whom a patient with suspected prostate came to see, is to rule out other prostate diseases, for example, cancer, and determine what form of disease a person has. It is very important to distinguish chronic pelvic pain syndrome from bacterial prostatitis with a confirmed or suspected pathogen. Here's what a doctor needs to do to understand it.

Ask the patient about symptoms and well-being.To gather more information, your doctor may suggest that you answer questions from a questionnaire called the Chronic Prostate Symptom Index. In some cases, in order not to waste time in the meeting, it makes sense to print the questionnaire and fill it out in advance.

Perform a physical examination.The doctor will examine the patient, paying special attention to the groin area. If there are swollen, painful lymph nodes in the groin, this increases the likelihood that the body is actually inflammatory. Typically, the exam involves a digital colon exam, which allows the doctor to assess the size, shape, and condition of the prostate. The study helps to understand if the prostate is enlarged. If the gland is painful to touch, it is more likely to be inflamed.

Is it possible to do without a digital colon examination

Digital rectal examination and prostate massage are not the most enjoyable procedures. In acute inflammation, this can be painful. Some patients are so eager to avoid these procedures that, in principle, they refuse to make an appointment with a urologist.

Digital examination of the rectum is a diagnostic method, but massage of the prostate gland through the rectum is done to obtain material for laboratory analysis - the secret of the prostate gland. If secretion cannot be obtained, the doctor may replace the prostate gland secretion test with the first urine test, or a two- and three-glass urine sample. These studies allow you to determine approximately where the problem area in the urinary tract is.

Sometimes, instead of this examination, a semen analysis is prescribed for the same purpose. Helps to understand if prostatitis is part of male genital infections and provides information about ejaculate quality. In addition, the number of leukocytes in the ejaculate makes it possible to distinguish between inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.

If the patient is concerned about an upcoming digital examination or prostate massage, I would advise you to discuss this with your doctor. Perhaps the prostate secretion analysis, to get which simply requires her massage, can be replaced by a urine or sperm analysis.

Order blood tests, urine and prostate secretions.The diagnostic standard includes a microscopic examination of prostate gland secretion, a general blood test, a general urine analysis with sediment microscopy, and a microbiological examination of urine and prostate gland secretions.

During microbiological studies, the patient's biological material is placed in a nutrient medium and they see which bacteria grow in it - this allows you to clarify the diagnosis. You can get tested at a private clinic for money or for free under compulsory medical insurance.

Other tests and examinations - such as the total concentration of prostate specific antigen (PSA) in the blood and transrectal prostate ultrasound (TRUS) - are usually not performed if prostate is suspected. In some cases, TRUS of the prostate may detect fibrosis, i. e. a scar or foci similar to a malignant tumor, but such studies are not indicated for all patients without exception.

How is prostatitis treated?

Treatment depends on the type of prostatitis. If the inflammation is provoked by bacteria, the doctor will choose antibiotics. And if the bacteria have nothing to do with it, medication will be required to help cope with the unpleasant symptoms of the disease.

Acute bacterial prostatitisstart treatment without waiting for test results - this is called empirical antibiotic therapy. With this approach, antibiotics are prescribed based on knowledge of which microbes are most likely to cause prostate infections.

As a rule, patients are prescribed antibacterial drugs that penetrate well into the tissues of the prostate gland and act on the most "known" causative agents of prostatitis and urinary tract infections.

Those people who feel more or less normal and treated at home usually take antibiotics in pills. And patients with high fever who are treated in hospital are more likely to prescribe injectable antibiotics. With this treatment, in most patients with acute prostatitis, fever and pain are relieved the second to sixth day after starting treatment.

When the patient's temperature returns to normal, and the signs of inflammation disappear, the doctor may transfer the patient from injections to pills. The total duration of antibiotic treatment is usually about 2-4 weeks.

Sometimes prostate massage is used not only as a diagnostic method but also as a therapeutic technique. It was once thought that it could help release excess secretions accumulated in the gland and thus reduce its swelling. However, today most experts have reached a consensus that prostate massage should be avoided for bacterial prostatitis. This is not only painful and useless, but can also worsen the course of the disease because as a result of the massage, bacteria can enter the neighboring, uninfected tissues.

Chronic bacterial prostatitisare also treated with antibiotics targeting gram-negative bacteria. For treatment, fluoroquinolones are commonly used - these antibiotics are considered quite safe. But if the doctor suspects that other microorganisms have caused prostatitis, he may prescribe additional antibacterial medication without waiting for test results.

With chronic prostatitis, antibiotics should be taken longer than with acute ones. In accordance with the recommendations of urologists, they are prescribed within 4-6 weeks.

Chronic abacterial prostatitisis not associated with bacteria, so patients with this disease are prescribed antibiotics only if, in addition to prostatitis, they have a urinary tract infection.

Since it is not clear what exactly causes abacterial prostatitis, treatment is primarily aimed at relieving pain during urination. To do this, doctors prescribe alpha-1-blockers, drugs that help relax the prostate muscles that compress the urethra. If the pain persists, your doctor may prescribe non-steroidal anti-inflammatory drugs. The dosage for each patient is chosen individually.

Some patients with abacterial prostatitis are helped by cognitive behavioral therapy - this is the name of the sessions with a psychologist, during which a person learns to cope with pain without medication. At the same time, there is still no scientific evidence of the effectiveness of psychological help for bacterial prostatitis.

Studies in which researchers tried to prove the effectiveness of other interventions, such as acupuncture, electromagnetic chair therapy, prostate massage, or transrectal therapy, were poorly planned and lasted very little - usually less than 12 weeks. So it is impossible to say whether all this helps or not.

How to avoid prostatitis: prevention

The main reason for discomfort in the prostate gland is a sedentary lifestyle and lack of regular sex life. Doctors believe that the highest chances of avoiding prostatitis are in men who:

1. Have safe sex regularly.
2. They regularly engage in moderate exercise.
3. Avoid hypothermia.
4. After reaching the age of 40, they undergo urological examination every year.

Where is it best to treat prostatitis - in a public or private clinic

The most important thing is that the principles of evidence-based medicine be followed in the diagnosis and treatment of prostatitis. It just depends on the doctor - and it doesn't matter where exactly he works.

Unfortunately, doctors in private clinics do not always adhere to medical care standards. This can lead to over-diagnosis and unnecessary treatment, so that the patient risks overpaying. In a state medical organization, the likelihood of adhering to all standards of diagnosis and treatment is higher. But patients need to consider that a full examination will take longer, sometimes much longer than during an examination at a private clinic.

Do not forget

1. Urinary tract problems in men are common, but not always the case in the prostate. To understand exactly what is going on with a person, you need to undergo a thorough examination.
2. Prostate problems rarely lead to erection difficulties. Usually, with prostatitis, it weakens due to psychological problems arising on the background of unpleasant symptoms.
3. Not every form of prostatitis is caused by bacteria: in 80-90% they have nothing to do with it. If a person with suspected prostate is prescribed antibiotics without additional tests, this is bad. Before taking them, it makes sense to consult another doctor.
4. A person with acute or chronic prostate may be prescribed a prostate massage to collect a glandular secretion for analysis.
5. The best way to prevent prostatitis is safe sex, a healthy lifestyle and after 40 years - a regular urological examination by a doctor.