The prostate is a chestnut-sized (18-20gr) accessory reproductive organ located between the bladder and the penis. The prostate is just in front of the rectum, below the bladder, and in the middle passes the urethra, which allows urine to flow out of the body. Producing some components of sperm, the prostate secretes the fluid that nourishes and protects the sperm. Chronic Prostatitis is a chronic (chronic) inflammatory disease with or without microbes that causes swelling of the prostate. Most of the complaints in prostate diseases are related to the pressure and effect on the urinary tract passing through it. It is the third most common prostate disease after prostate enlargement and prostate cancer, with a frequency of 10%. Chronic prostatitis is diagnosed in 1/3 of men who apply to the urology clinic with urogenital system complaints. It is a public health problem that is difficult to treat. It is not contagious, it is not possible for a partner or partner to pass it on, but some types of prostatitis can cause infections or other health problems that get worse if left untreated. Prostatitis is a disease that only impairs quality of life. It does not cause prostate cancer, prostate enlargement or any other nasty disease in the future.
one- Acute Prostatitis: Although it is rare, it is a severe clinical picture, it develops acutely (suddenly), it is mostly seen above middle age. There may be complaints of high fever, sweating, chills, nausea, vomiting, weakness, difficulty urinating and inability to urinate. Prostate abscess may develop, it is usually bacterial and may require hospitalization. Acute bacterial prostatitis is caused by common bacteria, usually by the penetration of infected urine into the prostate, becomes chronic (10%) if not treated well, and eventually chronic prostatitis occurs.
2- Chronic Bacterial Prostatitis: It is the actual effect of the prostate and the swelling of the prostate due to a bacterial agent of the prostate (80% E. Coli, Klebsiella, P. Aureginosa and proteus). It is a form of prostatitis, mostly seen in young people, which usually occurs with the progression of urinary tract or sexually transmitted infection to the prostate. In addition, untreated acute bacterial prostatitis, prostate enlargement, high pressure urination and reflux to the prostate channels, prostate stones, zinc deficiency, genetic and autoimmune factors, and rectal infections that can spread through lymphogenous causes are also counted among the causes of chronic bacterial prostatitis. bacterial infection accounts for a very small percentage of chronic prostatitis cases (3-4%). From time to time, the symptoms exacerbate in case of seizures, but the causative bacteria may not be determined exactly. In treatment, bacteria cannot be completely eradicated (cleaned) because they form a film around the bacteria, reducing antibiotic access.
3- Prostadynia-Non-Inflammatory-Chronic Pelvic Pain Syndrome: This term refers to conditions in which patients complain of chronic prostatitis but there is no evidence of prostate infection or inflammation. It is the most common type of chronic prostatitis (90%). It is not caused by bacteria, often a definite cause cannot be found. The complaints of the patients do not change much over time, they show exacerbation from time to time. Little is known about this type of prostatitis and it contains many unknowns. Several theories have been proposed to explain this type of prostatitis. Pressure build-up or elevation in the urinary tract, especially in the prostate region, due to some reasons, irritation and irritation caused by autoimmune or chemical processes, sensitivity and pain in the muscles and nerves in the pelvis can be counted among these theories.
4- Non-bacterial chronic (Asymptomatic inflammatory) prostatitis, also called inflammatory chronic pelvic pain syndrome: Patients have typical chronic prostatitis symptoms, but there are inflammatory findings in the urine sample and prostate fluid, inflammatory cells (leukocytes) but no bacterial agent. The cause of most cases of non-bacterial prostatitis is not well understood. Inflammatory cells (leukocytes) are often present in the urine and prostate. Some patients may have persistent low-grade infection that cannot be detected in a routine urine sample. However, most patients with non-bacterial prostatitis do not find evidence of infection, even with complex testing. This type of prostatitis does not usually cause many symptoms and is usually found incidentally. It does not require treatment.
In summary, prostatitis are examined in 4 categories. Category-1 is called acute prostatitis. Category-2 is called chronic bacterial prostatitis, category-3 is chronic pelvic pain syndrome or chronic abacterial prostatitis, and category-4 is asymptomatic prostatitis. Category 3 is the most common type of prostatitis. It constitutes 90% of all prostatitis cases. Therefore, when chronic prostatitis is mentioned, category 3, that is, chronic pelvic pain syndrome, comes to mind. Its symptoms are many and varied. Sometimes it can severely impair the quality of life, but it does not cause serious diseases.
Being young or middle-aged, having had a previous urinary tract infection or prostatitis, having congenital bladder neck height, using a permanent or temporary urinary catheter, pelvic trauma (long-distance driving, long-term cycling, sitting for a long time, etc.), more than one Having a sexual partner and/or having HIV/AIDS, having difficulty urinating (squeezing and/or intermittent urination) and having undergone prostate biopsy are among the risk factors for chronic prostatitis.
Systemic infection by blood (bacteremia), spreading to sperm channels in testis and epididymis (epididymitis), prostate abscess, deterioration in sperm parameters and infertility may develop.
Complaints and Symptoms
Chronic Prostatitis complaints are thought to be due to the pressure and irritation of the prostate region to the urinary canal, as described above, and the escaping of urine into the semen channels due to high pressure. Restlessness, restlessness and tension; Because of these complaints, the patient is constantly restless and nervous, he thinks that he has a bad disease and cannot be diagnosed. Because this disease tends to recur constantly. However, some studies have reported that chronic prostatitis is not a cause but a result in such nervous patients, so some of the patients apply to psychiatry clinics and are diagnosed with depression. These patients urinate with high pressure.
1-Urine Complaints: frequent urination, needing to urinate at night (nocturia), burning and pain when urinating, difficulty in starting urination and difficulty in urination, feeling of not being able to empty the bladder completely and feeling of continuous urine, dripping and inability to relax after urination, sudden feeling of urgency to urinate. aches; There may be pain in the head of the penis, numbness, numbness, pain during intercourse, stinging pain and fullness in the perineum between the anus and the penis during intercourse, pain and discomfort in one or both testicles, pain in the groin, pain in the lower abdomen, waist and anus region (perineum). .
2-Cloudy urine and blood may be seen in the urine
3- Sexual problems; sexual reluctance, premature ejaculation, erectile dysfunction, pain during ejaculation or pain after ejaculation, blood in the semen, decrease in the amount of semen and decrease in the pressure.
4- There may be flu-like complaints, especially in bacterial prostatitis
If your doctor suspects prostatitis, he or she will ask you to describe your symptoms in detail. He or she will question your general medical history, what medications you take, how much caffeine and alcohol you consume, and your sexual history, which may increase the risk of contracting sexually transmitted infections. Sexually transmitted infections can mimic the signs and symptoms of prostatitis. There is often no positive laboratory finding of prostatitis. Nothing can be found in the blood, urine and imaging tests. PSA test is a test that we mostly use in cancer screening and follow-up after treatment. Except for acute prostatitis, there is no abnormality in chronic prostatitis blood values. For the diagnosis of the most common type 3 chronic prostatitis, three or more of these 7 complaint groups, such as urinary tract, psycho-social, prostate organ, neurological, organ sensitivity and sexual function complaints, are diagnostic.
Urine Examination: A urine sample is taken for signs of infection in the urine. If necessary, urine culture may be requested. Urine tests are performed before and after the rectal examination to obtain an idea about the source of the current findings. This is called the 4 tube test and is very helpful in diagnosis.
Blood Tests: PSA, some tests showing focal or systemic infection and other routine tests are checked.
Rectal Examination: Digital rectal prostate examination should be done to patients with these complaints. This is done for both diagnostic and therapeutic purposes. In the diagnosis, the prostate is milked by rectal examination and the prostatic fluid is analyzed, if necessary, a culture sample can be taken. The presence of more than 20 leukocytes in each case in the prostate secretion is diagnostic. In the treatment, the prostate is massaged at periodic intervals, and the inflammatory secretion in the prostate is drained into the urethra, that is, the urinary tract. In addition, the channels in the prostate are opened and the secretions into the urethra are facilitated. However, blood circulation increases and the tissue heals itself and the given drugs penetrate the prostate.
Urodynamics: Bladder outlet dysfunction is detected in ⅓ cases.
Imaging Tests: In some cases, detailed examination of the urinary tract and prostate may be required, computed tomography or prostate ultrasonography may be requested. According to the complaints, findings and test results, it is concluded which of the chronic prostatitis types mentioned in the petition is.
Cystoscopy: It is also used in differential diagnosis, it helps in diagnosing other diseases of the prostate.
Diseases That Chronic Prostatitis May Confuse
Prostatitis; It can be confused with urethral stricture, bladder neck elevation, overactive bladder, urinary tract infection and benign prostate enlargement. In general, the symptoms are similar. All these diseases can be ruled out with the examinations and the diagnosis of chronic prostatitis is reached.
Before treatment, it should be ensured that the diagnosis is made correctly. All other diseases that can be confused with prostatitis should be ruled out. Before starting treatment, the type of prostatitis should be determined first. Chronic prostatitis is a very difficult disease to treat. Treatment is done, but the disease relapses. The disease progresses with exacerbations and remissions. In fact, the aim of treatment is to alleviate or eliminate symptoms. Usually, the exact reason for the occurrence of complaints in a patient with chronic prostatitis is not clear, more than one factor may be effective in these. While one patient may benefit from the treatment given, it may not work for another patient with a similar complaint. Some patients get better by trying some treatments on their own, while others have to continue to live with their symptoms despite various treatments. It is important to remember that very few of these treatments are effective in these patients. Patients with chronic prostatitis should pay attention to the following points: They should not make their body, especially their legs and feet cold, they should not sit on cold concrete, they should not drink acidic and alcoholic beverages, they should avoid spicy and spicy foods, frequent and regular intercourse and frequent ejaculation can reduce the symptoms of the patient, hot sitz baths are beneficial in these patients. They should not go into a cold pool or sea, should not wait with a wet swimsuit after leaving the pool or sea, should not be constipated, and should stay away from stress. As many complaints as there are simultaneous combined treatment can be given.
1-Antibiotic Treatment: Antibiotics have been the basis of chronic prostatitis treatment for many years. Antibiotics such as trimethoprim-sulfa (Bactrim), ciprofloxacin (Cipro) and levofloxacin (Levaquin) are the most common agents used in the treatment of chronic bacterial prostatitis. Since the diffusion of antibiotics into the prostate is difficult, they should be given in high doses for a long time, usually 4-6 weeks. For patients who do not benefit from this classical treatment, results can be obtained by using Fosfomycin 3 g sachet for 4-6 weeks. Even if bacteria are not detected in the urine or prostate fluid, it may be a chronic bacterial prostatitis and antibiotics may be recommended. Some patients may benefit from this treatment. Prostate stone is the factor that reduces the antibiotic effectiveness by 40%. After this treatment, the patient is relieved, but the disease may recur after 2-3 months. However, for the most part, the use of antibiotics alone does not eliminate the problem. Alternative treatment options are preferred for patients for whom antibiotics are not helpful.
2-Alpha Blocker Drugs: Alpha-blocker medications such as tamsulosin (Flomax) or terazosin (Hytrin) may be given to relax the muscles that control the bladder. These can relieve symptoms such as an urgent need to urinate, straining or dripping.
3-5Alpha-Reductase Inhibitors:The use of drugs that reduce the size of the prostate, such as Finasteride (Proscar), Dudasteride, can also reduce these complaints.
4-Painkillers and Anti-inflammatories:Pain relievers, anti-inflammatory drugs and muscle relaxants can help to some extent with complaints of pain and muscle spasms.
5-Biofeedback:Some patients may benefit from warm baths or biofeedback programs designed to reduce tension in the pelvic muscles.
6-Diet: Reducing and cutting out caffeine and alcohol can reduce irritation/irritation of the bladder and prostate.
7-Prostate massage:Some patients may be advised to evacuate more frequently or to massage the prostate regularly to reduce edema and swelling in the prostate.
8-Antidepressants:Antidepressants and anxiolytics may be recommended for stress relief.
9-Thermotherapy: The operation, which we call thermotherapy in chronic prostatitis, is an old treatment based on the principle of entering the prostate through the urinary tract and heating the prostate to a certain degree, destroying the nerves that cause the symptoms inside. However, it has lost its popularity in recent years. It has been almost abandoned due to its high side-effect profile. Instead, new alternative treatments have been developed that are non-invasive, do not harm the patient and provide a permanent treatment.
10- Shock Wave Therapy (ESWT): This treatment is performed with an extracorporeal shock wave device used to break stones with reduced intensity in the area called the perineum between the anus and testis. Its side effects are not known, although there are scientific data about it being an effective treatment, its effectiveness has not been fully proven. It has been determined that by reducing the inflammation of the prostate, there is a significant decrease in pain and complaints related to chronic prostatitis. It is reported to have no side effects.
11- Herbal Treatment: Although many patients receive such treatments, there is no evidence that herbs and some dietary supplements improve prostatitis. Some herbal treatments used for this purpose include Black oak bark yellow dye (quercetin), a chemical found in green tea, some bulbs, and other plants, ryegrass (cernilton, Black meadow grass-Rye grass), and saw palmetto (dwarf palm fruit, Sabal). Fruit) contains the extract of the plant. Not recommended unless recommended by a doctor.
12-Acupuncture:It is effective in some patients, but its effectiveness needs evidence.
13- Phosphodiesterase 5 inhibitors: available. It has a relaxing and anti-inflammatory effect.
15-Pentosanpolysulfate:It is recommended in type 3 prostatitis.