Bacterial chronic prostatitis

It is believed that bacterial chronic prostatitis is a rather rare pathology: thus, according to one study, among 656 patients with prostatitis symptoms, only 7% had data confirming category II of the disease. The data we obtained, in contrast to this opinion, indicate that the majority of patients with bacterial chronic prostatitis remain under-diagnosed for one reason or another; the use of various provocative tests (massage, taking alpha-blockers, enzyme instillations, LT, introduction of pyrogenal, allergens, bacteria (tuberculin), etc.) significantly improves the diagnosis of chronic prostatitis.

Persistence of the pathogenic microorganism in the prostate may be due to poor penetration of antimicrobial agents into the tissue and secretion of the prostate gland; in this case, a low concentration is created in the inflammation site, 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 end of the course of therapy, the symptoms resume. In addition, having begun as an infectious and inflammatory process, further persistent course of the disease can be maintained due to autoimmune mechanisms.

Clinical symptoms of infectious chronic prostatitis are variable. Despite the fact that chronic prostatitis may be a consequence of the acute form, many men suffering from bacterial chronic prostatitis have no indications of previous acute prostatitis. In some, bacterial chronic prostatitis is asymptomatic, but most patients complain of irritation of the urinary tract (dysuria, frequent urination, imperative urges, nocturia), as well as pain, which is usually localized in the pelvic and/or perineal area. Sometimes pain after ejaculation and the presence of blood in the semen are noted. 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 reveal any changes specific to chronic prostatitis. Microscopy of prostate secretion reveals a large number of leukocytes, but this is not pathognomonic for chronic prostatitis.

The main diagnostic criterion is a repeated urinary tract infection caused by the same pathogen and detection of the same pathogen in a bacteriological culture of prostate secretion. We emphasize once again that a rectal examination, and especially a prostate massage, should be performed after a urine test to avoid its contamination. The diagnostic titer is the microbial count, or colony-forming unit (CFU), exceeding 103/ml. Convincing is also the content of bacteria in the prostate secretion and in the third portion of urine, 10 times or more exceeding it in the second portion. When there are difficulties in obtaining prostate secretion, one can use a microscopic and bacteriological examination of the ejaculate, in which the prostate secretion makes up 30-40%.

Microorganisms, numbered only in tens and hundreds (CER, 10 ¹ -10 ² /ml), also cannot be ignored, especially considering multiresistant forms. However, it should be remembered that not every microorganism isolated from the prostate secretion can be considered as an etiological factor of prostatitis due to contamination of the material by the microflora of the urethra. Therefore, the main emphasis is placed on the clinical symptoms of chronic prostatitis: if there is no indication of recurrent urinary infection in the anamnesis, then the diagnosis of bacterial chronic prostatitis, according to leading experts in this field, is questionable.

One of the potential causes of bacterial persistence and recurrent infections is prostate stones. Prostate stones are detected by transrectal sonography in 75% of middle-aged men and almost 100% of elderly men. It is believed that the factors contributing to their formation are obstruction of the prostate ducts in its adenomatous hyperplasia and reflux of urine into the prostate. Infected prostate stones cannot be sterilized by drug therapy alone, therefore, in persistent bacterial chronic prostatitis with stones in the prostate, surgical treatment is sometimes resorted to - transurethral resection of the prostate. It should be borne in mind that there is a high probability of developing prostate tuberculosis, which can occur under the guise of nonspecific prostatitis. In this case, calcified foci of tuberculous inflammation in the prostate parenchyma can be mistaken for prostatolithiasis.

It is necessary to remember such forms as gonococcal prostatitis (pathogen - N. gonorrhoeae), as well as even rarer variants - fungal (associated with systemic mycoses) and parasitic prostatitis. Bacteriological and immunological diagnostic methods help to exclude these forms of prostatitis, although in case of gonococcal prostatitis that developed as a result of ascending urethral infection, after antibacterial therapy, the culture of prostate secretion may be negative (the culture of N. gonorrhoeae may not be cultured). Nevertheless, patients with a history of gonorrheal urethritis that 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 Solutab)] for 3-4 weeks.

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