How much does it cost to treat prostatitis

Research by residents of different countries has shown that 2-10% of adult men have symptoms in their lifetime that indicate prostate problems.

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

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Our articles are written with a passion for evidence-based medicine. We refer to reputable sources and seek the comments of reputable physicians. But remember: you and your doctor are responsible for your health. We do not write recipes, but give recommendations. It is up to you to rely on our position or not.

How the prostate works

The prostate or prostate is a walnut-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 key task of the prostateit consists in creating a secret that is part of the seed. Thanks to this secret, sperm can move. The second task of the prostate is contraction, enabling ejaculation, that is, ejaculation.

Next to the prostate, there are seminal vesicles connected to the vas deferens, through which the sperm leaves the genitals. Semen vesicles produce the liquid portion of semen and store prostate secretion.

The secret of the prostate is a mixture of citric acid and enzymes. This fluid dilutes the semen that flows into the urethra from the vascular deferes of the testis.

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 mechanism of erection.

But anxious urination, discomfort due to incomplete emptying of the bladder, pain, or discomfort associated with inflammation lead to the fact that the person begins to feel nervous and shy. This causes psychological problems - they usually negatively affect the erection.

What is prostatitis

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

At the same time, inflammation of the prostate 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 related to bacteria. This approach helps doctors make an important decision - whether to prescribe antibiotics and additional medications. Giving antibiotics to all patients with suspected prostatitis is wrong because non-microbial forms of prostatitis are more common than bacterial ones. Taking unnecessary antibiotics is bad for your health.

The NIDDK classification identifies five forms of prostatitis.

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

The disease usually begins unexpectedly and is accompanied by a general deterioration in well-being. The temperature rises to 38-39 ° C, and some people feel weakness, severe pain, or burning in the perineum, scrotum, or anus, in the lower abdomen, and sometimes in the muscles. Some people feel pain during ejaculation. Bacterial prostatitis sometimes results in 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 the symptoms of acute, but may be less severe or less severe. Fever and weakness are usually absent, lower abdominal pain is more painful than sharp, but it is difficult to start urinating and completely empty the bladder. Moreover, the unpleasant symptoms may temporarily disappear and reappear after some time.

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

Chronic abacterial prostatitis associated with inflammation.The symptoms of inflammatory nonbacterial 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 concentration of leukocytes will be high - this indicates inflammation of the prostate.

Chronic abacterial prostatitis or chronic pelvic pain syndrome, which 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 determine which cause leads to the development of the disease. Risk groups are also difficult to define.

Asymptomatic inflammatory prostatitis.This form of the disease does not cause discomfort. Inflammation is most often discovered accidentally when a patient is examined for other problems, such as infertility.

What makes prostatitis different from prostate adenoma?

In about 8% of men, after the age of 40, the prostate begins to increase in size - this is called prostate adenoma or benign prostatic hyperplasia. An overgrown prostate tightens the urethra and this can cause problems with urination: too often urges to urinate or leaking urine. When faced with adenoma symptoms, some patients may assume that they have developed prostatitis.

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

Adenoma can create serious discomfort, so if you have problems urinating, it is important to visit a urologist as soon as possible. However, 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 general data from the literature, in the world, 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 account for 80-90% of all cases.

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

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

How is prostatitis diagnosed?

From the patient's point of view, the symptoms of bacterial and nonbacterial 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 quality treatment. You can make an appointment with a urologist free of charge according to the compulsory medical insurance policies or make an appointment with a doctor in a private clinic.

The main task of the urologist, whom a patient with suspected prostatitis came to see, is to rule out other prostate diseases, for example, cancer, and to determine what form of the disease the 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 should do to figure it out.

Ask the patient about symptoms and well-being.To gather more information, your doctor may suggest answering questions from a questionnaire called the Chronic Prostatitis Symptom Index. In some cases, in order not to waste time in the meeting, it makes sense to print a 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, it increases the probability that the body is actually inflamed. Typically, the examination includes a digital rectal examination, which allows the doctor to assess the size, shape and condition of the prostate. The study helps to understand whether the prostate is enlarged. If the gland is painful to the touch, it is most likely inflamed.

Is it possible without a digital rectal examination?

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

Digital rectal examination is a diagnostic method, but prostate massage through the rectum is done to obtain material for laboratory analysis - the secret of the prostate. If the secretion cannot be obtained, the doctor may replace the analysis of prostate secretion, either by analysis of the first portion of urine, or by a urine sample of two and three cups. This research allows you to roughly determine where the problem area is in the urinary tract.

Sometimes semen analysis is prescribed for the same purpose instead of this test. It helps to understand whether prostatitis is part of male gonadal infections and provides information on the quality of ejaculate. In addition, the counting of leukocytes in the ejaculate enables the distinction between inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.

If the patient is worried about the upcoming digital examination or prostate massage, I would advise you to talk about it with your doctor. Perhaps the analysis of prostate secretion, which requires only a massage, can be replaced by the analysis of urine or semen.

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

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

Other tests and examinations - such as the concentration of total prostate-specific antigen (PSA) in the blood and transrectal prostate ultrasound (TRUS) - are usually not performed if prostatitis is suspected. In some cases, prostate TRUS can detect fibrosis, ie 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 caused by bacteria, the doctor will choose antibiotics. And if the bacteria have nothing to do with it, they will need medications to deal 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 the knowledge of which germs are most likely to cause prostate infections.

Patients are usually prescribed antibacterial drugs that penetrate well into the prostate tissue and act on the most popular causes of prostatitis and urinary tract infections.

Those people who feel more or less normal and are treated at home, usually get antibiotics in tablets. And patients with high fever who are treated in the hospital are more likely to be prescribed antibiotics by injection. With this treatment, in most patients with acute prostatitis, the fever and pain are relieved the second to sixth day after starting the medication.

When the patient's temperature normalizes and the signs of inflammation disappear, the doctor can transfer the patient from injections to tablets. 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. Today, however, most experts have reached a consensus that prostate massage should be avoided in bacterial prostatitis. It is not only painful and useless, but it 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 that target gram-negative bacteria. Fluoroquinolones are commonly used for treatment - these antibiotics are considered quite safe. But if the doctor suspects that other microorganisms have caused prostatitis, he may prescribe additional antibacterial drugs without waiting for test results.

With chronic prostatitis, antibiotics should be taken longer than with acute. According to the recommendations of urologists, they are prescribed for 4-6 weeks.

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

Since it is not clear what exactly causes abacterial prostatitis, treatment is mainly aimed at relieving pain when urinating. 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 nonsteroidal anti-inflammatory drugs. The dosage for each patient is selected individually.

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

Studies in which researchers tried to prove the effectiveness of other interventions, such as acupuncture, electromagnetic stool therapy, prostate massage or transrectal thermotherapy, were poorly planned and took too little time - 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 prostate discomfort is a sedentary lifestyle and lack of a regular sex life. Doctors believe that the greatest chances of avoiding prostatitis are in men who:

1. Have safe sex regularly.
2. They regularly engage in moderate exercise.
3. Avoid hypothermia.
4. When they turn 40, they undergo a urological examination every year.

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

The most important thing is to follow the principles of evidence-based medicine 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 the standards of medical care. This can lead to overdiagnosis and unnecessary treatment, so the patient risks overpaying. The state medical organization is more likely to comply with all standards of diagnosis and treatment. But patients must take into account that a complete examination will take more time, sometimes much more than during an examination in a private clinic.

Remember

1. Urinary tract problems in men are common, but not always the case with prostatitis. To understand exactly what is happening to a person, you need to undergo a thorough examination.
2. Prostate problems rarely lead to erection difficulties. Usually with prostatitis weakens due to psychological problems that arise in 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 prostatitis is prescribed antibiotics without additional tests, that is bad. Before taking it, it makes sense to consult another doctor.
4. People with acute or chronic prostatitis may be prescribed prostate massage to collect glandular secretions for analysis.
5. The best way to prevent prostatitis is protected sex, a healthy lifestyle, and after 40 years, a regular urological examination by a doctor.