How much does it cost to treat prostatitis

A survey of residents of different countries shows that 2-10% of adult men will have symptoms that indicate prostate problems during their lifetime.

Any urinary system disease is a wake-up call, and self-medication should be excluded in this case. However, the problem is not always related to prostatitis.

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Our article is full of enthusiasm for evidence-based medicine. We refer to reputable sources and seek the opinions of reputable doctors. But remember: you and your doctor are responsible for your health. We do not write prescriptions, we make recommendations. It is up to you to rely on our opinions.

How the prostate works

The prostate or prostate is a walnut-like organ located directly under the bladder. Between the two halves of the "nut" passes through the urethra-the tube through which urine drains from the bladder, and sperm drains from the testicles.

The main tasks of the prostateIt's about producing the secret as a part of semen. Thanks to this secret, sperm can move. The second task of the prostate is to contract and allow ejaculation, that is, ejaculation.

Next to the prostate is the seminal vesicle connected to the vas deferens, through which the sperm leave the genitals. The seminal vesicles produce the liquid part of semen and store prostate secretions.

The secret of the prostate is a mixture of citric acid and enzymes. This fluid dilutes the semen flowing from the testicular vas deferens into the urethra.

Prostate problems do not always cause erectile problems

In most cases, sexual dysfunction has nothing to do with prostate problems, because there is no physical connection between the prostate and erectile mechanisms.

However, poor urination, discomfort caused by incomplete bladder emptying, pain or discomfort associated with inflammation can cause a person to begin to feel nervous and shy. As a result, psychological problems can arise-usually, they can have a negative effect on erections.

What is prostatitis

Prostatitis is inflammation of the prostate that is related to pathogenic microorganisms or other non-infectious causes. Sometimes inflammation also affects the seminal vesicles-this is called seminal vesicle inflammation.

At the same time, inflammation of the prostate does not always cause pain and problems with urination, and the appearance of unpleasant symptoms is not necessarily related to inflammation of the prostate.

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

In order to simplify a little, the classification divides prostatitis into bacterial and bacterial, that is, it has nothing to do with bacteria. This method helps doctors make important decisions about whether to prescribe antibiotics and other drugs. It is wrong to give antibiotics to all patients with suspected prostatitis, because non-microbial forms of prostatitis are more common than bacteria. Taking unnecessary antibiotics is harmful to your health.

The NIDDK classification identifies five forms of prostatitis.

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

Usually, this disease starts unexpectedly and is accompanied by a general deterioration of health. Body temperature rises to 38-39°C, some people feel weak, perineum, scrotum or anus, lower abdomen, and sometimes muscles experience severe pain or burning. Some people feel pain during ejaculation. Sometimes bacterial prostatitis causes frequent urination, difficulty urinating, and pain.

Chronic bacterial prostatitis.This disease can also be caused by microorganisms typical of acute prostatitis. If symptoms persist for at least three months, the disease is considered chronic.

The symptoms of chronic bacterial prostatitis are similar to acute symptoms, but may be milder or milder. Usually there is no fever and weakness, lower abdominal pain is more than severe, but it is difficult to start urinating and completely empty the bladder. In addition, the unpleasant symptoms may disappear temporarily and reappear after a while.

Anyone can suffer from acute and chronic bacterial prostatitis. But those who are most at risk are those who are at a higher risk of exposure to bacteria: people who have sex, especially anal sex, people who don’t wear condoms, people who have urinary tract infections, and people who have recently undergone surgery or prostate biopsy.

Chronic bacterial 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 semen, prostate bone and urine, but the concentration of white blood cells will be high-this indicates that the prostate is inflamed.

Chronic bacterial prostatitis or chronic pelvic pain syndrome has nothing to do with inflammation.Symptoms are also similar to acute and chronic bacterial prostatitis. At the same time, there are no pathogenic bacteria in semen, prostate bone and urine, and the concentration of white blood cells is high-which indicates that the prostate is not inflamed.

In the case of non-bacterial forms of prostatitis, it is impossible to always find out the cause of the disease development. Risk groups are also difficult to define.

Asymptomatic inflammatory prostatitis.This form of disease does not cause any discomfort. In most cases, inflammation is discovered accidentally while checking the patient for other problems (such as infertility).

What is the difference between prostatitis and prostate adenoma

Approximately 8% of men begin to enlarge their prostate after the age of 40-this is called a prostate adenoma, or benign prostatic hyperplasia. An overgrown prostate constricts the urethra, so urination problems may occur: going to the toilet too frequently or leaking urine. When faced with the symptoms of adenoma, some patients may think that they have developed prostatitis.

Although some symptoms of BPH may indeed resemble prostatitis, they are not the same thing. Prostatitis is inflammation of the prostate. Adenoma is an age-related uncontrolled proliferation of prostate cells and has nothing to do with inflammation.

Adenomas can cause serious inconvenience, so if you have problems with urination, it is important to see 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 broad literature data, on a global scale, acute bacterial prostatitis occurs in 5-10% of cases, and chronic bacterial prostatitis occurs in 6-10% of cases. In addition, two variants of chronic bacterial prostatitis account for 80-90% of all cases of the disease.

If we conduct a large-scale microscopic examination of the prostate, we will find some signs of inflammation in all men 40 years later without exception. But it has nothing to do with the diagnosis of chronic bacterial prostatitis.

There are many urinary system diseases hidden under the mask of chronic prostatitis, some of which are quite serious and require immediate treatment. Therefore, I recommend that all patients with symptoms similar to prostatitis undergo a more detailed examination, which will help confirm the diagnosis.

How is prostatitis diagnosed?

From the patient's perspective, the symptoms of bacterial and non-bacterial prostatitis are very similar. Without consulting a urologist and performing special examinations, it is impossible to distinguish one form of prostatitis from another and receive high-quality treatment. You can make an appointment for a urologist for free under the compulsory medical insurance policy or make an appointment for a doctor in a private clinic.

The main task of a urologist is to rule out other diseases of the prostate, such as cancer, and to determine which disease a person has. It is important to distinguish chronic pelvic pain syndrome from bacterial prostatitis with confirmed or suspected pathogens. This is what the doctor should do to figure it out.

Ask the patient about symptoms and health status.To gather more information, your doctor may suggest that you answer the questions in a questionnaire called chronic prostatitis symptom index. In some cases, in order not to waste time on appointments, it makes sense to print out the questionnaire and fill it out in advance.

Have a physical examination.The doctor will examine the patient, paying special attention to the groin area. If the inguinal lymph nodes are swollen and painful, this increases the possibility that the body is actually in an inflammatory state. Usually, the examination includes a digital rectal examination, which the doctor can use to assess the size, shape, and condition of the prostate. The research helps to understand whether the prostate is enlarged. If the gland is painful to the touch, it is probably inflamed.

Is it possible not to have a digital rectal 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 operations that in principle they refuse to make appointments with urologists.

Digital rectal examination is a diagnostic method, but the purpose of massaging the prostate through the rectum is to obtain materials for laboratory analysis—the secret of the prostate. If the secret is not available, doctors can analyze the first part of urine or two and three cups of urine instead of analyzing prostate secretions. These studies allow you to roughly determine the location of the problem area in the urinary tract.

Sometimes, for the same purpose, semen analysis is prescribed instead of such an examination. It helps to understand whether prostatitis is part of a male gonad infection and provides information about the quality of ejaculation. In addition, the count of white blood cells in ejaculation makes it possible to distinguish the inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.

If the patient is concerned about the upcoming digital examination or prostate massage, I suggest you discuss it with your doctor. Perhaps the analysis of prostate secretions can be obtained by her massage, which can be replaced by urine or semen analysis.

Order blood tests, urine and prostate secretions.Diagnostic criteria include microscopic examination of prostate secretions, general blood tests, microscopic examination of urine sediment, and microbiological examination of urine and prostate secretions.

During the microbiological study, the patient's biological material is placed on a nutrient medium, and they will observe the bacteria growing on it-this allows you to confirm the diagnosis. According to the compulsory medical insurance, you can have the check-up in a private clinic for a fee or free of charge.

If prostatitis is suspected, other tests and examinations, such as total prostate specific antigen (PSA) concentration in the blood and transrectal prostate ultrasound (TRUS), are usually not performed. In some cases, TRUS of the prostate can show fibrosis, that is, scars or lesions similar to malignant tumors, but such studies are not without exception applicable to all patients.

How is prostatitis treated?

Treatment depends on the type of prostatitis. If the inflammation is caused by bacteria, the doctor will choose antibiotics. If bacteria have nothing to do with it, drugs are needed to help cope with the unpleasant symptoms of the disease.

Acute bacterial prostatitisNo need to wait for test results to start treatment-this is called empiric antibiotic therapy. In this way, antibiotics are prescribed based on knowledge of which bacteria are most likely to cause prostate infection.

Generally, antibacterial drugs prescribed to patients can penetrate well into the prostate tissue and act on the most "popular" pathogens of prostatitis and urinary tract infections.

Those who feel more or less normal and receive treatment at home usually receive antibiotics in pills. Patients with high fever who receive treatment in hospitals are more likely to be prescribed antibiotics by injection. Through this treatment, the fever and pain of most patients with acute prostatitis will be relieved from the 2nd to the 6th day after starting the medication.

When the patient's body temperature returns to normal and the signs of inflammation disappear, the doctor can switch the patient from an injection to a pill. 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 treatment technique. Someone once thought that it could help release excess secretions accumulated in the glands, thereby reducing their 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 also worsens the course of the disease, because the result of massage is that bacteria can enter adjacent uninfected tissues.

Chronic bacterial prostatitisAlso received antibiotic treatment against gram-negative bacteria. For treatment, fluoroquinolones are usually used-these antibiotics are considered quite safe. But if the doctor suspects that other microorganisms are causing prostatitis, he can prescribe additional antibacterial drugs without waiting for the test results.

For chronic prostatitis, antibiotics need to be taken longer than acute prostatitis. According to the recommendations of the urologist, they write a prescription within 4-6 weeks of treatment.

Chronic bacterial prostatitisIt has nothing to do with bacteria, so patients with this disease only use antibiotics when they have urinary tract infections in addition to prostatitis.

Since it is not clear what causes bacterial prostatitis, the main purpose of treatment is to relieve pain during urination. To this end, doctors will prescribe alpha-1 blockers, which help relax the prostate muscles that press on the urethra. If the pain persists, your doctor may prescribe non-steroidal anti-inflammatory drugs. The dose for each patient is selected individually.

Some patients with bacterial prostatitis are helped by cognitive behavioral therapy-this is the name of treatment with a psychologist, during which a person learns to deal with pain without medication. At the same time, there is no scientific basis for the effectiveness of psychological assistance for bacterial prostatitis.

Researchers trying to prove the effectiveness of other interventions (such as acupuncture, electromagnetic chair therapy, prostate massage, or transrectal hyperthermia) are poorly planned and take too short a time—usually less than 12 weeks. So it is impossible to say whether all this is helpful.

How to avoid prostatitis: prevention

The main cause of prostate discomfort is a sedentary lifestyle and lack of regular sex life. Doctors believe that the highest chance of avoiding prostatitis is the following men:

1. Have safe sex regularly.
2. They often exercise moderately.
3. Avoid hypothermia.
4. They are over 40 years old and undergo urological examinations every year.

Where to treat prostatitis better-in public or private clinics

The most important thing is that the diagnosis and treatment of prostatitis follow the principles of evidence-based medicine. It only depends on the doctor-and his specific work location is not important.

Unfortunately, doctors in private clinics do not always comply with medical standards. This may lead to overdiagnosis and unnecessary treatment, which puts patients at risk of overpaying. In national medical institutions, it is more likely to comply with all diagnostic and treatment standards. But patients need to consider that a complete examination takes more time, sometimes more time than an examination in a private clinic.

remember

1. Urinary tract problems in men are common, but not always in prostatitis. To understand what happened to a person, you need to conduct a thorough examination.
2. Prostate problems rarely cause erectile difficulties. Usually, with prostatitis, it is weakened by psychological problems that appear in the context of unpleasant symptoms.
3. Not all forms of prostatitis are caused by bacteria: 80-90% have nothing to do with bacteria. If a person suspected of having prostatitis takes antibiotics without additional testing, it is bad. Before taking them, it makes sense to consult another doctor.
4. People with acute or chronic prostatitis may receive prostate massage to collect glandular secretions for analysis.
5. The best way to prevent prostatitis is to protect sex, a healthy lifestyle, and after 40 years-regular urinary system examinations by a doctor.