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Prostatitis

  • Prostate inflammations, seminal and collicular vesicles, are the most frequent urogenital diseases

    Prostatitis is an inflammation of the prostate gland. Generally, we can´t identify its cause in one single infection, nevertheless, in some cases we can observe how a bacterial infection can spread throughout the urinary tract and reach the prostate gland. Accordingly to the duration of symptoms we can classify it as acute or chronic (persistent symptomatology during more than 3 months). Bacterial prostatitis is the most common cause of recurrent urinary infections found in the male population.

    Prostate inflammations, seminal and collicular vesicles (prostatitis, vesiculitis and coliculitis), that sometimes develop into chronic states, are the most frequent urogenital diseases in men. Most of the times they are associated with urinary infections. According to recent studies, the clinical condition for prostatitis is characterized in the first place by sexual disorders, reproductive impairments, pain symptoms, dysuria and psychoneurologic disorders which are difficult to treat and, consequently, disturb the sexual relationship between partners. Therefore, prostatitis turns into a social problem as well as a medical one.

    During the pre-antibiotic era, acute prostatitis was the most frequent but today, 98% of cases are latent forms of chronic prostatitis. One of the factors contributing to this situation is the decrease of immunologic potential in our population, due to unfavourable environmental situations, alcohol and tobacco abuse among men, and finally the increase of sexual transmitted infections [I.F. Iunda, 1981; 1987].

    Prostatitis was considered an independent nosology entity more than one hundred years ago. The chronic inflammatory process of the male sexual organs has a diffuse character but the main pathologic focus is situated in one single organ.

    A normal functional prostate has three barriers of protection:

    • Essentially, we are talking about a structure that is highly resistant morphologically and functionally; this barrier can be hindered by negative psycho-emotional states (asthenia or severe depression) and organic alterations at the level of the genital organs (traumatism, intoxication, perfusing disorders, etc);
    • Sufficient physiologic tone and vascularization of the internal genital organs; this barrier can be undermined by hypodinamia, sexual dysrhythmias, hypothermia and androgen insufficiency;
    • Anti-infectious barrier; this barrier is breached when the local imunobiological responses are weakened together with neurocirculatory asthenia, androgen insufficiency, microbial or drug intoxication, etc.

    The androgenic function holds a chief importance among the physiologic defense mechanisms. A normal level of androgens allows the maintenance of the genital organ´s tone, the active secretion in the prostate and the production of sufficient bactericidal components in the secretion. People who suffer from prostatitis show androgen and estrogen imbalances, which are due, normally, to metabolic disorders in steroid hormones. This situation happens in consequence of prostatic tonic perforations, congestion of the organ in the lesser pelvis and inflammation of the bile ducts or from a diminished hepatic function (liver). What also takes place together with the infection is the self-injury and hormonal degeneration.

    Prostate secretion in a healthy men is produced constantly (“resting secretion”). During urination and defecation the prostate gets rid, almost completely, from this secretion. It is now assumed that the main factors contributing to the development of prostatitis and other male sexual organ diseases are venous congestion and muscular atony of the lesser pelvis (81,1% of the known cases), which can be caused by the interruption or lengthening of the sexual act, sexual excesses, chronic constipation due to proctitis, sinusitis and sigmoiditis, a sedentary lifestyle and hypothermia. Among the inducing factors we can count traumatisms caused by instrumental exams, rough manipulations, general septic state, liver inflammations and bile ducts, angina, otitis, dental caries, proctitis, chronic endocarditis, chronic pneumonia and intoxications.

    In the case of intoxications (smoking, alcoholism, etc), traumatism, ionizing radiation effects, autonomous-nerve disorders, as well as vascular and immunologic due to secondary and long-lasting effects sustained towards the prostate, all of them create trophic changes in the autonomous innervation and in the immunologic prostate reactivity. Trophic and degenerative destructive disorders that follow the above situations turn the non-pathogenic and quasi-pathogenic flora into a pathogenic one, responsible for the development of the inflammation.

    The Symptoms of Prostatitis:
    The subjective and objective symptomatology of prostatitis is characterized by great variability and polymorphism. Nevertheless, it is possible to distinguish one thing in common in the clinical manifestation of prostatitis. In almost all forms of prostatitis, pain and uncomfortable sensations in the anal zone are present, as well as in the perineum, lumbar and pelvic zones. Furthermore, all of these are accompanied by erectile dysfunction, impotence, premature ejaculation, retarded ejaculation, retrograde ejaculation, anejaculation, pain during ejaculation, orgasm and reproductive disorders. This scenario is completed with particular aspects.

    General symptoms: shivering, fever, general weakness, easy fatigability, sleep disorders, nervousness, obsessions.

    Local symptoms: pain in the prostate, change in form, size and prostate consistency, high leukocyte reaction in the prostate secretion, extragenital pain, pelvic sympatheticalgia, weight in the lower part of the abdomen, pruritus (urethra, perineum, anus), genital paresthesia (tickling sensation or goose bumps in the urethra, cooling of sexual organs, etc), pathologic excretions in the urethra, the posterior urethra and the seminal vesicles, and finally rectal pathology.

    Functional symptoms: increase of spontaneous erections together with normal erections, normal erections are intensified or weakened, erectile dysfunction, impotence, premature ejaculation, retarded ejaculation, anejaculation, less intense orgasm, painful orgasms, anorgasmia (unable to have an orgasm), wearying of the sexual drive, alteration of the ejaculated volume, patospermia, primary infertility, secondary infertility. In most of the times, patients with prostatitis only show complaints regarding their sexual dysfunctions.

    Treatment of Prostatitis
    The pathogenic treatment which should be accompanied by anti-infective etiotropic treatment, has five major objectives:

    • General and local Immunotherapy;
    • Normalization of the prostate perfusion;
    • Recovering the secretion reflux from the prostate and the seminal vesicles, Littre and Cowper glands, due to the augmentation of the pelvic and perineal muscle tone and the muscular fibers of the prostate;
    • Recovering morphologic and structural elements in the pathological modifications of tissues;
    • Normalization of all the affected organs.

    These objectives are successfully achieved through an integrated therapy which includes low level laser therapy.

    Patients with non-specific prostate infections, seminal vesicles and colliculus (prostatitis, vesiculitis, colliculitis), should receive integrated and etiopatogenic treatment. A substantial number of prostatitis traditional treatments do not achieve ideal results, but this situation can turn radically when the treatment includes low level laser therapy. [R.Sh. Altinbaev, N.R. Kerimova, 1993; I.N. Danilova et al., 1985; A.K. Polonski, A.V. Tcherkassov, 1984; L.Ia. Reznikov et al., 1992; B.V. Iassinski et al., 1990].

    Thanks to the multilevel and multicomponent effect of low level laser radiation, able of normalizing blood circulation and metabolism, the use of laser in the treatment of urologic diseases increases the efficacy of the all remaining therapies. The significant improvement of lymphatic and blood fluxes in the irradiated area, offers a more efficient supply of antibiotics towards the prostate, something that allows the reduction of the administrated drug dosages.

    One of the crucial questions in the use of laser therapy is the choice of radiation parameters, the method and the treatment which will grant us the best therapeutic effect but also the absence of collateral damage.
    Laser therapy, in the acute and subacute phases, is a mean that contributes to the healing process of injuries through mobilizing the organism´s self-repairing mechanisms. The observation of simple rules of treatment and activity regime, allows us to achieve good therapeutic results, reducing the time of treatment and lessening the drug charge in which the patients are exposed to: adequate and rational nutrition, individual rhythm of activity and resting, therapeutic gymnastics, sexual hygiene, functional normalization of the organs that participate in the hormonopoiesis, administration of sedative drugs in case of any psychoneurologic symptomatology is present, elimination of potential points of infection.