Chronic prostatitis: a common pathology
The chronic prostatitis or Chronic Pelvic Pain Syndrome (CPPS) is a complex and disabling disorder, mainly affecting young and middle-aged men. It manifests as persistent pelvic pain, accompanied by urinary and sometimes sexual disorders.
What is chronic prostatitis?
Chronic prostatitis, also known as chronic pelvic pain syndrome (CPPS), is one of the most common forms of prostatitis. Unlike acute bacterial prostatitis, which is caused by an identifiable infection, chronic prostatitis occurs in the absence of obvious infectious agents, making diagnosis and management more complex. CPDS is a major problem in urology today, affecting up to 10 % of men over the course of their lives. The impact on quality of life is often significant, with symptoms interfering with patients' daily activities and emotional health.
Etiology and risk factors of chronic prostatitis
The exact cause of chronic prostatitis remains uncertain. Research suggests that it is a multifactorial pathology, involving a combination of infectious, inflammatory, neurological and psychological factors. Key etiological hypotheses include:
- Immune system dysfunction : An autoimmune reaction may cause persistent inflammation of the prostate, even in the absence of infection.
- Neurological factors Hypersensitivity or neuropathy of the pelvic nerves can lead to chronic pain. Pain circuits in the pelvic region may be deregulated, resulting in amplified pain perception.
- Urethral reflux Some researchers suggest that urine reflux in the prostatic ducts could cause inflammation and prolonged pelvic pain, favoring the development of chronic prostatitis.
- Stress and psychological factors Chronic stress and anxiety are often associated with symptom exacerbation. This association suggests an interaction between the central nervous system and the inflammatory response.
Symptomatology of chronic prostatitis
The symptoms of chronic prostatitis are often varied and persistent, complicating management. Clinical signs include:
- Pelvic pain Localized in the perineal area, it may also radiate to the lower back, testicles or pubic region. Pain may be continuous or intermittent, and is generally exacerbated by stress or certain physical activities.
- Urinary symptoms Patients frequently report an urgent need to urinate, a sensation of incomplete emptying, burning on urination and sometimes a decrease in urine flow.
- Pain during ejaculation Pain: This symptom is frequently reported by patients and can affect their sexual and emotional quality of life. This pain can sometimes lead to reduced libido and secondary erectile problems.
- Psychological impact : Prolonged discomfort and lack of curative treatment can lead to significant emotional distress, exacerbating anxiety and depression in many patients.
Diagnosis: A multidisciplinary approach
Diagnosis of chronic prostatitis relies on ruling out other possible causes of pelvic pain and urinary symptoms. Investigations often include:
- Clinical assessment and medical history : Particular attention is paid to symptoms and their evolution over time.
- Laboratory analysis Although infections are not the main cause, urine tests and prostate samples are taken to rule out any underlying bacterial infection.
- Physical examination and pelvic ultrasound These examinations visualize the structure of the prostate and assess any anatomical abnormalities that may be contributing to symptoms.
What treatments are available for SDPC?
Here is a list of the main treatment options for chronic prostatitis :
- Antibiotics Prostatitis: Initially used to rule out any potential bacterial infection, although chronic prostatitis is often non-bacterial.
- Non-steroidal anti-inflammatory drugs (NSAIDs) Helps reduce inflammation and pain.
- Alpha-blockers Medications that relax the muscles of the prostate and bladder neck, improving urinary flow and reducing pain.
- Pelvic physiotherapy Therapies targeting the pelvic floor muscles to reduce muscle tension and spasm, often associated with chronic pelvic pain.
- Stress management and psychological therapies Cognitive-behavioural therapy (CBT) and relaxation techniques help manage anxiety and stress, which can aggravate symptoms.
- Complementary therapies Techniques such as acupuncture, meditation and heat therapy (hot baths) to help relieve pain and reduce muscle tension.
- Lifestyle changes Treatment: Include reducing alcohol and caffeine consumption, regular exercise, and a balanced diet to help reduce symptoms.
- Transarterial artery embolization Minimally invasive technique involving the blocking of prostatic arteries to reduce inflammation and prostate volume, effective in refractory cases.
- Supplements and phytotherapy Plants such as saw palmetto and rye pollen extracts are sometimes used to relieve symptoms, although evidence of effectiveness is variable.
- Surgery (in case of complications): Rarely used, but transurethral resection of the prostate (TURP) may be considered in extreme cases where other treatments fail.
