At present, there are practically no studies deciphering the mechanisms of the possible influence of opportunistic pathogens on the morphological changes in the prostate gland. Many authors doubt that bacteria are the cause of chronic prostatitis. In clinical practice with prostate diseases preference is given to ultrasound examination as a reliable and time-consuming diagnostic test. At the same time, many authors note that for the diagnosis of inflammatory diseases of reproductive organs, the study of relevant secrets is an actual and promising scientific direction.The aim of the study was the investigation of qualitative and quantitative composition of microflora, a number of ejaculate proteins against the background of a different echoscopic picture of prostate.Materials and methods. The study included 18 men was in infertile couples for more than 3 years with a previously diagnosed chronic prostatitis (N41.1, observation group), and 28 healthy volunteers (comparison group). All participants in the study performed transrectal ultrasound. In the ejaculate, the concentrations of immunoglobulins of the main classes, total protein and albumin, as well as the level of oxidative modification of proteins were determined. Microbiological examination of the ejaculate was performed according to generally accepted methods. For statistical evaluation of the data obtained, an unpaired version of Student's t-test was used. Differences were considered statistically significant at p<0.05.Results. Microflora of the ejaculate in observation group was represented mainly by gram-positive cocci. In 39% of cases, the growth of Gram-negative microflora was established, from which Escherichia coli was isolated in 71% of the samples. In most samples, microorganisms were in the association, which is more typical for diffuse changes in prostate tissue. In cases with fibrosis, a noticeable narrowing of the spectrum of the released microflora was recorded: from Gram-negative bacteria only E. coli was isolated, and Gram-positive microorganisms were absent altogether. It was shown that the development of fibrosis in the prostate gland tissue is accompanied by an increase in the concentration of total protein and albumin in the ejaculate. When the process goes to the calcification stage, the levels of these indicators decrease. It was found that in all cases, with the exception of severe fibrosis, the concentration of IgG increases and IgA decreases. The development of fibrosis is accompanied by a decrease in the level of IgG. In the present study, in determining the level of oxidative modification of proteins, a decrease in the concentration of such molecules was found in patients of observation group.Discussion. In general, chronic inflammation in prostate of men of reproductive age in more than 60% of cases was characterized by fibrosis of the organ tissue and/or the formation of calcifications. In such situation, conditions are created for the persistence of opportunistic pathogenic microflora in fibro-modified tissue beyond the reach of immune system factors. In addition, there are phenomena of secondary immunodeficiency at the local level, manifested in a decrease in the number of leukocytes and their radical-producing function. That is why we consider the detection of conditionally pathogenic microorganisms as an essential fact of the pathogenesis of prostatitis, especially in the case of fibrosis and the formation of calcifications. Thus, the qualitative and quantitative study of microflora, the presence and degree of modification of the main protein components of the ejaculate, to a greater or lesser extent reacting to infectious inflammation, is primarily an asymptomatic one, broadens the concept of the pathogenesis of chronic prostatitis. As an addition to the ultrasound, its results allow us to clarify the duration of the inflammatory process, and to significantly decipher the echographic changes recorded at different stages of the development of the disease.
The reason of the using of an international estimation of signs the diseases of a prostate gland in the patients with the chronic prostatitis
