congestive prostatitisIt is a pathological process in the prostate gland caused by congestion. No pathogenic flora is detected; Microscopy of prostatic secretions, semen, and urine may reveal leukocytes. Symptoms include constant pain in the perineum, dysuria. The diagnosis is based on the results of bacterial culture of biomaterial and TRUS. There is no single treatment regimen for congestive prostatitis; Massage, physiotherapy, antimicrobial medications and alpha-blockers are prescribed. An individual approach is required, taking into account the existing symptoms. If conservative treatment fails, surgery is possible.
General information
Prostatitis can be infectious, caused by the presence of pathogenic microflora, or stagnant, associated with blood congestion, ejaculation retention and prostatic secretions. Congestive or congestive prostatitis (vegetative urogenital syndrome, prostatosis) is an outdated name. Modern specialists in the field of urology most often use the term "chronic pelvic pain syndrome without an inflammatory response" (CPPS). Prostatitis occurs in 25% of men aged 35 to 60 years, inflammation caused by congestive processes accounts for 88-90% of the total number of cases. The potentially congestive form of the disease is supported by pathogens that are in the L form, fixed in biofilms and not detected by routine methods.
Causes
The causes of congestive prostatitis can be associated with both the gland itself and extraprostatic factors. The exact etiology is unknown, probably due to stagnation of secretions in the prostate or is a consequence of venous congestion in the pelvic organs and scrotum. Some urologists consider the disease to be psychosomatic. The line between bacterial and abacterial inflammation is very arbitrary, with immunosuppression of any origin, due to the addition of secondary microflora, the process becomes infectious. Congestive prostatitis is caused by:
- Internal urological causes. Functional or structural pathology of the bladder: cervical obstruction, inability of the external sphincter to relax during bowel movements, impaired detrusor contractility contribute to urinary retention and, due to compression of the vessels, to blood stagnation. Prostate hyperplasia and tumor, urethral stricture, and obstructive bladder stones are also considered potential causes of venous congestion.
- Compression. Blood circulation is hindered by compression of the venous plexus by a retroperitoneal tumor, metastases, and intestinal loops filled with feces (constipation). The vessels of the genitourinary plexus dilate, blood flow slows down, tissues experience oxygen starvation and are replaced by non-functional structures. Some of the blood is deposited and disconnected from circulation.
- Behavioral factors. Refusal of sexual activity, irregular ejaculation, and the use of interrupted sexual intercourse as a means of preventing unwanted pregnancies cause blood flow and inflammation of the prostate tissue. During ejaculation, this gland is not completely drained. Constant masturbation can cause congestive prostatitis, because. . . For the development of an erection, a rush of blood to the genitals is necessary.
Predisposing factors include little physical activity, hypothermia and overheating, poor diet with a predominance of spicy and smoked foods. Alcohol and nicotine affect the tone of the vascular wall, disrupt redox processes and permeability, which causes swelling. The main prerequisites for the formation of congestive prostatitis affecting all organs of the male genital area (vesicles, testicles) are considered to be anomalies of the vascular system of the pelvis: valve insufficiency, congenital weakness of the venous wall.
Pathogenesis
The peripheral area of the prostate is made up of ducts that have a poorly developed drainage system, which prevents the release of secretions. As the prostate increases in size with age, patients develop reflux of urine into the prostate tubes. It has been observed that many men who suffer from prostatitis are more likely to suffer from allergies. Scientists believe that these patients may also suffer from autoimmune inflammation caused by a previous infection.
Urinary reflux is promoted by urethral strictures, bladder dysfunction and BPH. Reflux of even sterile urine causes chemical irritation and inflammation. Fibrosis of the tubules begins, preconditions for prostalithiasis are created, which increases intraductal obstruction and stagnation of secretions. Inadequate drainage of the acini triggers an inflammatory reaction, increased swelling is accompanied by the appearance of symptoms. The condition is aggravated by congestion (stagnation) of blood in the pelvis.
Classification
The general classification of prostatitis includes acute (I) and chronic (II) bacterial forms. Category III includes subtype IIIa – CPPS with inflammation and IIIb – CPPS without it. Congestive prostatitis is considered a manifestation of CPPS with the absence of an inflammatory response (IIIb). There is a clinical differentiation that takes into account the pathogenic and morphological characteristics of the disease:
- First stage.It is characterized by the predominance of exudation processes, emigration, arterial and venous hyperemia, which cause damage to the microvasculature and destruction of glandular tissue. These changes are recorded during the first years after the onset of the disease. The clinical picture in the first stage is more pronounced.
- Second stage.The initial processes of connective tissue proliferation develop and symptoms decrease. Due to the formation of thrombi, microcirculation is impaired, which aggravates sclerosis. At this stage, most patients experience sexual dysfunction: the erection and intensity of orgasm weaken, premature ejaculation develops, or, conversely, the man experiences difficulties in reaching climax.
- Third stage. Severe fibrosclerotic changes are typical. Connective tissue proliferation has been shown to be stimulated not only by inflammation, but also by the ischemia that accompanies congestive prostatitis. Complaints of difficulty urinating are typical and involvement of the kidneys in the pathological process is observed.
Symptoms of congestive prostatitis.
The pathology manifests itself with a variety of symptoms. Most patients describe the pain as constant discomfort in the perianal area, scrotum, or penis. Some notice increased perineal pain when sitting. The radiation of the pain is variable: in the lumbar area, in the inner thighs and in the tailbone. Inflammation of the gland often makes it difficult to start urination and weakens the urine stream. A type of congestive inflammation against the background of vascular pathology is usually accompanied by hemospermia, the appearance of blood in the semen.
Symptoms of bladder irritation include frequent urgency and urge urinary incontinence. With long-term pathology, depressive disorders develop. It is still debatable whether psycho-emotional characteristics cause discomfort in the perineum or, on the contrary, the pain caused by inflammation of the prostate affects the mental state of a man. An increase in temperature with chills indicates the transition from abacterial to infectious congestive prostatitis and the need to start pathognomonic treatment.
Complications
Congestive prostatitis with the addition of microflora can become acute bacterial. Neighboring organs and structures may be involved in the inflammatory process: vesicles, bladder, testicles. The function of the prostate is to produce fluid for sperm, it normally has a special composition that has a protective function for male germ cells. Insufficient amounts of nutrients and changes in the biochemical properties of prostate secretions inevitably affect the quality of ejaculation; Men with congestive prostatitis are more often diagnosed with infertility.
With severe inflammation of the organ, part of the urine after urination remains in the bladder, which leads to the formation of pathological reflux of urine into the ureters and renal collecting system. In response to reflux, hydronephrosis and persistent pyelonephritis with renal failure may occur. 50% of men develop sexual dysfunctions: painful ejaculation, dyspareunia, uncomfortable nocturnal erections, which worsens the quality of life and negatively affects the relationship.
Diagnosis
Determining the origin of the symptoms is crucial for the effective treatment of congestive prostatitis, which is why various questionnaires have been developed to facilitate the diagnosis: I-PSS, UPOINT. These questionnaires are available in Russified form and are used by urologists and andrologists in their practice. To exclude myofascial syndrome, consultation with a neurologist is indicated. On palpation, the prostate is enlarged, moderately painful, the stagnant nature of the disease is evidenced by varicose veins of the rectum. The diagnosis of congestive prostatitis includes:
- Lab test. A microscopic and cultural examination of the prostate juice is performed. A slight increase in the number of leukocytes under microscopy and negative bacterial culture results confirm abacterial congestive inflammation. PCR tests are performed to exclude the sexually transmitted nature of the disease. In the third portion of urine after massage, more pronounced leukocyturia is detected. To exclude a bladder tumor, urine cytology can be performed; in patients over 40 to 45 years of age, a PSA blood test is justified.
- Visual research methods.. The main instrumental diagnostic method remains TRUS, ultrasound of the bladder. The results of cystourethrography are informative in confirming bladder neck dysfunction, revealing intraprostatic and ejaculating reflux of urine and urethral stricture. In case of pronounced weakening of the jet, uroflowmetry is performed. The tension of the pelvic floor muscles is evaluated using a videourodynamic study.
The differential diagnosis is made with bladder carcinoma, BPH, interstitial cystitis. Similar manifestations are observed in genitourinary tuberculosis and urethral stricture, since these nosologies are also characterized by pain in the lower abdomen, symptoms of dysuria and difficulty urinating. Congestive prostatitis is distinguished from bacterial prostatitis; Furthermore, all pathological processes accompanying CPPS in men must be excluded.
Treatment of congestive prostatitis
The patient is recommended to normalize his sexual life, since regular ejaculation helps to drain the acini and improve microcirculation. Interrupted or prolonged sexual relations, which cause congestion, are unacceptable. Several products have been identified that increase the chemical aggressiveness of urine; Its consumption causes an increase in the symptoms of congestive prostatitis. Spices, coffee, marinades, smoked foods, alcoholic and carbonated drinks should be limited or, better yet, excluded. Treatment of congestive inflammation of the prostate can be conservative and surgical.
Conservative therapy
The treatment regimen is selected individually, depending on the predominant symptoms. In many patients, improvement occurs after taking antibacterial drugs, which is explained by incomplete diagnosis of latent infections. For slow urinary flow and the need to strain, alpha blockers are prescribed. Urinary urgency is neutralized with anticholinergic drugs. 5-alpha reductase inhibitors have been shown to reduce the severity of clinical manifestations by reducing the response of macrophages and leukocytes and their migration towards the inflammatory zone.
Pain relievers, nonsteroidal anti-inflammatories, and muscle relaxants can help relieve pain and muscle spasms. It is reasonable to include in the treatment regimen drugs that normalize microcirculation: phlebotonics (venotonics). If the stagnant process supports androgen deficiency, hormone replacement therapy is resorted to. Patients with anxiety, hypnotic and depressive disorders are recommended to consult a psychiatrist, who will select the optimal antidepressant.
With stagnant inflammation of the prostate, physiotherapy procedures help to normalize men's health. Laser, magnetotherapy, electrophoresis, etc. are used. Spa treatments help relieve the symptoms of dysuria and improve sexual function: drinking alkalizing mineral waters, paraffin and mud applications, massage showers. In some patients, a normalization of well-being is observed when performing exercise therapy to reduce tension in the pelvic muscles. Prostate massage does not replace natural ejaculation, but it improves blood circulation and drainage of the organ.
Minimally invasive treatment methods.
If conservative therapy is unsuccessful, high-tech interventions are considered: transurethral resection of the prostate and high-intensity focused ultrasound ablation. The most effective is transrectal hyperthermia, a non-invasive method based on the principle of thermal diffusion (the prostate is exposed to unfocused microwave energy). Heat increases tissue metabolism, reduces congestive symptoms and has a neuroanalgesic effect. Data on the effectiveness of the procedures in the treatment of congestive prostatitis are limited.
Prognosis and prevention
The prognosis for life is favorable, but chronic pelvic pain is difficult to treat. Sometimes congestive prostatitis resolves spontaneously over time. A prolonged circulatory disorder leads to sclerosis of the glandular tissue, which is manifested by a deterioration in the parameters of the spermogram. The prognosis of congestive prostatitis largely depends on the patient's compliance with all recommendations and lifestyle changes.
Prevention involves practicing sports, avoiding lifting heavy objects, normalizing sexual relations and avoiding the consumption of coffee and alcohol. When working sedentarily, it is recommended to take breaks to perform physical exercises and use a pillow. Loose-fitting underwear and pants are preferred. Patients are observed by a urologist with periodic evaluation of prostate secretions for inflammation and ultrasound and, if necessary, receive antibacterial treatment and prostate massage sessions.