Congestive prostatitisIt is a pathological process caused by blockage in the prostate gland. Pathogenic flora is not detected, leukocytes can be detected during microscopy of prostate secretion, sperm and urine. Symptoms include constant aching pain in the perineum, dysuria. Diagnosis is based on biomaterial and TRUS bacterial culture results. There is no single treatment regimen for congestive prostatitis, massage, physiotherapy, antimicrobial drugs 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 associated with stagnation, blood congestion, ejaculation and retention of prostate secretion. Congestive or congestive prostatitis (vegetative urogenital syndrome, prostatosis) is an outdated name. In the field of urology, modern specialists more often use the term "chronic pelvic pain syndrome without inflammatory response" (CPPS). Prostatitis occurs in 25% of men aged 35-60, inflammation caused by congestive processes accounts for 88-90% of all cases. A potentially congestive form of the disease is supported by pathogens in L-forms, fixed in biofilms and undetectable by conventional methods.
Reasons
The causes of congestive prostatitis can be associated with both the gland itself and extraprostatic factors. The exact etiology is unknown, but it is probably the result of stagnation of secretions in the prostate or venous congestion in the pelvic organs and testis. Some urologists consider the condition psychosomatic. The line between bacterial and bacterial inflammation is very arbitrary, with immunosuppression of any origin, the process becomes infectious due to the addition of secondary microflora. Congestive prostatitis is caused by:
- Internal urological causes. Functional or structural pathology of the bladder: cervical obstruction, inability to relax the external sphincter during bowel movements, impaired detrusor contractility contribute to urinary retention and blood stagnation due to compression of vessels. Prostate hyperplasia and swelling, urethral stricture, and obstructive bladder stones are also considered potential causes of venous obstruction.
- Compression. Blood circulation becomes difficult due to compression of the venous plexus by retroperitoneal tumor, metastases and stool-filled bowel loops (constipation). The vessels of the genitourinary plexus expand, the blood flow slows down, the tissues experience oxygen starvation and are replaced by non-functional structures. Part of the blood is collected and removed from the circulation.
- Behavioral factors. Abstaining from sexual activity, irregular ejaculation and the use of interrupted intercourse as a means of preventing unwanted pregnancy cause bleeding and swelling of the prostate gland tissue. During ejaculation, this gland does not empty completely. Constant masturbation can cause prostatitis because. . . Blood flow to the genitals is necessary for the development of an erection.
Predisposing factors include low physical activity, hypothermia and overheating, poor diet dominated by spicy, smoked foods. Alcohol and nicotine affect the tone of the vascular wall, disrupt redox processes and permeability, which causes swelling. The main conditions for the formation of congestive prostatitis with an effect on all organs of the male genital area (vesicles, testicles) are considered to be anomalies of the pelvic vascular system - valvular deficiency, congenital weakness of the venous wall.
Pathogenesis
The peripheral zone of the prostate gland consists of channels with a poorly developed drainage system, which prevents secretions from coming out. As the prostate grows with age, patients develop backflow of urine into the prostatic ducts. It has been noted that many men suffering from prostatitis are more prone to allergies. Scientists believe that such patients may also suffer from autoimmune-mediated inflammation caused by a previous infection.
Urinary reflux develops with urethral stricture, bladder dysfunction, and BPH. Even reflux of sterile urine causes chemical irritation and inflammation. Fibrosis of the ducts begins, initial conditions for prostatolithiasis are created, which increases intraductal obstruction and stagnation of secretions. Insufficient drainage of the acini causes an inflammatory reaction, increased swelling is accompanied by the appearance of symptoms. The condition is aggravated by blood congestion (stagnation) 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 in the absence of an inflammatory response (IIIb). There is a clinical difference that takes into account pathogenetic and morphological features of the disease:
- The first stage.It is characterized by the predominance of processes of exudation, emigration, arterial and venous hyperemia, resulting in damage to microvessels and destruction of glandular tissue. These changes are recorded in the first years after the onset of the disease. In the first stage, the clinical picture is most pronounced.
- The second stage.Primary processes of connective tissue proliferation develop and symptoms decrease. Due to the formation of thrombus, microcirculation suffers, which aggravates sclerosis. At this stage, sexual dysfunction is observed in most patients: the erection and intensity of orgasm weaken, premature ejaculation develops or, on the contrary, the man has difficulty reaching climax.
- The third stage. Severe fibrosclerotic changes are typical. It has been proven that proliferation of connective tissue is stimulated not only by inflammation, but also by ischemia accompanying congestive prostatitis. Complaints about the difficulty in urinating are typical, the involvement of the kidneys in the pathological process is noted.
Symptoms of congestive prostatitis
The pathology manifests itself with various symptoms. Most patients describe the pain as constant discomfort in the perianal area, scrotum, or penis. Some report increased perineal pain while sitting. The radiation of pain is variable - lower back, inner thigh, tailbone. Swelling of the gland often makes it difficult to urinate and weakens the flow of urine. Against the background of vascular pathology, inflammation of the congestive type is often accompanied by hemospermia - the appearance of blood in sperm.
Symptoms of bladder irritation include frequent urges and incontinence. Depressive disorders develop with long-term pathology. It is still controversial whether psycho-emotional characteristics cause discomfort in the perineum or, on the contrary, whether the pain caused by the swelling of the prostate gland affects the mental state of the man. An increase in temperature with chills indicates the transition of abacterial congestive prostatitis to an infectious one and the need to start pathognomonic treatment.
Complications
With the addition of microflora, congestive prostatitis can be acute bacterial. Adjacent organs and structures may be involved in the inflammatory process: vesicles, bladder, testicles. The role of the prostate gland is to produce fluid for sperm, which normally has a special composition that has a protective function for male sex cells. Insufficient nutrients and changes in the biochemical properties of prostate secretion inevitably affect the quality of discharge; men with congestive prostatitis are more often diagnosed with infertility.
With severe swelling of the organ, part of the urine remains in the bladder after urination, which causes pathological reflux to the ureters and the renal collecting system. In response to reflux, hydronephrosis and persistent pyelonephritis may occur with impaired renal function. 50% of men develop sexual dysfunction: painful ejaculation, dyspareunia, uncomfortable night erections, which worsen the quality of life and have a negative impact on the couple's relationship.
Diagnostics
Determining the origin of symptoms is very important for the effective treatment of congestive prostatitis, so various surveys have been developed to facilitate the diagnosis: I-PSS, UPOINT. These questionnaires are available in a Russianized form, which urologists and andrologists use in their practice. Consultation with a neurologist is indicated to rule out myofascial syndrome. During palpation, the prostate is enlarged, moderately painful, the congestive nature of the disease is evidenced by varicose veins of the rectum. Diagnosis of congestive prostatitis includes:
- Laboratory test. Microscopic and cultural examination of prostate juice is performed. Under the microscope, a slight increase in the number of leukocytes and negative results of bacterial culture confirm abacterial congestive inflammation. PCR tests are performed to exclude the sexually transmitted nature of the disease. After massage, more clear leukocyturia is detected in the third part of urine. Urine cytology can be performed to rule out bladder tumor, PSA blood test is justified in patients over 40-45 years of age.
- Visual research methods. The main instrumental diagnostic method remains TRUS, ultrasound of the bladder. The results of cystourethrography are informative to confirm the dysfunction of the bladder neck, detect prostatic and voiding reflux of urine, narrowing of the urethra. In case of obvious weakening of the reagent, uroflowmetry is performed. Pelvic floor muscle tension is assessed using a videourodynamic study.
Differential diagnosis is carried out with bladder carcinoma, BPH, interstitial cystitis. Similar manifestations are observed in genitourinary tuberculosis and urethral stricture, as these nosologies are also characterized by lower abdominal pain, symptoms of dysuria, and difficulty urinating. Congestive prostatitis differs from bacterial prostatitis, in addition, it is necessary to exclude all pathological processes accompanying CPPS in men.
Treatment of congestive prostatitis
The patient is recommended to normalize his sexual life, because regular ejaculation helps relieve hunger and improve microcirculation. Interrupted or prolonged intercourse that causes congestion is unacceptable. A number of products have been identified that increase the chemical aggressiveness of urine - their consumption leads to an increase in the symptoms of congestive prostatitis. Spices, coffee, marinades, smoked foods, alcoholic and carbonated drinks should be limited or better excluded. Treatment of congestive inflammation of the prostate gland 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 the incomplete diagnosis of hidden infections. Alpha-blockers are prescribed for slow urine flow and straining. Urine secretion is neutralized by 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 to the site of inflammation.
Pain relievers, nonsteroidal anti-inflammatory drugs, and muscle relaxants can help relieve pain and muscle spasms. It is advisable to include drugs that normalize microcirculation - phlebotonics (venotonics) in the treatment regimen. If the stagnant process supports androgen deficiency, they resort to hormone replacement therapy. Patients with anxiety-hypnotic and depressive disorders are recommended to consult a psychiatrist who will choose the optimal antidepressant.
Physiotherapy procedures with congestive inflammation of the prostate help to normalize men's health. They use laser and magnetic therapy, electrophoresis, etc. they use. Spa treatment helps to eliminate the symptoms of dysuria and improve sexual function: alkalizing mineral waters, paraffin and mud applications, massage showers. In some patients, the normalization of well-being is noted when carrying out exercise therapy to reduce tension in the pelvic muscles. Prostate massage does not replace natural ejaculation, it improves blood circulation and drainage of the organ.
Minimally invasive treatment methods
If conservative therapy fails, high-tech interventions are considered - transurethral resection of the prostate, 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 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 disappears on its own with time. Long-term blood circulation disorder leads to sclerosis of glandular tissue, which is manifested by deterioration of spermogram parameters. The prognosis of congestive prostatitis mainly depends on the patient's adherence to all recommendations and lifestyle changes.
Prevention consists of exercising, avoiding heavy loads, normalizing sexual relations, and avoiding coffee and alcohol consumption. When working in a sedentary position, it is recommended to take breaks for physical exercises and use a pillow. Loose underwear and pants are preferred. Patients are observed by a urologist with periodic assessment of prostate secretions for inflammation and ultrasound, and receive antibacterial treatment and prostate massage sessions as needed.