Congestive prostatitisis a pathological process in the prostate gland caused by congestion. Pathogenic flora is not detected, leukocytes can be detected by microscopy of prostate secretion, semen and urine. Symptoms include constant pain in the perineum, dysuria. Diagnosis is based on the results of bacterial culture of biomaterial and TRUS. There is no single treatment scheme for congestive prostatitis, massage, physiotherapy, antimicrobial drugs and alpha-blockers are prescribed. An individual approach is necessary, taking into account the existing symptoms. If conservative treatment is ineffective, surgery is possible.
Main information
Prostatitis can be infectious, caused by the presence of pathogenic microflora, or stagnant, associated with blood stagnation, retention of ejaculate and prostatic secretion. Congestive or congestive prostatitis (vegetative urogenital syndrome, prostatosis) is an outdated name. Modern specialists in the field of urology increasingly use the term "chronic pelvic pain syndrome without an inflammatory reaction" (CPPS). Prostatitis occurs in 25% of men aged 35-60 years, inflammation caused by stagnant processes represents 88-90% of the total number of cases The potentially congestive form of the disease is supported by pathogens that are in L-forms, fixed on biofilms and not detected by routine methods.
reasons
The causes of congestive prostatitis can be related to both the gland itself and extraprostatic factors. The exact etiology is unknown, possibly due to stasis of secretions in the prostate or a consequence of venous stasis in the pelvic organs and scrotum. Some urologists consider the condition to be psychosomatic. The boundary 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 a bowel movement, impaired contractility of the detrusor contribute to urine retention and, due to vessel compression, blood stagnation. Prostatic hyperplasia and tumor, urethral stricture, and obstructive bladder stones are also considered potential causes of venous congestion.
- Compression. Circulation is impaired due to compression of the venous plexus by a retroperitoneal tumor, metastases, and intestinal loops filled with feces (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 deposited and excluded 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 blood flow and swelling of the prostate tissue. During ejaculation, this gland is not completely drained. Constant masturbation can lead to stagnant prostatitis because. . . The development of an erection requires a rush of blood to the genitals.
Predisposing factors include low physical activity, hypothermia and overheating, improper nutrition with a predominance of spicy, smoked foods. Alcohol and nicotine affect the tone of the vascular wall, disrupt redox processes and permeability, which provokes swelling. The main prerequisites for the formation of congestive prostatitis affecting all organs of the male genital area (vesicles, testicles) are considered to be abnormalities of the vascular system of the small pelvis - valvular insufficiency, congenital weakness of the venous wall.
Pathogenesis
The peripheral zone of the prostate gland consists of ducts that have a poorly developed drainage system, which makes it difficult for secretions to flow out. As the prostate enlarges with age, patients develop urinary reflux into the prostatic tubes. 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.
Urine reflux is promoted by urethral strictures, bladder dysfunction, and DPH. Backflow of even sterile urine leads to chemical irritation and inflammation. Fibrosis of the tubules is initiated, prerequisites for prostatolithiasis are created, which increases intraductal obstruction and stagnation of secretions. Inadequate drainage of the acini triggers an inflammatory reaction, the increase in edema is accompanied by the appearance of symptoms. The condition is worsened 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 no inflammatory response (IIIb). There is a clinical differentiation that takes into account the pathogenetic and morphological features of the disease:
- First stage.It is characterized by a predominance of the processes of exudation, emigration, arterial and venous hyperemia, which leads to damage to the microvasculature and destruction of the glandular tissue. These changes are registered in the first years of the onset of the disease. The clinical picture of the first stage is the most pronounced.
- Second stage.The initial processes of connective tissue proliferation develop and symptoms decrease. Due to the formation of thrombi, microcirculation suffers, which worsens sclerosis. At this stage, most patients experience sexual dysfunction: the erection and the intensity of the orgasm weaken, premature ejaculation develops or, conversely, the man experiences difficulties in reaching climax.
- Third stage. Severe fibrosclerotic changes are characteristic. Connective tissue proliferation has been shown to be stimulated not only by inflammation but also by ischemia that accompanies congestive prostatitis. Complaints of difficulty urinating are characteristic, kidney involvement is noted in the pathological process.
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 note increased perineal pain when sitting. Irradiation of pain is variable - to the waist, the inner part of the thighs, the coccyx. Swelling of the gland often makes it difficult to start urinating and weakens the stream of urine. The stagnant type of inflammation against the background of vascular pathology is often accompanied by hemospermia - the appearance of blood in the semen.
Symptoms of bladder irritation include frequent urges and urinary incontinence. With prolonged pathology, depressive disorders develop. It is still debated whether psycho-emotional characteristics lead to discomfort in the perineum or, conversely, the pain caused by 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
Stagnant prostatitis with the addition of microflora can become 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 the sperm, it usually has a special composition that has a protective function for the male germ cells. Insufficient amounts of nutrients and changes in the biochemical properties of prostate secretion inevitably affect the quality of ejaculate, men with congestive prostatitis are more often diagnosed with infertility.
With severe swelling of the organ, part of the urine after urination remains in the bladder, which leads to the formation of pathological reflux of urine in the ureters and the renal collecting system. In response to reflux, hydronephrosis and persistent pyelonephritis with impaired renal function may occur. 50% of men develop sexual dysfunction: painful ejaculation, dyspareunia, uncomfortable night erections, which worsens the quality of life and negatively affects the relationship in the couple.
Diagnosis
Determining the origin of 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, they are used by urologists and andrologists in their practice. To rule out myofascial syndrome, consultation with a neurologist is indicated. On palpation, the prostate is enlarged, moderately painful, the congestive nature of the disease is evidenced by varicose veins of the rectum. The diagnosis of congestive prostatitis includes:
- Laboratory researches. Microscopic and cultural examination of prostate juice is done. A slight increase in leukocyte count on microscopy and negative bacterial culture results confirm abacterial congestive inflammation. PCR tests are performed to rule out the sexually transmitted nature of the disease. In the third portion of urine after the massage, a more pronounced leukocyturia was detected. To exclude a bladder tumor, urine cytology can be done, in patients over 40-45 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 ejaculatory urinary reflux, and urethral stricture. Uroflowmetry is performed in case of a marked weakening of the stream. Pelvic floor muscle tension is assessed using a videourodynamic study.
Differential diagnosis is carried out with carcinoma of the bladder, DPH, 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, in addition, all pathological processes accompanied by CPPS in men should be excluded.
Treatment of congestive prostatitis
The patient is recommended to normalize his sexual life, as regular ejaculation helps to drain the acini and improve microcirculation. Interrupted or prolonged intercourse that provokes congestion is unacceptable. A number of products have been found 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 eliminated. Treatment of stagnant inflammation of the prostate gland can be conservative and surgical.
Conservative therapy
The treatment regimen is selected individually, depending on the prevailing symptoms. In many patients, improvement occurs after taking antibacterial drugs, which is explained by incomplete diagnosis of latent infections. Alpha-blockers are prescribed for a slow stream of urine and the need to strain. The urge to urinate is neutralized with anticholinergic drugs. 5-alpha reductase inhibitors have been found to reduce the severity of clinical manifestations by reducing the response of macrophages and leukocytes and their migration into the inflammatory zone.
Pain relievers, nonsteroidal anti-inflammatory drugs, and muscle relaxants can help relieve pain and muscle spasms. In the treatment scheme, it is reasonable to include drugs that normalize microcirculation - phlebotonics (venotonics). If the stagnant process maintains 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.
In stagnant inflammation of the prostate, physical therapy procedures help to normalize men's health. They use laser and magnetic therapy, electrophoresis, etc. Balneotherapy helps to relieve the symptoms of dysuria and improve sexual function: taking alkalizing mineral waters, paraffin and mud applications, massage showers. In some patients, 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, but 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 resolves spontaneously over time. The long-term violation of blood circulation leads to sclerosis of the tissue of the gland, which is manifested by a deterioration of the parameters of the spermogram. The prognosis for congestive prostatitis largely depends on the patient's compliance with all recommendations and lifestyle changes.
Prevention includes exercising, avoiding heavy lifting, normalizing sexual relations and avoiding coffee and alcohol consumption. In sedentary work, it is recommended to take breaks to do physical exercises and use a pillow. Baggy pants and underwear are preferred. Patients are monitored by a urologist with periodic assessment of prostatic secretions for inflammation and ultrasound and, if necessary, receive antibacterial treatment and prostate massage sessions.