Congestive prostatitisis a pathological process in the prostate gland caused by congestion. Pathogenic flora was not detected; microscopy of prostate secretions, semen and urine may reveal leukocytes. Symptoms include persistent pain in the perineum, dysuria. Diagnostics is based on the results of bacterial cultures of biomaterials and TRUS. 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 existing symptoms. If conservative treatment fails, surgery is possible.
General information
Prostatitis can be infectious, due to the presence of pathogenic microflora, or stagnant, associated with blood congestion, retention of ejaculation and prostate secretion. Congestive or congestive prostatitis (vegetative urogenital syndrome, prostatosis) is an outdated name. Modern specialists in the field of urology more often use the term "chronic pelvic pain syndrome without inflammatory response" (CPPS). Prostatitis occurs in 25% of men aged 35-60 years, inflammation caused by the congestive process accounts for 88-90% of the total number of cases. The potentially congestive form of the disease is supported by pathogens that are L-shaped, fixed on biofilms and not detected by routine methods.
Cause
The cause of congestive prostatitis can be associated with the gland itself and with extraprostatic factors. The exact etiology is unknown, possibly due to stagnation of secretions in the prostate or as a result of venous congestion in the pelvic organs and scrotum. Some urologists consider this condition to be psychosomatic. The line between bacterial and abacterial inflammation is highly 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 contraction contributes to urinary retention and, due to duct compression, blood stagnation. Prostatic hyperplasia and tumors, urethral strictures, and obstructing bladder stones are also considered causes of venous congestion.
- Compression. Blood circulation is obstructed due to compression of the venous plexus by retroperitoneal tumors, metastases, and intestinal loops filled with feces (constipation). The vessels of the genitourinary plexus dilate, the blood flow slows down, the tissues are starved of oxygen and replaced by non-functional structures. Some of the blood is deposited and shut off from the circulation.
- Behavioral factors. Rejection of sexual activity, irregular ejaculation and the use of interrupted sexual intercourse as a means of preventing unwanted pregnancy cause blood flow and swelling of the prostate tissue. During ejaculation, these glands are not completely drained. Constant masturbation can cause congestive prostatitis, because. . . For the development of an erection, blood flow to the genitals is necessary.
Predisposing factors include low physical activity, hypothermia and overheating, poor diet with a predominance of spicy and smoked foods. Alcohol and nicotine affect the tone of vascular walls, disrupt redox processes and permeability, which causes swelling. The main prerequisite for the formation of congestive prostatitis with an effect on all organs of the male genital area (vesicles, testicles) is considered to be an anomaly of the pelvic vascular system - valve deficiency, congenital weakness of the venous wall.
Pathogenesis
The peripheral zone of the prostate gland consists of ducts with an underdeveloped drainage system, which prevents the outflow of secretions. As the prostate enlarges with age, patients experience reflux of urine into the prostate tube. It has been observed that many men who suffer from prostatitis are more prone to allergies. Scientists believe that such patients may also have autoimmune-mediated inflammation caused by previous infections.
Urine reflux is promoted by urethral stricture, bladder dysfunction, and BPH. Backflow of sterile urine leads to chemical irritation and inflammation. Tubular fibrosis is initiated, prerequisites are created for prostatolithiasis, which increases intraductal obstruction and secretion stagnation. Inadequate acini drainage triggers an inflammatory response, increased swelling is accompanied by the appearance of symptoms. This 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 subtypes 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 differentiation that takes into account the pathogenetic and morphological features of the disease:
- First stage.Characterized by the dominance of the process of exudation, migration, arterial and venous hyperemia, resulting in damage to microvasculature and destruction of glandular tissue. These changes are recorded in the first years from the onset of the disease. The clinical picture in the first stage is the most obvious.
- Second stage.The initial process of proliferation of connective tissue develops, and symptoms decrease. Due to the formation of thrombus, microcirculation suffers, which worsens sclerosis. At this stage, most patients experience sexual dysfunction: erection and orgasm intensity weaken, premature ejaculation develops, or on the contrary, the man has difficulty reaching climax.
- Third stage. Severe fibrosclerotic changes are typical. It has been proven that the proliferation of connective tissue is stimulated not only by inflammation, but also by ischemia accompanying congestive prostatitis. Complaints of difficulty urinating are typical, and kidney involvement in the pathological process is noted.
Symptoms of congestive prostatitis
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. Pain radiation is variable - to the lower back, inner thigh, tailbone. Swollen glands often make it difficult to start urinating and weaken the flow of urine. The type of congestive 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 urge incontinence. With long-term pathology, depressive disorders develop. It is still debatable whether the psycho-emotional characteristics lead to discomfort in the perineum or, on the contrary, the pain caused by the swelling of the prostate gland affects the mental state of a man. An increase in temperature with chills indicates the transition of abacterial congestive prostatitis to infectious and the need to start pathognomonic treatment.
Complications
Congestive prostatitis with increased microflora can be acute bacterial. Neighboring 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; usually it has a special composition that has a protective function for male germ cells. An insufficient amount of nutrients and changes in the biochemical properties of prostate secretion inevitably affect the quality of ejaculation; men with congestive prostatitis are more often diagnosed with infertility.
With severe organ swelling, part of the urine after urination remains in the bladder, which leads to the formation of pathological reflux of urine into the ureters and the renal collecting system. In response to reflux, persistent hydronephrosis and pyelonephritis with impaired renal function may occur. 50% of men suffer from sexual dysfunction: painful ejaculation, dyspareunia, uncomfortable erections at night, which worsens the quality of life and negatively affects relationships in couples.
Diagnostics
Determining the origin of symptoms is important for effective treatment of congestive prostatitis, therefore various questionnaires have been developed to facilitate diagnosis: I-PSS, UPOINT. This questionnaire is available in Russified form; it is 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 congestive nature of this disease is evidenced by rectal varicose veins. Diagnosis of congestive prostatitis includes:
- Lab test. Microscopic examination and culture of prostate juice is performed. A slight increase in the number of leukocytes under the microscope and negative bacterial culture results confirm abacterial congestive inflammation. PCR tests are performed to exclude the nature of sexually transmitted diseases. In the third portion of urine after massage, more significant leukocyturia is detected. To exclude a bladder tumor, urine cytology can be performed; in patients over 40-45 years of age, a PSA blood test is warranted.
- Visual research methods. The main instrumental diagnostic method remains TRUS, bladder ultrasound. The results of cystourethrography are informative in confirming bladder neck dysfunction, revealing intraprostatic urine reflux and ejaculation, and urethral stricture. In case of jet weakness, uroflowmetry is performed. Pelvic floor muscle tension was 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 this nosology is 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 must be excluded.
Treatment of congestive prostatitis
The patient is recommended to normalize his sex life, because regular ejaculation helps drain the acini and improves microcirculation. Interrupted or prolonged sexual intercourse, which creates congestion, is unacceptable. A number of products have been identified that increase the chemical aggressiveness of urine - their use leads to increased 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 symptoms that occur. In most patients, improvement occurs after taking antibacterial drugs, which is explained by the incomplete diagnosis of latent infection. For sluggish urinary flow and the need to strain, alpha blockers are prescribed. The urge to urinate 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 into the inflammatory zone.
Pain relievers, non-steroidal anti-inflammatory drugs 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, they use hormone replacement therapy. Patients suffering from anxiety-hypnotic disorders and depression are advised to consult a psychiatrist who will choose the optimal antidepressant.
With congestive inflammation of the prostate, physiotherapeutic procedures help normalize men's health. They use laser and magnetic therapy, electrophoresis, etc. Spa treatments help relieve symptoms of dysuria and improve sexual function: taking alkalizing mineral water, paraffin and mud rubs, massage baths. In some patients, 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 improves blood circulation and organ drainage.
Minimally invasive treatment methods
If conservative therapy is unsuccessful, 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 heat 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 procedure in the treatment of congestive prostatitis are limited.
Prognosis and prevention
The prognosis for life is good, but chronic pelvic pain is difficult to treat. Sometimes congestive prostatitis resolves spontaneously over time. Long-term blood circulation disorders lead to sclerosis of glandular tissue, which is shown by deterioration in spermogram parameters. The prognosis for congestive prostatitis largely depends on the patient's compliance with all recommendations and lifestyle changes.
Prevention involves playing sports, avoiding heavy lifting, normalizing sexual intercourse, and avoiding coffee and alcohol consumption. When working inactively, it is recommended to take a break to do physical exercise and use a pillow. Loose 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.