Congestive prostatitisis a pathological process in the prostate caused by blockage. No pathogenic flora is detected; Leukocytes can be detected during microscopy of prostate secretion, sperm and urine. Symptoms include constant aching pain in the perineum and dysuria. Diagnostics is based on the results of bacterial culture of biomaterial and TRUS. There is no standard treatment regimen for congestive prostatitis; massage, physiotherapy, antimicrobial drugs and alpha-blockers are prescribed. An individual approach is required, taking the existing symptoms into account. 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 stasis, ejaculate retention and prostate secretions. Congestive or congestive prostatitis (vegetative genitourinary syndrome, prostatosis) is an outdated name. Modern specialists in the field of urology more often use the term "chronic pelvic pain syndrome without an inflammatory reaction" (CPPS). Prostatitis occurs in 25% of men aged 35 to 60 years, inflammation caused by stasis processes accounts for 88-90% of the total number of casesThe potentially congestive form of the disease is supported by pathogens that are L-form, fixed on biofilms and undetected by routine methods.
causes
The causes of congestive prostatitis can be related to both the gland itself and extraprostatic factors. The exact etiology is unknown, probably due to stagnation of secretions in the prostate or a consequence of venous congestion in the pelvic organs and scrotum. Some urologists consider the disease to be psychosomatic. The boundary between bacterial and nonbacterial 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: obstruction of the cervix, inability of the external sphincter to relax during defecation, impaired contractility of the detrusor contribute to urinary retention and, due to compression of the vessels, blood stagnation. Prostatic hyperplasia and tumor, urethral stricture and obstructive bladder stone are also considered possible causes of venous stasis.
- compression. Blood flow is impaired by compression of the venous plexus by a retroperitoneal tumor, metastases, and intestinal loops filled with feces (constipation). The vessels of the urogenital plexus expand, blood flow slows down, the tissue suffers from a lack of oxygen and is replaced by non-functional structures. Some of the blood is deposited and switched off from the circulation.
- Behavioral factors. Refusal of sexual activity, irregular ejaculation, and use of intermittent intercourse to prevent unwanted pregnancy lead to increased blood flow and swelling of prostate tissue. During ejaculation, this gland is not completely emptied. Constant masturbation can lead to congestive prostatitis because. . . Blood flow to the genitals is necessary for an erection to occur.
The predisposing factors include low physical activity, hypothermia and overheating, and poor diet with predominantly spicy, smoked foods. Alcohol and nicotine affect the tone of the vascular wall, disrupt redox processes and permeability, which leads to swelling. The main prerequisites for the development of congestive prostatitis affecting all organs of the male genital area (vesicles, testicles) are considered to be anomalies of the pelvic vascular system - valve insufficiency, congenital weakness of the venous wall.
Pathogenesis
The peripheral zone of the prostate consists of ducts that have a poorly developed drainage system that hinders the outflow of secretions. As the prostate enlarges with age, patients experience backflow of urine into the prostate tubes. It has been found that many men suffering from prostatitis are more prone to allergies. Scientists believe such patients may also be suffering from autoimmune-mediated inflammation caused by a previous infection.
Urinary reflux is promoted by urethral strictures, bladder dysfunction, and BPH. Backflow of even sterile urine causes chemical irritation and inflammation. Fibrosis of the tubules is initiated, creating conditions for prostatolithiasis, which leads to intraductal obstruction and stasis of secretions. Insufficient drainage of the acini triggers an inflammatory reaction, and increasing 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 without an inflammatory reaction (IIIb). There is a clinical differentiation that takes into account the pathogenetic and morphological features of the disease:
- First stage.Characterized by the predominance of processes of exudation, emigration, arterial and venous hyperemia, leading to damage to the microvascular system and destruction of glandular tissue. These changes are recorded in the first few years after the onset of the disease. The clinical picture in the first stage is most pronounced.
- Second floor.The first processes of connective tissue proliferation develop and the symptoms decrease. Due to thrombus formation, microcirculation suffers, which aggravates sclerosis. At this stage, most patients experience sexual dysfunction: the erection and intensity of orgasm decrease, premature ejaculation occurs or, conversely, the man has difficulty reaching climax.
- Third section. Severe fibrosclerotic changes are typical. It has been proven that connective tissue proliferation is stimulated not only by inflammation, but also by ischemia, which accompanies congestive prostatitis. Complaints of difficulty urinating and involvement of the kidneys in the pathological process are typical.
Symptoms of congestive prostatitis
The pathology is manifested by a variety of symptoms. Most patients describe the pain as persistent discomfort in the perianal area, scrotum, or penis. Some notice increased perineal pain when sitting. The pain radiation is variable - in the lower back, the inner thighs, the tailbone. Swelling of the gland often makes it difficult to start urinating and weakens the urine stream. Congestive inflammation against the background of vascular pathology is often accompanied by hemospermia - the appearance of blood in semen.
Symptoms of bladder irritation include frequent urination and urge incontinence. With prolonged pathology, depressive disorders develop. It is still controversial whether psycho-emotional characteristics lead to discomfort in the perineal area or, conversely, pain caused by prostate swelling affects a man's psychological state. 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 the addition of microflora can become bacterial acute. Nearby organs and structures can be involved in the inflammatory process: vesicles, bladder, testicles. The prostate's job is to produce fluid for sperm; usually it 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 the ejaculate; Men with congestive prostatitis are more likely to be diagnosed with infertility.
With severe swelling of the organ, part of the urine remains in the bladder after urination, which leads to the formation of pathological reflux of urine into the ureters and the renal collecting system. Hydronephrosis and persistent pyelonephritis with impaired renal function may occur in response to reflux. 50% of men develop sexual dysfunction: painful ejaculation, dyspareunia, unpleasant nocturnal erections, which worsens the quality of life and negatively affects the couple relationship.
diagnosis
Determining the origin of symptoms is critical to the effective treatment of congestive prostatitis. Therefore, various questionnaires have been developed to facilitate diagnosis: I-PSS, UPOINT. These questionnaires are in Russified form and 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 and moderately painful; the congestive nature of the disease is demonstrated by varicose veins in the rectum. Diagnosis of congestive prostatitis includes:
- Laboratory tests. A microscopic and cultural examination of the prostate juice is carried out. A slight increase in the leukocyte count under the microscope and negative bacterial culture results confirm bacterial stasis inflammation. PCR tests are carried out to rule out a sexually transmitted disease. In the third portion of urine after the massage, more pronounced leukocyturia is detected. Urine cytology can be performed to rule out a bladder tumor; in patients over 40-45 years of age, a PSA blood test is warranted.
- 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 and reveal intraprostatic and ejaculatory reflux of urine as well as urethral stricture. If the jet is significantly weakened, uroflowmetry is carried out. The tension of the pelvic floor muscles is assessed using a videourodynamic examination.
The differential diagnosis is carried out with bladder carcinoma, BPH, interstitial cystitis. Similar manifestations are observed with genitourinary tuberculosis and urethral strictures, since these nosologies are also characterized by pain in the lower abdomen, symptoms of dysuria, and difficulty urinating. Congestive prostatitis is differentiated from bacterial prostatitis; In addition, all pathological processes associated with CPPS in men must be excluded.
Treatment of congestive prostatitis
The patient is recommended to normalize his sexual life, as regular ejaculation helps drain the acini and improve microcirculation. Intermittent or prolonged sexual intercourse that causes congestion is unacceptable. A number of products have been identified that increase the chemical aggressiveness of urine - their consumption leads to increased symptoms of congestive prostatitis. Spices, coffee, marinades, smoked foods, and 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 prevailing symptoms. Many patients experience improvement after taking antibacterial drugs, which is due to incomplete diagnosis of latent infections. Alpha blockers are prescribed if the urinary stream is sluggish and the urge to exert is present. The urge to urinate is neutralized with anticholinergics. 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 inflammatory zone.
Pain medications, nonsteroidal anti-inflammatory drugs, and muscle relaxants can help relieve pain and muscle spasms. It makes sense to include drugs in the treatment regimen that normalize microcirculation - phlebotonics (venotonics). 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 select the optimal antidepressant.
With congestive inflammation of the prostate, physiotherapeutic procedures contribute to the normalization of male health. They use laser and magnetic therapy, electrophoresis, etc. Spa treatments help to relieve the symptoms of dysuria and improve sexual function: taking alkalizing mineral water, paraffin and mud applications, massage showers. In some patients, when carrying out exercise therapy to reduce tension in the pelvic muscles, a normalization of well-being is noted. Prostate massage does not replace natural ejaculation, but rather improves blood circulation and drainage of the organ.
Minimally invasive treatment methods
If conservative therapy remains unsuccessful, high-tech interventions can be 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 congestion symptoms and has a neuroanalgesic effect. There are limited data on the effectiveness of procedures used to treat congestive prostatitis.
Prognosis and prevention
The prognosis for life is favorable, but chronic pelvic pain is difficult to treat. Sometimes congestive prostatitis resolves spontaneously over time. Long-term disruption of blood circulation leads to sclerosis of the glandular tissue, which is manifested by a deterioration in spermogram parameters. The prognosis of congestive prostatitis largely depends on the patient's compliance with all recommendations and lifestyle changes.
Prevention includes exercising, avoiding heavy lifting, normalizing sexual relationships, and avoiding consumption of coffee and alcohol. If you are sedentary, it is recommended to take breaks for physical exercises and use a pillow. Loose-fitting underwear and pants are preferred. Patients are observed by a urologist with regular assessment of prostate secretions for inflammation and ultrasound and, if necessary, receive antibacterial treatment and prostate massage sessions.