Congestive prostatitispathological process caused by prostate congestion. Pathogenic flora cannot be detected, microscopic examination of prostatic secretions, semen and urine may reveal leukocytes. Symptoms include constant aching pain in the perineum, dysuria. Diagnosis is based on the results of bacterial culture of biomaterial and TRUS. There is no uniform treatment regimen for the treatment of 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 caused by the presence of infectious, pathogenic microflora, or it can be associated with stagnation, blood clotting, and retention of ejaculate and prostate secretions. Congestive or congestive prostatitis (vegetative urogenital syndrome, prostatitis) is an obsolete name. Modern specialists working 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, inflammations caused by stagnant processes account for 88-90% of all cases. The potentially stagnant form of the disease is supported by pathogens that are L-shaped, fixed on biofilms, and cannot be detected by routine methods.
Cause
The causes of congestive prostatitis can be related to both the gland and extraprostatic factors. The exact etiology is unknown, probably due to stagnation of secretions in the prostate or venous stasis of the pelvic organs and scrotum. Some urologists consider the condition to be psychosomatic. The border between bacterial and abacterial inflammation is very arbitrary, in case of immunosuppression of any origin, the process becomes infectious with the addition of secondary microflora. Stagnant prostatitis is caused by:
- Internal urological causes. Functional or structural pathology of the bladder: neck obstruction, the external sphincter cannot relax during defecation, damage to the contractility of the detrusor contributes to retention of urine, and blood stagnation due to the compression of blood vessels. Prostatic hyperplasia and tumor, urethral stricture, and obstructive bladder stones are also possible causes of venous congestion.
- Compression. Blood circulation is obstructed by compression of the venous plexus by a retroperitoneal tumor, metastases and bowel loops filled with feces (constipation). The vessels of the urogenital plexus expand, the blood flow slows down, the tissues experience oxygen starvation, and dysfunctional structures take their place. Some of the blood is deposited and removed from the circulation.
- Behavioral factors. Refusal of sexual activity, irregular ejaculation and interrupted sexual intercourse as a means of preventing unwanted pregnancy cause blood flow and swelling of the prostate tissue. During ejaculation, this gland is not completely emptied. Constant masturbation can lead to stagnant prostatitis because. . . The formation of an erection requires blood flow to the genitals.
Predisposing factors include low physical activity, hypothermia and overheating, improper nutrition, with a preponderance of spicy, smoked foods. Alcohol and nicotine affect the tone of the vascular wall, disturb redox processes and permeability, which causes swelling. The main prerequisites for the development of congestive prostatitis, which affect all organs of the male genital area (vesicles, testicles), are disorders of the vascular system of the pelvis - valvular insufficiency, congenital weakness of the venous wall.
Pathogenesis
The peripheral zone of the prostate consists of channels with a poorly developed drainage system, which hinders the outflow of secretions. As the prostate enlarges with age, patients experience backflow of urine into the prostatic tubes. It has been found that many men with prostatitis are more prone to allergies. Scientists believe that such patients may also be suffering from autoimmune-mediated inflammation caused by a previous infection.
Urinary reflux is promoted by urethral stricture, bladder dysfunction and BPH. Backflow of still sterile urine leads to chemical irritation and inflammation. Fibrosis of the tubules begins, prerequisites for the development of prostatolithiasis, which increases intraductal blockage and stagnation of mucus. Inadequate drainage of the acini causes an inflammatory reaction, the increasing swelling is associated with the appearance of symptoms. The condition is aggravated by stasis (stasis) of blood in the pelvis.
Classification
The general classification of prostatitis includes acute (I) and chronic (II) bacterial forms. The III. category includes subtype IIIa – CPPS with inflammation and IIIb – CPPS without. Congestive prostatitis is a manifestation of CPPS with a lack of inflammatory response (IIIb). There is a clinical distinction that takes into account the pathogenetic and morphological features of the disease:
- First phase.It is characterized by a predominance of secretion, emigration, arterial and venous hyperemia, which results in damage to the microvasculature and destruction of glandular tissue. These changes are recorded in the first years from the onset of the disease. The clinical picture is most pronounced in the first stage.
- Second stage.The initial processes of connective tissue proliferation develop, and symptoms decrease. Microcirculation suffers due to thrombus formation, which aggravates sclerosis. At this stage, most patients experience sexual dysfunction: the intensity of erection and orgasm weakens, premature ejaculation develops, or conversely, the man has difficulty reaching climax.
- Third stage. Severe fibrosclerotic lesions are characteristic. It has been proven that the proliferation of connective tissue is stimulated not only by inflammation, but also by ischemia accompanying congestive prostatitis. Complaints related to urinary difficulties are characteristic, and the involvement of the kidney in the pathological process can be observed.
Symptoms of stagnant prostatitis
The pathology manifests itself with various symptoms. Most patients describe the pain as a constant discomfort in the perianal area, scrotum or penis. Some people experience increased perineal pain when sitting. Irradiation of pain varies - on the lower back, inner thighs, tailbone. Swelling of the gland often makes it difficult to urinate and weakens the flow of urine. Congestive-type inflammation underlying vascular pathology is often accompanied by hemospermia - the appearance of blood in semen.
Symptoms of bladder irritation include frequent urges and urge 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 the swelling of the prostate gland affects the mental state of the man. A rise in temperature accompanied by 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. Neighboring organs and structures can also be involved in the inflammatory process: bladders, bladder, testicles. The function of the prostate is to produce fluid for sperm, usually of a special composition, which has a protective function for male germ cells. An insufficient amount of nutrients and a change in the biochemical properties of the prostate secretion inevitably affect the quality of the ejaculate, men with congestive prostatitis are more often diagnosed with infertility.
In case of severe swelling of the organ, after urination, part of the urine remains in the bladder, which leads to the development of pathological reflux of urine into the ureters and the renal collecting system. In response to reflux, hydronephrosis and persistent pyelonephritis may occur with impaired kidney function. 50% of men develop sexual dysfunction: painful ejaculation, dyspareunia, unpleasant erection at night, which worsens the quality of life and negatively affects relationships.
Diagnostics
Determining the origin of the symptoms is crucial in the effective treatment of congestive prostatitis, therefore various questionnaires have been developed to facilitate the diagnosis: I-PSS, UPOINT. These questionnaires are available in Russian, and are used by urologists and andrologists in their practice. In order to rule out myofascial syndrome, a consultation with a neurologist is necessary. On palpation, the prostate is enlarged and moderately painful, and the stagnant nature of the disease is evidenced by rectal varicose veins. The diagnosis of congestive prostatitis includes:
- Laboratory examination. Microscopic and cultural examination of the prostate juice is performed. A slight increase in the number of leukocytes under the microscope and negative bacterial culture results confirm abacterial stasis inflammation. PCR tests are performed to rule out the sexually transmitted nature of the disease. After the massage, a more pronounced leukocyturia can be detected in the third part of the urine. A urine cytology can be performed to rule out a bladder tumor, and a PSA blood test is warranted in patients over 40-45 years of age.
- Visual research methods. The main instrumental diagnostic method is still TRUS, ultrasound of the bladder. The results of cystourethrography are informative in confirming dysfunction of the bladder neck, revealing intraprostatic and ejaculatory urine reflux and urethral stricture. In the case of pronounced weakening of the jet, uroflowmetry is performed. The tension of the pelvic floor muscles is assessed with a videourodynamic examination.
The differential diagnosis is made with bladder carcinoma, BPH, and interstitial cystitis. Similar manifestations can be observed in urinary tract tuberculosis and urethral stricture, as these nosologies are characterized by lower abdominal pain, symptoms of dysuria, and difficulty urinating. Stagnant prostatitis is distinguished from bacterial prostatitis, and all pathological processes that accompany CPPS in men must be excluded.
Treatment of congestive prostatitis
The patient is recommended to normalize his sex life, as regular ejaculation helps acini and improves microcirculation. Interrupted 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, alcoholic and carbonated drinks should be limited or even better excluded. Treatment of congestive inflammation of the prostate can be conservative or surgical.
Conservative therapy
The treatment regimen is selected individually, depending on the prevailing symptoms. Many patients improve after taking antibacterial drugs, which can be explained by incomplete diagnosis of latent infections. Alpha-blockers are prescribed for slow urine flow and the need for straining. Urgent urination 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 to the inflammatory zone.
Pain relievers, NSAIDs, 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 resort to hormone replacement therapy. Patients suffering from anxiety-hypnotic and depressive disorders are advised 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 and magnet therapy, electrophoresis, etc. are applied. The spa treatment helps alleviate the symptoms of dysuria and improve sexual function: alkalizing mineral waters, paraffin and mud wraps, massage showers. In some patients, the normalization of well-being is observed during exercise therapy aimed at reducing the tension of 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 is unsuccessful, high-tech interventions should 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). The heat increases tissue metabolism, reduces congestion symptoms and has a neuropain-relieving effect. Data on the effectiveness of procedures used 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. Prolonged circulatory disturbance leads to sclerosis of the glandular tissue, which manifests itself in the deterioration of spermogram parameters. The prognosis of congestive prostatitis depends largely on whether the patient complies with all recommendations and lifestyle changes.
Prevention includes exercising, avoiding heavy lifting, normalizing sexual relations, and avoiding coffee and alcohol. During sitting work, it is recommended to take breaks to perform physical exercises and use a pillow. Loose-fitting underwear and trousers are preferred. The patients are monitored by a urologist, who periodically assesses the prostate discharge for inflammation and with ultrasound, and if necessary, takes part in antibacterial treatment and prostate massage.