Congestive prostatitisis a pathological process in the prostate caused by blockage. Pathogenic flora was not detected, microscopy of prostate secretions, sperm and urine can reveal leukocytes. Symptoms include constant aching pain in the perineum, dysuria. Diagnostics is based on the results of bacterial culture 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 the existing symptoms. 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 stagnation, retention of ejaculate and prostate secretions. Congestive or congestive prostatitis (vegetative urogenital syndrome, prostatosis) is an outdated name.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 congestive processes accounts for 88-90% of the total number of cases. Potentially congestivethe form of the disease is supported by pathogens that are L-shaped, fixed on biofilms and not detected 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 it is a consequence of venous congestion in the pelvic organs and scrotum. Some urologists consider this condition psychosomatic. The border 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 urinary bladder: cervical obstruction, inability to relax the external sphincter during bowel movements, impaired detrusor contractility contribute to urine retention and, due to blood vessel compression, blood stagnation. Prostatic hyperplasia and tumor, urethral stricture, and obstructive bladder stones are also considered potential causes of venous congestion.
- Compression. Blood circulation is hampered 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 feel oxygen starvation and are replaced by dysfunctional structures. Part of the blood settles and is excluded from the circulation.
- Behavioral factors. Refusal of sexual activity, irregular ejaculation and 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 congestive prostatitis, because. . . For the development of an erection, a rush of blood to the genitals is necessary.
Predisposing factors include low physical activity, hypothermia and overheating, poor diet with a predominance of spicy, smoked food. Alcohol and nicotine affect the tone of the vascular wall, disrupt redox processes and permeability, which causes swelling. The main prerequisites for the development of congestive prostatitis with an effect on all organs of the male genital area (vesicles, testicles) are considered to be anomalies 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 that have a poorly developed drainage system, which makes it difficult to drain secretions. As the prostate enlarges with age, patients develop urine reflux into the prostatic tubes. It has been noticed 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 is caused by urethral strictures, bladder dysfunction and BPH. Backflow of even sterile urine leads to chemical irritation and inflammation. Fibrosis of tubules is initiated, prerequisites for prostatolithiasis are created, which increases intraductal obstruction and stagnation of secretions. Inadequate drainage of the acinus causes an inflammatory reaction, the increase in swelling is accompanied by the appearance of symptoms. The condition worsens with 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 with the absence of an inflammatory response (IIIb). There is a clinical differentiation that takes into account the pathogenetic and morphological characteristics of the disease:
- The first stage.It is characterized by the dominance of processes of exudation, emigration, arterial and venous hyperemia, which results in damage to the microvasculature and destruction of glandular tissue. These changes are noted during the first years after the onset of the disease. The clinical picture in the first stage is the most pronounced.
- The second stage.The initial processes of connective tissue proliferation develop, and the symptoms decrease. Due to the formation of thrombus, microcirculation suffers, which worsens sclerosis. In this phase, most patients experience sexual dysfunction: erection and orgasm intensity weaken, premature ejaculation develops or vice versa, the man experiences difficulties in reaching climax.
- The third phase. 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 of difficulty urinating are typical, and kidney involvement in the pathological process is noted.
Symptoms of congestive prostatitis
Pathology is manifested by various symptoms. Most patients describe the pain as constant discomfort in the perianal area, scrotum or penis. Some notice increased pain in the perineum when sitting. Irradiation of pain is variable - to the lower back, inner thighs, coccyx. Swelling of the gland often makes it difficult to urinate and weakens the flow of urine. The congestive 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 urge urinary incontinence. Along with long-term pathology, depressive disorders develop. It is still debatable whether psychoemotional characteristics lead to discomfort in the perineum or, conversely, pain caused by prostate swelling affects the psychological state of the 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 the addition of microflora can become acute bacterial. Neighboring organs and structures may be involved in the inflammatory process: vesicles, bladder, testicles. The role of the prostate is to produce fluid for sperm; it usually 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 ejaculate, and men with congestive prostatitis are more often diagnosed with infertility.
In severe organ swelling, part of the urine after urination remains in the bladder, which leads to the creation of pathological urine reflux into the ureters and renal collecting system. In response to reflux, hydronephrosis and persistent pyelonephritis with impaired kidney function may occur. In 50% of men, sexual dysfunction develops: painful ejaculation, dyspareunia, unpleasant night erections, which worsens the quality of life and negatively affects the couple's relationship.
Diagnostics
Determining the origin of symptoms is essential for effective treatment of congestive prostatitis, therefore 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. In order to rule out myofascial syndrome, a consultation with a neurologist is indicated. On palpation, the prostate is enlarged, moderately painful; the congestive nature of the disease is evidenced by dilated rectal veins. The diagnosis of congestive prostatitis includes:
- Laboratory testing. A microscopic and cultural examination of the prostate juice is performed. A slight increase in the number of leukocytes under the microscope and negative results of bacterial culture confirm abacterial congestive inflammation. PCR tests are performed to exclude the sexually transmitted nature of the disease. In the third portion of urine after the massage, more pronounced leukocyturia is observed. To rule out a bladder tumor, urine cytology can be done, and in patients older than 40-45 years, a PSA blood test is justified.
- Methods of visual research. 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 reflux of urine, and urethral stricture. In the case of marked weakening of the stream, uroflowmetry is performed. Pelvic floor muscle tension is assessed using a videourodynamic study.
Differential diagnosis is carried out with bladder cancer, BPH, interstitial cystitis. Similar manifestations are observed in genitourinary tuberculosis and urethral stricture, as these nosologies are also characterized by pain in the lower abdomen, symptoms of dysuria and difficulty urinating. Congestive prostatitis differs from bacterial prostatitis, in addition, all pathological processes that are accompanied by CPPS in men must be excluded.
Treatment of congestive prostatitis
The patient is recommended to normalize his sexual life, because regular ejaculation helps to drain the acinus and improve microcirculation. Interrupted or prolonged sexual relations that cause stagnation are 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 and surgical.
Conservative therapy
The treatment regimen is selected individually, depending on the prevailing symptoms. Many patients improve after taking antibacterial drugs, which is explained by the incomplete diagnosis of latent infections. Alpha-blockers are prescribed for delayed urination and the need to strain. The urgent need 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, nonsteroidal 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 resort to hormone replacement therapy. Patients with anxiety-hypnotic and depressive disorders are advised to consult a psychiatrist who will choose the optimal antidepressant.
In congestive inflammation of the prostate, physiotherapeutic procedures help normalize men's health. They use laser and magnetic therapy, electrophoresis, etc. Spa treatment helps to relieve symptoms of dysuria and improve sexual function: taking alkalizing mineral waters, paraffin and mud applications, massage shower. In some patients, a 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 circulation and drainage of the organ.
Minimally invasive treatment methods
If conservative therapy is unsuccessful, high-tech interventions are considered - transurethral resection of the prostate, focused high-intensity 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. Long-term circulatory disorder leads to sclerosis of the gland tissue, which is manifested by deterioration of spermogram parameters. The prognosis of congestive prostatitis largely depends on the patient's adherence to all recommendations and lifestyle changes.
Prevention includes playing sports, avoiding heavy lifting, normalizing sexual relations and avoiding coffee and alcohol consumption. During sedentary work, breaks for physical exercises and the use of pillows are recommended. Underwear and wide-cut pants are preferred. Patients are monitored by a urologist with periodic assessment of prostate secretions for inflammation and ultrasound, and if necessary, they receive antibacterial treatment and prostate massage sessions.