Congestive prostatitisis a pathological process in the prostate caused by congestion. Pathogenic flora is not detected; Microscopy of prostate secretions, semen, and urine may reveal leukocytes. Symptoms include constant pain in the perineum, dysuria. Diagnosis is based on the results of bacterial culture of the biomaterial and TRUS. There is no single treatment regimen for congestive prostatitis; massage, physiotherapy, antimicrobial medications 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 congestion, ejaculate retention and prostate secretions. Congestive or congestive prostatitis (vegetative urogenital syndrome, prostatosis) is an outdated name. Modern specialists in the field of urology most often use the term "chronic pelvic pain syndrome without inflammatory response" (CPPS). Prostatitis occurs in 25% of men aged 35 to 60, inflammation caused by congestive processes accounts for 88 to 90% of the total number of cases. The potentially congestive form of the disease is sustained by pathogens that are in the L form, fixed in biofilms and not detected by routine methods.
Causes
The causes of congestive prostatitis may be associated with 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 condition psychosomatic. The line between bacterial and non-bacterial 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 bowel movements, decreased contractility of the detrusor contribute to urinary retention and, due to compression of the vessels, blood stagnation. Prostate hyperplasia and tumor, urethral stricture and obstructive bladder stones are also considered potential causes of venous congestion.
- Compression. Blood 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 dilate, blood flow decreases, tissues suffer from a lack of oxygen and are replaced by non-functional structures. Part of the blood is deposited and disconnected from circulation.
- Behavioral factors. Refusal of sexual activity, irregular ejaculation, and the use of interrupted sexual intercourse as a way to prevent unwanted pregnancy cause blood flow and swelling of prostate tissue. During ejaculation, this gland is 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, inadequate nutrition with a predominance of spicy and smoked foods. Alcohol and nicotine affect the tone of the vascular wall, disrupt redox processes and permeability, which causes swelling. The main prerequisites for the formation of congestive prostatitis affecting all organs of the male genital area (vesicles, testicles) are considered anomalies of the vascular system of the pelvis - valve insufficiency, congenital weakness of the venous wall.
Pathogenesis
The peripheral area of the prostate is made up of ducts that have a poorly developed drainage system, which prevents the flow of secretions. As the prostate enlarges with age, patients develop reflux of urine into the prostate tubes. It has been observed that many men who suffer from prostatitis are more prone to allergies. Scientists believe these patients may also suffer from autoimmune inflammation caused by a previous infection.
Urinary reflux is promoted by urethral strictures, bladder dysfunction, and BPH. Reflux of even sterile urine causes chemical irritation and inflammation. Fibrosis of the tubules begins, prerequisites for prostatolithiasis are created, which increases intraductal obstruction and stagnation of secretions. Inadequate drainage of the acini triggers an inflammatory reaction, increasing swelling 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 inflammation. Congestive prostatitis is considered a manifestation of CPPS with a lack of inflammatory response (IIIb). There is a clinical differentiation that takes into account the pathogenetic and morphological characteristics of the disease:
- First step.It is characterized by the predominance of exudation, emigration, arterial and venous hyperemia, resulting in damage to the microvasculature and destruction of glandular tissue. These changes are recorded during the first years of the onset of the disease. The clinical picture in the first phase is more pronounced.
- Second stage. The initial processes of connective tissue proliferation develop and symptoms subside. Due to the formation of thrombi, microcirculation suffers, which worsens sclerosis. At this stage, most patients experience sexual dysfunction: the erection and orgasm intensity weaken, premature ejaculation develops or vice versa, 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 that accompanies congestive prostatitis. Complaints of difficulty urinating are typical and renal involvement in the pathological process is observed.
Symptoms of congestive prostatitis
The pathology manifests itself with a variety of symptoms. Most patients describe the pain as constant discomfort in the perianal region, scrotum or penis. Some notice increased perineal pain when sitting. The radiation of pain is variable - to the lower back, inner thighs, coccyx. Swelling of the gland often makes it difficult to urinate and weakens the stream of urine. A 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 urgency and urgency urinary incontinence. With long-term pathology, depressive disorders develop. It is still debatable whether psycho-emotional characteristics lead to discomfort in the perineum or, conversely, whether the pain caused by prostate swelling affects the man's mental state. An increase in temperature with chills indicates the transition from bacterial to infectious congestive prostatitis and the need to begin pathognomonic treatment.
Complications
Congestive prostatitis with added 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; Normally 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 ejaculation; 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 renal collecting system. In response to reflux, hydronephrosis and persistent pyelonephritis may occur with impaired renal function. 50% of men develop sexual dysfunction: painful ejaculation, dyspareunia, uncomfortable nocturnal erections, which worsens the quality of life and negatively affects the couple's relationship.
Diagnosis
Determining the origin of symptoms is crucial for the effective treatment of congestive prostatitis, which is why several questionnaires have been developed to facilitate diagnosis: I-PSS, UPOINT. These questionnaires are available in Russified format and are 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 the disease is evidenced by varicose veins of the rectum. Diagnosis of congestive prostatitis includes:
- Testing in the laboratory" or "Experimental testing. A microscopic and cultural examination of prostate juice is performed. A slight increase in the number of leukocytes under microscopy and negative bacterial culture results confirm bacterial congestive inflammation. PCR tests are performed to exclude the sexually transmitted nature of the disease. In the third portion of urine after massage, more pronounced leukocyturia is detected. To exclude bladder tumor, urine cytology can be performed; in patients over 40-45 years of age, a PSA blood test is justified.
- Visual search methods. The main instrumental diagnostic method remains TRUS, bladder ultrasound. The results of cystourethrography are informative in confirming bladder neck dysfunction, revealing intraprostatic and ejaculatory reflux of urine and urethral stricture. In case of pronounced weakening of the jet, uroflowmetry is performed. Pelvic floor muscle tension is assessed using a videourodynamic study.
Differential diagnosis is made with bladder carcinoma, BPH, 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 differentiated from bacterial prostatitis; in addition, all pathological processes accompanied by CPPS in men must be excluded.
Treatment of congestive prostatitis
It is recommended that the patient normalize their sexual life, as regular ejaculation helps to drain the acini and improve microcirculation. Interrupted or prolonged sexual intercourse, which causes congestion, is unacceptable. Several products have been identified 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, 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. In many patients, improvement occurs after the use of antibacterial drugs, which is explained by the incomplete diagnosis of latent infections. For slow urinary flow and need for straining, alpha-blockers are prescribed. Urinary urgency is neutralized with anticholinergic medications. 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, nonsteroidal anti-inflammatories, and muscle relaxants can help relieve pain and muscle spasms. It is reasonable to include drugs that normalize microcirculation – phlebotonics (venotonics) in the treatment regimen. 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 select the ideal antidepressant.
With congestive inflammation of the prostate, physiotherapeutic procedures help to normalize men's health. They use laser and magnetic therapy, electrophoresis, etc. Spa treatment helps to alleviate 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 observed while undergoing exercise therapy to reduce tension in the pelvic muscles. Prostatic massage does not replace natural ejaculation, but it 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 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 treating 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. A prolonged circulatory disorder 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 adherence to all recommendations and lifestyle changes.
Prevention involves playing sports, avoiding heavy lifting, normalizing sexual relations and avoiding coffee and alcohol consumption. When working sedentary, it is recommended to take breaks to exercise and use a pillow. Choose underwear and loose pants. 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.