Congestive prostatitisis a pathological process in the prostate gland caused by congestion. Pathogenic flora is not detected; microscopy of prostatic secretions, semen, and urine may reveal leukocytes. Symptoms include constant pain in the perineum, dysuria. Diagnostics are based on the results of bacterial culture of biomaterial and TRUS. There is no single treatment regimen for congestive prostatitis; massage, physical therapy, 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 congestion, ejaculatory retention and prostatic secretions. Congestive or congestive prostatitis (vegetative urogenital syndrome, prostatitis) is an outdated name. Modern urologists more often use the term "chronic pelvic pain syndrome without inflammatory response" (CPPS). Prostatitis occurs in 25% of men aged 35-60, inflammation caused by congestive processes 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 in biofilms, and undetectable by routine methods.
Reasons
The causes of congestive prostatitis can be related to both the gland itself and extraprostatic factors. The exact etiology is unknown, possibly due to stagnation of secretions in the prostate or is a consequence of venous congestion in the pelvic organs and scrotum. Some urologists consider the condition to be psychosomatic. The line between bacterial and 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: the obstruction of the cervix, the inability of the external sphincter to relax during bowel movements, the reduced contractility of the detrusor contribute to urine 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 congestion.
- Compression. Blood circulation is obstructed due to compression of the venous plexus by a retroperitoneal tumor, metastases, and intestinal loops filled with feces (constipation). The vessels of the urogenital plexus dilate, blood flow slows down, tissues experience oxygen starvation and are replaced by non-functional structures. Some of the blood is deposited and deactivated by the circulation.
- Behavioral factors. Refusal of sexual activity, irregular ejaculation and the use of intermittent intercourse as a means of preventing unwanted pregnancy cause blood flow and swelling of the prostate tissue. During ejaculation, this gland does not drain completely. Constant masturbation can lead to congestive prostatitis, because. . . Blood flow to the genitals is necessary for the development of an erection.
Predisposing factors include low physical activity, hypothermia and overheating, poor diet with a predominance of spicy, smoky foods. Alcohol and nicotine affect the tone of the vascular wall, disrupt redox processes and permeability, which causes edema. The main conditions for the formation of congestive prostatitis affecting all organs of the male genital area (vesicles, testicles) are considered abnormalities of the vascular system of the pelvis - valvular insufficiency, congenital weakness of the venous wall.
Pathogenesis
The peripheral zone of the prostate gland consists of ducts that have a poorly developed drainage system, which prevents the outflow of secretions. As the prostate enlarges with age, patients develop reflux of urine into the prostatic ducts. It has been noted 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.
Urine reflux is promoted by urethral strictures, bladder dysfunction and BPH. Backflow of even sterile urine leads to chemical irritation and inflammation. Fibrosis of the tubules begins, conditions are created for prostatolithiasis, which increases intraductal obstruction and stagnation of secretions. Inadequate drainage of acids triggers an inflammatory reaction, the increase in edema is accompanied by the appearance of symptoms. The 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. Class III includes subtype 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.It is characterized by the prevalence of processes of exudation, exudation, arterial and venous hyperemia, resulting in damage to the microvascular system and destruction of the glandular tissue. These changes are recorded during the first years from the onset of the disease. The clinical picture in the first stage is more pronounced.
- Second level.The initial proliferative processes of the connective tissue develop and the symptoms decrease. Due to the formation of a clot, the microcirculation suffers, which worsens the hardening. At this stage, most patients experience sexual dysfunction: the erection and the intensity of the orgasm weaken, premature ejaculation develops or vice versa, the man faces difficulties in reaching climax.
- Third stage. Severe fibrosclerotic changes are characteristic. It has been shown that the proliferation of connective tissue is stimulated not only by inflammation, but also by ischemia accompanying congestive prostatitis. Complaints of difficulty urinating are characteristic, and there is involvement of the kidneys in the pathological process.
Symptoms of congestive prostatitis
The pathology manifests itself with a variety of symptoms. Most patients describe the pain as constant discomfort in the perianal area, scrotum or penis. Some note increased pain in the perineum when sitting. The radiation of pain is variable - in the lower back, inner thighs, tail. Swelling of the gland often makes it difficult to urinate and weakens the flow 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 urge and urge incontinence. With long-term pathology, depressive disorders develop. It is still debatable whether psycho-emotional characteristics lead to discomfort in the perineum or, on the contrary, pain caused by prostate enlargement affects a man's mental state. An increase in temperature with chills indicates the transition of bacterial congestive prostatitis to infectious and the need to start pathognomonic treatment.
Complications
Congestive prostatitis with the addition of microflora can become acute bacterial. Adjacent organs and structures may be involved in the inflammatory process: vesicles, bladder, testicles. The role of the prostate gland is to produce fluid for semen; 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 prostatic 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 the renal collecting system. In response to reflux, hydronephrosis and persistent pyelonephritis with impaired renal function may occur. 50% of men develop sexual dysfunction: painful ejaculation, dyspareunia, uncomfortable night erections, which worsen the quality of life and negatively affect the relationship in a couple.
Diagnostics
Determining the origin of symptoms is crucial for the effective treatment of congestive prostatitis, so various questionnaires have been developed to facilitate the diagnosis: I-PSS, UPOINT. These questionnaires are available in Russian; they are used by urologists and andrologists in their practice. To rule out myofascial syndrome, consultation with a neurologist is recommended. On palpation, the prostate is enlarged, moderately painful; the congestive nature of the disease is evidenced by rectal varicosities. The diagnosis of congestive prostatitis includes:
- Laboratory check. A microscopic and cultural examination of the prostate juice is done. A slight increase in the number of leukocytes under the microscope and negative results of bacterial culture confirm bacterial congestive inflammation. PCR tests are performed to rule out the sexually transmitted nature of the disease. In the third dose of urine after the massage, more pronounced leukocyturia is detected. To rule out a bladder tumor, urine cytology can be done; in patients older than 40-45 years, a PSA blood test is warranted.
- Visual research methods. The main instrumental diagnostic method remains TRUS, ultrasound of the bladder. Cystourethrography results are informative in confirming bladder neck dysfunction, revealing intraprostatic and ejaculatory reflux, and urethral stricture. In case of strong weakening of the jet, urometry is performed. Pelvic floor muscle tension is assessed using a video urodynamic study.
Differential diagnosis is carried out with bladder carcinoma, BPH, interstitial cystitis. Similar manifestations are observed in tuberculosis of the genitourinary system and urethral stricture, as these pathologies are 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 accompanying CPPS in men must be excluded.
Treatment of congestive prostatitis
The patient is advised to normalize his sex life, as regular ejaculation helps to drain the cells and improve microcirculation. Intermittent or prolonged intercourse, which 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 better excluded. Treatment of congestive inflammation of the prostate gland can be conservative and surgical.
Conservative therapy
The therapeutic regimen is selected individually, depending on the prevailing symptoms. In many patients, improvement occurs after taking antibacterial drugs, which is explained by the incomplete diagnosis of latent infection. For slow urine flow and the need to strain, alpha-blockers are prescribed. Urgent urination is neutralized with anticholinergic drugs. 5-alpha reductase inhibitors have been shown to reduce the severity of clinical manifestations by reducing macrophage and leukocyte response and migration to the inflammatory zone.
Pain relievers, nonsteroidal anti-inflammatory drugs, and muscle relaxants can help relieve pain and muscle spasms. It makes sense 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.
With congestive inflammation of the prostate, physical therapy procedures help normalize men's health. They use laser and magnetic therapy, electrophoresis, etc. Spa treatment helps relieve symptoms of dysuria and improve sexual function: taking alkaline mineral waters, paraffin and mud applications, massage showers. 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 drainage of the organ.
Minimally invasive treatment methods
If conservative treatment is unsuccessful, high-tech operations are considered - transurethral resection of the prostate, high-intensity focused ultrasound ablation. The most effective is rectal 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. A long-term circulatory disorder leads to hardening of the tissue of the gland, which is manifested by a deterioration of the parameters of the spermogram. The prognosis for congestive prostatitis largely depends on the patient's compliance with all recommendations and lifestyle changes.
Prevention includes sports, avoiding heavy weights, normalizing sexual relations and avoiding drinking coffee and alcohol. When working in a sitting position, it is recommended to take breaks to do physical exercises and use a pillow. Loose underwear and pants are preferred. Patients are monitored by a urologist with periodic evaluation of prostate secretions for inflammation and ultrasound and, if necessary, receive antibacterial therapy and prostate massage sessions.