Congestive prostatitisis a pathological process in the prostate gland caused by congestion. Pathogenic flora is not detected; microscopy of prostate secretions, semen and urine may reveal leukocytes. Symptoms include constant aching pain in the perineum, dysuria. Diagnostics is based on the results of bacterial culture of biomaterial 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 congestion, 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 Congestive or congestive prostatitis (vegetative urogenital syndrome, prostatosis) is an outdated name.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 35-60 years old, 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 in L-forms, fixed on biofilms and not detected by routine methods.
Causes
The causes of congestive prostatitis can be associated both with the gland itself and with extraprostatic factors. The exact etiology is unknown, probably due to stagnation of secretions in the prostate or is a consequence of venous congestion in the pelvic organs and scrotum. Some urologists regard the condition as psychosomatic. The line 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 bladder: cervical obstruction, inability of the external sphincter to relax during bowel movements, impaired detrusor contractility contribute to urinary retention and, due to compression of the vessels, blood stagnation. Prostate hyperplasia and tumor, urethral stricture, and obstructive bladder stone 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 dilate, blood flow slows down, tissues experience oxygen starvation and are replaced by non-functional structures. Part of the blood is deposited and switched off from circulation.
- Behavioral factors. Refusal of sexual activity, irregular ejaculation and the use of 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 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 foods. Alcohol and nicotine affect the tone of the vascular wall, disrupt redox processes and permeability, which provokes swelling. The main prerequisites for the formation 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 gland consists of ducts that have a poorly developed drainage system, which impedes the outflow of secretions. As the prostate enlarges with age, patients develop reflux of urine into the prostatic tubes. 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. The backflow of even sterile urine leads to chemical irritation and inflammation. Fibrosis of the tubules is initiated, preconditions are created for prostatolithiasis, 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 aggravated 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 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 features of the disease:
- First stage.Characterized by the predominance of processes 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 from the onset of the disease. The clinical picture at the first stage is most pronounced.
- Second stage.The initial processes of connective tissue proliferation develop, and 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 weaken, premature ejaculation develops, or vice versa, the man experiences difficulties in achieving 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 kidney involvement in the pathological process is noted.
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 perineal pain when sitting. The irradiation of pain is variable - to the lower back, inner thighs, tailbone. Swelling of the gland often makes it difficult to start urination and weakens the urine stream. 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 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, pain caused by swelling of the prostate gland affects the mental state of a man. An increase in temperature with chills indicates the transition of abacterial congestive prostatitis to infectious and the need to begin 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 gland 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 prostatic secretions inevitably affect the quality of the ejaculate; 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 into 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 nocturnal erections, which worsens the quality of life and negatively affects the relationship in a couple.
Diagnostics
Determining the origin of symptoms is crucial for the effective treatment of congestive prostatitis, therefore various questionnaires have been developed to facilitate diagnosis: I-PSS, UPOINT. These questionnaires are available in Russified form; they 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:
- Laboratory 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 abacterial congestive inflammation. PCR tests are carried out to exclude the sexually transmitted nature of the disease. In the third portion of urine after the massage, more pronounced leukocyturia is detected. To exclude a bladder tumor, urine cytology can be performed; in patients over 40-45 years old, a PSA blood test is justified.
- Visual research methods. The main instrumental diagnostic method remains TRUS, ultrasound of the bladder. The results of cystourethrography are informative in confirming dysfunction of the bladder neck, revealing intraprostatic and ejaculatory reflux of urine, and urethral stricture. In case of pronounced weakening of the jet, uroflowmetry is performed. The tension of the pelvic floor muscles is assessed using a videourodynamic study.
Differential diagnosis is carried out 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 distinguished 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 sex life, since regular ejaculation helps drain the acini and improve microcirculation. Interrupted or prolonged sexual intercourse, which provokes 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 yet excluded. Treatment of congestive inflammation of the prostate gland can be conservative and surgical.
Conservative therapy
The treatment regimen is selected individually, depending on the prevailing symptoms. In many patients, improvement occurs after taking antibacterial drugs, which is explained by incomplete diagnosis of latent infections. For sluggish urinary stream and the need to strain, alpha-blockers are prescribed. Urinary urgency 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 select the optimal antidepressant.
With congestive inflammation of the prostate, physiotherapeutic 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 alkalizing mineral waters, paraffin and mud applications, massage showers. In some patients, normalization of well-being is noted when performing exercise therapy to reduce tension in the pelvic muscles. Prostatic 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 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 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 sclerosis of the gland tissue, which is manifested by a deterioration in spermogram parameters. The prognosis for congestive prostatitis largely depends on the patient’s compliance with all recommendations and lifestyle changes.
Prevention involves playing sports, avoiding heavy lifting, normalizing sexual relationships, and avoiding consumption of coffee and alcohol. When working sedentarily, it is recommended to take breaks to do physical exercises and use a pillow. Loose-fitting underwear and trousers are preferred. Patients are observed by a urologist with periodic assessment of prostate secretions for inflammation and ultrasound, and, if necessary, receive antibacterial treatment and prostate massage sessions.