Colliculitis is an inflammation of the seminal tubercle. It can be an independent nosology or a secondary pathology caused by the transition of inflammation from the posterior part of the urethra, prostate. Symptoms are variable: with superficial colliculitis, clinical manifestations may be absent, premature ejaculation, painful sensations during erection and ejaculation, sometimes an admixture of blood in semen are typical for a common lesion. The diagnosis is confirmed by urethroscopy, studies on STIs and TRUS are used to establish the etiology. Treatment involves etiotropic antibacterial therapy, in severe cases, resection of the seminal tubercle is performed.
Colliculitis is an inflammatory process in the seminal tubercle (mound). Normally, its length is 10-20 mm, width is 2-4 mm, height is 3-4 mm. Until now, the purpose of this anatomical structure remains debatable. The fact that the nerve endings of the afferent pathways involved in the act of ejaculation are concentrated in the seminal mound is confirmed by the fact that when this anatomical formation is mechanically stimulated, semen is ejected from the mouths of the vas deferens. The prevalence of pathology has nothing to do with geographical residence and race. It is believed that any sexually active man can face inflammation of the mound. Some authors believe that colliculitis is a special case of posterior urethritis with predominant changes in this anatomical structure.
Primary (true) and secondary (reactive) colliculitis are distinguished, the causes of each form are variable. The causes of true colliculitis are a violation of innervation and blood circulation in combination with the addition of a secondary infection by lymphogenic or hematogenic pathway. Secondary inflammation of the seminal mound often develops with posterior urethritis, prostatitis and vesiculitis. Pathogenic flora is represented by specific pathogens: chlamydia trachomatis (44%), mycoplasma genitalium (31%), trichomonas vaginalis (13%), herpes viruses 1 and 2 (7.1% and 2.6%). Adenovirus, streptococci, candida, gram-negative microbes, Mycobacterium tuberculosis, etc. are less common. As predisposing factors are considered:
- Sexual excesses. Prolonged or interrupted sexual intercourse, lack of sexual activity and excessive masturbation are equally harmful to men, as they provoke stagnation of blood and disrupt natural sexual mechanisms. The duration and frequency of harmful practices are important.
- Varicose veins. Varicose veins of the pelvis with stagnant phenomena under appropriate conditions (weakening of immunity and migration of pathogenic bacteria from any part of the body – carious teeth, inflamed tonsils, prostate, rectum, etc.) can initiate the inflammatory process of the seminal tubercle.
- Local inflammation. In men with chronic recurrent urethritis and prostatitis of both specific and non-specific etiology, the generalization of the process with the spread of the seminal mound to the tissues occurs more often. At risk are people who practice homosexual contacts and prefer polygamous relationships without barrier contraception.
- Traumatic injuries. Injury to the seminal tubercle can occur during a number of medical procedures: urethroscopy, catheterization, augmentation, or when performing surgery on the prostate gland or urethra. Microbial flora (more often gram-negative bacteria) begins to actively develop, spreading, among other things, to the seminal tubercle.
The leading role in the inflammation of the seminal tubercle belongs to a violation of microcirculation. The changes are aggravated by an infected prostate secret, which is secreted and stagnates in the posterior urethra. Inflammation of the mucosa of this part of the urethra and the seminal mound leads to a violation of innervation, which creates a vicious circle: lack of adequate drainage (reflex violation of evacuation function), a permanent microbial focus, increased stagnation.
In the formation of spontaneous painful erections, early ejaculation and changes in orgasmic sensations, hyperexpression of the cerebrospinal centers of erection and ejaculation in inflammation due to edema and hypertrophy of the seminal mound with constant pulsation is important. In general, the pathogenesis of colliculitis includes damage to the epithelial cells of the mucous membrane or invasion of an infectious agent (bacterial, viral, fungal) with subsequent inflammatory changes, including accumulation of leukocytes and chemical mediators (antibodies, cytokines and interleukins), resulting in edema, hyperemia and pain.
Like any inflammatory process, by the nature of the course, colliculitis can be acute (bright clinical manifestations) or chronic (erased symptoms). According to the clinical and morphological classification in andrology, the following types of colliculitis are distinguished:
- With mild infiltration. The most favorable form is found with recently existing inflammation. With treatment, there is more chance of a full recovery.
- With solid infiltration. Connective tissue elements prevail in the structure of the inflammatory infiltrate, which gives it density. The response to therapy is partial, there is a tendency to a recurrent course.
- With the development of coarse scar connective tissue (atrophic colliculitis). The wrinkled seed mound is significantly compacted. These changes develop with prolonged inflammation, sometimes existing for several years.
- Based on the urethroscopic picture, the nature of mucosal changes, the severity and duration of the process are assessed, and management tactics are determined. There are three forms of colliculitis:
- Erosive. It is characterized by the appearance of ulceration on the background of severe inflammation. It is detected mainly in patients with severe immunosuppression. Excessive fragility of blood vessels contributes to the formation of erosive defects.
- Granulomatous. The proliferation of granulations, as a rule, occurs against the background of subsiding inflammation. In this way, the tissues are cleaned of necrotizing products formed as a result of inflammation.
- Polypous. The formation of polypoid or cyst-like growths on the seed mound is extremely rare. Perhaps this is preceded by prolonged irritation of the seminal tubercle and increased blood supply.
The severity of symptoms depends on the stage of inflammation, the state of the organs of the male reproductive system, sexual preferences. Temperature reaction and general weakness are rare, their presence indicates the spread of the process to the prostate gland, seminal vesicles, bladder. Initially, the clinical manifestations are erased, in the future there is discomfort in the perineum, scrotum, rectum (a feeling of the presence of a foreign body), burning when urinating, constant urge to urinate.
As the inflammation progresses, the patient may complain about the appearance of blood veins in the sperm, discharge from the urethra, weakening of the pressure of the urine stream, its intermittency. In some patients, involuntary ejaculation occurs during defecation. In 50%, there is a weakening of the strength of natural erections, but the appearance of painful spontaneous tensions of the penis.
Complications associated with obstruction include chronic urinary retention, inflammation of the bladder (cystitis), urination disorders with hypertrophy of the seminal tubercle. In the absence of adequate therapy, coliculitis takes a recurrent course, which is why the tissues of the seminal mound are replaced by coarse connective tissue. This is fraught with an obstructive form of infertility, since the mouths of the vas deferens open on the seminal tubercle. In 70% of cases, colliculitis leads to various functional copulatory disorders: “fading” of orgasm, the development of spontaneous erections not associated with sexual arousal, rapid ejaculation or inability to reach a climax, etc. These symptoms negatively affect the patient’s psyche, in the absence of timely help from a urologist or andrologist, the situation is aggravated by neurosis-like conditions.
The diagnosis of inflammation of the seminal tubercle is established on the basis of complaints, the history of the disease, palpation of the prostate gland and clinical and urological examination data. Connection with sexual contact without a condom, acute onset are typical for urethritis and secondary colliculitis. The gradual development of the disease, the absence of changes on the part of the urethral mucosa, soreness during rectal examination when pressing in the projection of the seminal tubercle indicate primary pathology. Laboratory and instrumental diagnostics include:
- STI testing. To establish the pathogen, PCR diagnostics, back-seeding of biomaterial (urethral discharge, prostate secretion, sperm) on nutrient media, smear microscopy, etc. are used. If 5 or more leukocytes are detected in a smear from the urethra during primary microscopy, a deeper examination is necessary. HIV and syphilis testing is mandatory.
- A three-cup urine sample. In the first portion of urine, leukocyturia, bacteriuria are detected, which indicates in favor of urethritis. These changes are indications for cultural diagnostics. With primary colliculitis, inflammatory manifestations in the urine may be absent. Changes in the second and third portions of urine are typical for cystitis and pyelonephritis.
- Examination of prostate secretions. Microscopy of prostate juice reveals an increased number of leukocytes, bacteria, a decrease in lecithin grains, red blood cells. These changes suggest inflammation in the prostate gland (seminal vesicles). To clarify the state of the prostate, TRU are performed.
- Urethroscopy. The study allows you to visually assess all morphological changes, i.e. to consider atrophy, erosion, polyps, etc. The mucous membrane in the acute inflammatory process of the seminal tubercle, as well as the mucosa of the posterior urethra, is edematous, hyperemic; it may occupy half or more of the diameter of the urethra (the exception is the atrophic form, in which the seminal mound is reduced in size, there is no hyperemia).
Differential diagnosis is carried out with prostate adenoma, urethral stricture (with symptoms of difficulty urinating), prostatitis, urinary tract infection, cystitis, vesiculitis, hypertrophy of the seminal mound. A patient with colliculitis may need consultations with a dermatovenerologist, andrologist, vascular surgeon, psychotherapist (with concomitant neurosis).
Treatment is prescribed taking into account the isolated pathogen. If there are no manifestations, they resort to dynamic observation and recommend correction of behavior. In case of ineffectiveness of conservative therapy and frequent relapses, transurethral resection of the seminal tubercle can be performed. The same intervention is indicated for obturation of the seminal ducts and infertility. Taking into account the indications (the severity of complaints and changes during the examination, the likelihood of relapse), the treatment regimen includes:
- Antibiotics. First-line therapy for confirmed inflammatory process. Empirical prescribing of drugs for colliculitis is not the best choice due to the development of resistance to some broad-spectrum antibiotics (fluoroquinolones, cephalosporins). During treatment, the patient is recommended to abstain from sexual life and refuse extractive dishes, alcohol, marinades, etc.
- Symptomatic remedies. With colliculitis, the increase in the seminal mound can be so pronounced that the outflow of urine is disrupted, therefore, alpha-blockers are prescribed to improve the quality of urination. Analgesics, antispasmodics, nonsteroidal anti-inflammatory drugs are indicated for pain. To improve blood circulation in the pelvic area, phlebotonics are used, multivitamins with minerals, adaptogens are used as general tonic agents.
- Physiotherapy effect. Magnetic infrared laser therapy, low-intensity laser radiation, ultrasound therapy, electrophoresis with anesthetics (for pain), antibiotics, enzymes (for inflammation), transurethral or transrectal thermotherapy, etc. help to reduce the symptoms of colliculitis. In patients over 45 years of age, the level of total PSA in the blood is examined before performing physiotherapy.
- Local treatment. Urethral instillations are carried out with solutions with antimicrobial action (contraindication – concomitant acute urethritis, there is a risk of spreading pathogenic microflora under fluid pressure), microclysms with decoctions of herbs, oils, rectal suppositories are used. Out of exacerbation, sanatorium-resort treatment in a specialized sanatorium is possible.
Prognosis and prevention
The prognosis with timely therapy is favorable: dysuric symptoms, soreness, erectile dysfunction disappear. Preventive measures include adherence to monogamous relationships, the use of barrier methods of contraception during casual sexual intercourse, timely sanitation of infectious foci in the body, and especially in the pelvic organs, physical exercises, regular sexual life, compliance with hygiene rules. If colliculitis has developed against the background of a sexually transmitted infection, both partners are subject to treatment. The resumption of sexual activity is possible only after the control of cure. Regular examination by a urologist and timely treatment at the first symptoms of trouble can help prevent a number of complications.