Hypertrophy of the seminal tubercle is the excessive development of smooth muscle fibers and connective tissue of the anatomical elevation located in the prostatic part of the urethra. Symptoms are variable and are associated with the size of the formation: if there are no obstacles to the outflow of urine, there are no manifestations. With the development of infravesical obstruction, a sluggish jet appears, frequent urination in small portions, discomfort in the lower abdomen, painful erection during urination, recurrent infections. Adult patients may have dyspareunia, early ejaculation, or retrograde ejaculation. Cystourethrography and urethroscopy are used for diagnosis. Treatment for severe hypertrophy is operative.
Hypertrophy of the seminal tubercle (seminal mound) is an increase in the volume and mass of the anatomical formation located in the posterior part of the prostatic part of the urethra. On the surface of the seminal tubercle, the ducts of the prostate gland and the vas deferens open, the organ has a rich innervation and blood supply. Pathology can be congenital (extremely rare) and acquired. In adult men, hypertrophy of the seminal tubercle is not an independent disease and accompanies colliculitis, inflammation of the prostate, seminal vesicles, stone formation in the ducts of the vas deferens. The embryological defect leading to congenital pathology is unknown.
The exact causes of congenital hypertrophy of the seminal tubercle have not been determined. Back in the middle of the last century, scientists suggested that in some cases, estrogen intake by the expectant mother during pregnancy leads to hypertrophy. There is a possibility that the pathology is facilitated by the impact of negative external conditions on a woman during gestation: radiation, insolation, intoxication, contact with household chemicals, etc. The following conditions can lead to hypertrophy in an adult male:
- Stagnation of blood. Slow blood circulation and a greater amount of blood in the capillaries with varicose veins of the pelvis, stagnation in the absence of ejaculation contribute to hyperemia and an increase in the seminal tubercle. Sexual excesses (prolonged or interrupted sexual intercourse, masturbation) increase the blood filling of the organ and are considered as causes of hypertrophy.
- Inflammation. The inflammatory process is accompanied by edema, infiltration, hyperemia and organ dysfunction. Nerve endings acquire hypersensitivity, which is manifested by pain. Due to edema, the passage of sperm is difficult. Local increase in pressure and increased muscle work contribute to an increase in the seminal mound.
- Mechanical obstacles. The deposition of calcinates can interfere with the outflow of seminal fluid. In combination with inflammatory changes and increased stress, this leads to hypertrophic processes in the seminal tubercle. The process is aggravated by paralysis of contractile elements against a background of constant tension.
The development of the inflammatory process is facilitated by stagnation of blood caused by various reasons. A local increase in pressure leads to hemostasis in vascular structures, which disrupts nutrition and favors increased reproduction of pathogenic flora. At the stage of alteration, characterized by damage to the structure of cells, there is a violation of their function. Exudation is characterized by the release of plasma and cellular structures through the vascular wall into inflamed tissues. At the stage of proliferation, the connective tissue grows compensatorily. These processes lead to an increase in the size of the seminal mound in inflammatory genesis. With a congenital anomaly, it is not known for certain which mechanisms trigger the processes of hypertrophy. Presumably, the reason is the residual folds of the urogenital membrane or paramesonephral ducts against the background of incomplete reduction during embryonic development.
Clinical manifestations depend on the degree of obstruction of the urethra, concomitant pathology and possible complications. If there are no obstacles to urodynamics, symptoms may be absent. With significant hypertrophy, the patient complains of urination disorders, imperative urges, painful erection, early ejaculation. With a significant increase in the tubercle, the ejaculate can be thrown into the bladder, which is manifested by the absence of sperm during orgasm and infertility. The urine stream is sluggish or intermittent, the man has to strain, there is a feeling of incomplete urine discharge.
In children, pathology can be suspected by difficulty frequent urination in small portions, bloating, developmental delay, lethargy, increased blood pressure, crying during urination. A child over 5 years old may have painful tension of the penis during urination, urinary incontinence. Hypertrophy of the seminal mound in newborns is combined with other congenital defects of the urogenital tract: urethral septum, valves, cysts, diverticula, abnormalities of the kidneys and ureters. Recurrent urinary tract infections are typical, which is manifested by an increase in temperature, the release of cloudy urine, breast rejection and anxiety.
All complications of hypertrophy of the seminal tubercle are associated with the inability to adequately empty the bladder and obturation of the vas deferens. In stagnant urine, pathogenic microflora actively multiplies. With an increase in intra-abdominal pressure when strained by vesicoureteral reflux, infected urine enters the kidneys, which is why pyelonephritis joins. Constant urine withdrawal causes hydronephrotic transformation of the kidneys and the formation of chronic renal failure. Other complications may include erectile dysfunction, dyspareunia, infertility, chronic pelvic pain syndrome, urinary incontinence, overactive bladder.
With the development of antenatal diagnostics, an increase in the seminal mound can be suspected during ultrasound examination of the fetus. An indirect sign is hydronephrosis of the kidneys. If for some reason ultrasound screening was not performed in a pregnant woman, there is a risk of late diagnosis of pathology and loss of functional ability of the kidneys. Differential diagnosis of acquired hypertrophy is carried out with urethral stricture, prostate adenoma, blocking stone, tumor, diverticulum; congenital — with malformations of the urethra — septum, valves, cysts, etc. Some patients may need to consult a nephrologist and an andrologist. In both adults and children, the final diagnosis is established using laboratory and instrumental methods of examination:
- Analyzes. Laboratory diagnostics are performed to find a possible cause or complications. It includes a general analysis of urine and blood test, the determination of urea and creatinine, a smear test for STIs (in adults), a sample of Zimnitsky, Nechiporenko, cultural studies of the urethra to determine the flora and its sensitivity to drugs.
- Urethrocystoscopy. During visual examination, a hypertrophied seminal tubercle is visualized on the lower wall of the urethra. Pathognomonic changes in the bladder are represented by signs of trabecularity, thickening of the walls, which is associated with constant straining during urination.
- Radiological methods. Ascending urethrography involves the introduction of a contrast agent into the urethra, followed by a series of radiographs. A typical picture is a filling defect, which indicates an obstacle to the discharge of urine. Excretory urography with mictional descending cystourethrography allows us to assess not only the degree of obstruction and developmental abnormalities, but also kidney function. An increase in creatinine and urea is a contraindication to intravenous administration of contrast.
At the first symptoms of trouble, it is important to consult a doctor, negative consequences can be avoided if an adequate passage of urine is restored in a timely manner. Without this measure, conservative therapy of concomitant inflammation (antibiotics, antispasmodics, nonsteroidal anti-inflammatory drugs) will be ineffective.
The indication for the operation — transurethral resection — is a violation of urodynamics, severe pain syndrome, erectile dysfunction, retrograde ejaculation. In newborns with an anomaly of the seminal mound, it is not always possible to perform surgery immediately, which is hindered by the small diameter of the urethra. In these cases, the issue of urine removal is solved by alternative methods (catheterization, vesicostomy, ureterocutaneostomy) and only after stabilization of the condition and as the child grows, endourethral resection of the seminal tubercle is performed. In the postoperative period, antibiotics, uroseptics, herbal diuretics, and rational nutrition are prescribed.
Prognosis and prevention
The prognosis for life in adults with timely treatment is favorable. In boys (if the anomaly of the seminal mound is the only violation), there is no danger to life and development after surgery; with the addition of renal failure, the prognosis is serious. Preventive measures for adults include safe sex, avoidance of sexual excesses, timely treatment of prostate inflammation, regular ejaculation. In order to minimize the risks of giving birth to a child with abnormalities of the development of the genitourinary system, it is necessary to abandon bad habits, avoid contact with teratogenic substances, do not take medications during gestation at your discretion. Performed ultrasound of the fetus as a screening will not prevent pathology, but will help to identify it in time, to carry out effective treatment at an early date in order to avoid serious complications.