Prostate cyst is a congenital or acquired formation of the prostate gland, which is an encapsulated cavity with fluid. Often small cysts have no clinical manifestations, and only 5% of patients have symptoms including pelvic pain, hemospermia, painful ejaculation, dysuric disorders. The gold standard of diagnostics is TRU. To exclude a malignant tumor process, MRI of the prostate is performed, a blood test for the PSA level. Management tactics vary from dynamic observation to surgical intervention: TOUR, laser marsupialization, puncture with sclerosis, open surgery.
Prostate cyst occurs in less than 1% of men. With the availability of visualization methods, as some researchers believe, this figure can be increased to 5-8.6%. Congenital cystic cavity is diagnosed in 10% of cases, acquired – in 90%.With age, the likelihood of this pathology increases. Men who practice casual sex without a condom have the greatest risk. Parasitic cysts in the prostate are described, they occur in endemic areas and are secondary to an infectious disease. The sizes of cystic cavities are variable and average 0.5-1.2 cm. There are giant cysts up to 7 cm, they are mostly congenital.
The causes of congenital and acquired prostate cysts differ. In the first case, the pathology is caused by developmental abnormalities during embryogenesis, in the second – by a number of conditions that have a negative impact on the functioning of the prostate gland:
- Urological diseases. Long-term chronic prostatitis with frequent exacerbations, fibrosis, prostatolithiasis lead to the formation of a cystic neoplasm. Cysts in the gland are formed in some forms of prostate cancer. In men with BPH and background atrophy, small cystic cavities can also be visualized on ultrasound.
- Behavioral factors. Everything that creates stagnation of blood in the pelvic organs (sedentary lifestyle, tendency to constipation, lack of regular ejaculation) disrupts the glandular structures of the organ. The juice of the prostate gland thickens and remains in the acinuses. Further secretion leads to the formation of a cyst.
- Traumatization. Any prostate surgery can be complicated by an inflammatory process with the proliferation of fibrous tissue, which negatively affects the production of secretions. The prostate gland can be injured during medical manipulations: cystoscopy, urethral augmentation, catheterization, when performing a transrectal biopsy. The cavity of such a cyst is filled with blood.
A prostate cyst can be localized in any area of it. The mechanism of formation depends on the pathogenetic factor. With severe inflammation, bacteria and leukocytes are present in the contents of the cyst, in this case, a cystic neoplasm is the body’s desire to distinguish the infectious process.
A non-infectious prostate cyst is formed under the influence of damage and concomitant proliferation processes aimed at restoring tissue. Scarring changes do not allow the secret to get out, it accumulates in glandular lobules, and then encapsulates. The developing tumor squeezes the acinuses, which leads to inadequate drainage of the gland.
The congenital pathology is caused by a violation of the differentiation of the Muller ducts against the background of a deficiency of the anti-Muller hormone produced by the testes. Possible negative factors affecting the lack of reduction of these ducts and low AMH levels are considered to be the effects of alcohol, drugs, radiation, and some diseases suffered in the early stages of pregnancy. If several multicameral cysts are formed, the formation of combined defects of the genitourinary system is likely.
A single classification that would take into account all aspects has not been developed in modern andrology. Prostate cyst can be true (primary, congenital) and false (secondary, acquired, retention). The following types of formations are distinguished:
- Cyst of the median line (Muller’s duct). The formation is located along the median line above the seminal tubercle. There is no communication with the urethra. Median cysts also include a cyst of the prostate uterus (utricular cyst, located closer to the urethra), the ejaculatory duct.
- Parenchymal cyst. A simple prostate cyst is detected as an isolated lesion in the thickness of the gland. It is acquired due to a violation of the outflow of prostate juice. Accompanied by inflammatory changes. There may be multiple cysts of the prostate parenchyma. More often they are localized in the transitional or peripheral zone.
- Complex cysts. This group includes infectious cysts, including tuberculosis etiology, complicated (purulent) forms and hemorrhagic formations (due to necrosis, gland infarction, bleeding after biopsy). Any localization.
- Cystic tumor. Cystic carcinoma is a complex malignant tumor of large size, located more often along the median line, with the involvement of seminal vesicles. Cystadenoma is a rare benign tumor, also originates from the glandular epithelium, forms a cystic cavity during development. This also includes a dermoid prostatic cyst containing elements of keratinization.
- Prostate cyst, secondary to some diseases. The cavity is formed in infectious parasitic diseases (echinococcosis, schistosomiasis). The size depends on the duration of infection. Any location.
The clinical picture depends on the size of the cyst: if it is less than 5 mm, there are no symptoms. The location of the cystic neoplasm also affects the manifestations of pathology. With a median cyst larger than 5 cm, obstructive and irritative symptoms appear from the urinary tract: frequent urination in small portions, inability to immediately begin urination, discomfort, a feeling of incomplete emptying of the bladder. Some patients have hematuria, pain in the lower abdomen, in the rectum.
For a cyst of the ejaculatory duct, dysuria, an admixture of blood in semen are typical. If the cystic formation of the prostate parenchyma presses on the neck of the bladder, urination disorders appear, while the cyst is less than 3 cm in size. With all large cysts, there may be pain during ejaculation, soreness in the perineum during sexual contact. In patients with concomitant pathology affecting the weakening of the immune system (HIV, diabetes mellitus, the condition after chemoradiotherapy), the prostate cyst is able to fester with transformation into an abscess. At the same time, the temperature rises to 38-39 °With chills, general well-being suffers (weakness, fatigue), pain in the perineum and during the act of urination are significantly pronounced.
Prostate cyst supports chronic pelvic pain syndrome, which worsens the quality of life. When an infection is attached, purulent melting of tissues occurs in weakened patients. A large cavity squeezes the prostate tissue, which is manifested by the deformation of the organ with dyspareunia. Some men have a cyst rupture with bleeding.
Large neoplasms can lead to acute and chronic urinary retention with frequent recurrent infections of the urogenital tract. Prostate cysts are considered as the causes of obstructive azoospermia with a 2-sided lesion. At the same time, a cystic cavity is also formed in the ejaculatory duct.
In most cases, a prostate cyst is diagnosed accidentally when performing a study for another reason, for example, with an increase in PSA levels. On palpation, the cystic cavity is rounded, elastic, but finger rectal examination does not always detect a cyst. The diagnostic algorithm includes:
- Visualization methods. TRU allows you to make a diagnosis with high accuracy; it shows the dimensions, contours, density of the contents, partitions. MRI of the prostate is performed when a tumor form of the disease is suspected, tomograms demonstrate the relationship of the formation with the surrounding tissues.
- Laboratory diagnostics. To determine the concomitant inflammatory process and its causes, the secret of the prostate gland is examined. If the number of leukocytes in it is increased, PCR tests for STDs are prescribed. With a cyst of the ejaculatory duct, oligospermia may be detected in the spermogram. The sowing of biomaterial is justified to determine the microflora and its sensitivity to antibiotics.
Differential diagnosis is carried out with prostate cancer. To do this, blood is evaluated for prostate-specific antigen in dynamics, with an increase in its level, a transrectal biopsy is performed. A cyst in the prostate is suspicious of malignancy if its contents are heterogeneous, there is calcification, septa.
Small asymptomatic cysts do not require active tactics, they are monitored using ultrasound. Patients are led by a urologist, but an andrologist or a geneticist may be required. Surgical treatment is indicated for large neoplasms, with complications, including the expected ones. Open surgeries are rare due to high traumatism. Interventions that can be performed with a prostate cyst:
- Drainage. Transrectal or trans-interventional puncture is performed to evacuate the exudate. In order to prevent relapse, a sclerosant is introduced at the end of the manipulation, causing “gluing” of the walls. The resulting liquid is sent for morphological examination.
- TURED. Transurethral resection of the ejaculatory ducts is one of the ways to treat median prostate cysts in obstructive male infertility. The disadvantages include the likelihood of developing repeated stenosis of the mouths, a decrease in the intensity of orgasm.
- Laser marsupialization. The opening of the cyst is carried out with a holmium laser with the formation of a wide mouth. Access is through the urethra, under the control of transrectal ultrasound. The operation is less traumatic, has a lower percentage of complications, does not violate orgasmic sensations, since it does not affect the seminal tubercle.
Prognosis and prevention
The prognosis for life is favorable with the right management tactics. Prevention includes a healthy lifestyle, regular sex, rejection of casual sexual relations. Visiting a urologist, timely, adequate treatment of inflammatory prostate diseases are important aspects in the prevention of cysts formation. Experts recommend avoiding situations that provoke congestive phenomena in the pelvis: monitor the regularity of the stool, do not use interrupted sexual intercourse as a method of contraception, exercise.