Prostatic congestion is a pathological process in the prostate gland caused by stagnant phenomena. Pathogenic flora is not detected, white blood cells can be detected by microscopy of prostate secretions, semen and urine. Symptoms include constant aching pain in the perineum, dysuric disorders. Diagnostics is based on the results of back-sowing of biomaterial, TRU. There is no single treatment regimen for congestive prostatitis, massage, physiotherapy, antimicrobials, alpha-blockers are prescribed. An individual approach is required, taking into account the existing symptoms. If conservative treatment is unsuccessful, surgery is possible.
ICD 10
N42.1 N41.1
General information
Prostatitis can be infectious, due to the presence of pathogenic microflora, or stagnant, associated with blood congestion, delayed ejaculate and prostate secretion. Congestive or congestive prostatitis (vegetative urogenital syndrome, prostatosis) is an outdated name. Modern specialists in the field of urology often use the term “chronic pelvic pain syndrome without an inflammatory reaction” (CPPS). Prostatitis occurs in 25% of men aged 35-60 years, inflammation caused by stagnant processes accounts for 88-90% of the total number of cases. The potentially congestive form of the disease is supported by pathogens in L-forms, fixed on biofilms and not detected by routine methods.
Causes
The causes of prostatic congestion can be associated with both the gland itself and extraprostatic factors. The exact etiology is unknown, probably due to stagnation of secretions in the prostate or is a consequence of venous fullness in the pelvic organs, scrotum. Some urologists regard the condition as psychosomatic. The line between bacterial and abacterial inflammation is very conditional, with immunosuppression of any genesis due to the addition of secondary microflora, the process becomes infectious. Prostatic congestion is caused by:
- Internal urological causes. Functional or structural pathology of the bladder: obstruction of the neck, inability of the external sphincter to relax during emptying, violation of the contractility of detrusor contribute to urinary retention and, due to compression compression of blood vessels, stagnation of blood. Prostate hyperplasia and tumor, urethral strictures, blocking bladder stone are also considered as potential causes of venous congestion.
- Compression. Blood circulation is hindered due to compression of the venous plexus by a tumor of the retroperitoneal space, metastases, intestinal loops filled with feces (constipation). The vessels of the genitourinary plexus expand, blood flow slows down, tissues experience oxygen starvation, are replaced by non-functional structures. Part of the blood is deposited, turned 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 filling, swelling of prostate tissues. During ejaculation, this gland is not completely drained. Constant masturbation can lead to prostatic congestion, because a rush of blood to the genitals is necessary for the development of an erection.
Predisposing factors include low physical activity, hypothermia and overheating, poor nutrition with a predominance of spicy, smoked food. Alcohol and nicotine affect the tone of the vascular wall, disrupt redox processes, permeability, which provokes swelling. The main prerequisites for the formation of prostatic congestion with an effect on all organs of the male genital sphere (vesicles, testicles) are considered 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 complicates the outflow of secretions. As the prostate increases with age, patients develop urine reflux into the prostatic tubules. It is 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, urinary dysfunction, BPH. The reverse casting of even sterile urine leads to chemical irritation, inflammation. Tubular fibrosis is initiated, prerequisites for prostatolithiasis are created, which increases intra-flow obstruction, stagnation of secretions. Inadequate drainage of acinuses triggers an inflammatory reaction, an 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. 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 reaction (IIIb). There is a clinical differentiation that takes into account the pathogenetic and morphological features of the disease:
- The first stage. The predominance of the processes of exudation, emigration, arterial and venous hyperemia, entailing damage to the microcirculatory bed, destruction of the gland tissues, is characteristic. These changes are recorded during the first years from the onset of the disease. The clinical picture at the first stage is most pronounced.
- The second stage. The initial processes of connective tissue proliferation develop, the symptoms decrease. Due to thrombosis, microcirculation suffers, which aggravates sclerosis. At this stage, most patients have sexual dysfunction: the erection and intensity of orgasm weakens, premature ejaculation develops, or vice versa, the man experiences difficulties in reaching the climax.
- The third stage. Pronounced fibrosclerotic changes are typical. It has been proven that the proliferation of connective tissue stimulates not only inflammation, but also ischemia accompanying prostatic congestion. Complaints of difficulty urinating are characteristic, involvement in the pathological process of the kidneys is noted.
Symptoms
Pathology is manifested by a variety of symptoms. Most patients describe pain as constant discomfort in the perianal region, scrotum or penis. Some note an increase in perineal pain when sitting. The irradiation of pain is variable – in the lower back, inner thighs, coccyx. Swelling of the gland often contributes to the difficulty of starting the act of urination, weakening of the urine stream. Stagnant type of inflammation against the background of vascular pathology is often accompanied by hemospermia — the appearance of blood in semen.
Symptoms of bladder irritation are represented by frequent urge, urgent urinary incontinence. With a long-term pathology, depressive disorders are formed. Until now, controversial psychoemotional features lead to discomfort in the perineum or vice versa, 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 prostatic congestion to infectious and the need to start pathognomonic treatment.
Complications
Prostatic congestion 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 the production of fluid for sperm, normally it has a special composition that has a protective function for male germ cells. Insufficient amount of nutrients, changes in the biochemical properties of prostatic secretions inevitably affect the quality of the ejaculate, men with prostatic congestion are more likely to be diagnosed with infertility.
With pronounced edema of the organ, part of the urine remains in the bladder after urination, which leads to the formation of a pathological discharge of urine into the ureters and the cup-pelvis system of the kidneys. In response to reflux, hydronephrosis, persistent pyelonephritis with impaired renal function may join. 50% of men develop sexual dysfunction: painful ejaculation, dyspareunia, uncomfortable nocturnal erections, which worsens the quality of life, negatively affects the relationship in a couple.
Diagnostics
Determining the origin of symptoms is crucial for the effective treatment of prostatic congestion, therefore, various questionnaires have been developed to facilitate diagnosis: I-PSS, UPOINT. These questionnaires are in Russified form, they are used by urologists and andrologists in their practice. To exclude myofascial syndrome, a neurologist’s consultation 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. Microscopic, cultural examination of prostate juice is carried out. A slight increase in the number of leukocytes under microscopy and negative results of bakposev confirm abacterial stagnant inflammation. PCR analyses are carried out to exclude the venereal nature of the disease. In the third portion of urine after massage, more pronounced leukocyturia is detected. To exclude a bladder tumor, urine cytology can be performed, and a blood test for PSA is justified in patients older than 40-45 years.
- Visual methods of research. The main instrumental method of diagnosis remains ultrasound, ultrasound of the bladder. The results of cystourethrography are informative in confirming the dysfunction of the bladder neck, detect intra-static and ejaculatory reflux of urine, urethral stricture. With a pronounced weakening of the jet, uroflowmetry is performed. The tension of the pelvic floor muscles is assessed using a video-dynamic study.
Differential diagnosis is performed with bladder carcinoma, BPH, interstitial cystitis. Similar manifestations are observed in urogenital tuberculosis, urethral stricture, since these nosologies are also characterized by pain in the lower abdomen, symptoms of dysuria, difficulty urinating. prostatic congestion is distinguished from bacterial, in addition, all pathological processes that are accompanied by CPPS in men are subject to exclusion.
Treatment
The patient is recommended to normalize sexual life, since regular ejaculation contributes to the drainage of acinuses, improving microcirculation. Interrupted or prolonged sexual intercourse provoking a congregation is unacceptable. A number of products that increase the chemical aggressiveness of urine are indicated – their use leads to an increase in the symptoms of prostatic congestion. Spices, coffee, marinades, smoked meats, alcoholic and carbonated beverages should be limited, and it is better to exclude. Treatment of congestive inflammation of the prostate gland can be conservative and operative.
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. With a sluggish urinary stream, the need for straining is prescribed alpha-blockers. Urgent urge to urinate is neutralized by anticholinergic agents. It has been proven that 5-alpha-reductase inhibitors reduce the severity of clinical manifestations by reducing the reaction of macrophages and leukocytes and their migration to the inflammatory zone.
Painkillers, nonsteroidal anti-inflammatory drugs and muscle relaxants can help with pain and muscle spasms. It is justified to include in the therapy regimen means that normalize microcirculation – phlebotonics (venotonics). If the stagnant process supports androgen deficiency, hormone replacement therapy is resorted to. Patients with anxiety-hypochondriacal, depressive disorders are advised to consult a psychiatrist who will select the optimal antidepressant.
With stagnant inflammation of the prostate, physiotherapy procedures help to normalize men’s health. Laser and magnetic therapy, electrophoresis, etc. are used. The removal of symptoms of dysuria, the improvement of sexual function is promoted by sanatorium treatment: the reception of alkalizing mineral waters, paraffin and mud applications, massage showers. In some patients, normalization of well-being is noted when performing physical therapy to reduce pelvic muscle tension. Prostatic massage does not replace natural ejaculation, but improves blood circulation and drainage of the organ.
Minimally invasive methods of treatment
If conservative therapy is unsuccessful, the issue of high–tech interventions is being considered – transurethral resection of the prostate, high-intensity focused ultrasound ablation. The most effective transrectal hyperthermia is a non–invasive method based on the principle of thermal diffusion (the prostate is affected by unfocused microwave energy). Heat increases tissue metabolism, reduces congestive manifestations, 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 itself over time. A long-term circulatory disorder leads to sclerosis of the gland tissues, which is manifested by a deterioration in the parameters of the spermogram. The prognosis for prostatic congestion largely depends on the patient’s compliance with all recommendations, lifestyle changes.
Prevention involves playing sports, refusing to lift weights, normalizing sexual relations, avoiding coffee and alcohol consumption. When doing sedentary work, it is recommended to stop for physical exercises, use a pillow. Underwear and trousers are preferred in a loose fit. Patients are monitored by a urologist with periodic evaluation of prostate secretion for inflammation and ultrasound, if necessary, receive antibacterial treatment, prostate massage sessions.
