Prostatocystitis is a combined inflammation of the bladder and prostate gland. Symptoms correlate with the severity of the pathology, include discomfort in the perineum, frequent urination with a decrease in the amount of urine excreted, a feeling of incomplete emptying. Diagnosis is based on ultrasound of the bladder, transrectal finger and ultrasound examination of the prostate. From laboratory tests, prostatocystitis is confirmed by changes in urine tests and prostate secretion, the results of culture seeding. Treatment involves the use of antibiotics and uroseptics, taking into account sensitivity, NSAIDs, physiotherapy.
ICD 10
N41.3 Prostatocystitis
Meaning
Prostatocystitis is more often diagnosed in men over 45-50 years old who have undergone transurethral resection of the gland, bladder wall, ejaculatory ducts. Urologists believe that pathology is also associated with anatomical anomalies, diseases that contribute to obstruction of the lower urinary tract and require surgical correction. According to statistics, in patients under 50 years of age, the incidence is 5-8 cases per 10 thousand population and correlates with infection with sexually transmitted diseases. After 65 years of age, bacteria are found in the urine and juice of the prostate gland in 10% of men, and the prevalence of inflammatory diseases of the genitourinary sphere reaches 20-50%.
Causes
The cause of pathology is the penetration and reproduction of pathogenic microorganisms in the acinuses of the gland and the mucous membrane of the bladder, which more often occurs with prolonged persistence of microflora in the urogenital tract. Predisposing factors include a burdened premorbid background (diabetes mellitus, HIV, hormone intake). Prostatocystitis can provoke hypothermia, blood congestion in the pelvic organs, an infectious viral disease. As the main conditions leading to inflammation of the prostate and bladder, urologists consider:
- Operations and medical manipulations. During transurethral resection (TUR), catheterization, and bougie, tissues are injured, due to the addition of secondary microflora, an inflammatory process develops. Urethrocystoscopy, pyeloscopy, lithotripsy under a number of conditions lead to prostatocystitis. In patients with functioning epicystostoma, the risk of urinary tract infection remains high even with the use of preventive antibiotic therapy.
- Urological diseases. Pathologies accompanied by a violation of urine outflow (urethral stricture, pronounced phimosis, BPH, etc.) support inflammation. During the discharge of the concretion, micro-fractures of the mucosa occur, entrance gates for microbes contained in infected urine are formed. The formation of vesicostatic reflux with blocking concretion can cause acute prostatocystitis, vesiculitis, orchoepididymitis.
- Venereal infections. Sexual contact with an infected partner leads to the development of venereal disease. Timely treatment by a urologist or venereologist reduces the likelihood of complications. In the absence of adequate therapy, as a result of latent STIs, the process is generalized with the spread from the urethra to the prostate gland and bladder. Men who practice penile-anal contacts without protective equipment are in a special risk zone.
- Radiation therapy. The passage of radiation therapy for a tumor in the pelvis is complicated by the development of post-radiation prostatocystitis, rectitis. Radiation not only blocks the mitosis of a tumor cell, but also causes a burn of nearby structures. Impaired blood and lymph outflow due to vascular damage, edema and fibrosclerotic changes support inflammation. Receiving chemotherapy drugs for cancer causes immunosuppression, which aggravates the process.
Pathogenesis
Ways of transmission of infection with prostatocystitis: ascending (through the urethra), lymphogenic and hematogenic, descending (microorganisms enter the mucous membrane of the bladder, and then into the prostate from the kidneys). In response to contact with the pathogen, a cascade of mesenchymal-vascular reactions is triggered, aimed at delineating the inflammatory focus and facilitating phagocytosis. Humoral and cellular defense systems eventually deplete and stop working.
Hypothermia and a decrease in the reactivity of the immune system leads to the progression of inflammation in the acinuses. Their adequate drainage occurs only with regular ejaculation, blockage of the excretory ducts of the gland contributes to the persistence of pathogenic microflora. The consequence of inflammation is a violation of microcirculation: vascular tone decreases, blood flow slows down, microthrombs form in venules and arterioles. Ischemia and failure of biochemical processes in the prostate support the inflammatory process, which can spread to neighboring organs: the bladder, appendages, seminal vesicles, etc.
Symptoms
The symptoms of pathology are variable, depending on the stage of inflammation (acute or chronic). There are several dozen clinical manifestations of inflammation of the prostate, bladder, but it is not always possible to reliably identify the localization of the pathological process. Symptoms include pain of varying intensity in the perineum, genitals. Increased pain can be provoked by taking alcohol or spicy food, physical exertion, defecation.
From the general symptoms, weakness, sleep disorders, myalgia are distinguished. An increase in body temperature is more typical for acute prostatocystitis or exacerbation of the chronic process. Symptoms of urination disorders are represented by frequent urges, pain, a feeling of incomplete emptying of the bladder. The sluggishness of the urine stream is recorded in half of the patients. The amount of urine released once has been reduced, its properties have been changed (sediment, unpleasant odor). In the acute period, some patients develop incontinence with an urgent urge.
50% of men suffering from prostatocystitis are diagnosed with sexual dysfunction, which is manifested by difficulty in achieving an erection, early ejaculation, discomfort during or after ejaculation. Orgasmic sensations are erased, libido is reduced to the point of complete absence of sexual desire, which causes depressive disorders.
Complications
Prostatocystitis can be complicated by infertility. The role of the prostate is to produce part of the fluid for ejaculate. When acinuses are blocked, bacteria enter the sperm, the parameters of the spermogram change, which is expressed in the appearance of morphologically altered forms of spermatozoa, a violation of their activity and a decrease in the number. Involvement in the inflammation of the ejaculatory ducts and testicles causes secretory and obstructive forms of male infertility. With a persistent process, pathogens can migrate upward into the kidneys with the addition of pyelonephritis. The constant stagnation of urine in prostatocystitis with background obstruction and neurogenic disorders is complicated by chronic renal failure.
In the absence of treatment or severe immunosuppression, the formation of an abscess, fistula formation is possible. The adverse outcomes of inflammation associated with high mortality include urosepsis. Pronounced swelling of the prostate gland with impaired passage of urine is considered as the main cause of acute urinary retention in men. In patients without obstruction, the constant excretion of urine in small portions leads to the formation of a microcyst, which significantly worsens the quality of life.
Diagnostics
The tactics of the examination is determined by a urologist or andrologist based on complaints and physical examination data. Palpatory signs characteristic of prostate inflammation are an increase in the size of the gland due to swelling, tension, soreness when pressed, smoothness of the median groove. When palpating the lower abdomen, pain appears in the projection of the bladder.
Not all clinicians consider it necessary to perform a cystoscopy, believing that endoscopy is more justified for a suspected tumor or interstitial cystitis. An increase in the PSA level above 4 ng/ml requires an assessment of the indicator in dynamics. The examination algorithm for prostatocystitis includes:
- Laboratory diagnostics. Inflammatory changes are present in blood and urine tests. The secret of the prostate and urine are sown on nutrient media to determine the pathogen and its sensitivity to drugs. Sometimes urine is examined before prostate massage and after, an approximately equal number of leukocytes and bacteria in both samples indicates prostatocystitis. Microscopy of the separated urethra, prostate juice and PCR tests are used in the diagnosis of STIs.
- Instrumental visualization methods. Ultrasound of the bladder with the control of residual urine is the main way to diagnose prostatocystitis. MRI (CT) is prescribed if concomitant neoplastic process and purulent-destructive complications are suspected. Urodynamic tests are performed when a patient complains of a change in the quality of the urine stream, which is a way to reliably confirm the degree of obstruction.
Differential diagnosis is carried out with urogenital tuberculosis, malignant neoplasms of the prostate gland and bladder, urolithiasis. For men over 50 years of age, a comparative analysis with benign prostatic hyperplasia is justified. Similar clinical manifestations are observed in urethral stricture and chronic pelvic pain syndrome, but inflammatory changes in these pathologies are usually absent.
Treatment
The treatment program correlates with the pathogenetic factor and the degree of its influence on the activity of inflammation. Antibiotics remain the first-line drugs in the treatment of acute prostatocystitis. In urgent situations, they are prescribed empirically, and after receiving the results of bakposev, indicating resistance, the treatment regimen is adjusted. Both partners receive medications for STIs, and the use of a condom is recommended throughout the course (until recovery is confirmed).
With prostatocystitis on the background of supportive concomitant pathology and in a serious condition of the patient, hospitalization in a urological hospital is indicated. Complex treatment includes:
- Drug therapy. In addition to antibiotics, uroseptics, analgesics and antipyretics are prescribed for the acute process. To maintain adequate diuresis, infusion therapy is performed. Obstructive symptoms are eliminated with the help of alpha-blockers. To normalize metabolic processes, the scheme includes drugs that restore blood and lymph circulation, multivitamin complexes, and for the prevention of fibrosis – enzymatic drugs.
- Local impact. The prostate has an extensive vascular network, which increases the concentration of the active substance in its tissues during transrectal administration of the drug. Suppositories with anti-inflammatory and decongestant effects, microclysms with herbal decoctions are used as local agents. After the acute process is stopped, laser magnetotherapy, inductometry, massage, mud treatments, etc. are possible. Instillations of the bladder are carried out.
- Surgical treatment. Most patients do not need surgery. Indications for intervention are a purulent-destructive process in the gland; often recurrent prostatocystitis resistant to antibacterial therapy; background purulent prostatolithiasis. Open prostatectomy, partial or total transurethral resection of the prostate is possible. With acute urinary retention, an epicystostoma is removed.
Prognosis and prevention
The prognosis of prostatocystitis without concomitant urological diseases, provided the timeliness and adequacy of therapy is favorable. The outcome of inflammation in the case of an aggravated premorbid background is relatively favorable or requires clarification for each patient separately. Prevention includes early detection of diseases of the genitourinary sphere, preventive measures: taking herbal medicines, avoiding hypothermia, taking tests as planned.
A man with prostatocystitis should change or adjust his behavioral habits: exercise (without lifting weights), exclude spicy dishes and alcohol, normalize the rhythm of sexual life. Sexual excesses, delayed ejaculation during sexual arousal, free sexual relations without a condom should not be practiced, since all of the above increases the likelihood of developing urological pathology.