Vesiculitis is an inflammation of the seminal vesicles. Affects mainly men at the age of sexual activity. In an isolated state, the disease rarely occurs, in most cases it accompanies prostatitis. The leading clinical signs are an admixture of blood in semen and painful erections. With a long process, changes in the spermogram are recorded. For diagnosis, palpatory examination, trans-rectal ultrasound, prostate juice and seminal vesicles, PCR tests for STIs, cultural studies are used. Treatment involves the appointment of antibacterial and anti-inflammatory drugs, physiotherapy.
ICD 10
N49.0 Inflammatory diseases of the seminal vesicle
Meaning
Vesiculitis (spermatocystitis) is a urological disease manifested by inflammation of the seminal vesicles – the paired glandular organ of the male reproductive system. In shape, the organ resembles a twisted spiral 5-7 cm long, 2-4 cm wide and 1-2 cm thick. The main function of these anatomical structures is the production of a part of the secret for sperm. The juice of the seminal vesicles contains proteins, fructose and vitamin C, which provides nutrition, protection and motility of spermatozoa. In case of failed ejaculation, spermiophages in vesicles dispose of the remnants of seminal fluid. Prevention of vesiculitis and subsequent infertility is one of the important tasks of modern andrology.
Causes
The weakening of immune reactions of any genesis is considered as predisposing factors: hypothermia, alcoholism, taking certain medications, etc. There are two types of vesiculitis: infectious and aseptic. In the first case, representatives of coccoid flora, E. coli, and STI pathogens lead to inflammation. In endemic areas, chronic spermatocystitis can be supported by schistosomiasis and tuberculosis. For aseptic vesiculitis, anatomical prerequisites and congestive stagnation of blood in the pelvis are paramount. The main causes of vesiculitis are:
- Concomitant diseases. Infectious vesiculitis often complicates other chronic or acute pathologies of the male urogenital tract – prostatitis, urethritis and epididymitis. Sometimes inflammation is provoked by pathogenic microflora from extragenitally located foci (tonsillitis, caries) or the disease develops against the background of a viral infection.
- Congestion. All factors leading to stagnation of blood in the pelvic organs, under appropriate conditions (immunosuppression, hypothermia) can be complicated by aseptic vesiculitis. Pelvic vein congestion accompanies chronic constipation, low motor activity, sexual excesses. Too active sexual life (including masturbation), artificial prolongation of sexual intercourse, lack of regular ejaculation can provoke venous stagnation.
- Traumatization. Injury of vesicles is possible with transurethral resection, diagnostic studies (cystourethroscopy), during catheterization. When booging about urethral stricture, inflammation often develops, which involves the tissues of the urethra, seminal vesicles, and prostate. Vesiculitis can occur after penile-anal contacts in a homosexual couple.
- Anatomical predisposition. The cause of the aseptic inflammatory process in the seminal vesicle is the contact of vesicle tissues with urine or semen as a result of congenital or acquired reflux, duct atresia. As a result of these anatomical defects, vesiculitis can manifest itself even in a child, its features are persistent course, resistance to antibacterial therapy and unilateral lesion.
Pathogenesis
With the development of infectious vesiculitis, pathogens (bacteria, viruses, fungi) provoke inflammation of the vesicles, edema and infiltration of tissues complicate the outflow of urine. Constant retention of urine leads to urethral-seminal reflux and aggravation of the infectious process. Violation of the contractile function of the vesicles according to the hyporeflective type is manifested by a decrease in the amount of ejaculate produced. Vesicles are abundantly supplied with blood, with inflammation, the vessels lose elasticity and tear, which is facilitated by an increase in pressure in the pelvic cavity during ejaculation.
In aseptic vesiculitis, the congestionof the genitourinary venous plexus leads to arterial constriction, venous fullness and increased vascular permeability. As a result of these processes, ischemia develops in all pelvic organs, including vesicles. It has been proven that with inflammation, testosterone levels decrease and prolactin levels increase, which has a negative effect on the secretory activity of vesicles and fertility.
With aseptic inflammation, the contractile function of the seminal vesicles is disrupted by hyperreflective type, resulting in early ejaculation, spontaneous erections and nocturnal emissions. With any type of inflammation, spermatodynamics suffers, infertility can form. Aseptic vesiculitis with activation of the secondary microflora takes on an inflammatory character. Recent studies have shown that insufficient production of semiohelin I contributes to the occurrence of vesiculitis, which is associated with the loss of natural defense mechanisms against bacteria.
Classification
The lesion of vesicles can be unilateral and bilateral, acute and chronic. Urologists and andrologists use a classification that takes into account the severity of inflammation. Data for determining this indicator is obtained by endoscopic examination – vesiculoscopy. The following forms of vesiculitis are distinguished:
- Catarrhal. Superficial inflammation is characterized by mucosal redness, exudation. Vesicles are somewhat enlarged in size, contain inhomogeneous fluid, in which protein, erythrocytes and leukocytes may be present.
- Deep. It is characterized by the further spread of the inflammatory process from the mucous membrane of the vesicle to the underlying layers (submucosal and muscular). Seminal vesicles are enlarged, edematous, hyperemic. A large amount of pus is detected in their contents.
- Common (paravesiculitis). Neighboring tissues bordering the seminal vesicles are involved in the process. It precedes empyema of vesicles – a complication associated with purulent melting of these anatomical structures.
Symptoms
The main symptoms indicating the development of pathology are the appearance of sperm with blood veins (like currant jelly) and spontaneous (without sexual arousal) painful erections. The severity of the manifestations correlates with the nature of the process, with acute inflammation, the symptoms are more pronounced, including discomfort in the perineum, lower abdomen. Unpleasant sensations increase during defecation and as the bladder fills.
In 90% of men, vesiculitis is accompanied by dyspareunia – painful spasms in the perineum during and after sexual contact with irradiation into the penis and testicles. Spermatocystitis can manifest itself in the form of violations of sexual function: lethargy of erection, premature ejaculation, decreased orgasmic sensations or difficulties in reaching climax. Often, patients pay attention to a visual change in the quality of the ejaculate: the amount of sperm is reduced, clots may be present, an atypical smell.
With a pronounced inflammatory process, general well-being suffers: weakness, temperature reaction, headache and bone-joint pain appear. In 70% of cases, vesiculitis is accompanied by dysuric disorders: frequent urge to urinate, a change in the quality of the urine stream, a feeling of incomplete emptying. Chronic vesiculitis is more often asymptomatic and is detected during an examination conducted for infertility.
Complications
As a complication of acute vesiculitis, chronization of the process is considered, in which atrophy of the seminal vesicles and loss of their functions occur. Vesicle abscess (empyema) is rarely diagnosed as a consequence of inadequate therapy or its absence in patients with immunosuppression. Against the background of pronounced edema, the outflow of urine is disturbed, which is manifested by its chronic delay with the development of persistent infections of the lower and upper urinary tract. With bilateral lesion of vesicles, fertility decreases, infertility develops.
Diagnostics
Diagnosis of vesiculitis is difficult, since similar complaints may be present in a number of nosologies. The tactics of the examination is determined by the urologist or andrologist. After assessing the symptoms, the doctor proceeds to a physical examination of the genitals and a finger examination of the prostate gland, vesicles. When inflamed, they are large in size and density, painful on palpation. The examination is carried out according to the following algorithm:
- Laboratory diagnostics. There are inflammatory changes in the general analysis of urine and blood. In the secret of the vesicles and prostate, an increased number of leukocytes and bacteria, red blood cells are detected. Biochemical analysis shows a reduced amount of fructose and vitamin C. The degree of severity of changes in the spermogram is variable – from asthenospermia to oligospermia with a predominance of degenerative types of sperm. To clarify the type of pathogen, a PCR analysis for STIs is performed, and the ejaculate is vaccinated.
- Instrumental research. The diagnosis of the first line includes trans-rectal ultrasound. Ultrasound scanning shows typical signs of inflammation: enlargement and swelling of vesicles, inhomogeneity of their contents, increased vascularization. The technique makes it possible to simultaneously assess the condition of the prostate gland. The diagnosis is confirmed by vesiculoscopy, which allows you to visualize changes in the vesicles. MRI and CT of the pelvis are performed if a concomitant tumor process or congenital malformations are suspected.
Differential diagnosis is carried out with primary tumors, a cyst and a tuberculous lesion. Similar manifestations can be observed with secondary metastasis of pelvic neoplasms into vesicles, primarily invasion of prostate cancer. To exclude a malignant prostate tumor with a spread to the seminal vesicles, a blood test is prescribed for the PSA level.
Treatment
Therapeutic measures depend on the etiological factor, the severity of inflammation and concomitant pathology. With data indicating purulent inflammation, therapy is started empirically, without waiting for the results of a cultural study. The treatment regimen includes drugs and physiotherapeutic effects that affect all links of pathogenesis: inflammation, circulatory disorders, immunosuppression:
- Drug therapy. Antibacterial agents of a wide spectrum of action are prescribed (for STIs – taking into account the pathogen), immunomodulators, enzymes. NSAIDs enhance the effect of antibiotics, reduce pain and normalize the temperature reaction. Phlebotonics are used to improve blood circulation. With concomitant obstructive disorders, the use of alpha-blockers is justified.
- Physiotherapy. Physiotherapy promotes the concentration of drugs in the area of inflammation, reduces swelling and the severity of pain syndrome, improves microcirculation. Magnetic laser exposure, UHF, transrectal electrophoresis with antibiotics and painkillers are used. One of the effective methods is transurethral or transrectal microwave therapy or hyperthermia.
- Spa treatment. 1-2 months after the acute condition is relieved, rehabilitation in a sanatorium is possible. Mud swabs into the rectum, applications, prostate massage and microclysms with herbal decoctions contribute to the complete recovery of the patient. Ingestion of mineral water increases diuresis and accelerates the removal of pathogens from the urogenital tract. Physical activity and special exercises eliminate the congestion of the pelvic organs.
Prognosis and prevention
The prognosis of vesiculitis with timely treatment and adequate therapy is favorable. In men with frequent relapses of inflammation, the cause of the disease affects the outcome. Taking cytostatics, diabetes mellitus and HIV infection make the prognosis heavier. In advanced cases, with the development of purulent complications, an organ-bearing operation can be performed, leading to infertility.
Preventive measures include timely sanitation of foci of infection in the body, exclusion of hypothermia, normalization of the intestine. Using a condom, exercising and regular sex without a long delay of ejaculation help to preserve men’s health. If there are any symptoms of trouble from the organs of the urogenital tract, you should immediately make an appointment with a urologist.