congestive prostatitis

congestive prostatitisIt is a pathological process caused by prostate congestion. No pathogenic flora are detected; leukocytes may be identified on microscopic examination of prostatic secretions, semen, and urine. Symptoms include persistent perineal pain and difficulty urinating. Diagnosis was based on bacterial culture results of biological material and TRUS. There is no single treatment for congestive prostatitis; massage, physical therapy, antibiotics, and alpha-blockers are needed. Taking into account existing symptoms requires an individualized approach. If conservative treatment fails, surgery may be performed.

General information

Prostatitis can be infectious, caused by the presence of pathogenic microflora, or it can be stagnant, associated with congestion, ejaculation retention, and prostatic discharge. Congestive or congestive prostatitis (vegetative genitourinary syndrome, prostatopathy) is an outdated name. Modern experts in the field of urology more often use the term "chronic pelvic pain syndrome without inflammation" (CPPS). Prostatitis occurs in 25% of men aged 35-60 years, and inflammation caused by the congestion process accounts for 88-90% of the total cases. The underlying hyperemic form of the disease is supported by L-type pathogens that are anchored in biofilms and cannot be detected by conventional methods.

reason

The causes of congestive prostatitis may be related to the gland itself and extraprostatic factors. The exact cause is unknown but may be the result of stagnant secretions from the prostate or congestion of the pelvic organs and scrotal veins. Some urologists consider this condition to be psychosomatic. The line between bacterial and non-bacterial inflammation is very arbitrary; with any source of immunosuppression, the process can become infectious due to an increase in secondary microbiota. Congestive prostatitis is caused by:

• Internal urinary system causes. Functional or structural pathology of the bladder: Cervical obstruction, inability of the external sphincter to relax during defecation, impaired detrusor contractility leading to urinary retention, and blood stasis due to vascular compression. Prostatic hyperplasia and tumors, urethral strictures, and obstructive bladder stones are also considered potential causes of venous congestion.
• compression. Circulation is impeded due to compression of the venous plexus by retroperitoneal tumors, metastases, and stool-filled intestinal loops (constipation). The blood vessels of the urogenital plexus dilate, blood flow slows down, the tissues are starved of oxygen and replaced by non-functional structures. Some of the blood settles and stops circulation.
• behavioral factors. Refusing sexual activity, irregular ejaculation, and using interruptions in intercourse as a means of preventing unwanted pregnancy can cause blood flow and prostate tissue swelling. During ejaculation, this gland is not completely emptied. Frequent masturbation can lead to congestive prostatitis because. . . For the development of an erection, blood flow to the genitals is necessary.

Predisposing factors include low physical activity, hypothermia and overheating, and poor diet (mainly spicy and smoked foods). Alcohol and nicotine affect the tone of blood vessel walls, disrupt redox processes and permeability, thereby causing swelling. The main prerequisites for the development of congestive prostatitis affecting all organs of the male reproductive area (vesicles, testicles) are considered abnormalities of the pelvic vasculature - insufficiency of the valves, congenital weakness of the walls of the veins.

onset

The area surrounding the prostate is made up of ducts with an underdeveloped drainage system that blocks the outflow of secretions. As the prostate enlarges with age, a patient's urine can back up into the prostatic ducts. It has been noted that many men with prostatitis are more susceptible to allergies. Scientists believe such patients may also suffer from autoimmune-mediated inflammation caused by previous infections.Urethral stricture, bladder dysfunction, and prostatic enlargement can promote urinary reflux. Even the reflux of sterile urine can cause chemical irritation and inflammation. Renal tubular fibrosis begins, prerequisite for the formation of prostatic stones, thereby increasing intraductal obstruction and secretion stagnation. Inadequate acinar drainage can trigger an inflammatory response, with increased swelling and accompanying symptoms. Congestion (stagnation) of blood in the pelvis can worsen the condition.

Classification

General classifications of prostatitis include acute (I) and chronic (II) bacterial forms. Class III includes subtype IIIa (CPPS with inflammation) and subtype IIIb (CPPS without inflammation). Congestive prostatitis is considered a manifestation of CPPS without an inflammatory response (IIIb). Taking into account the pathogenesis and morphological features of the disease, clinical distinctions exist:

• The first stage.It is characterized by the predominance of extravasation, exudation, arterial and venous hyperemic processes, leading to damage to the microvasculature and destruction of glandular tissue. These changes were recorded within the first few years after the onset of the disease. The clinical manifestations are most obvious in the first stage.
• second stage.An initial process of connective tissue proliferation begins to develop, and symptoms decrease. Due to thrombosis, microcirculation is compromised, thereby exacerbating sclerosis. At this stage, most patients experience sexual dysfunction: the intensity of erections and orgasms weakens, premature ejaculation occurs, and vice versa, men have difficulty reaching orgasm.
• The third phase. Severe fibrosclerotic changes are typical. It has been demonstrated that the proliferation of connective tissue is stimulated not only by inflammation but also by the ischemia accompanying congestive prostatitis. Complaints of dysuria are typical, and renal involvement in the pathological process is noted.

Symptoms of congestive prostatitis

Pathology manifests itself in a variety of symptoms. Most patients describe the pain as persistent discomfort in the perianal area, scrotum, or penis. Some people notice increased perineal pain when sitting. Radiation of pain is variable - lower back, inner thighs, tailbone. Swelling of the glands often makes urination difficult and impairs urine flow. Congestive inflammation in the context of vascular pathology is often accompanied by hemospermia - the presence of blood in the semen.Symptoms of bladder irritation include frequent urinary urgency and urge incontinence. Depression occurs with long-term pathological changes. It remains controversial whether psycho-emotional characteristics contribute to perineal discomfort or, conversely, pain caused by prostate swelling affects a man's mental state. An increase in body temperature accompanied by chills indicates that nonbacterial congestive prostatitis has transformed into infectious prostatitis and requires the initiation of specific treatment.

complication

Congestive prostatitis plus microbiota can turn into acute bacterial prostatitis. Adjacent organs and structures may be involved in the inflammatory process: vesicles, bladder, testicles. The prostate's job is to produce fluid for sperm; it usually has a special ingredient that protects male reproductive cells. Nutritional deficiencies and changes in the biochemical properties of prostate secretions inevitably affect the quality of ejaculation; men with congestive prostatitis are more likely to be diagnosed with infertility.Due to severe swelling of the organ, part of the urine remains in the bladder after urination, causing pathological reflux of urine into the ureter and renal collecting system. Hydronephrosis and persistent pyelonephritis with impaired renal function may occur due to reflux. Sexual dysfunction occurs in 50% of men: painful ejaculation, dyspareunia, uncomfortable nocturnal erections, which reduces the quality of life and negatively affects the relationship.

diagnosis

Determining the source of symptoms is crucial for effective treatment of congestive prostatitis, therefore various questionnaires have been developed to facilitate diagnosis: I-PSS, UPOINT. These questionnaires are available in Russian; urologists and andrologists use them in practice. To rule out myofascial syndrome, a consultation with a neurologist is required. On palpation, the prostate is enlarged and moderately painful; rectal varices attest to the congestive nature of the disease. Diagnosis of congestive prostatitis includes:

• lab testing. Microscopic and cultural examination of prostatic fluid is performed. Nonbacterial congestive inflammation was confirmed by a mild microscopic increase in leukocyte count and negative bacterial culture results. A PCR test is performed to rule out the sexually transmitted nature of the disease. In the third urine after massage, more pronounced leukocyturia was detected. To exclude bladder tumors, urine cytology can be performed; in patients over 40-45 years of age, a PSA blood test is reasonable.
• visual research methods. The main instrumental diagnostic method remains TRUS (bladder ultrasonography). The results of cystourethrography are important in confirming bladder neck dysfunction, revealing intraprostatic and ejaculatory urinary reflux, and urethral stricture. If the jet is significantly reduced, perform uroflowmetry. Assess pelvic floor muscle tone using a videourodynamic study.

Differential diagnosis with bladder cancer, BPH, interstitial cystitis. Similar findings are seen in genitourinary tuberculosis and urethral stricture, as these diseases are also characterized by symptoms of lower abdominal pain, dysuria, and dysuria. Congestive prostatitis is different from bacterial prostatitis; moreover, all pathological processes accompanying CPPS in men must be excluded.

Treatment of congestive prostatitis

The patient is advised to resume a normal sexual life, as regular ejaculation helps drain the acini and improves microcirculation. Interrupted or prolonged sexual intercourse can cause congestion and is unacceptable. Many products have been found to increase the chemical aggressiveness of urine - and their consumption can lead to increased symptoms of congestive prostatitis. Spices, coffee, marinades, smoked foods, alcohol and carbonated drinks should be limited or preferably excluded. Treatment of congestive inflammation of the prostate can be conservative or surgical.

Conservative treatment

Treatment options are chosen individually based on the main symptoms. Many patients improve after taking antimicrobials because of incomplete diagnosis of latent infection. For cases where urine flow is slow and requires straining, alpha-blockers may be used. Anticholinergic drugs can neutralize urinary urgency. 5-alpha reductase inhibitors have been shown to reduce the severity of clinical manifestations by reducing the response of macrophages and leukocytes and their migration to areas of inflammation.Pain relievers, nonsteroidal anti-inflammatory drugs, and muscle relaxants can help relieve pain and muscle spasms. It is reasonable to include in the treatment regimen drugs that normalize microcirculation - intravenous injections (venotonics). If the stalled process results in androgen deficiency, they resort to hormone replacement therapy. Patients suffering from anxiety hypnosis and depression are advised to consult a psychiatrist who will choose the best antidepressant medication.For congestive inflammation of the prostate, physical therapy procedures can help normalize male health. They use laser and magnet therapy, electrophoresis, and more. Hydrotherapy treatments can help relieve symptoms of dysuria and improve sexual function: alkalized mineral water, paraffin and mud application, massage showers. In some patients, health returns to normal when exercise therapy is performed to reduce tension in the pelvic muscles. Prostate massage does not replace natural ejaculation but improves circulation and drainage of the organ.

Minimally invasive treatment methods

If conservative treatment is unsuccessful, high-tech interventions—transurethral resection of the prostate, high-intensity focused ultrasound ablation—can be considered. The most effective is transrectal hyperthermia - a non-invasive method based on the principle of heat diffusion (the prostate is exposed to unfocused microwave energy). Heat increases tissue metabolism, relieves congestion symptoms, and has neural analgesic effects. There are limited data on the effectiveness of treatments for congestive prostatitis.

prognosis and prevention

Life prognosis is good, but chronic pelvic pain is difficult to treat. Sometimes, congestive prostatitis resolves on its own over time. Long-term circulatory impairment can lead to hardening of glandular tissue, manifested by deterioration of spermatogram parameters. The prognosis of congestive prostatitis depends largely on the patient's compliance with all recommendations and lifestyle changes.Prevention includes exercising, avoiding heavy lifting, normalizing sexual relations, and avoiding coffee and alcohol. When working sedentary for long periods of time, it is recommended to take breaks for physical activity and use pillows. Loose underwear and pants are preferred. The urologist observes the patient, regularly evaluates the inflammation of the prostate secretions and performs ultrasound examinations, and if necessary, receives antimicrobial treatment and prostate massage.