Contents
The prostate gland (otherwise known as the prostate) performs several significant functions in the male body. The main role is the development of a special secret that maintains the acidity of the environment necessary for the life of spermatozoa, liquefies the sperm, contains nutrients so that the spermatozoa can remain viable in the female genital organs for some time. The prostate also has an antimicrobial function, protecting the urinary tract from infection by pathogens. The musculature of the gland is involved in the acts of ejaculation and urination. Also in the organ there is a biochemical transformation of the male sex hormone – testosterone.
Damage to the prostate gland as a result of any pathological process leads to negative consequences in terms of reproductive function, resistance to genitourinary infections, etc.
One of these pathologies is, developing mainly due to inflammation, fibrosis in the prostate. Fibrotic changes are the replacement of normal gland tissue with the so-called connective tissue. The latter in the body usually plays a supporting-protective role, differs in structure from the prostate tissue and is not capable of performing the functions of this organ. With a significant growth of fibrous foci, they may compress the urinary and vas deferens, disrupt their work (sclerosis of the prostate).
In simple terms, areas of fibrosis in the prostate can be compared to scars and scars on the skin after inflammation or injury. In these places, the skin loses its elasticity. So the prostate, in places of such “scars” loses its functionality.
Causes and danger of fibrosis
The main cause of the disease is considered to be a long-term inflammatory process (chronic prostatitis). Chronic prostatitis, most often provoked by bacterial agents, causes destruction of the gland tissue with subsequent development of fibrosis in the lesions. In turn, the proliferation of connective tissue supports the persistence of infection and the further progression of inflammation (there is a corresponding term “fibrous prostatitis”). A vicious circle arises – an infectious or bacterial agent is able to hide in areas of fibrosis, as in a “capsule” and does not reveal itself in any way until an external provocation occurs. There is an impression that the infectious prostatitis is cured. But as soon as such a capsule is disturbed (acute respiratory infections, colds, overstrain of the pelvic muscles, etc.), the infectious agent goes beyond its capsule and again causes inflammation in the prostate.
This is the main danger of fibrous prostatitis – false-negative results of tests for infections are often possible. According to the analyzes, everything is clear, and six months later the patient again complains of an exacerbation of prostatitis. And during the period of exacerbation of prostatitis, the infection (one or more) is still detected in the analysis. The patient asks the question – Where did she come from ?! There were no outside contacts. Often this even becomes the cause of a scandal in the family and claims to the spouse. And the reason is that the infection was not completely cured during the last course of treatment. Therefore, the treatment of fibrous prostatitis has its own characteristics, which are described below.
Prostatitis is a fairly common disease: up to 30% of men aged 18 to 50 are diagnosed with it, while almost 5% of patients with the chronic form have the “end result” of the disease – fibrosclerosis.
Factors contributing to the occurrence of fibrotic changes in the prostate include: • venous congestion in the pelvic area (impaired outflow of blood through the veins), usually associated with prolonged immobility; • atherosclerotic changes in blood vessels; • allergies; • promiscuous/irregular sexual life; • sexual abstinence; • hormonal and immune disorders.
Fibrosis classification
Depending on the degree of spread of fibrosis against the background of prostatitis, stages are distinguished, characterized by: • initial changes in the gland tissue (infiltrative-parenchymal stage); • signs of inflammation and damage to the walls of the prostate (interstitial-alternative); • the presence of pronounced foci of connective tissue (focal-sclerotic); • replacement by connective tissue of most of the glandular (total sclerotic). There are other classifications, including those that take into account the presence of foci of fibrosis: • as a congenital condition; • with atrophy; • with cystic transformation; • with adenomatous hyperplasia, etc.
Symptoms
In the early stages, the disease may not have any symptoms. As the progression progresses, the following stages are distinguished with characteristic clinical pictures: • urination disorders (with timely access to a doctor and adequate treatment, the prognosis at this stage is favorable); • functional disorders of the passage of urine in the urinary system (more pronounced difficulty urinating, incomplete emptying, etc.); • changes in the organs (development of pyelonephritis, hydronephrosis, expansion of the renal pelvis, etc.); • severe damage to the ureters, kidneys, bladder, seminiferous tubules, etc.
Fibrous changes in the gland, requiring a referral to a specialist, can be manifested by: • acute pain during ejaculation; • discomfort when urinating; • weakening of erection, obliteration of orgasm; • pain in the groin area; • the appearance of blood in the semen.
Diagnostics
The following methods are used to make a diagnosis: • laboratory tests (urinalysis, blood tests, prostate secretions, ejaculate, cytology, tests for STIs, etc.); • rectal examination; • Ultrasound (foci of fibrosis may be detected); • transrectal ultrasound (TRUS) (the probe is inserted into the rectum, which allows for a more detailed study); • CT, MRI; • urethro and cystoscopy; • prostatography; • radioisotope research; • assessment of prostate function (spermogram).
If single areas of fibrosis are detected on ultrasound in the absence of symptoms and laboratory signs of the disease, treatment is not required (it is considered an anatomical feature).
Differential diagnosis of the disease with such pathologies as benign tumors, cancer, prostate tuberculosis is important.
Treatment of fibrosis of the prostate
Treatment of chronic prostatitis with the initial stage of fibrosis is carried out conservatively: long-term use of antibiotics, taking alpha-blockers. Additionally, the following may be prescribed: • vitamins; • physiotherapeutic procedures; • prostate massage.
The treatment of chronic fibrous prostatitis has one feature – it is necessary to “open the capsule” with the infection, which may be hiding in the areas of fibrosis. If this is not done, the antibiotic will not reach these scar tissues. For this purpose, drugs that soften the prostate and open closed ducts are added to the course of treatment.
Sclerosis of the prostate is treated only by surgical methods, including laser surgery. The choice of technique is carried out depending on the severity of changes and concomitant pathologies. The prognosis is satisfactory if the intervention is performed before the development of a serious lesion of the renal system (chronic renal failure).
Prevention
The main measure of prevention is the prevention of chronic prostatitis by: • prevention, timely detection and treatment of infectious diseases; • giving up alcohol abuse and smoking; • normalization of the regime of work and rest; • maintaining an active lifestyle.