Sexually Transmitted Diseases - I. I. Mavrov 2005

Diseases of the Reproductive Organs of Various Etiologies
Prostate Sclerosis

Prostate sclerosis is a condition characterized by hardening of the Prostate Gland, caused by the replacement of its damaged functional elements with connective (typically fibrous) tissue. The proliferation of Fibrous Connective Tissue throughout the prostate volume is observed in chronic inflammation or chronic circulatory insufficiency.

Etiology AND Pathogenesis. Recent years have seen an increase in the number of patients suffering from prostate sclerosis, primarily as a consequence of chronic prostatitis (Karpenko et al., 1985; Tkachuk et al., 1989). This occurs because prostatitis damages the glandular stroma and triggers inflammation. Against the Background of this inflammatory process, reparative (replacement) fibrosis and chronic venous congestion (Hypoxia) develop, the Collagen-synthesizing function of fibroblasts increases, and sclerosis of the prostatic parenchyma ensues.

The sclerotic process involves adjacent Organs (the bladder neck, the trigone of the bladder, the ureteral orifices, and the Seminal Vesicles), which causes urodynamic disorders in the vesicourethral segment and the intramural sections of the Ureters.

Important factors in the onset of the disease include vascular sclerosis and hemodynamic disturbances that emerge within the prostate regardless of the presence or absence of infection. Reduced Blood flow and insufficient blood supply cause prostate sclerosis not only in elderly individuals but also in young people.

One potential cause of prostate sclerosis may be urinary reflux into the prostate gland. Experimental studies and clinical observations have established that passive urine backflow into the prostate—particularly its peripheral zone—is possible because the prostatic ducts open into the Urethra at a right angle, against the urine flow (Kravets, 1984). Urinary reflux into the prostate can lead to atrophy, stone formation, inflammation, and conditions favorable for pathogen penetration. The consequences of urinary reflux include the dilation of excretory ducts and The formation of cavities that collect urine. Urinary substances form calculi, and The process of prostatic atrophy progresses. In later Stages of the disease, these cavities in the gland disappear or change shape, being replaced by fibrous connective tissue.

Another potential cause of prostate sclerosis involves mechanical factors (calculi in the bladder, urethra, or prostate). Bladder and urethral stones exert mechanical pressure, promoting urinary reflux into the prostate, which can cause cystic dilation of the prostatic glands, as well as focal inflammatory infiltrates and areas of fibrosis in the stroma. In areas of fibrosis, the glands are sharply atrophied, devoid of epithelium, and compressed within inflammatory infiltrates. Massive inflammatory infiltrates are observed around altered glands, enveloping their excretory ducts like sleeves; epithelial metaplasia occurs in the terminal sections of the excretory ducts; and proliferation of fibrous connective tissue occurs around the glandular lobules, extending into the glandular lumen (Mavrov and Glebova, 1975). Prostate sclerosis may also result from past trauma and surgeries, or frequent urethral sounding (Karpenko et al., 1985).

Sclerotic Changes in the prostate can occur As a result of autoimmune and allergic factors, exposure to certain toxic substances, and hormonal medications. Congenital Anomalies of the urethra are also among the causes capable of triggering prostate sclerosis.

The Clinical presentation of sclerosis is highly diverse, driven by anatomical, functional, and morphological changes in the prostate, bladder, and ureters. The disease manifests as voiding dysfunction, pain, sexual disorders, chronic renal failure, pathological impurities in the urine, and the formation of urinary fistulae. Hemodynamic disorders, slowed blood flow, and inadequate blood supply cause pain and lower Urinary Tract symptoms.

Voiding disorders include: dysuria with various Clinical Features (burning sensation, a narrowed and sluggish urinary stream); frequent urination, observed early in the disease (associated with cystitis and trigonitis); incomplete bladder emptying, forcing patients to strain or massage the suprapubic area; an interrupted urinary stream, indicating Bladder stones; Urinary Incontinence; and quite frequently, Acute Urinary Retention, typically occurring with an overdistended bladder or following endovesical manipulations.

Most commonly, pain in prostate sclerosis occurs in the Perineum, rectum, groin, urethra, testicles, and occasionally in the lumbar region or the Pubic Symphysis. Constant, unremitting pain indicates a complicated course of prostate sclerosis. Glandular dysfunction causes profound dystrophic changes in the reproductive organs.

Frequently, symptoms of sexual dysfunction dominate the clinical picture of prostate sclerosis. Signs of sexual disorders (decreased libido, lack of adequate erections, premature ejaculation, lack of satisfaction from intercourse, muted orgasm, etc.) coincide temporally with pain in the sacrum, perineum, along the spermatic cords, and dysuric disorders. Some patients note a worsening of their condition and burning pain during urination.

In A number of cases, prostate sclerosis is accompanied by renal failure, indicating a progressive disease course and the involvement of the upper urinary tract and Kidneys in the inflammatory process.

The Diagnosis is established based on a detailed medical history, correlation of patient Complaints with objective findings, and the results of urological and Laboratory tests. A targeted examination of the act of urination, the condition of the urethra, prostate, bladder, upper urinary tract, kidneys, and sexual function allows for an accurate diagnosis.

Urinalysis generally reveals leukocyturia, while a small proportion of patients show isolated leukocytes in the urinary sediment. Proteinuria is noted in patients whose prostate sclerosis is complicated by Pyelonephritis.

Important diagnostic tools include uroflowmetry, cystoscopy, radiography, radionuclide imaging, electromyography, and ultrasound. Palpation of the prostate helps clarify the diagnosis: in sclerosis, the gland is firm, reduced in size, and moderately tender. No secretion is expressed during prostate massage. A pathognomonic symptom of prostate sclerosis is also the narrowing and shortening of the prostatic urethra.

Treatment. The primary treatment method for prostate sclerosis is surgical, aimed at removing the pathological focus, restoring normal urination, and eliminating stasis in the upper urinary tract. Treatment is more effective the earlier the surgery is performed. Medical therapy plays an auxiliary role during preoperative preparation and in the postoperative period.