Sexually Transmitted Diseases - I. I. Mavrov 2005

Vascular Diseases of the Genitals
Venous Stasis of the Prostate

Prostatic venous stasis is a pathological circulatory disorder caused by impaired venous Blood outflow. The Blood supply to the Prostate Gland and the Urinary Bladder is interconnected. Branches of the inferior vesical Arteries, running through the periprostatic tissue, supply the prostate. Small branches originating from the middle rectal artery extend to the posterior surface of the gland. Additionally, a branch from the internal pudendal artery, known as the arteria prostatica, supplies the organ. The arterial vessels on both sides of the prostate anastomose with one another. The prostatic Veins form a plexus (plexus venosus prostaticus) situated between the capsule and the Fascia of the gland. The prostatic venous plexus represents the lower section of the larger vesicopudendal venous plexus (plexus venosus vesicopudendalis), which receives the dorsal VEINS OF THE Penis and the posterior scrotal veins. This plexus anastomoses with the hemorrhoidal veins and the vesical plexus, located on the lateral walls and the Base of the urinary bladder. The blood supply to the prostate gland and its venous network ultimately lead to The Development of venous congestion within the prostate.

Etiology AND Pathogenesis. Factors predisposing to this condition include the stagnation of prostatic secretion and ejaculate within the gland, alongside venous stasis associated with blood pooling in the pelvic veins, with which the prostate is connected via anastomoses.

The causes of secretory stasis and venous stasis in the prostate stem from various sexual dysrhythmias (coitus interruptus, prolonged abstinence, irregular or unpaced sexual activity, and sexual abstinence). In the pelvis, venous stasis can be triggered by varicosities, proctitis, and other inflammatory processes.

Numerous anastomoses between the pelvic veins and the prostatic veins ensure that even minor venous stasis in the pelvis leads to venous stasis within the gland, predisposing it to congestive or infectious prostatitis and causing persistent inflammation.

Hemodynamic Disorders of the prostate lead to a sharp decline in its metabolic processes, accompanied by impaired barrier, secretory, incretory, and motor Functions. Hemodynamic disturbances cause alterations in the interstitial tissue of the prostate: it becomes edematous and loosened, and the number of cellular elements in the stroma decreases. Simultaneously, the function of smooth Muscle elements is impaired, resulting in a reduced MOTOR FUNCTION OF the prostate gland (I. I. Mavrov, 1978; I. F. Yunda, 1984). This, in turn, promotes secretory stasis within the acini and exacerbates existing hemodynamic disorders.

Clinical manifestations. During Puberty and, particularly, active sexual life, patients may experience dull, uncomfortable sensations in the perineal region, especially after prolonged standing or occupational standing; nocturia, where a large volume of urine is passed at night rather than during the day; and occasionally painful, difficult urination. In some cases, these symptoms are mild and cause minimal discomfort. Prolonged sexual abstinence or sexual excesses, as well as alcohol consumption, disrupt prostatic hemodynamics and intensify these clinical manifestations.

VARICOSE VEINS OF the lower extremities and hemorrhoidal veins, especially in individuals prone to thrombophlebitis, can cause congestive prostatitis. Pronounced prostatic venous stasis serves as a predisposing pathogenetic factor for bleeding, particularly during and after prostatectomy.

Diagnosis involves examining the lower extremities and hemorrhoidal veins; palpating inflammatory infiltrates along the course of dilated veins; and evaluating the Blood Coagulation and anticoagulant systems.

Treatment aims to eliminate varicose veins either conservatively (wearing compression stockings, hirudotherapy, therapeutic exercise, etc.) or surgically. When congestive prostatitis develops, therapeutic and preventive measures focus on correcting sexual dysrhythmias, eliminating the causes of pelvic venous stasis, and treating inflammatory and congestive Diseases of the pelvic Organs.

Reflexotherapy is prescribed in combination with other therapeutic measures. If conservative therapy proves ineffective, Surgical treatment is applied.