RU
What lies behind the term «Prostatovesicular reflux»?
Prostatovesicular reflux (PVR) is a pathological condition characterized by the retrograde movement of urine from the bladder into the tissues of the prostate gland. Under normal circumstances, urine should flow unidirectionally — from the kidneys through the ureters into the bladder, and then externally via the urethra. However, under certain conditions, this natural process is disrupted, resulting in a portion of urine being propelled back into the prostate.
What causes the reverse flow of urine into the prostate gland?
The etiology of urine reflux into the prostate can be multifaceted. Here are some of the most prevalent factors contributing to the development of PVR:
- Congenital anomalies in the structure of the urinary tract or the prostate gland itself, creating preconditions for reverse urine flow.
- Dysfunction of the bladder and urethral sphincters, leading to incomplete closure and insufficient sealing capacity.
- Increased intravesical pressure during urination due to straining, prolonged suppression of urges, or bladder overdistension.
- Inflammatory processes in the urinary tract, prostate, or urethra, causing edema and obstruction.
What symptoms may indicate the presence of PVR?
The clinical manifestations of prostatovesicular reflux are diverse and largely depend on the severity of the urine backflow, as well as the presence of secondary infection and concomitant complications. The most characteristic signs of PVR include:
- Dull, dragging, or stabbing pain in the perineum, groin area, lower abdomen, or scrotum
- Increased urinary frequency, predominantly at night
- Difficulties during urination: weak stream, intermittency, pain, or burning sensation
- Sensation of incomplete bladder emptying after using the toilet
- Macrohematuria (visible blood in urine) or hemospermia (blood in semen)
- Fever, chills, general intoxication of the body
- Rapid fatigue, decreased work capacity, apathy
It's crucial to remember that many of these symptoms can occur in other genitourinary diseases, so self-diagnosis is inadvisable. Only a qualified specialist can determine the true cause of the ailment after a comprehensive examination.
What are the potential consequences of untreated PVR?
Ignoring the initial signs of urine reflux into the prostate gland and the absence of adequate therapy can lead to serious repercussions for men's health:
- Development of chronic inflammatory process in prostate tissues (chronic prostatitis)
- Formation of purulent cavities in the prostate gland (prostatic abscess)
- Replacement of functional prostate tissue with scar tissue (prostatic sclerosis)
- Involvement of seminal vesicles in the inflammatory process (vesiculitis)
- Spread of infection to the epididymis (epididymitis)
- Reduced fertility up to complete sterility (infertility)
How is urine reflux into the prostate diagnosed?
To detect prostatovesicular reflux and determine its severity, a urologist may order a series of additional investigations:
- Patient interview and physical examination with prostate palpation
- Laboratory tests: urinalysis, urine culture with antibiotic sensitivity, prostate secretion analysis
- Ultrasound scanning of the pelvic organs and bladder
- Internal examination of the bladder and urethra using an endoscope (urethrocystoscopy)
- Assessment of bladder and sphincter function (urodynamic tests)
- X-ray examination with contrast medium injection (voiding cystourethrography)
What does voiding cystourethrography reveal in PVR?
Voiding cystourethrography (VCUG) is considered the most informative method for diagnosing urine reflux into the prostate. During the procedure, a radiopaque contrast agent is introduced into the bladder via a catheter, followed by a series of images taken during urination. The radiographs clearly show the retrograde flow of contrast from the bladder into the prostatic urethra and prostate tissues. This not only confirms the presence of PVR but also allows for determining its degree according to the international classification.
What treatment methods exist for prostatovesicular reflux?
The therapeutic approach to reverse urine flow into the prostate gland depends on various factors: disease duration, reflux severity, presence of secondary infection, and concomitant pathologies. The main treatment goals are to eliminate the causes of PVR, alleviate symptoms, and prevent potential complications. The primary treatment methods include:
- Antibacterial drugs to suppress the infectious process in the urinary tract and prostate.
- Alpha-adrenoblockers, which reduce the tone of the prostate's smooth muscles and bladder neck, thereby improving urine passage.
- M-cholinolytics, relaxing the detrusor muscle of the bladder and reducing intravesical pressure.
- Physiotherapy procedures: heat treatments, prostate massage, electromyostimulation.
- Surgical intervention in cases of ineffective conservative therapy and significant anatomical abnormalities.
Can PVR development be prevented?
To reduce the risk of urine reflux into the prostate gland, it is recommended to adhere to several simple rules:
- Seek medical attention immediately upon the appearance of the first signs of urinary tract infection or prostatitis
- Avoid excessively long intervals between urinations, empty the bladder completely
- Prevent overcooling, especially in the pelvic area
- Regularly engage in moderate physical activity, gymnastics, swimming
- Maintain a balanced diet, limiting spicy, fatty, and smoked foods
- Undergo an annual preventive examination by a urologist after the age of 40
Conclusion
Prostatovesicular reflux is a rather insidious condition that, in the absence of proper attention and treatment, can lead to a whole «bouquet» of serious urological problems. However, there's no need for despair — timely diagnosis and expertly selected therapy allow for successfully coping with this ailment and preserving men's health for many years to come. The key is to listen to your body, not be embarrassed to consult a doctor at the slightest discomfort, and strictly follow all specialist recommendations. Remember, taking care of yourself is not a whim, but a vital necessity!