29.03.2024

Fibrosis (sclerosis) of the prostate: symptoms and treatment

Persistent with frequent relapses inflammation of the prostate gland – the cause of fibrosis of prostate.

The pathological process leads to the formation in the parenchyma of the body seals that will eventually spread to the vesicles, bladder neck, the mouth of the ureters.

These changes disrupt the function of the genitourinary system men, provoke the symptoms of obstruction of the lower urinary tract.

The replacement of functional tissue connecting inevitably changes the architecture of blood and lymphatic vessels, which contributes to hypoxia in the tissue.

As a result of fibrosis of the prostate may be sclerosis. When hardening of the tissue are sealed, and the iron itself is compressed, reduced in size.

And fibrosis, and multiple sclerosis part of the same pathological process.

Predisposing factors to fibrosis of the prostate

Factors contributing to fibrosis of the prostate, several:

  • the formation of an inflammatory infiltrate on the background of trauma (surgery, iatrogenic damage, diagnostic studies, etc.), sexually transmitted infections, prostatitis, kidney stones;
  • anomalies of development of organs of the urogenital system;
  • atherosclerosis;
  • the passage of radiotherapy on the small pelvis organs;
  • it’s congestion of: the absence of regular ejaculation, varicose disease of the pelvic organs, low motor activity;
  • genetic predisposition;
  • autoimmune diseases;
  • allergic reactions;
  • the action of the toxins;
  • the use of hormonal drugs;
  • endocrine diseases: diabetes mellitus type 2;
  • aging with change of a hormonal background.

Fibrosis at a young age can lead to negative changes in the semen and infertility.

Basic mechanisms:

  • Atherosclerosis: venous congestion – hypoxia – activated kollageninducyruemuyu functions of fibroblasts.
  • Stones and trauma: intraprostatically reflux atrophy and inflammation – prostatitis (stones in the prostate gland) – enhanced synthesis and replacement of defects of fibrous connective tissue.
Pathogenesis

Fibrosis can be considered as erroneous wound healing process characterized by activation and accumulation of myofibroblasts, which temporarily occur in many tissues as a normal part of the response to a violation of integrity. Several types of cells, including fibroblasts, pericytes, fibroblasts and mesenchymal cells can be converted into an myofibroblast. Common features of differentiation myofibroblasts are the expression of α-smooth muscle actin (α-SMA) and collagen type I, an ECM component, encoded by myofibroblastoma.

Myofibroblasts with α-SMA form focal adhesions with the surrounding collagen ECM. The subsequent closing of the wound reduces them to mechanical stress, potentially feel of α-SMA, which is considered mechanosensory proteins, which leads to dissolution of focal adhesions disassembly of α-SMA and eventual apoptosis of myofibroblasts. If closure of the wound occurs, myofibroblast not receive a mechanical signal for apoptosis and continue to accumulate and precipitate the ECM, thereby replacing the normal tissue and fibrous.

Fibrosis occurs after the inflammation is considered a natural healing process, which is characterized by the accumulation of myofibroblasts, deposition of collagen, remodeling of the extracellular matrix (ECM), increased density of tissues and loss of elasticity

Symptoms and signs of fibrosis of the prostate

The clinical picture is diverse, patognomonichnykh no complaints. Similar symptoms were found in all diseases associated with difficulty of urination in the background of the obstruction of the lower urinary tract:

The complaints are worth paying attention to:

Complications that can develop on the background of fibrosis of the prostate:

How to diagnose fibrosis of the prostate

For the diagnosis of fibrosis (sclerosis) of the prostate are used by all methods of examination for prostatitis, but the criterion, which would confirm the diagnosis a biopsy.

Initially, during a visit to the reception, the doctor will evaluate all of the complaint, conduct an external examination and transrectal propellerom the prostate gland. If the disease is in an advanced stage – the number of prostate secretion on the background of massage will be minimal.

To improve the accuracy of diagnosis, before taking the juice of the prostate gland should refrain from ejaculation for 2-3 days.

Instrumental diagnostics

Necessarily that when you appeal to the doctor will performed all of the above methods of diagnosis of fibrosis of prostate. The scheme of examination is determined by the expert in each case individually.

Laboratory diagnosis

The analyses do not to confirm the change of the tissue structures of the prostate, and to clarify the overall picture of the disease and possible complications.

In the scheme might include the following:

Treatment of fibrosis of the prostate

Pathology is difficult to drug therapy, as processes of replacement of functional tissue on the fibrous irreversible. Treatment can be prescribed for people with fibro prostatitis, prostate adenoma, which are accompanied by violation of the outflow of urine, if structural changes have not gone too far.

Often a man ignores the symptoms of distress and did not go to the doctor.

It is unreasonable, as in the early stages of the disease is the effect of the following events:

  • physiotherapy: laser therapy, exposure to agents, by using, massage, mud tampons, etc.
  • the broad-spectrum antibiotics and anti-inflammatories;
  • antispasmodics and analgesics;
  • adaptogens;
  • herbal;
  • antidepressants (with the intractable pelvic pain syndrome);
  • biostimulants;
  • enzymes;
  • multivitamins;
  • hormone replacement therapy for confirmed low levels of androgens;
  • drugs that improve the microcirculation in the tissues of the prostate.

For improvement of outflow of urine, if symptoms of obstruction to urination, prescribed alpha-blockers and inhibitors of 5-alpha reductase.

If the background of conservative therapy positive dynamics was not observed, the only chance is an operation.

Indications for surgical intervention:

  • a large amount of residual urine in the bladder;
  • adverse changes in the kidney (progression of renal hydronephrosis, renal failure);
  • the absence of effect from therapy;
  • the frequent recurrence of urinary tract infections;
  • intractable pain syndrome;
  • urolithiasis;
  • dysfunction of the lower urinary tract.

Modern surgical intervention in complicated sclerosis of the prostate:

  • transurethral resection (TURP);
  • surgical laser ablation.

Laser ablation is preferred since the method effects on tissues more gentle, and the need for re-intervention is less.

The study was conducted, which demonstrated that when violation of urination associated with obstruction of the lower urinary tract, a more effective surgical approaches (TURP or laser ablation) and medical treatment alpha-blockers and inhibitors of 5-alpha reductase only stabilizes the condition.

What are the new developments underway for the treatment of fibrosis of the prostate

Some experts believe that antifibrotics drugs can be effective for treating/slowing the progression of fibrosis of the prostate and restore adequate flow of urine on the background of obstruction of the lower urinary tract.

Some antifibrotics drugs are currently in preclinical or clinical trials for idiopathic pulmonary fibrosis. Pirfenidone, which targets the TGF-β is approved for use in Japan and the European Union. Therapy designed to inhibit the activity of specific inflammatory proteins such as TNF-α (etanercept), interleukin-13 (QAX576) and CCL2 (CNTO-888), is in clinical trials phase II. These new substances are designed to interfere in the activity of specific proteins that contribute to proconvertin of myofibroblasts or products of the ECM, including TGF-β1, a growth factor of connective tissue, lysyl oxidase, interleukins, chemokines, CC-type integrins and signaling proteins (e.g., JNK and Jak2). Some of these substances may be useful for the treatment of dysfunction of the urinary tract, fibrosis is supported by men without surgical ablation.

It is possible that the methods of introduction of new drugs will not be the system, the substances will affect the desired tissue by instillation into the bladder, or injection into the prostate.

Thus, the inflammation of the tissues caused by aging, infection or other processes associated with subsequent development of fibrosis in the prostate gland, which leads to disruption of the functions of the organs of urination.

In some cases, the disease process could prevent or slow down, but focus is on treatment of the underlying disease.

Regular sex life, the only proven partner, exercise and annual preventive examination by a urologist can help a man to maintain health.

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