Prostate cysts are cyst-like changes in the prostate gland due to congenital or acquired causes. Congenital cysts are incomplete degeneration of the paramedian ducts, which fuse in the median line and form a deep diverticulum or cyst under the bladder that opens posterior to the prostatic urethra. Acquired cysts are incomplete or intermittent obstruction of the alveoli caused by a tough prostatic stroma, which gradually thickens the alveolar epithelium and eventually results in a retention cyst. They can be located anywhere in the prostate or protrude into the bladder neck and are 1 to 2 cm in diameter.
The prostate cyst can be complicated by infection and stones. Larger cysts can compress the urethra and cause difficulty in urination, with common symptoms such as urinary urgency, frequency, effort to urinate, thin urine lines and urinary retention. Congenital prostate cysts are often associated with congenital disorders such as hypospadias, cryptorchidism, and renal insufficiency. In large cysts, the cyst is palpable in the prostate on rectal examination, and the urethrography shows curved pressure marks in the posterior urethra. Smaller, asymptomatic cysts may not require treatment, while larger cysts or small cysts with symptoms may be treated surgically. Cyst puncture aspiration via perineum or transrectum under ultrasound localization followed by injection of coagulant has been reported, but it is prone to recurrence.
Common causes
The prostate gland is obstructed during embryonic development, and the prostate stroma causes incomplete or intermittent obstruction of the alveoli.
Common symptoms
Urinary urgency, frequent urination, straining to urinate, thin urine line, urinary retention, etc.
Etiology
1. True prostate cysts
The prostate gland is obstructed during embryonic development, causing narrowing of the prostatic ducts, resulting in obstruction and gradual retention of the contents, so it is a retention prostate cyst.
2, congenital cysts
The cyst is formed by the abnormal development of the middle renal duct and the middle paranephric duct and the partial expansion of the duct lumen. The cysts that originate from the parametrial duct are often located in the middle of the posterior prostate, while the cysts that originate from the parametrial duct are located at the sides. These cysts do not actually originate in the prostate gland and often adhere to the posterior bladder wall. The size of the cyst can often grow to be so large that pressure on the bladder neck causes difficulty in urination and pressure on the rectum causes a feeling of anal swelling and difficulty in defecation. The congenital prostate cyst is often accompanied by congenital diseases such as hypospadias, cryptorchidism and renal insufficiency.
3. Acquired cysts
It is caused by incomplete or intermittent obstruction of the glandular follicles due to the tough prostate stroma, which gradually thickens the epithelium of the glandular follicles and eventually results in retention cysts, which can be located anywhere in the prostate or protrude into the bladder neck, with a diameter of 1 to 2 cm.
4, inflammatory cysts
It is a chronic inflammation of the prostate that causes the connective tissue to proliferate, leading to narrowing of the prostate duct and retention of secretions to form cysts.
5. Parasitic cysts
The cysts are caused by parasites, such as worms that cause chronic inflammation in and around the prostate ducts; or by granulomatous hyperplasia, which gradually forms cysts.
The above-mentioned cysts are most common with retained prostate cysts, which can occur in any part of the gland.
Clinical presentation
Prostatic cysts consist of normal glandular vesicles, or are multi-housed, with vesicles lined with columnar epithelium, some with hypocubic epithelium, and the capsule is filled with plasmacytic or plasma blood fluid. Prostate cysts can be complicated by infection and stones. Larger cysts can obstruct urine flow when they grow and press against the urethra or bladder neck. Common symptoms include urinary urgency, frequent urination, straining to urinate, thin urine line, urinary retention, etc. When pressed against the rectum, it can cause difficulty in defecation. If the cyst is large, the cyst can be palpated in the prostate on rectal examination.
Examination
1.Cystoscopy
A semicircular, or tipped, round, transparent mass of 1 to 2 cm in diameter can be seen protruding from the neck of the bladder. Most of them are acquired cysts.
2.X-ray examination
(1) Intravenous urography? can detect urinary tract abnormalities, such as renal dysplasia, etc.
(2) Urethrography? It does not show because the cyst is not connected with urethra, and there is no abnormal finding.
3.B-type ultrasonography
A round or oval transmissive area with smooth inner wall, clear edges and no internal echogenicity can be found in the prostate area. Transrectal ultrasound shows a well-defined, round, echogenic area extending from the center of the prostate to the upper posterior, in the shape of a teardrop, connected to the seminal frenulum by a small tip.
4.CT examination
A large prostate cyst and a Mullerian duct cyst are located in the posterior midline of the prostate and are round, well-defined cystic lesions with aqueous density.
5, rectal or perineal puncture
If the cyst is too large, the cystic fluid can be extracted by rectal or perineal puncture. Acquired cysts are clarified mucus, or may be dark brown or bloody, and the cyst fluid may contain sperm.
Diagnosis
Pathological changes in prostate cysts can be diagnosed by pathological sections of the cysts. Understanding the mechanism of prostate cyst formation can be very helpful in the diagnosis of prostate cysts.
Treatment
Smaller asymptomatic cysts do not need to be treated, while larger cysts or small symptomatic cysts can be treated surgically via transcystal, extracystal, perineal, transrectal and other routes. Surgical excision is often incomplete due to poor exposure, with a high recurrence rate and many complications. Surgical resection of cysts near the perineum by trans-perineal approach is likely to cause ED and should be used with caution in young patients. There are reports of trans-perineal or trans-rectal cyst puncture and aspiration under ultrasound positioning, followed by injection of coagulant, but they are prone to recurrence. Cysts near the urinary bladder or protruding into the bladder are removed with transvesical surgical resection or transurethral electrodesiccation to remove most of the top of the cyst to allow adequate drainage. Laparoscopic resection of prostate cysts has the advantages of clear tissue exposure, short operative time, less damage to pelvic tissues, less trauma, no fistula, less bleeding, etc. It is the preferred method for treating prostate cysts that protrude toward the back of the urethra and bladder neck. For cysts near the urethra or protruding into the bladder, transurethral electrical resection of the cyst is the best route for the procedure, but in younger patients, preservation of the seminal caruncle is essential for normal ejaculation. When a patient has persistent high fever that does not subside, urinary symptoms that do not improve significantly, urethral overflow of pus, and bowel irregularities, the possibility of a prostate cyst should be considered and treated with abscess incision and drainage or puncture and drainage after the diagnosis is confirmed with the help of ultrasound and other tests. Only when the abscess is completely eliminated will the above symptoms be relieved.
Puncture treatment is relatively simple. A long needle is inserted into the abscess cavity through anal diagnosis and aspirated with a syringe until the pus is completely removed. Sometimes it will not be completely eliminated at one time, and two or several times are needed to achieve satisfactory results.
When the pus cavity is large and there is a lot of pus, it is better to drain the pus cavity by incision. The anorectoscope is used to expose the prostate area, and a sharp knife is used to cut the rectal wall into the abscess cavity, drain the pus out and place a drainage tube, depending on the drainage, and then decide the time to remove the drainage tube in conjunction with the examination. The current treatment still requires the use of antibiotics with the treatment.
The physiotherapy is helpful for both acute prostatitis and abscesses. It is a good idea to use it to promote the absorption of inflammation.
Prevention
1, pay attention to personal cleanliness and hygiene.
2, adjust the work, life rules, work and rest, avoid excessive fatigue. According to the change of temperature, you should increase and decrease clothes at the right time to avoid catching cold.
3.Keep your bowels open, have regular bowel movements every day, and eat more vegetables in your daily diet. Eat the right amount of fruit and the right amount of activity, in the event of constipation should be timely treatment.
4, keep a relaxed mood, optimism and open-mindedness, timely detoxification of their bad mood.
5, over a regular, responsible sex life, should not be too frequent, but not without, generally to have sex the next day without fatigue is appropriate.
6, do not eat chili and other stimulating food, arrange three meals a day, to achieve a balanced diet.
7, drink more water, drink at least 7 glasses of water a day (about 2000 ml), every morning after waking up that a glass of water (70 ml).
8, do not sit down, sit for an hour or so to stand up and move around.
9, moderate exercise.