What types of prostate cysts are there?
Congenital cysts are associated with the preservation of remnants of embryonic structures: these are cysts of the prostate uterus and Müllerian cysts located along the midline of the gland. Acquired cysts are much more common and are formed when the excretory duct of the prostate lobule becomes clogged with thickened secretions, inflammatory edema, or an adenoma node. The secretion continues to be produced and stretches the duct, forming a cavity. Separately, cysts are distinguished after inflammation and abscess, as well as cysts of the seminal vesicles and ejaculatory ducts, which can affect the quality of sperm.
- Congenital cysts along the midline of the gland
- Retention cysts due to blockage of the duct
- Cysts after prostatitis
- Cysts associated with prostate adenoma
- Vas deferens cysts
- Post-abscess cavities
Symptoms and when they appear
Small cysts do not produce symptoms and remain an incidental finding. Complaints appear when the formation reaches a size at which it compresses the urethra or the neck of the bladder. Then the stream of urine weakens, urination becomes intermittent, a feeling of incomplete emptying and frequent urges at night appear. Midline cysts can cause discomfort in the perineum, pain during ejaculation and a decrease in ejaculate volume. With suppuration, the picture changes dramatically: the temperature rises, pain in the perineum becomes pronounced.
- Most often asymptomatic
- Weakening and intermittency of urine stream
- Frequent urges, including at night
- Feeling of incomplete emptying of the bladder
- Discomfort in the perineum and rectum
- Pain during ejaculation, decreased sperm volume
Survey
The main method is transrectal ultrasound of the prostate: it shows the size, location, contents of the cyst and its relationship to the urethra and ejaculatory ducts. A routine ultrasound of the bladder and prostate allows one to assess the volume of the gland and residual urine. Uroflowmetry objectively measures the rate of urine flow. A urine test is required, and for men over a certain age, a PSA test is required to rule out concomitant pathologies. If the picture is unclear, or there is a suspicion of an abscess or tumor component, an MRI of the pelvis is performed.
- TRUS of the prostate is the main method
- Ultrasound of the bladder with determination of residual urine
- Uroflowmetry
- Urinalysis and culture if infection is suspected
- PSA total and free
- MRI of the pelvis with an unclear picture
Treatment
Asymptomatic small cysts are not treated: control TRUS once a year is sufficient. If the cyst is causing urinary problems, recurring infections, pain, or infertility, a urologist will consider active options. Most often, cyst puncture is performed under ultrasound control with evacuation of the contents, sometimes with sclerosis of the cavity. For large cysts located close to the urethra, endoscopic opening through the urethra is used. A festering cyst requires urgent drainage and antibiotics. Medicines cannot remove the cyst itself: drugs treat the accompanying inflammation.
- Observation and control TRUS for asymptomatic cysts
- Ultrasound-guided puncture and drainage
- Endoscopic opening of large cysts
- Urgent drainage for suppuration
- Treatment of concomitant prostatitis and adenoma
- Antibiotics only as prescribed by a doctor
Surveillance and prevention
There is no specific prevention of prostate cysts, but most acquired cysts are associated with stagnation of secretions and inflammation, so the measures coincide with the prevention of prostatitis. Regular physical activity, avoiding sitting for long periods of time without breaks, regular sex life, timely treatment of urinary tract infections and adequate fluid intake are helpful. For men over 50 years of age and with a family history, an annual examination by a urologist with ultrasound and PSA is recommended - this allows timely detection of not only cysts, but also more serious changes.
- Annual examination by a urologist after 50 years
- Control TRUS according to the schedule established by the doctor
- Regular physical activity
- Breaks during prolonged sedentary work
- Timely treatment of urinary tract infections
- Refusal of self-medication with warming
