Seminal vesicle. Symptoms and treatment of inflammation of the seminal vesicles What is the seminal vesicle needed for?

SEMINALS(vesiculae seminales, glandulae seminales) represent a paired organ developing from the Wolffian canals, | consisting of two sac-like formations located between the infero-posterior wall of the bladder and the ampulla of the rectum, above the upper edge of the prostate gland; directed with their longitudinal axis from top to bottom and inside, with their apex extending 4-5 times above Lieto’s triangle and the mouth of the ureters cm. The lower end of the S. p. fits under the upper edge of the prostate gland, so that the latter overlaps them. With their necks, the S. p. form a not entirely closed angle, and in newborns and people over 60 years old it is obtuse, and in mature and old age it is 60-80°. The peritoneum, passing from the bladder to the upper surface of the S. p., covers them for 1-2 cm, then ascends along the rectum.-S. n. of an adult is usually 4-5 cm length, 1.5-2 cm wide and 1-1.5 cm thickness represents Seminal vesicles protrude a winding pipe-stata and ductus deferens: 1- „ nfip gtpppttkg ductus deferens; 2-ampul-K U>J 10 ooe sides

la ductus deferentis; 3 -di-verticula ampullae; 4 -ductus excretorius vesiculae seminalis; 5-ductus ejacula-torius; 6-isthmus prosta-

Both cut have 3-5 side tubes. The lower edge of the tube emerging from the neck of the putae; 7-basis prostatae; 8- zyrka, forms d. lobus sinister; 9 - lobus PX p r ptnriii4 Ggm mrr ^ dexter; 10 - urethra; 11 - excreionus ^CM. rice.), corpus vesiculae seminalis. The K-th, together with the canal of the ampulla of the efferent duct, forms the ejaculatory duct (d. ejaculatorius). S. items are placed in a bag, consisting mainly of connective and muscle tissue; their surface is tuberous, ellipsoidal in shape, slightly flattened in the anteroposterior direction. Abundant blood supply originates from the hypogastric artery with vessels extending from it: inferior vesical (a. vesicalis inf.), middle hemorrhoidal (a. haemorrhoidal. med.). The artery of the external duct (a. deferentialis) is located on its anterior wall and gives off a branch that anastomoses with the middle hemorrhoidal artery and with the lower branch of the testicular artery (a. spermatica int.). The veins generally correspond to the course of the arteries; the vein of the efferent duct, coming from the tail of the epididymis, connects with the external vein of the testicle. These veins form a plexus surrounding the efferent duct, ampulla and passing into the plexus of the prostatic venosus (pi. venosus seminalis) and further into the venous vesicoprostatic plexus (pi. venos. vesico-prostaticus). - Lymph, vessels. according to Sappey, numerous and densely anastomose with each other; then gathering into 2-3 trunks, they flow into the hypogastric lymph. vessels. The nerves of the S. p. come from the fibers of the subgastric sympath. plexuses, partly from the n. pelvicus, forming, together with the spinal nerves, plexuses that enclose the spinal cord. The walls of the spinal cord consist of three layers—connective tissue, muscular and mucous membrane. The medial wall, i.e., facing the efferent duct, is thicker than the lateral one. The mucous membrane has jagged elevations of the most varied shapes, from small individual protrusions to a reticulum in some places filling the entire lumen of the S. p. The epithelium is single-layer cylindrical, partly multi-layer cylindrical, sometimes cubic (Zaigraev). - Physiol. the meaning of S. p. is still not sufficiently clarified. The secretion of S. p. is transparent glassy, ​​sometimes yellowish, odorless, alkaline (pH 7.6 according to Armistead). It contains fat-like droplets of varying sizes, some 5-■ 10 times larger than leukocytes, viscous, gelatinous clumps called “sago grains.” When stained, the latter give a reaction to mucin and a weakly positive reaction to fat, easily dissolve in acetic acid and are called simpexions by Roben. The secretion of S. p., according to Kohn's research, contains crystals of three kinds: Reinik's, Lyubarshai and Betcher." The purpose of the secretion of S. p. is to liquefy the environment, causing greater mobility of sperm, to nourish sperm not only inside the S. p., but and in semen ejaculated into the vagina. According to the latest research, S. p. apparently take part in internal secretion. Research methodology S. p.-see. Vesiculitis And Vesiculography. Malformations of S. p. are generally rare. Most often, there is underdevelopment or absence of one S. item. In these cases, there are usually no correspondences. testicles or kidneys. There have been cases of fusion of both S. p. into one, located in the middle, as well as cases of absence of both S. p. The vesiculography method revealed other smaller malformations, such as. connecting both S. points to each other with a tube. The practical significance of these anomalies is insignificant. - Injury of the S. p. is observed extremely rarely due to the deep position and their easy mobility. - - Cysts, ectasia, dropsy and empyema of the S. p. are observed most often due to blockage or obliteration of the ejaculatory duct due to chronically inflammatory process or prostate hypertrophy. Their contents are either pure serous fluid, or cloudy with an admixture of mucus, or pus. The sizes of these formations are extremely different - from a small nut to a tumor extending into the pelvic cavity. Thus, Fronstein described empyema, where the amount of pus in the S. p. exceeded 700 cm\ Diagnosis of these formations does not present any difficulties: when palpating the S. p., an elastic tumor of the appropriate size is felt through the rectum. In doubtful cases, vesiculography can be performed, and in extreme cases, puncture of the S. p. Stones of the S. p. are a relatively rare disease; they are formed due to stagnation of secretion as a result of narrowing of the ejaculatory duct, more often in old age. They consist mainly of calcium phosphate. Their diagnosis is based on palpation of the S. p. through the rectum, preferably on a curved metal bougie inserted through the urethra, and on radiography. Subjective symptoms are expressed in the form of pain during ejaculation, which can reach spermatic colic (colique spermatique). Other symptoms are not much different from the subjective disorders caused by prostatitis, vesiculitis and posterior urethritis. Treatment consists of trying to crush and remove the stone through the ejaculatory duct by pressing on the S. p. through the rectum. For pain, hot sitz baths and even drugs are prescribed. In severe cases, surgical intervention should be resorted to. - TumorsSp. both benign and malignant are extremely rare. The most common cancer is S. p., both primary and in the form of metastases or grown from neighboring organs. Recognizing them is quite difficult, but pain in the groin area, colon and perineum, difficulty defecating and urinating should raise suspicion of this disease. Cystoscopically, there is bullous edema in the area of ​​the corresponding seminal vesicle. When palpated through the rectum, a lumpy, enlarged seminal vesicle can be felt. - Little is known about the syphilitic disease S. p. Individual cases of THIS Suffering are described.M. Having started playing.

In isolated form, inflammation of the seminal vesicles (synonyms - vesiculitis, spermatocystitis) is quite rare. Most often it is detected together with prostatitis and other diseases of the genitourinary system in men. Chronic vesiculitis is recorded more often than acute.

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  1. Anatomy and function

  The seminal vesicles (vesiculae seminales) are paired organs located between the prostate, rectum and bladder. On the inside of the vesicle is the vas deferens. Such close arrangement of organs leads to the fact that inflammation, starting in one of them, can quickly spread to the seminal vesicles.

  Vesiculae seminales have:

  1. 1 front surface, tightly fused to the bottom of the bladder;
  2. 2 posterior surface adjacent to the ampulla of the rectum;
  3. 3 the base of the bubble is its upper rounded end;
  4. 4 the body of the bubble – its expanded middle part;
  5. 5 the lower part, which passes into the ejaculatory duct. The lower part is narrower and smoother than the body, lying at the base of the prostate gland.

  The wall of the seminal vesicle consists of the following layers:

  • external – connective tissue;
  • muscular - longitudinal muscle fibers are located on the outside and circular muscle fibers in the inner part of the layer;
  • internal – mucous membrane.

  In fact, the seminal vesicle is a 5 x 2 x 1 cm sac, which has a cellular structure on the inside and opens at the bottom into the ejaculatory duct. If the superficial and muscular layers are partially removed, the vesiculae seminales look like highly convoluted tubes up to 10-12 cm long when straightened.

  

  Figure 1 - Anatomy of seminal vesicles (seminal vesicle): left in section. Illustration source - Medscape.com

  1.1. Internal structure of seminal vesicles

  The mucous membrane has numerous protrusions, resulting in the formation of multiple interconnected cells (vesicles). Epithelial cells produce a secretion that makes up 50-60% of the seminal fluid. It is necessary to maintain the life of sperm, as well as protect them from adverse effects. The production of this secretion is controlled by the hormone testosterone. Spermiophages are also present here, destroying old sperm.

  1.2. Blood supply and innervation

  The seminal vesicles receive innervation from the nerve fibers of the plexus of the vas deferens. Involuntary contractions of the muscular membrane at the time of ejaculation lead to the expulsion of secretions containing sperm into the ejaculatory duct.

  Blood supply of vesiculae seminales:

  • artery of the vas deferens, middle rectal artery, inferior artery of the bladder;
  • venous plexus of the bladder;
  • lymph outflow - to the internal iliac lymph nodes.

  Currently, most experts believe that vesiculae seminales perform the following functions:

  • Participation in the process of ejaculation - contraction of the muscle layer of the vesicles causes the secretion of the seminal vesicles to mix with the secretion of the prostate and directs the resulting sperm into the urethra.
  • Destruction of old spermatozoa by spermiophages.
  • Ensuring the viability of sperm - the epithelial cells of the seminal vesicles produce fructose, which gives the male reproductive cells the necessary energy, and also synthesize an alkaline secretion that envelops the sperm and protects them when they enter the vagina from the adverse effects of cervical mucus.

  2. What is vesiculitis?

  Vesiculitis is an inflammation of the seminal vesicles caused by a bacterial or viral infection, less commonly associated with impaired blood supply to tissues. The main causative agents of spermatocystitis have always been considered Chlamydia trachomatis.

  Recent studies (Park SH and others, 2015) have also shown the role of nonspecific microflora (Escherichia coli, staphylococci, fecal enterococcus). Tuberculous vesiculitis occurs occasionally. In some patients, the type of pathogenic microorganism cannot be determined.

  Compared to the prostate gland, the seminal vesicles are much less often involved in the inflammation process, so spermatocystitis is not a common disease.

  2.1. ICD X code for spermatocystitis

  According to the international classification of diseases, X revision, vesiculitis has code N 49.0 (inflammatory diseases of the seminal vesicle).

  2.2. Causes of vesiculitis

  At a young age, trichomonas, staphylococcal and gonorrheal infections are more common, and in the elderly, infection with Escherichia coli plays a major role. Fungal vesiculitis can occur in persons with reduced immunity, for example, with long-term use of glucocorticoids, cytostatics, as well as primary and secondary immunodeficiencies.

  The routes of infection penetration into vesiculae seminales are as follows:

  1. 1 Hematogenous. The pathogen enters the blood vessels from existing foci of infection, for example, with sinusitis, tonsillitis, osteomyelitis, ARVI, etc.
  2. 2 Lymphogenic. Characteristic for the spread of infection from neighboring organs - with proctitis, prostatitis, paraproctitis.
  3. 3 Canalicular:
     • ascending, when the infection occurs, the presence of urethral strictures;
     • descending, when the infection spreads through urine flow with other UTIs.

  2.3. Risk factors

  Risk factors for the occurrence of vesiculitis are:

  1. 1 Physical inactivity, sedentary work.
  2. 2 Sexual excesses, masturbation with the introduction of various objects into the urethra.
  3. 3 Interrupted sexual intercourse (especially against the background of urethritis, prostatitis).
  4. 4 Presence of STIs (chlamydia, trichomoniasis, gonorrhea).
  5. 5 Irregular sex life.
  6. 6 Immunodeficiency conditions, hypothermia.
  7. 7 Infections of other genitourinary organs.

  3. Classification and stages of the inflammatory process

  According to the nature of the course, vesiculitis can be acute or chronic. The stages of acute vesiculitis are the same as those of any other acute infectious process: the beginning, the height of the disease and the period of convalescence, which can end with complete recovery or transition to a chronic form. Accordingly, chronic vesiculitis has stages of exacerbation and remission of the disease.

  The stages of the inflammatory process in spermatocystitis are as follows:

  1. 1 Superficial, catarrhal vesiculitis. Inflammation affects only the outer layer of the mucous membrane of the seminal vesicle. Its hyperemia, edema, thickening (infiltration) is observed. The secreted secretion may contain traces of blood, its volume is increased.
  2. 2 Deep. The inflammatory process spreads to deeper layers, including the muscle layer. This leads to compaction and thickening of the wall of the seminal vesicle, and abscesses may form.
  3. 3 Empyema. With the addition of pyogenic flora, intense purulent damage to the tissues of the vesiculae seminales is observed, cavities filled with pus appear.
  4. 4 Paravesiculitis. The inflammatory process affects not only the seminal vesicle, but also the surrounding tissue.

  Empyema and paravesiculitis are usually considered complications of the underlying disease.

  Chronic inflammation that exists for a long time can lead to atrophy of these organs. In general, the following stages of the process can be distinguished:

  1. 1 Thickening of the mucous membrane, disruption of the outflow of the contents of the vesicles. Stagnation further aggravates the inflammatory process and provokes further proliferation of the epithelium and thickening of the walls of this organ.
  2. 2 Atrophy and sclerosis of the mucous membrane. As a result of inflammation, the structures are replaced by connective tissue. In sperm there is a decrease in the amount of fructose and other components necessary for the normal functioning of sperm.
  3. 3 Atrophy of the muscular and outer layer of the seminal vesicle. Deep inflammation leads to the replacement of the muscle layer with connective tissue, so the vesicles gradually lose the ability to fully contract during ejaculation. Vesiculae seminales increase in volume, and progressive erectile dysfunction is observed.

  3.1. What else is dangerous about vesiculitis?

  In addition to empyema and paravesiculitis, there are other serious complications:

  1. 1 Inflammation of the veins of the vesical plexus (thrombophlebitis) - with acute vesiculitis.
  2. 2 Formation of fistulas (for example, when opening an abscess into the rectum, bladder, abdominal cavity) and further spread of infection (also in an acute process).
  3. 3 Male infertility.
  4. 4 Chronic inflammation of the mucous membrane of the urethra, prostate, etc.

  4. Clinical picture of acute vesiculitis

  As an independent disease, acute vesiculitis is rare: it usually occurs against the background of acute prostatitis and urethritis (usually STDs). The final diagnosis should be made on the basis of the clinical picture, the nature of the course of the disease and laboratory and instrumental examination data.

  Symptoms of acute vesiculitis are nonspecific; they can also occur with other diseases of the genitourinary system:

  • Increased fatigue, general weakness.
  • Increase in temperature (not higher than 37.5-38 degrees).
  • Frequent urge to urinate.
  • Pain in the perineum, rectum, anus.
  • Traces of blood in semen (hemospermia).
  • Painful ejaculations.

  A typical symptom characteristic of acute inflammation of the seminal vesicles is the simultaneous occurrence of pain over the pubic symphysis during defecation and the appearance of discharge from the urethra, similar to sperm, with a large amount of pus.

  Ultrasound reveals enlargement and deformation of the seminal vesicles, purulent cavities (abscesses), and a slight decrease in the volume of vesiculae seminales before and after ejaculation (normally they decrease by almost 2 times). With vesiculography, it is possible to visualize an increase in the size of formations, changes in the relief of the mucous membrane, and thickening of their walls.

  CT and MRI are rarely used to confirm the diagnosis, mainly for the differential diagnosis of spermatocystitis with a tumor process. These methods also make it possible to establish an increase in the size of the seminal vesicles, thickening of their walls and other changes characteristic of acute inflammation.

  Laboratory research:

  1. 1 Spermogram - the presence of red blood cells, leukocytes, microorganisms, a decrease in the amount of fructose in the sperm. Altered sperm may also occur. Reducing the volume of ejaculate.
  2. 2 General clinical blood test - acceleration of ESR, increase in the number of leukocytes (leukocytosis).
  3. 3 – the sample may contain pus, blood and bacteria. If the patency of the ejaculatory duct is preserved, then in the first portion of urine there is pus, an abundance of epithelial rejected cells, dead sperm, and bacteria.

  Untreated acute vesiculitis often becomes chronic.

  5. Features of the chronic form

  During exacerbation of chronic vesiculitis, the same symptoms are observed as during acute vesiculitis, but their intensity is less pronounced. As the disease progresses, signs characteristic of atrophy of the seminal vesicles and loss of function become noticeable. These symptoms are quite constant and occur both during the period of exacerbation and during the period of remission of spermatocystitis:

  1. 1 Violation of the ejaculation process (pain, weakness).
  2. 2 Sperm leakage.
  3. 3 Mild aching pain in the rectum, anus, pubis, sacrum, testicles, perineum.
  4. 4 Increased pain during bowel movements or urination, as well as during ejaculation.

  With PRE, the seminal vesicles may be palpated as dense cords. Ultrasound shows thickening of the walls, atrophic changes in the muscle layer and mucous membrane.

  Laboratory data for chronic vesiculitis:

  • Cytological examination of urine - in later stages, cells with altered nuclei and resembling transitional cell carcinoma may be encountered.
  • Spermogram - a decrease in the amount of ejaculate, the presence of mucus in it, an increase in the number of leukocytes, red blood cells, a decrease in the number of sperm or their complete absence.

  In some cases, chronic vesiculitis is completely asymptomatic for a long period of time.

  6. Diagnostic measures

  Diagnosis of spermatocystitis is carried out in several stages:

  1. 1 Examination by a doctor. Anamnesis collection, identification of characteristic complaints, urological examination, DRE. Taking the contents of vesiculae seminales for analysis and isolation of a possible pathogen.
  2. 2 Conducting transrectal ultrasound . This is a fairly informative research method that can be used to confirm the diagnosis with a high degree of accuracy.

  As a rule, analysis of the contents of the seminal vesicles, ultrasound and general examination are sufficient to confirm the diagnosis. Additional laboratory and instrumental studies (transrectal puncture vesiculography, MRI, CT, urine, blood tests, etc.) help clarify the nature of the disease, assess the intensity of inflammation and are used for differential diagnosis.

  7. Patient treatment tactics

  Treatment of vesiculitis is complex and is prescribed in accordance with three basic principles:

  1. 1 Elimination, if possible, of the cause of vesiculitis - etiotropic therapy (antibiotics).
  2. 2 Prevention of disease progression, prevention of complications - pathogenetic therapy.
  3. 3 Alleviation of the patient’s general condition – symptomatic therapy.

  It is unacceptable to treat vesiculitis using folk remedies at home, especially in the acute form.

  7.1. Antibacterial drugs

  For bacterial spermatocystitis, antibiotics are prescribed taking into account the sensitivity of the main pathogen. Until the doctor has information about the pathogen, drugs can be prescribed empirically. The following antibiotics are prescribed to treat vesiculitis:

  1. 1 Nonspecific flora (Escherichia coli, staphylococcus):
     • fluoroquinolones - ofloxacin, ciprofloxacin;
     • macrolides – erythromycin, azithromycin, clarithromycin;
     • nitrofurans – nitrofurantoin, furazidin.
  2. 2 For rare or urogenital infections (ureaplasma, proteus, klebsiella, mycoplasma, gardnerella, gonorrhea, etc.):
     • macrolides (mycoplasma, chlamydia) - azithromycin, clarithromycin, josamycin;
     • tetracyclines (chlamydia) - doxycycline;
     • cephalosporins (gonococci) - ceftriaxone, ceftibuten, ceftazidime;
     • gardnerellosis, trichomoniasis - metronidazole, makmiror.

  7.2. Symptomatic therapy

  When the temperature rises, antipyretics (NSAIDs) are indicated; for severe pain, NSAIDs, antispasmodics in the form of tablets and rectal suppositories are indicated. The possibilities of physical therapy (laser therapy, UHF and other techniques) are being actively studied, although the evidence base on it has not been collected.

  7.3. Surgery

  Surgical interventions are indicated when complications arise, for example, with empyema, abscesses (drainage, washing them with saline or an antiseptic, evacuation of purulent contents). In extremely rare cases, they resort to removing the seminal vesicles.

  7.4. Prevention

  To avoid relapse of the disease, you must follow the following recommendations from specialists:

  1. 1 Lead a healthy lifestyle, do not abuse alcohol, do not smoke, do not get too cold.
  2. 2 Exercise regularly.
  3. 3 Avoid congestion in the pelvic area (do not sit for a long time, be sure to take active breaks).
  4. 4 Live a regular sex life without sexual excesses, have protected sex, perform annual screening for STIs.
  5. 5 Timely treat chronic infections UTI (cystitis, pyelonephritis, etc.) and sanitize other foci of infections.

The seminal vesicles are a paired organ of the male reproductive system. There are right and left seminal vesicles, which are located on the posterior surface of the prostate gland on both sides. The main functions of this organ are the production of fructose, which supports the vital activity and motor activity of sperm, as well as the absorption of sperm by special spermiophage cells during unrealized sexual intercourse. In addition to this, the seminal vesicles participate in the act of ejaculation by releasing their secretions into the urethra during ejaculation. The most common disease of the seminal vesicles is their inflammation or vesiculitis.

Causes of the disease

The reasons that cause inflammation of the seminal vesicles are microbial flora, which reaches them in several ways: hematogenously or ascending through the urethra. Vesiculitis is also often a complication of inflammation of the prostate and epididymitis. Among the pathogens that cause inflammation of the seminal vesicles are Neisseria gonorrhoeae, Mycoplasma, Staphylococcus aureus, Escherichia coli, Enterococcus, etc. Infection with these pathogens occurs through unprotected sexual intercourse and failure to comply with personal hygiene rules. Predisposing factors for this disease are: low physical activity, alcohol abuse, uncontrolled sexual intercourse. There are acute and chronic forms of the disease.

Diagnosis and therapy of acute form

Symptoms of acute vesiculitis are divided into local and general. Common symptoms include: feeling of weakness, drowsiness, low-grade fever or fever, chills and other signs that are characteristic of general inflammatory syndrome. Local symptoms include: pain in the groin and rectal area, which may intensify with defecation. The patient experiences pain during ejaculation, hemospermia (detection of blood in semen) is possible.

Diagnosis of acute vesiculitis must include a general blood test. Here we will see an increase in ESR and leukocytosis - these are the main markers of the inflammatory response. It is equally important to palpate the seminal vesicles, which is preceded by a digital diagnosis of the rectum. The seminal vesicles will be swollen, and the patient will experience pain. However, with a high location, they are not always accessible to palpation, which should not be a basis for excluding the diagnosis of vesiculitis. After palpation, due to mechanical irritation, the seminal vesicles secrete fluid, which can be found in the urine or as discharge from the urethra. This fluid will have an increased content of leukocytes and red blood cells. By inoculating this secretion on nutrient media, it is possible to determine sensitivity to antibiotics for further selection of antibacterial therapy. Diagnosis of vesiculitis includes urine analysis using a three-glass sample.

With vesiculitis, it is possible to detect blood in the urine, most often in the last sample. The main instrumental method in the diagnosis of acute vesiculitis is ultrasound. On ultrasound you can see asymmetrical, dilated, cystic-changed seminal vesicles.

Treatment of acute vesiculitis begins with the prescription of antibiotics, which are selected based on the results of culture of the secretion of the seminal vesicles. However, this research method does not always give quick results, and then the antibiotic is prescribed empirically, that is, the most common causative agent of this disease and the antibiotic sensitive to it are selected. Preference is given to penicillin antibiotics or intramuscular cephalosporins. Sulfonamides are also prescribed.

If you have constipation, it is recommended to use drugs that enhance colon motility. Painkillers are preferable in the form of rectal suppositories (anesthesin). If acute inflammation of the seminal vesicles is complicated by the accumulation of pus in them, then immediate surgical treatment is required. In this case, drainage of pus from the cavities by puncture under ultrasound control is indicated, followed by sanitization of the seminal vesicles with antiseptic solutions.

Therapeutic measures for chronic disease

Chronic vesiculitis most often develops against the background of incompletely cured acute vesiculitis. This is possible due to the wrong choice of antibiotic therapy, non-compliance with the doctor’s recommendations on the duration of treatment, or a complete refusal to consult a specialist.

Patients complain of such reasons as pain in the groin, rectal area, and lower back. In almost all cases, changes in urinary function (blood in the urine, cloudiness, increased frequency of urination), involuntary nocturnal emissions and priapism are associated.

As with acute vesiculitis, diagnosis includes a blood test (increased ESR, leukocytosis), analysis of the secretion of the seminal vesicles (detection of leukocytes and red blood cells, asthenozoospermia), and data from instrumental studies (asymmetric, dilated, cystic-changed seminal vesicles according to data Ultrasound).

Treatment of chronic vesiculitis should be comprehensive, and in addition to the measures used for the acute form of the disease (antibiotic therapy, the use of chemical antiseptics (sulfonamides)), it should include physiotherapy methods. It is important to avoid alcohol and spicy foods. If you are overweight, it is important to follow a diet and lead an active lifestyle.

The need for therapeutic measures

Vesiculitis is one of the common causes of male infertility. A dysfunction of the seminal vesicles causes impaired sperm motility, and without this it is impossible for them to pass through the female genital tract. Therefore, if it is impossible to conceive, both partners need a comprehensive examination of reproductive function. The examination of men includes a spermogram. This method consists of studying the quantitative and qualitative composition of ejaculate. In a patient with vesiculitis, the quantitative composition of the seminal fluid will be normal, while sperm motility will be sharply reduced. In addition to this, an ultrasound of the prostate gland and seminal vesicles is performed to exclude inflammatory diseases of these organs.

Prevention of inflammation of the seminal vesicles

In order to prevent the development of this disease, it is important to remember that one of the most important factors in the development of diseases is our lifestyle. It is very important to maintain a certain physical activity during the day in order to avoid stagnation in the pelvic organs. You should also not abuse alcoholic beverages or overly spicy and fatty foods, as all this leads to serious metabolic disorders, which subsequently affects all organs, including the male reproductive system. In the presence of other inflammatory diseases (prostatitis, epididymitis, cystitis, urethritis), it is important to promptly and fully carry out treatment in order to avoid complications and the process becoming chronic. An annual examination by a urologist (andrologist) is very important, which should become mandatory for men after 40 years of age. It is men in this age category who are ten times more likely to develop inflammatory diseases, cancer of the prostate gland and seminal vesicles.

By following treatment and these simple rules, you can significantly reduce the risk of developing a disease such as vesiculitis and live a healthy and fulfilling life.

The content of the article:

What is vesiculitis

The seminal vesicles are a paired organ located above the prostate gland. They are small in size (thickness up to 1 cm, width no more than 2 cm, length from 6 to 8 cm), and have a bag-like shape. The posterior part of the seminal vesicles is adjacent to the vesico-rectal septum, and the anterior part is adjacent to the bladder.

The organ is distinguished by a body and a neck, which passes into the ducts. Only the lower part of the vesicles is covered by the peritoneum. More than two-thirds of them are outside the peritoneum.

The main purpose of the seminal vesicles is related to reproductive function - they produce seminal fluid. When ejaculation occurs, sperm enter this fluid. Then prostate secretion is added to it, after which it flows out.

Inflammatory phenomena in the seminal vesicles are called “vesiculitis.” This condition is quite serious. It is usually infectious in nature and can cause infertility. Most often, vesiculitis is caused by pathogenic bacteria. These include Escherichia coli, gonococcus, staphylococcus and a number of others. Vesiculitis often occurs against the background of some other inflammation of the genital area (orchitis, urethritis, prostatitis). But in some men it can become a complication of diseases such as flu or sore throat.

Acute vesiculitis can be diagnosed by performing a digital examination and ultrasound through the rectum. The MRI method is also used, urine, semen and seminal vesicle fluid are analyzed. The composition of the blood must be examined.

Very often vesiculitis is combined with chronic prostatitis. Approximately 5% of men are diagnosed with both of these diseases at the same time. This is explained very simply - the vesicles connect to the prostate gland through the ejaculatory duct. If inflammation occurs in the prostate, it can quickly spread to the seminal vesicles. At first, the disease develops without showing itself in any way. But over time, symptoms still make themselves felt.

In more than two thirds of patients, chronic pathology can be explained by congestion in the pelvic area. Therefore, the risk group includes men employed in office work and leading a sedentary life. Also negative influencing factors include: lack of regular sexual intercourse, reduced immunity, lack of sleep, constant nervous tension. In such situations, the development of the disease can be triggered by any microbe that has penetrated the gland.

In approximately 30% of patients, chronic vesiculitis occurs if the acute form of the disease has not been properly treated, or with other chronic processes in the genital organs. The diagnosis is confirmed by the results of an ultrasound examination.

We list the main factors that provoke vesiculitis:

Lack of physical activity, sedentary work.
Poor diet leading to constipation.
Immune suppression.
Hypothermia.
Lack of regular sex life.
Increased sexual activity.

There are two possible ways for infection to reach the vesicles - from the blood or through the vas deferens (ascending). The process can be either acute or chronic. It depends on what symptoms the disease will manifest itself.

Symptoms of vesiculitis in men

The following symptoms are typical for the acute form of inflammation:

Increased temperature (38 degrees or more, fever is possible).
Pain in the rectum, perineum, groin area (they become stronger during defecation and ejaculation).
Increased urge to empty the bladder.
Blood in semen.

In the chronic form of the disease, a man is bothered by the following symptoms:

Pulling pain in several areas (rectum, perineum, sacrum).
Increased pain during erection and ejaculation.
Hemospermia.

Diagnosis of vesiculitis in men

The following methods help to make a diagnosis of vesiculitis.

Finger examination

It is a basic diagnostic method for suspected vesiculitis. The examination is carried out in this way: the patient squats, and the doctor performs a rectal examination using the index finger. If there is inflammation in the blisters, painful lumps are palpated above the prostate.

Analysis of seminal vesicle discharge

The procedure begins with flushing the bladder through a catheter. It is then filled with isotonic sodium chloride solution. After this, the seminal vesicles are massaged, and the patient submits urine for analysis. Method – 4-5 glass sample. Visually, you can detect an admixture of blood, pus, and sperm. The microscope makes it possible to identify an increased number of leukocytes, red blood cells, pathological sperm, and pathogens are detected.

Vesiculography

One of the standard examination methods for vesiculitis. It gives doctors the opportunity to rule out some other diseases - sarcoma and tuberculosis. Refers to invasive techniques. Using special equipment, contrast is injected into the duct. Before this, an incision must be made in the scrotum area. Once the contrast agent is injected, an X-ray examination is performed. With vesiculitis, the image shows an increase in bubbles. Their walls thicken, and changes in the surface topography are detected.

Ultrasound

Using ultrasound, you can obtain detailed information about structural changes in the vesicles. Their increase or deformation is clearly visible.

CT scan

With this modern diagnostic method, a more accurate image of the seminal vesicles can be obtained. The main disadvantage of the procedure is its expensive cost. Therefore, they resort to it infrequently. Usually the diagnosis is made using simpler methods.

Laboratory research

If vesiculitis is suspected, a man is referred for the following tests:

Blood test. With a bacterial infection, the number of leukocytes in it increases. The ESR rate becomes higher.
Urinalysis (general). In patients with vesiculitis, leukocytes, blood, and pathogenic bacteria can be detected.
Sperm examination. Red blood cells, leukocytes, bacteria, abnormal sperm are detected against the background of a decrease in the total number of sperm, and a decrease in fructose.

Treatment methods for vesiculitis

Treatment regimens for vesiculitis may vary. It all depends on the form of the disease. If there is an acute course, the patient needs bed rest. The diet during this period should be gentle, and under no circumstances should constipation be allowed.

Drug therapy involves the following measures:

Elimination of pain and inflammation. For this purpose, analgesics (Diclofenac, Analgin) and antispasmodics (Papaverine, No-shpa) are prescribed. If the pain is very severe, narcotic drugs (Omnopon, Promedol) may be prescribed.
Decreased sexual activity in men. For this purpose, a solution of sodium bromide is used.
Elimination of infection. Sulfonamides, nitrofuran derivatives and fluoroquinolones are used as antimicrobial drugs.

When the patient's body temperature returns to normal, heat therapy sessions are recommended. These include:

Herbal baths (sitz baths). The optimal water temperature is about 40 degrees. The duration of the procedure is no more than 20 minutes. It is advisable to repeat three times a day.
Paraffin applications.
Applying a heating pad to the perineum.
Microclysters are hot (40 degrees). They can use antipyrine, which helps relieve symptoms.

If pus has accumulated, the likelihood of serious complications increases - the purulent process can spread throughout the pelvis or abdominal cavity. Therefore, we have to resort to surgery - opening through the perineum.

If the patient follows all the doctor’s instructions, the chances of a full recovery are high. But sometimes acute inflammation causes complications. Thus, in patients with a bilateral process, reproductive function may be impaired.

With a mild course of the chronic process, therapy begins in conservative ways.

Treatment is on an outpatient basis

The patient's condition is alleviated with antispasmodics and analgesics. It is recommended to prescribe antibiotics only after studying sensitivity to them. The following agents can be used for antibacterial therapy: fluoroquinolones (Ciprofloxacin, Levofloxacin), nitrofurans (Furadonin, Furagin), tetracyclines (Doxycycline), macrolides (Azithromycin, Erythromycin), cephalosporins (Cefalexin, Ceftriaxone).

For successful recovery, a properly selected regimen of antimicrobial drugs is necessary. The dosage and duration of treatment is determined only by the attending physician.

To enhance the effect of therapy, the patient is additionally prescribed immunomodulators (such as Levomizol, Viferon).

If there is a prolonged purulent process, injection of antibiotics or surgery is indicated. Sometimes you even have to resort to a radical method - vesiculectomy. The patient is placed in a hospital, where he must follow a regime that excludes physical activity and receive gentle nutrition.

Treatment regimens for vesiculitis in men

With white staphylococcus, E. coli.

Erythromycin: 200 mg per day for 2 or 3 doses, course - from 1 to 2 weeks.
Sumamed: the first day 500 mg in the morning and at night, then 4 days 500 mg once a day.
Doxycycline: 100 mg twice a day. Course - 10-12 days, on the first day 200 mg once
Metacycline: 300 mg twice daily. Course – from 5 to 10 days.
Furagin: 50 mg twice or thrice daily with food. Course – from a week to 10 days
Bactrim: two tablets twice a day. Course – from 5 days to two weeks.

Proteus, Klebsiella, Gardnerella, Ureaplasma, Chlamydia, Mycoplasma.

The man and his partner are treated at the same time. On the first day of therapy they must take immunoprotector. When three days have passed, antibacterial therapy (macrolide or tetracycline plus biseptol) is prescribed for 10 days. There should be two antibacterial courses, with a break of several days.

Tuberculosis, syphilis, gonorrhea

Treatment is being carried out penicillins, cephalosporins, rifampicin. Benzyl penicillin used according to this scheme - 3-9 units IM.

Attention should also be paid to adjuvant therapy. To enhance local protection, UHF procedures are recommended. Baths with medicinal mud and water, acupuncture, and warm microenemas with herbs will help restore damaged tissue.

In addition, a special therapeutic massage of the seminal vesicles and prostate is very useful. It will help improve blood supply to the pelvis and perineum. For the same purpose, physical therapy courses are recommended.

At the final stages of treatment, when recovery occurs, folk remedies can be used. They will help consolidate the result. Such activities must be agreed upon with a doctor.

Propolis suppositories for rectal use have a healing effect. They can be purchased at the pharmacy. This folk recipe has earned a lot of positive reviews - honey is mixed in equal parts with pollen and taken a teaspoon 3-4 times a day. Duration of treatment is about 6 weeks.

To relieve inflammation, you can use herbal decoctions. Take chamomile, agrimony, calendula, and yarrow in equal parts and mix. Brew two tablespoons of the herbal mixture in a thermos with two glasses of water and let it brew for three hours. The finished mixture must be filtered. Drink herbs one third of a glass before meals.

Possible complications of vesiculitis

A severe component of the disease is suppuration of the blisters, known as empyema. This standing has pronounced symptoms. Severe pain occurs in the groin and sacrum areas. There is a sharp rise in temperature. The patient feels weak and shivering. In this case, immediate hospitalization for surgery is indicated. It is impossible to delay treatment, otherwise the process will begin to spread further, up to the development of sepsis. And this already threatens to be fatal.
Another complication of vesiculitis is infertility. With prolonged inflammation, the blisters may dry out and no longer perform their function. In this case, the loss of fertility will become irreversible.

Also, inflammation of the seminal vesicles leads to problems in intimate life. A man's erectile function may be impaired and the quality of his orgasm may decrease.

Prevention of vesiculitis in men

To prevent this disease, it is important to avoid a sedentary lifestyle, hypothermia, stress, and unprotected sexual intercourse. It is useful to play sports, especially running and swimming. As for the diet, you should add more fruits and vegetables to it.

Also, timely treatment of other inflammatory processes plays an important role in preventing vesiculitis.

SEMINALS - paired formations related to the internal male genital organs and are part of the vas deferens.

S. p. develop from lateral protrusions of the terminal sections of the mesonephric (Wolffian) ducts.

Anatomy

They are located laterally from the vas deferens (see), above the prostate gland (see), behind and to the side of the bottom of the bladder (see). Only the upper parts of the S. p. are covered with peritoneum. The position of the S. p. can change due to the filling and emptying of the bladder and rectum.

S. p. have a spindle-shaped shape, a bumpy surface and are highly convoluted tubes, the length of which in the straightened state is 100-120 mm, and the diameter is 6-7 mm. In an unexpanded state, the seminal vesicle has the appearance of an oblong body, somewhat flattened in the anteroposterior direction, up to 50 mm long, up to 20 mm wide and approx. 10 mm.

There are anterior and posterior surfaces of the sp., the upper expanded end is the base, the middle part is the body and the lower, tapering end, which passes into the excretory duct (ductus excretorius), which, connecting with the vas deferens (ductus deferens), together with it forms the ejaculatory duct (ductus ejaculatorius; fig.).

The sp. is supplied with blood from the descending branch of the artery of the vas deferens (a. ductus deferentis). Venous blood from the seminal vesicles flows through the veins into the vesical venous plexus (plexus venosus vesicalis), and then through the vesical veins (vv. vesicales) into the internal iliac vein (v. iliaca interna). Lymph from S. flows into the internal iliac lymph nodes (nodi lymphatici iliaci int.). The innervation of the S. is carried out from the plexus of the vas deferens (plexus deferentialis).

Histology

On a section, the S. p. has the appearance of bubbles communicating with each other. The wall of the S. p. consists of three shells. On the outside it is covered with an adventitia membrane (tunica adventitia). Underneath it is a well-developed muscular layer (tunica muscularis), which makes up most of the wall of the S. p. The muscular layer of the wall facing the vas deferens is thicker than on the opposite side. The mucous membrane (tunica mucosa) is located deeper, the edges form numerous branched folds with jagged elevations of the most varied shapes - from small individual outgrowths to mesh-cellular structures, in some places filling the entire lumen of the S. p. The mucous membrane is covered with a single-layer (in some places double-row) prismatic epithelium.

Functional meaning

The functions of S. p. are diverse and insufficiently studied. The glandular cells of the mucous membrane of the S. p. secrete a secretion that is grayish-white in color, gelatin-like consistency, odorless, with an alkaline reaction (pH 7.3). It contains denser inclusions, which are called “sago grains”, or simpexia. The main component of sperm secretion is fructose, which is necessary to ensure metabolic processes in spermatozoa, as well as to maintain their motility. The secretion of S. p. gives the ejaculate greater viscosity, increases its volume, and creates favorable conditions for fertilization. It is believed that the degree of stretching of S. and. secretome affects the excitability of the erection center. The secretory function of S. p. depends on the influence of male sex hormones (see), which is confirmed by the extinction of their secretory activity after castration.

Examination methods

The most accessible method of examining S. p. is palpation through the rectum (see Rectal examination). They are felt just above the prostate gland, on either side of the midline. Normally, S. items are determined with difficulty and only when they are filled with secretion. By palpation, S. p. are an oblong-shaped formation of elastic consistency with a somewhat uneven surface. There is also a method of palpation of the S. p., in which the patient sits on the finger of the examining doctor; in this position of the patient, the S. p. massage is performed (Pikker's method). The resulting secretion is subjected to microscopic and bacterial examination. research. A valuable method of studying S. p. is vesiculography (see).

Pathology

There are malformations, injuries, diseases and tumors of S. p.

Developmental defects S. p. are extremely rare. These include hypoplasia, aplasia, doubling of one or both S. p., fusion of S. p. into one unpaired formation. The practical significance of S.'s developmental defects is insignificant. It is not always possible to diagnose developmental defects of the S. p. using palpation and vesicle photography. Treatment is usually not carried out. If an inflammatory process occurs, conservative treatment is prescribed.

Damage. Closed injuries (ruptures) of the joint can occur with fractures of the pelvic bones and severe injuries of the perineum. Gunshot wounds of S. p., as a rule, are combined with injury to other organs. Injury to the S. p. is possible during cystectomy for bladder tumors. The most characteristic sign of damage to the S. p. is the leakage of sperm from the wound or formed fistulas. The rest of the wedge, the picture does not have any specific signs, and therefore damage to the S. p. is recognized late. Combined injuries are masked by a wedge, a picture of damage to the bladder, prostate gland, rectum, and ureter.

The nature of the surgical intervention depends on the characteristics of the injury. If S. p. is damaged over a large area, then vesiculectomy is performed (see). For small or bilateral injuries, S. p. are limited to draining the wound.

The prognosis for damage to the S. p. is generally favorable. With bilateral damage, the ability to fertilize may be reduced.

Diseases. The most common inflammation of S. p. is vesiculitis, the causative agents of which can be gonococci, staphylococci, streptococci, etc. (see Vesiculitis). Isolated tuberculous vesiculitis is observed extremely rarely; more often, tuberculous vesiculitis is combined with damage to other genital organs and is observed in the majority of patients with tuberculosis of the reproductive system (see Extrapulmonary tuberculosis).

Tumors. Benign* tumors of S. p. - fibroma (see), fibroadenoma (see), myoma (see), lipoma (see), neuroma (see) - are very rare. Clinically, they can manifest as constant pain and sensation of a foreign body in the perineum, hemospermia (see), dysuria (see). Benign tumors, growing, retain a spherical or pear-shaped shape for a long time, without infiltrating the surrounding organs and tissues. Treatment of benign tumors is surgical. In this case, they are limited to removing the affected vesicle. The prognosis after vesiculectomy for a benign tumor of one of the S. p. is favorable.

Malignant tumors of S. p. are also rare, of which the most common is cancer (see), less often - sarcoma (see). First wedge, the picture is the same as with benign tumors. When the tumor grows into surrounding tissues and organs, signs of compression of the urethra and rectum may appear. Metastases are most often detected in the lungs, kidneys and peritoneum. Rectal examination reveals a dense, lumpy, painless formation or extensive infiltration above the prostate gland. Using vesiculography, a filling defect in the affected S. p. is detected. In unclear cases, a transrectal tissue biopsy of the S. p. is performed. For malignant tumors of the S. p., vesiculectomy is indicated (see). If the tumor is detected late, surgery often involves removing the tumor along with the prostate gland and sometimes the bladder. The prognosis for malignant tumors of S. p. is unfavorable.

Bibliography: G ekhman B. S. Nonspecific epididymitis, M., 1963; 3 a and graev M. A. On the comparative anatomy of the seminal vesicle, Sat. scientific works, dedicated. XL anniversary of scientific doctor, active. prof. B. N. Kholtsova, p. 267, L., 1929; K and N D. V. Benign tumors of the seminal vesicles, Urology, No. 3, p. 27, 1963; Clinical oncourology, ed. E. B. Marinbakha, M., 1975; P o-rudominsky I. M. Sexual disorders in men, M., 1968; P ytel A. Ya. and P. ytel Yu. A. X-ray diagnosis of urological diseases, M., 1966; Reznik B. M. Tuberculosis of male genital organs, M., 1972; Guide to Clinical Urology, ed. A. Ya. Pytelya, p. 187, 208, M., 1970; S a m o i l o A. G. About the blood supply to the seminal vesicles and ampullae of the vas deferens, in the book: Vopr. anat. vessel, syst. child and adult, ed. A. V. Shilova, p. 343, JI., 1958; Shkolnikov L. G., Selivanov V. P. and Ts o d y k with V. M. Damage to the pelvis and pelvic organs, M., 1966; Knaus H. Die Reifung der Spermatozoen in den mannlichen Samenwegen, Wien. med. Wschr., S. 790, 1958; Mann T. Biochemistry of seeds, L.-N.Y., 1954.

K. D. Panikratov; V. Ya. Bocharov (an.).