Prostate injury during massage

Injury to the prostate and seminal vesicles

The prostate (prostata) is an unpaired organ of the male reproductive system, located in the anterior lower part of the small pelvis under the bladder. seminal vesicles (glandula seminalis) are paired formations related to the internal male genital organs and protruding as part of the vas deferens.

The prostate and seminal vesicles are located in the depths of the small pelvis, protected by its bones and muscular-aponeurotic formations of the perineum; anatomically and topographically closely related to the bladder, urethra (urethra), rectum, urogenital diaphragm, so their damage is most often multiple and combined.

Closed and open injuries of the prostate and seminal vesicles are distinguished. Depending on the type of injury, bruises and lacerations are distinguished among closed injuries, with open injuries - bruises, tangential, blind and through wounds.

Closed lesions of the prostate and seminal vesicles

Closed damage to the prostate and seminal vesicles can occur with fractures of the pelvic bones, a strong blow to the perineum or a fall on it. Bruises and ruptures of these organs are usually combined with damage to the venous plexus adjacent to them. At the same time, the membranous and prostatic parts of the urethra and the rectum can be damaged.

Iatrogenic damage to the prostate also occurs with the forced introduction of metal instruments into the posterior urethra, especially when it narrows (urethral stricture) or prostate adenoma.

Endourethral damage to the prostate can be single or multiple and are called false passages. There are an incomplete false passage (they do not penetrate the entire prostate) and a complete false passage (penetrating beyond it into the pelvic tissue, seminal vesicles, bladder, rectum).

Symptoms of closed injuries of the prostate and seminal vesicles:

• Pain in the anus and perineum.
• Difficulty with painful urination.
• Hematuria.
• Hemospermia.

In severe trauma, combined with significant damage to the pelvic bones, clearly expressed symptoms of the latter smooth out or hide the clinical manifestations of damage to the prostate and seminal vesicles. Injury (damage) to the seminal vesicles in all cases are recognized late, as they do not have specific symptoms.

Endourethral injuries of the prostate are manifested by pain in the perineum, bleeding from the urethra (urethra), painful difficulty urinating, acute urinary retention (AUR).

Combined injuries of the prostate and urethra or bladder, complete false passages can lead to urinary leakage, urinary infiltration and the occurrence of phlegmon of the pelvic tissue. In some cases, urosepsis develops.

The diagnosis is established on the basis of anamnesis, assessment of existing symptoms, examination results.

At rectal examination, the prostate is enlarged in size, uneven consistency: it may show areas of softening, infiltration of paraprostatic tissues due to hemorrhage or urohematoma is determined. Her palpation is sharply painful.

Ultrasound (ultrasound diagnostics) and CT (computer diagnostics) are of great help in diagnosing damage to this localization. On urethrocystograms, leakage of the contrast agent into the prostate, paraprostatic tissue can be seen.

For prostate bruises, patients are prescribed bed rest, painkillers, hemostatic and antibacterial drugs. With urinary retention, it is advisable to establish a permanent balloon catheter; sometimes capillary punctures of the bladder are used, indications for cystostomy may appear.

To stop bleeding from the prostate, in addition to conventional hemostatic agents, they successfully use a pressure bandage on the perineum, local hypothermia, tamponade of the bleeding prostate and the prostatic part of the urethra with a dosed tension of the balloon-catheter using a fixed aseptic napkin on the urethral catheter at the external opening of the urethra .

With ruptures of the prostate, its injury by fragments of the pelvic bones with extensive hemorrhages, sometimes there is a need for surgical treatment. It consists in exposing the prostate by perineal or retropubic or vesical access, removing bone fragments, outflowing blood and clots from it, stopping bleeding by applying eight-shaped sutures or tamponade of the damaged and bleeding prostate.

Open injuries of the prostate and seminal vesicles

Open injuries of the prostate and seminal vesicles are observed with gunshot and stab wounds. Gunshot wounds (bullet, shrapnel, mine-explosive) of these organs were quite rare during the Great Patriotic War and, as a rule, were combined.In modern military conflicts, mine-explosive wounds, which are always combined, predominate.

Stab wounds occur in domestic, industrial or military conditions when sharp piercing objects are introduced through the perineum or rectum. The same group includes iatrogenic damage to the prostate and seminal vesicles during surgery for removal of the rectum and bladder, prostate biopsy, paraprostatic blockade, etc.

The anatomical location of the prostate in the small pelvis predisposes to combined injuries of the bladder and pelvic bones. In this regard, the clinical signs of prostate injury are smoothed out or hidden by symptoms of damage to the bladder and pelvic bones. Only after some time, continuing hematuria, urination disorders (dysuria) and pain in the perineum and anus, radiating to the head of the penis, make one suspect a prostate injury.

The main symptoms of stab wounds of the prostate are bleeding, pain in the perineum and rectum, radiating to the head of the penis, and dysuria (urination disorders). With combined injuries of the urethra (urethra), bladder and rectum, streaks of urine can join, its excretion through the rectum or perineal wound, fecal discharge and gases through the wound.

The most characteristic sign of open damage to the seminal vesicles is the outflow of sperm from the wound or the formation of fistulas.

The diagnosis of prostate injury is established taking into account the localization of the inlet and outlet openings and the projection of the wound channel, examination of the perineum, digital rectal examination, which makes it possible to determine the deformation of the organ. Often the fact of injury to the prostate is confirmed during surgery for injury to the bladder.

Diagnosis of stab wounds is based on an assessment of complaints, anamnesis, localization of the wound, the projection of the wound channel, the results of a physical examination with mandatory palpation of the prostate, the data of a survey radiograph of the pelvic region, urethro- and fistulograms, ultrasound and CT of the pelvic organs. MRI (magnetic resonance imaging) not only reveals damage to the prostate, but also to surrounding tissues.

Therapeutic tactics for combined injuries of the bladder and prostate is always operational and is determined primarily by localization and the need for an emergency stop of bleeding. In other cases, the sequence of actions of the urologist includes performing a lower median laparotomy, primary treatment and suturing of bladder wounds, sanitation and drainage of the abdominal cavity with an intraperitoneal wound of the bladder, sparing treatment of the prostate wound, hemostasis, vesical fistula, drainage of perivesical and paraprostatic tissue, suturing of a laparotomic wound , treatment and drainage of musculoskeletal wounds and immobilization of bone fragments.

Treatment of wounds of the prostate consists in the primary surgical treatment of the wound, removal of foreign bodies, stopping bleeding, opening and draining urinary streaks and abscesses. With simultaneous damage to the urethra (urethra) and rectum, a cystostomy is applied, an unnatural anus (colostomy), the pelvic tissue is drained. In case of damage to the seminal vesicles, it is usually limited to drainage of the wound.

Conservative treatment is possible for mild isolated wounds of the prostate with minor bleeding and no signs of inflammation. An example would be treatment after an uncomplicated prostate biopsy.

Prostate damage

The prostate, protected by the bony walls of the pelvic ring and the muscular-aponeurotic layers of the perineum, rarely undergoes isolated damage, which is more often combined with damage to the rectum, bladder, seminal vesicles. Damage to the prostate is facilitated by its pathological conditions: chronic inflammatory processes, plethora, fragility of tissue changes and reduced mobility of the gland due to infiltration and swelling of the ligamentous apparatus. Damage to the prostate can be closed and open.

Closed injuries from the urethra usually occur as a result of an incorrect, violent instrumental examination of the bladder during the introduction of a catheter, bougie, cystoscope, lithotriptor. More often, such damage is observed with strictures or inflammatory changes in the walls of the urethra, prostate adenoma. Forcible insertion of instruments can lead to the formation of a false passage in the prostate tissue, going in the direction of the bladder or periprostatic tissue.

Injury to the prostate is accompanied by pain, hematuria, urinary excretion of blood with clots, dysuria, and fever. In mild cases, these phenomena disappear after 2-3 days.In severe cases, hematuria and dysuria last much longer; often an infection joins, which leads to the occurrence of parenchymal prostatitis or to the formation of an abscess of the prostate gland.

With simultaneous damage to the periprostatic tissue, urinary infiltration may occur, extending to the pelvic tissue, followed by the formation of urinary phlegmon, which requires immediate surgical treatment.

The diagnosis is made on the basis of palpation of the prostate through the rectum. Palpation is painful; the prostate is unevenly enlarged, dense; areas of softening are determined. All of these phenomena may concern any one lobe or spread to the entire prostate gland. If there is an abscess, then palpation is marked by fluctuation.

Open injuries of the prostate occur with gunshot wounds, falling from the crotch on the edge of an object, or wounding with a piercing or cutting weapon and are much less common than closed ones. Gunshot wounds of the prostate are usually combined with damage to the bladder, rectum, urethra. Isolated injuries of the prostate are extremely rare.

With a combined wound, the symptoms of prostate damage do not appear immediately; signs of damage to neighboring organs come to the fore: urinary streaks, the passage of urine and feces from the wound, the passage of gases in the urine. After some time, symptoms of injury to the prostate gland join: pain in the anus, dysuric phenomena, hematuria. Urinary leakage followed by urosepsis usually leads to the death of the wounded

The diagnosis of prostate lesions is made on the basis of a palpation examination through the rectum (which makes it possible to identify a deformity or wound of the prostate gland), as well as urethrography. First aid for wounding the prostate is the primary treatment of the wound. If the prostate gland and bladder are damaged, a suprapubic fistula should be applied. With urinary leakage, drainage is performed through the obturator foramen or through the recto-sciatic fossa (see Drainage in urology). With simultaneous wounding of the rectum, anus praeternaturalis is applied (see). With an extensive injury to the prostate with a foreign body, a perineal prostotomy is indicated.

Prostate injury during massage

In the practice of a doctor, there are also patients with chronic prostate trauma. B. N. Holtsov (1927) noticed that during systematic and long trips on horseback, on a bicycle, motorcycle and other modes of transport, a chronic injury to the gland often occurs.

In these cases, congestion occurs in the prostate gland, contributing to the development of infection. It is very difficult to treat such patients. They are prescribed treatment for prostatitis and banned from driving.

Patients report pain in the perineum, hemospermia, and sometimes painful urination.

In these cases, hemorrhages of various sizes occur in the prostate gland, which can cause the development of acute or chronic inflammation. Moreover, pathological changes in the secretion of the gland of these patients are usually not detected during the first examination.

Prostate damage can also occur during its puncture biopsy. A puncture biopsy becomes especially traumatic with repeated examination with a thick needle. Symptoms of this type of prostate injury are pain in the perineum, bleeding from the urethra, hematospermia, difficulty urinating or urinary retention.

Patients are prescribed bed rest, hemostatic and painkillers, sulfonamides and antibiotics. With urinary retention, an indwelling catheter is placed. After 2-3 days of treatment, the bleeding stops and the disorders disappear.

The long-term results of severe damage to the prostate gland are unfavorable. Its glandular tissue is not restored. Wound healing occurs by replacing the glandular connective tissue

The prognosis in such cases is unfavorable.

Open injuries of the prostate

Open isolated injuries of the prostate gland are relatively rare and are diagnosed. Usually, prostate injuries are combined with injuries to the urethra, bladder, and rectum.

With open injuries, bruising, tangential, blind and through wounds of the prostate gland and seminal vesicles are isolated. Damage of this kind is observed with gunshot and stab wounds.

Gunshot wounds of the prostate gland, as a rule, are combined with a wound of the perineum, urethra, bladder, rectum, and damage to the pelvic bones. Isolated wounds of the prostate gland, even in wartime, were rare.

With mild injuries to the prostate, the urogenital diaphragm is damaged.Severe damage is accompanied by a violation of its integrity. If, when the prostate gland is injured, the urogenital diaphragm is not on-When. violation of its integrity, urine, seeping through the wounds of the prostate gland, spreads in two directions - in the fiber of the small haz and in the tissue of the perineum and scrotum.

This greatly aggravates the outcome of the wound process. Urinary leakage and urosepsis can be fatal. With a more favorable course of injury, urethrorectal or urethroperineal fistulas are formed (L. I. Dunaevsky, 1970).