notes by dr Claudio Italiano
The prostate, located at the base of the bladder, is the gland that actively
participates in the formation of the seminal fluid: its inflammation could also
cause a fertility problem, as well as painful ejaculation, so much so that it
has been seen that up to 20% of male infertility they depend on infection of the
prostate and seminal vesicles. The term prostatitis is widely abused to indicate
the most varied pathological forms affecting the prostate gland and the bladder
neck.
The ascending urethral pathway is the one most frequently followed by germs or parasites that penetrate during sexual intercourse. In fact, by studying the urethral cultures of patients who had repeated relationships with women carrying Gram-negative germs in the vaginal vestibule, transient colonization of the male urethra was observed with the same germs.
Secondary prostatitis to endouretral maneuvers (catheterization, cystoscopy, instillations, endoscopic resections) also recognize this access path. The reflux of urine in the prostate ducts is related to the increase in endourethral pressure due to a downstream obstacle (urethral stenosis or external urethral meatus).
If the urine that comes back is infected, the germs are brought into the gland with this mechanism.
For granulomatous prostatitis, characterized by the presence of nonspecific parenchymal granulomas, there is no certain etiopathogenetic attribution. From time to time they were held responsible: the inflammatory stimulus supported by stagnation in the interstitial secretion of the prostate, allergic motives and autoimmune processes. In abnormal prostatitis, the negativity of the cultivation finding is matched by the relief of a leucocytosis in the glandular secret which would demonstrate the inflammatory nature of the disease, whose etiology is still unknown to this day. Viral agents, mycoplasmas, or, more likely, Chlamydia trachomatis, which is responsible for most non-gonococcal urethritis, are thought to be involved.
Finally, prostatodynia recognizes etiopathogenetic motives generally of a dysfunctional type similar to those described in the chapter of the bladder neck disectasis, in the absence of any inflammatory findings.
Prostatitis is classified in:
- Type I - Bacterial acute prostatitis: prostatitis caused by bacteria, not long
lasting.
- Type II - Bacterial chronic prostatitis: the cause is always of bacterial
origin, but prolonged over time, characteristic of prostate patients.
- Type III - Chronic abnormal prostatitis: called chronic pelvic pain syndrome (CPPS),
is characterized by prolonged duration and by causes of non-bacterial origins.
It is often linked to intestinal dysfunction or poor nutrition.
- Type IV - Asymptomatic / hyposymptomatic prostatitis: form of prostatitis in
which there is total or almost total absence of symptoms.
It is characterized by the presence of a purulent exudate inside the acini with edema and a leukocyte and inflammatory reaction periacinosa and periduttale; the exudate, together with the products of the desquamation of the glandular epithelium, pours into the urethra. If the infection does not resolve spontaneously or as a result of therapy, the inflammation tends to reach the periacin interstitium and then the pericapsular cell forming a prostatic and periprostatic phlegone that can fistulize in various directions.
Characteristic of the chronic forms is the presence of one or more abscesses,
mostly small, surrounded by a thick reactive fibrotic capsule and sometimes
communicating with the posterior urethra.
The existence of this communication, if on the one hand favors the emptying of
the ascending cavity, on the other hand allows the urine to reach the residual
cord and stagnate in it giving rise, especially if infected, to the formation of
prostatic stones. The symptomatology is less striking than in the acute but exasperately relapsing
forms, so much so as to induce not slight psychological problems to the patients.
The prevailing symptom is pollakiuria with imperious stimulus accompanied by
urinary burning along the urethra.
Pains, usually of a gravitational type, can
appear on a perineal, suprapubic, scrotal level. Another important feature is
the appearance of recurrent cystitis that in young subjects in practice are
always supported by a prostatic bacterium. Fever is very rare and is linked to
episodes of exacerbation.
Signs and symptoms at the level of the genitals are represented by difficult and
painful erections, the appearance of intermittent hemispheres and episodes of
relapsing epididymitis.
prostatite
to learn more:
L'ipertrofia_prostatica
La poliuria
L'ematuria
Le infezioni urinarie
L'orchite
L'uretrite
Malattie a trasmissione sessuale
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