Granulomatous prostatitis
Introduction
Introduction to granulomatous prostatitis Granulomatous prostatitis (granulomatous prostatitis) is a rare disease, mostly non-specific, often associated with recent urinary tract infections. Most cases of rectal examination can be associated with prostate induration or diffuse lumps, which are indistinguishable from prostate cancer. basic knowledge The proportion of illness: 0.0006% Susceptible people: male Mode of infection: non-infectious Complications: hematuria
Cause
Causes of granulomatous prostatitis
Causes
The incidence of granulomatous prostatitis is related to local strong foreign body reaction. Prostate catheter obstruction is the primary factor. The causes include inflammatory process caused by bacterial infection or tissue necrosis caused by surgical trauma. Prostatic hyperplasia may also cause or aggravate obstruction of prostate duct. Infection and inflammation destroy the ducts and glandular epithelium, cell debris, bacterial toxins and prostate secretions into the interstitial space, becoming foreign bodies in the matrix, triggering granulomatous inflammatory reactions, granulomatous inflammation may be limited, may also affect the entire prostate, The inflammation is relieved slowly, and it takes about 2 to 3 months to be replaced by fibrous connective tissue and the texture changes.
Stillwell (1987) classified granulomatous prostatitis into four categories according to the cause:
Specificity (3%):
Accounted for 3%, pathogenic microorganisms include bacteria, tuberculosis, Brucella, Treponema pallidum, viruses and fungi, etc., in which BCG is complicated by granulomatous prostatitis after bladder tumor resection, as a complication of bladder perfusion BCG The incidence rate is 0.9% to 1.3%, second only to the incidence of cystitis and fever. Some people have a pathological examination of the prostate of patients with bladder-infused BCG, and the incidence of this disease is actually very high (41% to 75). %), from the beginning of the perfusion to the discovery of the disease on average about 1 year (3 to 25 months).
Systemic granulomatosis (3%):
3%, in the local manifestations of granulomatous diseases involving multiple organs of the body, including allergic granulomatosis (Churg-Strauss syndrome) and Wegener granulomatosis, the former often associated with multiple organ granulomatosis and asthma, Because of the obvious eosinophilic infiltration in granuloma, it is also called eosinophilic granulomatous prostatitis, the latter is hereditary disease, and more complicated with respiratory granuloma and vasculitis.
Non-specific (70%):
Accounted for 70%, often secondary to recent urinary tract infections.
Urethral surgery (20%):
After surgery or needle biopsy accounted for 24%, transurethral surgery including TUR-P and TUR-Bt, half of the disease within 6 months after surgery.
PathogenesisThe surface of the prostate can be nodular, the nodules are lobular, some glands have small cysts, or visible gray-white dense areas, all granulomatous prostatitis, nodular and diffuse lesions accounted for 40 % and 60%.
Small and tough yellow granular nodules are visible to the naked eye. Microscopic examination is rich in non-caseal granuloma (with or without central liquefaction necrosis). These granulomas are confined to the area around the acinus and can also invade the entire gland. The lesion is filled with epithelioid cells, and the foam-like cells of the tissue cells predominate and are easily confused with cancer cells. The prostate cells can be replaced by dense lobular granulocytes and eosinophil infiltration. The ducts often expand and rupture, full. Inflammatory cells, which may have extreme edema at the early stage of the lesion, are stained with yeast, fungi, and tuberculosis except for specific granulomatous reactions.
Prevention
Granulomatous prostatitis prevention
Life is temperate, pay attention to rest, work and rest, and orderly life.
Complication
Granulomatous prostatitis complications Complications
Chilling, frequent urination, dysuria, perineal traction pain.
Symptom
Granulomatous prostatitis symptoms common symptoms dysuria urinary frequency urinary tract burning chills nodules hematuria granuloma
83% of patients have severe symptoms of lower urinary tract infections, such as fever, chills, frequent urination, urinary tract burning, dysuria, occasional hematuria, perineal pain, and pubic discomfort.
Rectal examination: granulomatous prostatitis lumps generally develop faster, nodules, elastic, irregular, inconsistent soft and hard.
Examine
Examination of granulomatous prostatitis
Routine tests are not helpful for diagnosis. Some patients have increased white blood cells, accelerated erythrocyte sedimentation rate, and increased blood eosinophils. The significance is very small. In addition to allergic granulomatous prostatitis, other parts of fungal or parasitic infections are also possible. Most patients have pyuria, half of the patients have microscopic hematuria, gram-negative bacteria can be seen in urine culture, and blood acid phosphatase and alkaline phosphatase increase are rare.
Prostatic specific antigen (PSA) can be transiently elevated and more easily confused with prostate cancer. Speights (1996) reported 10 cases of pathologically confirmed non-specific granulomatous prostatitis, 4 cases of blood PSA>4.0ng/ml 3 cases of PSA between 4.0 and 6.0 ng / ml, 1 case of 10.1 ng / ml, all cases of PSA returned to normal after more than 1 year of follow-up, but need to pay attention to the case of persistent abnormal PSA should be repeated biopsy, except for prostate cancer .
1. Imaging examination
Through the suprapubic B-ultrasound or transrectal B-ultrasound, the hypoechoic nodules in the prostate, or the uneven echo of the prostate, are similar to prostate cancer. Other B-ultrasounds have enlarged prostate, irregular shape but intact capsule, etc. MRI Diagnostic help is not great, pay attention to the discovery of individual prostate cancer complicated by this disease. In addition, even if the diagnosis of this disease has been obtained, if there is evidence of suspicious prostate cancer during follow-up, a biopsy is needed again.
2. Prostate biopsy
The Trageneol Tru-Cut biopsy puncture for histological examination or transrectal ultrasound guided fine needle aspiration for histological examination can confirm the diagnosis.
Diagnosis
Diagnosis and diagnosis of granulomatous prostatitis
Acute urinary tract infection occurred recently, followed by lower urinary tract obstruction, while the prostate rapidly increased, hardened, induration, blood PSA may increase, B-ultrasound found hypoechoic nodules or enlarged prostate, uneven density, should Considering the possibility of granulomatous prostatitis, a prostate biopsy guided by B-ultrasound is needed to confirm the diagnosis. If unconditional biopsy, it can be treated with antibiotics or anti-inflammatory drugs. The rectal examination is performed once every 2 weeks. After 2 months, 1 to 2 months, the rectal examination if the induration becomes smaller, other normal, can be diagnosed.
The disease needs to be differentiated from prostate cancer, bacterial or non-bacterial prostatitis, and the diagnosis depends on pathological examination. In the early stage of prostate cancer, the nodule is generally deep, and the infiltration in the middle or late stage is enlarged or agglomerated. Sexuality, unevenness, inelasticity.
