Post Date December, 03 2023
1、 Classification:
This disease is divided into nonspecific, prostate biopsy or tur type, specific, and granulomatous prostatitis secondary to systemic granulomatosis. The latter can be further divided into Wagener's granulomatosis and allergic granulomatosis. The pathogenesis is complex and not yet fully understood. It may be an allergic inflammatory reaction or a strong granulomatous reaction of the prostate to local pathogenic factors.
2、 Clinical manifestations:
About 2/3 of the patients are aged 50-70 years old, and most of them present with irritating urination or obstructive symptoms, while very few may not have any discomfort. About 71% of the patients had recent acute lower urinary tract infection, chills and high fever before diagnosis, manifested as acute cystitis or prostatitis, which can be accompanied by acute urinary retention, which generally lasts for 3 to 4 weeks. There can be gross hematuria, but most of them are microscopic hematuria. Others can also be manifested as lumbosacral, bladder, groin and perineum pain and discomfort, testis, epididymitis, etc. The above symptoms all tend to worsen in the short term.
3、 Pathological findings:
The etiology of nonspecific granulomatous prostatitis is unknown but the most common. Granuloma is usually non caseous, small but numerous, and can be diffusely distributed throughout the entire section, often involving several prostate lobules. It is characterized by epithelioid histiocytes or a large number of foam like histiocytes and multinucleated giant cells gathering in a nodular manner, and may be accompanied by plasma cells and lymphocytes, in which there may be complete or partially complete acini and lumens. Eosinophil infiltration and central liquefaction necrosis are relatively rare.
The incidence of granulomatous prostatitis secondary to tur or biopsy is second only to nonspecific granulomatous prostatitis, which accounts for more than 90% of granulomatous prostatitis. Its typical feature is a flexible, slender rheumatic granuloma with a fenced array of epithelioid tissue cells around its periphery. Specific granulomatous prostatitis is often caused by bacterial, viral, fungal, and even protozoan and metazoan infections. Tuberculosis is the most common cause, most of which is related to intravesical BCG infusion. The characteristic histologic manifestation is scattered caseous or non caseous granulomas with central necrosis and liquefaction without eosinophil infiltration. Specific diagnosis can be obtained if acid-fast bacilli can be found in the granuloma. One patient in this group was diagnosed as granulomatous prostatitis after two biopsies, and was diagnosed as a post bcg type due to the discovery of acid fast bacilli in the granuloma. Allergic granulomatous prostatitis can be classified as simple and secondary to systemic granulomatous disease, both of which are very rare.
