Post Date December, 03 2023
Non specific granulomatous prostatitis is relatively rare. It is generally believed that non specific granulomatous prostatitis is a foreign body reaction or allergic reaction caused by substances with poor solubility produced by the proliferation of the reticuloendothelial system in the human body. Foreign body reactions include epithelial ulcer necrosis and prostate tube obstruction. "There is stasis of semen or bacterial products in the prostate, and the components of semen have an autoimmune reaction. If they flow back to the prostate interstitium, they become foreign bodies, resulting in a foreign body reaction that causes tissue damage, damages the prostate gland wall, forms tissue necrosis, and finally protrudes into the interstitium to form granulomas.".
Schmidt divides the disease into two types: allergic and non allergic. The following are described separately:
(1) Allergic granulomatous prostatitis: often secondary to systemic allergic reactions, bronchial asthma, or recurrent allergic rhinitis, paranasal sinusitis, etc. "Because the prostate has the same allergic tissue reactions as elsewhere, such as the lungs and bronchi.". Immunoallergic reactions aggravate tissue reactions. Sperm and semen can also produce autoantibodies, causing this disease.
The main symptoms are hardening and fullness around the prostate due to massive cell infiltration and edema, no tenderness in the prostate, frequent urination, painful urination, painful ejaculation, small or normal white blood cells in the prostate fluid, and increased blood eosinophils. The diagnosis was made by the presence of eosinophils in urine deposits and prostate fluid stained with Reid's staining.
Treatment is mainly with hormones or antihistamines, but the prognosis is often poor.
(2) Non allergic granulomatous prostatitis: It often occurs in the elderly, mainly due to the reaction of prostate tissue to foreign bodies produced by semen components and bacterial products that stagnate in the stroma.
The main symptoms are similar to bladder neck obstruction, with frequent urination, pain in urination, burning sensation of the urethra, increased prostatic discharge, lower back and perineal pain, and radiation pain in the groin, testicles, and suprapubic bone. This disease is characterized by rapid progress of these symptoms, which soon develop into urinary retention. Prostate gland enlargement, induration, and fixation on anal examination. It is often mistaken for prostate cancer.
The diagnosis is mainly confirmed by biopsy of prostate tissue through perineal puncture. The pus cells in prostate fluid are slightly higher than normal. Cystoscopy can have rapidly developing bladder neck obstruction lesions.
The majority of treatments require transurethral resection of the prostate. Anti histamine drugs can also be used to eliminate edema, or prednisolone can be used for treatment. For those with unobvious obstruction symptoms, it is recommended to observe for sufficient time to wait for self healing. Antibiotics can be used for 2-4 weeks, and surgical treatment can only be considered if they are ineffective. However, there are also many cases that, regardless of the treatment, can spontaneously alleviate and improve after a certain period of time. Generally, it takes about 2-4 weeks for symptoms to disappear, and it takes about 4-18 months for tenderness and mass to disappear during prostate examination.
