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Diseases of the Prostate 1

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Diseases of the Prostate 1 402 XX. Diseases of the Male Genital System N.B.2: Diseases of the prostate 1. Inflammatory: 1. Acute: (a) Chiefly from gonorrheal urethritis. (Prostatitis) (b) May be by pyogenic micro-organisms such as staphylococci, streptococci or B. coli. (c) After operations or instrumentations (catheterization, urethral dilatation and cystoscopy). Types: i. Catarrhal (common). ii. Purulent follicular, behind blocked duct purulent exudate abscess. iii. Purulent diffuse: Diffuse cellulitis wide-spread suppuration and destruction of glandular tissue abscess which bursts into the urethra, rectum or surface of perineum. Features: Enlarged, Oedematous, Congested, Spongy and Soft prostate Areas of necrosis disseminated abscesses. 2. Chronic: Gonococcal: i. Insidious from the start. ii. On top of acute. Features: Small, fibrosed and firm prostate. 3. Granulomatous: (a) Non-specific (as a sequel to prostatitis). (b) Tuberculosis From genito-urinary tract (20%) or by blood stream (from an organ such as the lung). Features: - Miliary tubercles caseous masses tuberculous abscess. Firm nodular masses asymmetrical enlargement. Diffuse tuberculous infiltration. Complications: i. Bursting of abscess into: (a) Urethra. (b) Exterior fistula. ii. Extension to : (a) Vesicles. (b) Bladder. (c) Syphilis. (d) Actinomycosis. (e) Bilharziasis of the prostate Enlarged prostate by fresh bilharziomata + diffuse lesions) is rather common in adults suffering from Bilharziasis of the urinary tract dysuria +-frequency of micturition+ pain and discomfort in the suprapubic and perineal regions + Hemospermia and powerful sexual excitement. Later on, fibrosisdiminution in size of prostate (shrinkage) which becomes nodular, hard and adherent to the seminal vesicles lowered sexual power. Bilharziasis of the prostatic urethra. Infiltrative stage hyperplastic stage haemospermia (with B. ova) and sexual excitability. Fibrotic stage scarring (but no actual narrowing which if occurred, is not sufficient to give rise to obstructive symptoms (D.D. obstruction and/or narrowing of the penile urethra). No (or very little) haemospermia and weakened sexual power. : The Batson venous plexus (Batson veins) is a network of valveless veins in the human body that connect the deep pelvic veins and thoracic veins (draining the inferior end of the urinary bladder, breast and prostate) to the internal vertebral venous plexuses. Because of their location and lack of valves, they are believed to provide a route for the spread of cancer metastases. These metastases commonly arise from cancer of the pelvic organs such as the rectum and prostate and may spread to the vertebral column or brain. The plexus is named after anatomist Oscar Vivian Batson, who first described it in 1940. Batson's plexus is part of the Cerebrospinal venous system. Batson's venous plexus may also allow the spread of infection in a similar manner. Urinary tract infections like pyelonephritis have been shown to spread to cause osteomyelitis of the vertebrae via this route. The osteomyelitis in such a case will resolve concurrently with the same antibiotic that treats the urinary tract infection because both infections are from the same organism. III. Miscellaneous 1. Cysts (congenital or acquired) from remnants of Mullerian or Wolffian ducts or from occlusion of prostatic ducts difficult micturition. 2. Diverticulae: (a) Congenital (rare, small and asymptomatic). (b) Acquired (on top of prostatitis and duct occlusion). Is commoner, multiple and branched pyuria and haematuria. 3. Calculi: (a) Formed in the substance of the prostate by calcium phosphate and carbonate + corpora amylacia. Are multiple, small, associated with the senile prostate and are symptomless (or with few symptoms). (b) On top of urinary calculus (in posterior urethra) haematuria, colic and symptoms of vesical neck-obstruction. 4. Infarct: Haemorrhagic well-defined area pale, yellowish-grey, soft-firm and fibrosed. 5. Atrophy (rare): Reduction in size; firmer in consistence; greyish white on section; very little glandular tissue; weak micturition: frequent urination; dribbling stream. 6. Nodular hyperplasia (senile prostate): Arises from the so-called inner shell of the prostate). Is very common from: i. Ageing. ii. Endocrine imbalance (decreased testicular function + drop in androgen formation + relative hyper-estrinism). Features: Nodular enlargement in lateral or/and middle (median) lobes compression of urethra or/and projection up into floor of urethra ball-valve obstruction. Nodules: When chiefly of glandular tissue proliferation and dilatation well- demarcated; yellowish-pink; soft; oozing out of milky-white fluid. When chiefly of fibromuscular tissue not so demarcated from the prostatic capsule; false encapsulation from the compressed surrounding tissue; pale grey; firmer; no fluid is oozed out. Symptoms: o Compression of urethra and its sequels. o Retention cystitis infection of residual urine secondary changes in bladder infection in kidney and renal pelvis uraemia. .
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