Inflammatory diseases of the scrotum

Classification and features of prostate inflammation

The group of inflammatory diseases of the prostate is classified according to the clinical course into acute and chronic forms. The etiology may be infectious in nature (bacteria, viruses, fungi) or caused by non-infectious factors, including prolonged stasis of secretion. Often, the exact cause cannot be determined.

The main mechanism for the development of infectious forms is the reflux of infected urine from the lower urinary tract into the glandular ducts. Pathogen penetration is also possible via hematogenous route in bacteremia or lymphatic route from the rectum.

Acute bacterial prostatitis

This is an acutely developing non-specific inflammatory process most commonly induced by gram-negative flora (primarily E. coli), as well as enterococci, gonococci, or trichomonads. Predisposing conditions include hypothermia, lower urinary tract infections, and STIs.

Macroscopically, the organ swells and becomes dense, diffusely or focally. Inflammation goes through three sequential morphological stages:

1. Catarrhal: marked stromal edema, vascular congestion, and neutrophil accumulation in the ducts are observed.
2. Follicular: the inflammatory infiltrate spreads to the secretory units (acini).
3. Parenchymal: diffuse neutrophil infiltrates form, with the appearance of microabscesses and foci of granulation tissue proliferation.

Without proper therapy, the process can lead to acute urinary retention and the development of urogenic sepsis.

Chronic forms of prostatitis

Chronic inflammation can be an independent disease or a consequence of undertreated acute form. Several main variants are distinguished:

• Chronic bacterial prostatitis. Often caused by intracellular microorganisms (Chlamydia trachomatis, mycoplasmas, ureaplasmas). Provoked by hypodynamia, irregular sexual life rhythm, and dietary factors. Macroscopically, the gland is deformed and dense. At the microscopic level, foci of lymphocyte, macrophage, and plasma cell accumulation, as well as proliferation of fibrous tissue, are visible in the stroma. The disease has a prolonged course, responds poorly to therapy, and can be complicated by infertility.
• Chronic non-bacterial prostatitis. The most common form. Occurs predominantly after 50 years of age. Microscopically, glandular lumens are dilated and filled with lipid-laden macrophages and neutrophils, while the stroma is infiltrated by lymphocytes.
• Chronic granulomatous prostatitis. A rare specific pathology associated with tuberculosis, syphilis, or fungal infections. Characterized by the formation of specific granulomas and fibrosis.
• Malakoplakia. A special type of chronic granulomatous inflammation in which atrophy of the glandular apparatus is accompanied by metaplasia of the duct epithelium.

Benign prostatic hyperplasia and tumors

In addition to inflammatory processes, dyshormonal and oncological changes frequently develop in the prostate tissue.

Benign prostatic hyperplasia (BPH) is the most frequent neoplasm of the male genitalia, affecting the periurethral zone. The risk of its development increases sharply with age (from 25% in 50-year-old men to 90% in 70-year-olds). The pathogenesis is based on elevated estrogen levels (due to testosterone conversion) and concomitant chronic inflammation.

Macroscopically, the gland enlarges and acquires a firm-elastic consistency. Nodules form that compress the urethra, triggering a cascade of complications ranging from hydronephrosis to urogenic sepsis. The most common histological form is simple glandular, in which branched acini predominate over the stroma.

High-grade prostatic intraepithelial neoplasia (PIN) is considered an obligate precancerous lesion, which typically progresses to prostate cancer (most commonly adenocarcinoma). Cancer is diagnosed by determining total and free prostate-specific antigen (PSA) levels, TRUS, and biopsy.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Penile cancer: macroscopic growth forms and histological types.
• Developmental anomalies of the prostate gland (agenesis, ectopia, true cysts).
• Histological forms of benign prostatic hyperplasia (BPH).
• Basal cell hyperplasia and prostatic intraepithelial neoplasia (PIN).
• Diagnostic criteria and risk factors for prostate cancer.

Other topics in the section "Chapter 18. Diseases of the Male Reproductive System"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.