Physiology of the prostate gland
The prostate gland plays a key role in the formation of full-fledged seminal fluid. Its secretion is rich in specific proteins, citric acid, and prostaglandins. This fluid not only provides the necessary volume of the ejaculate but also imparts the biological properties required for fertilization.
In addition to its exocrine role, the gland performs important supplementary tasks. It actively participates in the metabolism of male sex hormones, exerts a regulatory effect on spermatogenesis, and influences the activity of the hypothalamic-pituitary system.
Inflammatory diseases of the penis
Among non-neoplastic pathologies of the male genital organs, inflammatory processes occupy a leading position. The most clinically significant forms are balanoposthitis and cavernositis.
Balanoposthitis
This is a combined inflammation of the skin of the glans penis and the inner layer of the prepuce. An unfavorable background contributes to the development of the disease: the presence of diabetes mellitus, chronic infections, or immunodeficiency states (often associated with purulent inflammation of the urethra).
Classification of acute forms:
- Catarrhal: hyperemia and edema. Subsequently, the affected epidermis sloughs off, forming superficial erosions.
- Erosive: formation of more distinct defects.
- Purulent-ulcerative: deep lesion with purulent exudate.
- Gangrenous: severe outcome with the development of penile necrosis.
Chronic balanoposthitis is dangerous due to cicatricial changes in the prepuce, which inevitably leads to the development of phimosis — a pathological narrowing that prevents the exposure of the glans.
Cavernositis
It is much less common and represents inflammation of the corpora cavernosa. Infection can penetrate:
- Via a hematogenous route (against the background of tonsillitis, osteomyelitis, sepsis).
- During organ trauma.
- As a result of intracavernosal medication injections.
- As a complication of acute purulent urethritis.
Hormonal regulation of the reproductive system
To understand the pathogenesis of diseases, it is important to consider the hormonal axis, which is regulated by the hypothalamus. The arcuate nucleus releases stimulating gonadotropin-releasing hormone and inhibiting gonadostatin.
In response, the pituitary gland secretes:
- Luteinizing hormone (LH): stimulates interstitial Leydig cells to produce testosterone.
- Follicle-stimulating hormone (FSH): acts on Sertoli cells, causing them to synthesize androgen-binding protein.
The complex of testosterone and androgen-binding protein triggers spermatogenesis. The system operates on a negative feedback principle: excess testosterone suppresses the pituitary and hypothalamus.
Complications and fibrous changes
Chronic inflammation can lead to fibrous changes. For example, long-standing balanoposthitis causes phimosis. In turn, an attempt at forcible exposure of the glans in phimosis can lead to paraphimosis — acute entrapment of the glans by the cicatricial ring of the prepuce.
Severe sclerotic processes in the corpora cavernosa themselves (cavernous fibrosis) most often result from prolonged priapism (pathological erection lasting more than 3 days) or previous inflammation. This condition leads to partial or complete loss of erectile function.
Briefly: answers to topical questions
What inflammatory non-neoplastic diseases of the male reproductive system are distinguished in pathomorphology?
In pathomorphology, inflammatory diseases of various organs of the male reproductive system are distinguished. The main nosologies include:
- Balanoposthitis — inflammation of the skin of the glans penis and the inner layer of the prepuce.
- Cavernositis — inflammation of the corpora cavernosa of the penis.
- Orchitis — inflammation of the testicular tissue (including acute infectious and specific orchitis).
- Epididymitis — inflammation of the epididymis.
- Prostatitis — inflammation of the prostate gland (acute and chronic).
- Vesiculitis — inflammation of the seminal vesicles.
What are the main pathways of infection entry into the prostate gland in the development of prostatitis?
The main pathways of infection entry into the prostate gland in the development of prostatitis involve three mechanisms. The following infection routes are distinguished:
- Urogenital pathway — reflux of infected urine into the ducts of the gland (usually as a consequence of a lower urinary tract infection).
- Lymphogenic spread — transport of infection via lymphatic vessels from the rectum.
- Hematogenous dissemination — penetration of the pathogen with the bloodstream during bacteremia.
What morphological forms of acute prostatitis are distinguished in pathomorphology?
Based on the depth and extent of morphological changes, three forms of acute prostatitis are distinguished. These include:
- Catarrhal form — marked neutrophilic infiltration of the prostatic ducts against the background of vascular congestion and stromal edema.
- Follicular form — addition of foci of inflammatory infiltration in the secretory divisions of the prostate to the changes in the ducts.
- Parenchymatous form — formation of diffuse infiltrates composed of neutrophils, the appearance of abscesses and foci of granulation.
What microscopic changes are characteristic of parenchymatous prostatitis?
Parenchymatous prostatitis is characterized by:
- Diffuse infiltrates consisting predominantly of neutrophils.
- Abscesses.
- Foci of granulation.
Which cellular elements form the basis of the inflammatory infiltrate in chronic nonspecific prostatitis?
The basis of the inflammatory infiltrate in chronic prostatitis is formed by mononuclear cells, as well as neutrophils depending on the form. The cellular composition includes:
- Lymphocytes — infiltrate the stroma and adjacent tissue of the gland.
- Plasma cells — are present in the inflammatory foci of the stroma.
- Macrophages — detected in the stroma; in non-bacterial prostatitis, macrophages loaded with lipids are found in the lumens of the glands.
- Neutrophils — fill the dilated glands in chronic non-bacterial prostatitis.
What types of specific granulomatous prostatitis are encountered in clinical practice?
Specific granulomatous prostatitis includes forms associated with:
- Tuberculosis.
- Syphilis.
- Fungal infection.
Tuberculous prostatitis is characterized by the formation of epithelioid cell granulomas with foci of caseous necrosis.
What are the possible local complications of acute purulent prostatitis?
Possible local complications and morphological manifestations of acute purulent prostatitis include:
- Urinary retention.
- In the parenchymal form — formation of abscesses and foci of granulation.
What morphological outcomes are characteristic of long-standing chronic prostatitis?
Long-standing chronic prostatitis is characterized by sclerotic changes in the organ tissue and stone formation. The main morphological outcomes include:
- Fibrosis — proliferation of granulation and fibrous tissue in the glandular stroma is frequently detected, leading to its induration and deformation.
- Lithiasis (stone formation) — the formation of intraprostatic calculi (prostatic stones), which serve as a reservoir for the pathogen.
To memorize testicular cells: Leydig — Luteinizing hormone (both start with L in Russian) → produce testosterone. Sertoli — FSH (stimulate Spermatogenesis and Secrete protein).
Class and exam questions
What is the difference between phimosis and paraphimosis?
Phimosis is the narrowing of the foreskin, making it impossible to expose the glans penis. Paraphimosis is an acute complication where the narrowed foreskin traps the already exposed glans, impairing blood circulation.
What do Sertoli cells produce besides stimulating spermatogenesis?
They possess endocrine function: they synthesize estrogens, androgen-binding protein, and inhibin, which acts on the pituitary gland via a negative feedback loop.
What are the main causative agents of ordinary balanopostitis?
The pathology is most commonly based on staphylococci, streptococci, trichomonads, and fungal infection.
What else to study on this topic
- Peyronie's disease and mechanisms of fibroplastic induration
- Tumor lesions of the penis: the role of HPV and condylomata acuminata
- Carcinoma in situ (Bowen's disease, erythroplasia of Queyrat, bowenoid papulosis)
- Urethral malformations: hypospadias and epispadias
- Mechanisms of traumatic injuries of the penis (fracture, dislocation)
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