Chronic prostatitis
The key to the influence of prostate on human body is that its gland tissue can produce and secrete a liquid called prostatic fluid. It is also an exocrine gland, which can secrete 0.5-2ml of dilute milky white liquid every day. Prostate fluid is mixed with semen during ejaculation, accounting for about 65,438+03%-32% of the total semen. It contains fruit acid and amino acid, which is the energy source of sperm activity. Prostate fluid contains a lot of citric acid, phosphoric acid, potassium, sodium, magnesium, calcium and other substances, which can make sperm move. In addition, the prostate is an endocrine gland, and the acid phosphatase secreted by it increases sharply after puberty and tends to be stable after reaching the peak level. Only when prostate cancer occurs, acid phosphatase will increase obviously, so the change of acid phosphatase is used to diagnose prostate cancer in medicine.
The blood supply of the prostate is abundant, but the blood circuit in the prostate is not so smooth, and it can only flow into the internal iliac vein through many tiny veins, so the reflux resistance is great. It is precisely because of this feature that pathogenic bacteria or other harmful substances in other parts of the body are easy to invade the prostate and difficult to remove, which increases the chance of prostate damage.
In addition, prostaglandins secreted by prostate can promote the growth and maturation of sperm. If the prostaglandin E content per milliliter of sperm is less than 1 1 mg, sperm cannot mature. It can be said that if there is no prostate, or there is a serious disease in the prostate, it is impossible to have normal sperm activity and fertility.
Main physiological functions of prostate
The physiological function of prostate can be summarized into four aspects.
First of all, it has exocrine function. Prostate is the largest accessory gonad of men and one of the exocrine glands of human body. It can secrete prostatic fluid, is an important component of semen, plays an important role in the normal function of sperm and is very important for fertility. The secretion of prostatic fluid is regulated by androgen.
Second, it has endocrine function. Prostate is rich in 5α- reductase, which can convert testosterone into dihydrotestosterone with more physiological activity. Dihydro testosterone plays an important role in the pathogenesis of benign prostatic hyperplasia. By blocking 5α- reductase, the production of dihydrotestosterone can be reduced, thus shrinking the hyperplastic prostate tissue.
Third, it has the function of controlling urination. The prostate surrounds the urethra and is close to the bladder neck, forming a proximal urethral wall, and its annular smooth muscle fibers surround the urethra prostate and participate in the formation of internal urethral sphincter. When micturition impulse occurs, with the contraction of detrusor, the internal sphincter relaxes, which makes micturition go smoothly.
Fourth, it has the function of transportation. There are urethra and two ejaculatory ducts in the prostate parenchyma. During ejaculation, the muscles of prostate and seminal vesicle gland contract, and the contents of vas deferens and seminal vesicle gland can be pressed into the posterior urethra through the ejaculatory duct and then excreted. To sum up, the prostate has four important functions and plays an important role in the human body.
Changes of prostate structure in life.
In a person's life, the structure of prostate will change with age. /kloc-Before the age of 0/0, the prostate was very small, and the glandular tissue was underdeveloped. It was mainly composed of muscle tissue and connective tissue, and there was no real glandular duct, only germ. By the age of 10, on the basis of germ, glandular epithelial cells began to increase, forming glandular ducts. In adolescence, with the development of testis, the glandular ducts of prostate rapidly develop into acinus, and the stroma also increases, reaching its peak at the age of 24. Around the age of 30, epithelial cells fold into acini, which complicates the acini structure. From the age of 45 to 50, the folded epithelial tissue in the acinus began to disappear, and the whole prostate began to degenerate, but the glands around the urethra began to proliferate, compressing the surrounding area and shrinking it, and finally forming the so-called "surgical sac".
It can be seen that the structure of the prostate is changing all his life. As far as its size is concerned, childhood is very small, and adolescence can more than double. It is relatively stable between the ages of 20 and 50, and increases after the age of 50, which may develop into benign prostatic hyperplasia.
Relationship between prostate and urethra
Prostate belongs to male reproductive system and urethra belongs to urinary system, but the anatomical position of male urogenital organs is very close, so the relationship between them is very close.
The prostate is located below the bladder and above the urogenital diaphragm. The urethra passes through the center of the prostate, which surrounds the urethra. The urethra surrounded by the prostate is called urethral prostate, which starts from the bladder neck and ends at the urogenital septum, with an average length of about 3 cm. This urethra runs through the whole prostate from the bottom to the top, located in the prostate parenchyma, slightly narrower at both ends and wider in the middle, which is the largest diameter of male middle urethra. On the posterior wall of urethra and prostate, the midline is a vertical protrusion called urethral crest. The middle part of the urethral crest expands into a dome called seminal vesicle. There is a round or slender longitudinal fissure hole in the center of seminal vesicle, which is called prostate capsule. Below the prostate capsule are the openings of two ejaculatory ducts. The sulcus on both sides of urethral crest, called prostatic sinus, has many openings of prostatic excretory duct, from which prostatic fluid can be discharged into urethra.
When the prostate is hyperplastic, the enlarged prostate can compress the urethra and prostate, making it tortuous and narrow, leading to dysuria. Inflammation of the prostate is usually accompanied by inflammation of the urethra and prostate. Similarly, urinary tract and prostate diseases can also affect the prostate. Therefore, the prostate and urethra are closely related in anatomy, physiology and pathology.
Relationship between prostate and seminal vesicle and ejaculatory duct
The prostate surrounds the posterior part of urethra, and the posterior part clings to the anterior wall of rectum. Above the prostate, between the bladder floor and rectum, there are two pairs of organs obliquely penetrating into the prostate, namely the paired seminal vesicle and ejaculatory duct.
The left and right seminal vesicles are about 4 ~ 5 cm long, flat, lobulated and nearly inverted, and close to the posterior wall of bladder and rectum. The seminal vesicle contains a large number of polycystic glands with large glandular cavities. Its drainage tube meets the end of vas deferens, passes through the prostate and enters the urethra prostate, and opens on the urethral crest. The ejaculatory duct is extremely short, only 2 cm long, paired with the left and right seminal vesicles and the ends of the left and right vas deferens. Both ejaculatory ducts penetrate the prostate and open at the posterior urethral caruncle. The ejaculatory duct is the dividing line between the posterior lobe and the middle lobe of prostate.
It can be seen that the prostate is closely related to seminal vesicle and ejaculatory duct. When suffering from prostatitis, seminal vesicles can often be involved, leading to seminal vesiculitis. These three factors can affect each other physiologically and pathologically.
Classification of prostatitis
Prostatitis is a common disease in adult men, accounting for about 25% ~ 30% of outpatient diseases in urology. It can be asymptomatic, obvious, persistent, and even cause persistent or recurrent urogenital infections, which can be divided into the following categories:
(1) Nonspecific bacterial prostatitis: It can be divided into acute prostatitis and chronic prostatitis. Acute prostatitis refers to acute inflammation caused by nonspecific bacterial infection of prostate, mainly manifested as urgency, frequent urination, dysuria, rectal and perineal pain. Chronic prostatitis is a chronic inflammation caused by nonspecific bacterial infection of prostate, which is mainly manifested as discomfort in abdomen, perineum and testis, and white dripping at urethral orifice, which is common in young and middle-aged men.
(2) Idiopathic nonbacterial prostatitis: clinically, there are symptoms such as prostate pain, abnormal urination, and prostatic fluid overflowing at the urethral orifice. White blood cells in prostatic fluid can be increased, but bacterial culture has no bacterial growth.
(3) Nonspecific granulomatous prostatitis: Clinically, it is mainly manifested as frequent micturition, dysuria, burning urethral pain, pain in the back or perineum, but the disease develops rapidly, accompanied by symptoms such as excessive prostatic secretion and acute urinary retention. It is a foreign body reaction or allergic reaction caused by substances with poor solubility produced after the proliferation of reticuloendothelial system, so it can be divided into allergic and non-allergic.
(4) Prostatic pain and prostate congestion: Clinically, it is characterized by frequent urination, urgency, dysuria and discomfort in the prostate, or genuine prostate pain. There are no pus cells in the prostatic fluid and no obvious infectious lesions, which belongs to a kind of non-bacterial prostatitis.
(5) Specific prostatitis: including prostatitis caused by Neisseria gonorrhoeae, fungi and parasites (such as trichomonas).
(6) Prostatitis caused by other reasons: such as prostatitis caused by virus infection, mycoplasma infection and Chlamydomonas infection.
Etiology of chronic prostatitis
The etiology of chronic prostatitis has not been fully clarified so far, and there are different opinions. So far, the cause of chronic prostatitis can not be explained by a single theory. The analysis is related to the following factors.
(1) Prostate hyperemia: Prostate hyperemia caused by various reasons, especially passive hyperemia, is an important pathogenic factor. Non-infectious and non-microbial congestion lasts for a long time and can form non-specific inflammatory reaction. In addition, congestion is common in the following situations: ① abnormal sexual life: frequent sexual life, forced interruption of sexual intercourse, or excessive masturbation can make the prostate abnormally congested. However, excessive restraint in sexual life will also produce long-term automatic excitement, resulting in passive congestion. ② Direct compression of perineum: Riding a bicycle, riding a horse and sitting for a long time can make the prostate hyperemia, especially riding a bicycle. ③ Drinking: Drinking can make the reproductive organs congested and cause sexual excitement. 4 excessive massage: excessive or frequent manipulation during prostate massage will make the prostate congested, which is iatrogenic congestion. 5 Cold: Is the prostate rich in α? Adrenergic receptors, after catching cold, can cause sympathetic nerve activity, lead to increased urethral pressure, hinder excretion, and the prostate tube also hinders excretion due to contraction, resulting in congestion.
(2) Microbial infection: various microorganisms, such as bacteria, protozoa, molds, viruses, etc. , can become infectious pathogens, but bacteria are the most common. The invasion routes of bacteria include:
Blood-borne infection: infection focus can be found in more than 90% bacterial prostatitis.
Lymphatic infection: inflammation of lower urinary tract organs and colon and rectum can infect prostate through lymph.
Direct transmission: Bacteria in urethra can directly cause prostate infection.
(3) Autoimmune factors: Chronic prostatitis has a certain relationship with autoimmune factors, because "anti-prostate antibodies" have been found in arthritis patients; Others found at least 1 positive antigen-antibody system in serum examination.
(4) allergic reaction to virus: it can also lead to inflammation.
(5) Psychosomatic factors: Some people say that this factor is as high as 50%. In a word, there are many reasons for chronic prostatitis, and one factor cannot be emphasized unilaterally. Specific patients should be analyzed according to different situations.
Changes of prostate after chronic prostatitis
Many patients with chronic prostatitis want to know more about their diseases. One question they are worried about is what will happen to the prostate after suffering from chronic prostatitis.
Pathologically, due to the different severity of the disease and the different duration of the disease, the changes after prostate disease are also different. Generally speaking, the pathological manifestations of chronic prostatitis are nonspecific, and the inflammatory reaction is more limited and less obvious than that of acute prostatitis. There are plasma cells, macrophages and regional lymphocytes in and around prostate acinus, and the fibrous tissue of glandular leaves proliferates obviously. Some patients' glandular ducts are blocked by pus and exfoliated epithelial cells, which leads to poor drainage and vesicle expansion.
Digital rectal examination can touch the prostate and feel flexible. If the prostate fibrosis is serious, the glands can shrink and extend to the posterior urethra, making the bladder neck hard. At the same time, there are chronic inflammatory changes in seminal vesicle and ampulla of vas deferens, wall thickening and proliferation of surrounding fibrous tissue.
In addition, although soft spot disease belongs to granulomatous prostatitis, it actually belongs to chronic prostatitis, because some studies have confirmed that soft spot disease is caused by gram-negative bacilli, especially Escherichia coli infection. Histologically, a large number of granulomatous nodules of macrophages, lymphocytes and plasma cells can be seen, and a large number of sty can be seen in the cytoplasm of macrophages. Gutman inclusion bodies were round or oval, and PSA and calcium staining were positive.
Symptoms of chronic prostatitis
The symptoms of patients with prostatitis are diverse and complicated, and the common clinical symptoms and signs are as follows:
(1) During acute attack or abscess formation, fever, fatigue, anorexia, nausea, chills and collapse occur.
(2) The burning sensation of urethra during urination can spread to the penis head, and there is unclean secretion at the urethral orifice in the morning.
(3) The perineum and the anus damp of the posterior urethra are sticky and uncomfortable, full of pressure, sedentary, squatting or defecating.
(4) Radiation pain can occur in the innervation range from chest 10 to sacrum 3, and there are many low back pains.
(5) Sexual dysfunction.
(6) A series of symptoms such as dizziness, tinnitus, dizziness, insomnia, dreaminess and depression.
(7) For some patients who are not treated for a long time, allergic reactions or rheumatic changes such as neuritis and arthritis can be caused.
(8) When seminal vesicle infection is serious, the number of sperm will decrease, and the sperm will not liquefy, resulting in infertility.
The symptoms of chronic prostatitis are various, and the symptoms are not directly proportional to the severity of inflammation. Some patients have a lot of pus cells but no symptoms, and some patients have normal or near-normal prostatic fluid, but the clinical symptoms are very serious. Common symptoms can be summarized as follows:
(1) Discomfort in micturition: Frequent micturition and urethral burning may occur. In the morning, the urethral orifice secretes mucus, sticky silk and pus, and the urine is turbid or white after defecation. In severe cases, terminal hematuria and dysuria may occur.
(2) Local symptoms: discomfort in the posterior urethra, perineum and anus, heavy pressure or fullness, squatting or defecation.
(3) Radiation pain: The prostate or seminal vesicle is rich in sympathetic innervation. When inflammation occurs, the internal tension of gland increases, which can stimulate sympathetic nerve and cause metastatic low back pain. Pain can radiate to penis, testis, scrotum, groin, perineum, lower abdomen, thigh, buttocks, rectum and other parts.
(4) Sexual dysfunction: the main manifestations are decreased libido and premature ejaculation, and young unmarried people often show nocturnal emission, neurasthenia and depression.
(5) Others: Chronic bacterial prostatitis can cause allergic reactions, such as iritis, arthritis and neuritis. Can also be complicated with neurosis, manifested as fatigue, dizziness, insomnia, depression.