Granulomatous prostatitis

　　The onset of granulomatous prostatitis is related to a strong local foreign body reaction. Prostatic duct obstruction is the primary factor, caused by inflammatory processes induced by bacterial infections or tissue necrosis caused by surgical trauma, and prostatic hyperplasia may also cause or worsen the obstruction of the prostatic duct. Infection and inflammation destroy the ductal and glandular epithelium, cellular debris, bacterial toxins, and prostatic secretions enter the tissue spaces, become foreign bodies in the stroma, and trigger a granulomatous inflammatory reaction. Granulomatous inflammation may be localized or may involve the entire prostate. The inflammation subsides slowly, taking about 2 to 3 months, and is replaced by fibrous connective tissue locally, with changes in texture. Experts classify granulomatous prostatitis into 4 categories according to the etiology:

　　7. Non-specific cases account for 70% and are often secondary to recent urinary tract infections.

　　6. After transurethral surgery or needle biopsy, it accounts for 24%. Transurethral surgery includes TUR-P and TUR-Bt, half of which occur within 6 months after surgery.

　　3. Specific cases account for 3%. Pathogens include bacteria, tuberculosis, brucellosis, syphilis, viruses, and fungi, etc. The incidence of granulomatous prostatitis after transurethral resection of bladder tumor and postoperative instillation of BCG vaccine has received widespread attention, as a complication of bladder instillation of BCG vaccine, its incidence rate is 0.9% to 1.3%, second only to cystitis and fever. Some people have also performed pathological examination on the prostate of patients with bladder instillation of BCG vaccine, and found that the actual incidence of the disease is actually very high (41% to 75%). It takes about 1 year on average from the beginning of instillation to the discovery of the disease (3 to 25 months).

　　4. Systemic granulomatosis accounts for 3%, which is the local manifestation of granulomatous diseases involving multiple organs in the prostate, including allergic granulomatosis (Churg-Strauss syndrome) and Wegener's granulomatosis. The former is often associated with multiple organ granulomatosis and asthma, and is also known as eosinophilic granulomatous prostatitis due to the obvious infiltration of eosinophils in the granuloma. The latter is a genetic disease, often complicated with granulomatosis of the respiratory tract and vasculitis.

　　Granulomatous prostatitis is usually non-specific and often associated with recent urinary tract infections. It is difficult to distinguish from prostate cancer. Then, what are the complications of granulomatous prostatitis? The following experts introduce the complications of granulomatous prostatitis.

　　1. Effects on sexual function and fertility

　　It is mainly manifested as a decrease in sexual function, such as a short time of sexual intercourse or premature ejaculation, which may be related to inflammatory stimulation of the granulomatous prostatic. The relationship between impotence and granulomatous prostatitis is not yet certain. Granulomatous prostatitis does not directly damage the neural-vascular function of penile erection. Long-term discomfort can produce psychological pressure on patients, making them feel suppressed and worried, especially those who are not familiar with the disease often think there is a problem with their sexual function. Over time, it may lead to psychogenic impotence. Blood seminal fluid may occur when prostatitis is complicated with seminal vesiculitis.

　　The main component of semen is prostatic fluid, and the sperm discharged from the testis and epididymis must be nourished and transported by seminal plasma, including prostatic fluid, to have the ability to combine with eggs. The routine semen of patients with granulomatous prostatitis often shows reduced sperm vitality and a higher mortality rate. The incidence of infertility in patients with prostatitis is significantly higher than that in the general population.

　　2. Effects on the whole body

　　In addition to local urinary system symptoms, granulomatous prostatitis can also manifest as allergic iridocyclitis, arthritis, endocarditis, myositis, etc. Patients with granulomatous prostatitis often show obvious mental symptoms, such as tension, high stress, and long-term fatigue, insomnia, frequent dreams, easy fatigue, hypochondriasis, and anxiety. These patients often pay excessive attention to their health status and seek evidence from all sides to confirm it. It is very difficult to change their hypochondriacal psychology, no matter how patient the doctors are in their explanations. Although patients often hold a suspicious attitude towards doctors' explanations and treatments, their desire for treatment is quite urgent. The relationship between prostatitis and mental symptoms is not yet clear. Why does stress cause prostatitis, and how does prostatitis lead to mental and neurological symptoms, which is worthy of further study. There is a direct internal connection between mental and neurological symptoms and individual personality characteristics, so the degree of mental symptoms in different individuals with granulomatous prostatitis can vary greatly.

　　83% of patients with granulomatous prostatitis have severe symptoms of lower urinary tract infection, such as fever, chills, frequent urination, burning sensation of the urethra, and dysuria. Blood in urine, perineal pain, and discomfort above the pubic bone are occasionally seen. Rectal examination: The masses of granulomatous prostatitis generally develop rapidly, with large, elastic, irregular nodules, and inconsistent hardness and softness.

　　Granulomatous prostatitis is a rare disease, mostly non-specific, often associated with recent urinary tract infections. Most cases can be palpated for hard nodules or diffuse hard masses in the rectum, which are difficult to differentiate from prostate cancer. So, how to prevent granulomatous prostatitis? The following experts introduce the preventive measures for granulomatous prostatitis:

　　1. Drink plenty of water:Drinking plenty of water leads to increased urination, and highly concentrated urine can stimulate the prostate, which can be harmful if there is long-term adverse stimulation. Drinking plenty of water can not only dilute the blood but also effectively dilute the concentration of urine.

　　2. Do not hold urine:Once the bladder is full and you feel the need to urinate, you should urinate. Holding urine is harmful to the bladder and prostate. Before taking a long-distance bus, you should empty your bladder before getting on the bus, and if you feel an urgent need to urinate during the journey, you should greet the driver and get off the bus to urinate. Never hold it in.

　　3. Control sex life:To prevent benign prostatic hyperplasia, it is necessary to start paying attention from young adulthood. The key is to have moderate sex life, neither indulging nor abstaining. Frequent sex can keep the prostate in a state of congestion for a long time, leading to enlargement of the prostate. Therefore, especially in the period of strong sexual desire in young people, attention should be paid to controlling sex life, avoiding repeated congestion of the prostate, and giving the prostate sufficient time to recover and repair. Of course, excessive abstinence can also cause a sense of fullness and discomfort, which is also not good for the prostate.

　　4. Relax more:Lifestyle stress may increase the chance of prostate enlargement. Clinical studies have shown that when lifestyle stress is reduced, prostatic symptoms will be alleviated, so it is best to maintain a relaxed state in daily life.

　　5. Take a warm bath:Taking a warm bath can relieve muscle and prostate tension, alleviate discomfort, and is undoubtedly very beneficial for patients with prostatitis. If you take a warm bath of the perineum 1-2 times a day, the same good effect can be achieved.

　　6. Maintain cleanliness:The scrotum of males has a large degree of elasticity and secretes a lot of sweat. In addition, the perineum has poor ventilation, which is prone to accumulate dirt and grime. Local bacteria often take advantage of this to enter, leading to prostatitis, benign prostatic hyperplasia, and a decrease in sexual function. If not paid attention to in time, serious infections may occur. Therefore, persistently cleaning the perineum is an important link in preventing prostatitis. In addition, it is very necessary to rinse the external genitalia each time sexual contact occurs.

　　7. Prevent cold exposure:Do not sit for a long time on cool stones, as cold can enhance sympathetic nerve activity, leading to increased intravesical pressure and causing backflow.

　　8. Avoid friction:Friction in the perineum can exacerbate the symptoms of prostatitis, causing significant discomfort to the patient. To prevent harmful friction locally, it is advisable to ride a bicycle less often, and absolutely not to ride a bicycle or motorcycle for long periods or long distances.

　　9. Adjust lifestyle:It is best to avoid drinking alcohol and eating spicy foods such as chili and ginger to prevent repeated congestion and exacerbation of local swelling and pain in the prostate and bladder neck. Since constipation may worsen the symptoms of prostate prolapse, it is advisable to eat more vegetables and fruits in daily life to reduce the occurrence of constipation, and to use medications such as Maren Wan for bowel softening and defecation if necessary.

　　Granulomatous prostatitis does not usually provide much help in diagnosis through routine laboratory tests. Some patients may have an increase in blood leukocytes, an accelerated erythrocyte sedimentation rate, and a rare increase in eosinophils, which has little significance. This is because, in addition to allergic granulomatous prostatitis, fungal or parasitic infections in other parts of the body are also possible. Most patients have purulent urine, half of whom have microscopic hematuria, and urine cultures may show Gram-negative bacteria. It is very rare for blood acid phosphatase and alkaline phosphatase levels to be elevated.

　　Blood prostate-specific antigen may transiently increase, making it more likely to be confused with prostate cancer. There are reports of 10 cases of pathologically confirmed non-specific granulomatous prostatitis, 4 cases with blood PSA > 4.0 ng/ml, including 3 cases between 4.0-6.0 ng/ml, and 1 case of 10.1 ng/ml. All cases have returned to normal within 1 year of follow-up, but attention should be paid to repeated biopsies for cases with persistent abnormal PSA, to exclude prostate cancer.

　　1. Imaging examination

　　Transpubic B-ultrasound or transrectal B-ultrasound can show hyperechoic nodules within the prostate or uneven echo of the prostate, similar to prostate cancer; other B-ultrasound findings include prostate enlargement, irregular shape but intact capsule, etc. MRI is not very helpful for diagnosis, and attention should be paid to the discovery of individual cases of prostate cancer that may occur concurrently with this disease. In addition, even if the diagnosis of this disease has been obtained, if suspicious evidence of prostate cancer is found during follow-up, a repeat biopsy is still needed.

　　2. Prostate needle biopsy

　　Transperineal Travenol Tru-Cut biopsy puncture for histological examination or transrectal ultrasound-guided fine needle puncture for histological examination can make an accurate diagnosis.

　　Patients with granulomatous prostatitis should eat nourishing, light, sweet, and moistening foods; eat nutrient-rich foods; eat vitamin A-rich foods; eat foods that enhance immune function; eat foods with anti-tumor effects.

　　Patients with granulomatous prostatitis should avoid drinking coffee and other stimulating beverages; avoid eating spicy and刺激性 food; avoid eating greasy, fried, moldy, and preserved food; avoid eating pork head meat and other hair-raising foods; avoid eating seafood; avoid eating warm and hot foods.

　　Granulomatous prostatitis is mainly treated with antibacterial and anti-inflammatory drugs, supplemented by traditional Chinese medicine treatment. Antibiotics and anti-inflammatory drugs should be alternated for 2-3 months, and the lump will quickly disappear if treated in time. The principle of traditional Chinese medicine treatment is: tonifying kidney Yin, softening hard masses, promoting blood circulation and removing blood stasis, clearing heat and detoxifying, and promoting diuresis. Intramuscular injection of placental tissue fluid also has a significant therapeutic effect. A few patients with severe obstruction symptoms may need to undergo prostatectomy. It should be noted that the adhesion of the prostate is serious, and the operation is difficult.