Prostatitis pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yazan Daaboul, M.D. Maliha Shakil, M.D. [2]
Overview
The exact pathogenesis of bacterial prostatitis is not yet fully understood. Two possible theories include ascending urethral infection and the reflux of urine via the ejaculatory and prostatic ducts.[1][2]
Pathogenesis
Acute Bacterial Prostatitis
The exact pathogenesis of acute prostatitis is not yet fully understood. Two possible theories include ascending urethral infection from the meatus and the reflux of urine via the ejaculatory and prostatic ducts.[1]
Chronic Bacterial Prostatitis
The pathogenesis of chronic bacterial prostatitis is thought to include ascending infection from the distal urethra to the prostate.[2]
Chronic prostatitis/chronic pelvic pain syndrome
The symptoms of CP/CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological and endocrine systems. Theories behind the disease include stress-driven hypothalamic-pituitary-adrenal axis dysfunction and adrenocortical hormone (endocrine) abnormalities, neurogenic inflammation, and myofascial pain syndrome. In the latter two categories, dysregulation of the local nervous system due to past trauma, infection or an anxious disposition and chronic albeit unconscious pelvic tensing lead to inflammation that is mediated by substances released by nerve cells (such as substance P). The prostate (and other areas of the genitourinary tract: bladder, urethra, testicles) can become inflamed by the action of the chronically activated pelvic nerves on the mast cells at the end of the nerve pathways.[3]
Microscopic Pathology
On microscopic histopathologic analysis, acute prostatitis may be characterized by:[4]
- Neutrophils within the glands, between the epithelial cells or within the stroma
On microscopic histopathologic analysis, chronic prostatitis may be characterized by:[4]
- Lymphocytes within the glands, between the epithelial cells or within the stroma
References
- ↑ 1.0 1.1 Stevermer JJ, Easley SK (2000). "Treatment of prostatitis". Am Fam Physician. 61 (10): 3015–22, 3025–6. PMID 10839552.
- ↑ 2.0 2.1 Sharp VJ, Takacs EB, Powell CR (2010). "Prostatitis: diagnosis and treatment". Am Fam Physician. 82 (4): 397–406. PMID 20704171.
- ↑ Chronic prostatitis/chronic pelvic pain syndrome. Wikipedia 2016. https://en.wikipedia.org/wiki/Chronic_prostatitis/chronic_pelvic_pain_syndrome. Accessed on March 2, 2016
- ↑ 4.0 4.1 Prostate Gland.Libre Pathology. http://librepathology.org/wiki/Prostate_gland#Acute_inflammation_of_the_prostate_gland. Accessed on March 2, 2016