Medical Treatment of the Prostate Gland. Part 3
The Department of Urology of the New York Hospital
(Given January 31, 1941)
Diseases of the Prostate Gland
Prostatitis
2. Chronic Prostatitis
Chronic inflammation of the prostate gland is a very common condition in adult males. In our series of 350 postmortem studies, a large number of the specimens showed evidence of inflammation of the prostate.
The chronically infected prostate is a common focus of infection, and urologists have repeatedly emphasized the importance of examining the gland and its secretion when searching for the source of obscure infectious conditions. We regard the prostate as second only to infected tonsils as a cause of arthritis. It may also be responsible for endocarditis, neuritis, iritis, and myositis.
Etiology and Bacteriology. Chronic prostatitis may result from any cause which congests the gland, such as long-standing infection, sexual abuse, or instrumental or other trauma. Other possible etiological factors are prostatic calculosis, stricture of the urethra, and certain vitamin deficiencies and endocrine dyscrasias.
Chronic prostatitis is most frequently the sequel to an acute infection, which may be caused by either the gonococcus or other organisms. The incidence of acute prostatitis as a complication of gonorrheal urethritis has been variously estimated at from 50 to 90 per cent; and untreated acute gonorrheal prostatitis, or incompletely treated posterior urethritis, is undoubtedly the most important factor in the production of chronic prostatitis. Only immediately after the acute inflammation has subsided is the gonococcus to be found in the prostatic strippings.
Chronic inflammations are by no means always due to the gonococcus, however. Non-specific infection is common, and may be a direct extension from the urethra; or blood-borne from a focus in the tonsils, teeth, or sinuses; or the aftermath of an acute systemic infection. The most common organisms demonstrated are the colon bacillus and the staphylococcus, streptococcus and their subforms.
Pathology. Microscopically, there are usually to be observed regions of inflammatory reaction in and about the acini, characterized by an increase of the polymorphonuclear cells, lymphocytes, and plasma cells, with marked proliferation of connective tissue. In other cases, the micro-pathological changes consist in circumscribed areas of round cell or polymorphonuclear cell infiltration. Minute abscesses are sometimes observed.
In a large percentage of cases, cystoscopic examination will show pathological changes in the region of the bladder neck, trigone, or posterior urethra. There is usually more or less involvement of the seminal vesicles, which may be soft and atrophic, or enlarged and indurated.