Article 105: The Relationship and Pathological Manifestations of Urethritis and Chronic Prostatitis

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Treatment and recuperation of common diseases

What is the relationship between urethritis and chronic prostatitis?

Urethritis is often caused by obstruction at the urethral opening or within the urethra, such as phimosis, posterior urethral valves, urethral stricture, and urethral stones. Its main symptoms include copious discharge from the urethral opening, or only a small amount of serous discharge during the first urination in the morning, burning sensation during urination, urinary frequency, urgency, and the presence of pus cells and red blood cells in the urine.

In the chronic phase of urethritis, the lesions are mainly located in the posterior urethra, bladder neck, and trigone, sometimes spreading to the entire urethra. Since the prostate gland is anatomically part of the posterior urethra, persistent urethritis can easily invade the prostate and cause chronic prostatitis, often due to gonococcal, mycoplasma, or chlamydia infections. Conversely, persistent chronic prostatitis can also invade the posterior urethra, causing posterior urethritis, mainly manifested as urinary frequency, terminal dysuria, weak urine stream, and in severe cases, difficulty urinating.

The above illustrates that urethritis and chronic prostatitis are mutually causal and closely related. Therefore, regardless of which disease one has, one should actively seek treatment to prevent the condition from worsening.

Pathological manifestations of chronic prostatitis

From a pathological perspective, the changes in the prostate gland vary depending on the severity and duration of the condition. Generally speaking, the pathological manifestations of chronic prostatitis are nonspecific, and the inflammatory response is more localized and less pronounced than in acute prostatitis. There is varying degrees of aggregation of plasma cells, macrophages, and regional lymphocytes within and around the prostatic acini, and significant fibrous tissue hyperplasia in the lobes.

In some patients, the glandular ducts are blocked by purulent material and sloughed epithelial cells, resulting in poor drainage and dilated vesicles. A digital rectal examination reveals a soft, resilient prostate gland. If prostatic fibrosis is severe, the gland may atrophy and extend to the posterior urethra, causing bladder neck sclerosis. Chronic inflammatory changes are also present in the seminal vesicles and ampulla of the vas deferens, with thickened walls and surrounding fibrous tissue hyperplasia.

What are the symptoms of chronic prostatitis?

1. Urinary symptoms: Frequent urination, urgency, painful urination, difficulty urinating, and nocturia. Some patients may experience a thin, clear, or milky white fluid, i.e., prostatic fluid, dripping from the urethra before or after urination or defecation.

2. Pain: Due to persistent chronic inflammation, nerve reflexes can cause discomfort in the lower body, with severe tenderness and a feeling of heaviness in the perineum, anus, and scrotum. This pain often radiates to the suprapubic region, lumbosacral region, bilateral groins, and perineum, and can also cause lower limb pain, causing significant suffering and restlessness. Symptoms are generally more pronounced in the morning.

3. Changes in sexual function: Premature ejaculation, nocturnal emission, decreased libido, or erectile dysfunction may occur. Some patients experience painful ejaculation and hematospermia. Chronic prostatitis is a significant cause of infertility in some cases.

4. Neurasthenia: Symptoms include insomnia, vivid dreams, fatigue, dizziness, lack of self-confidence, and low mood. Some patients experience memory loss, or exhibit symptoms primarily associated with neurasthenia.

In addition, during a digital rectal examination, the prostate may be enlarged, normal, or shrunken, with an uneven surface texture, nodular appearance, or tenderness. Most patients experience changes in urine color, such as dark or cloudy urine, or milky white urine at the end of urination; gross hematuria is relatively rare, and most cases present as microscopic hematuria.

What tests should be done?

1. Urinalysis: Generally negative. Occasionally a small number of white blood cells may be seen, but in the acute phase, clumps of white blood cells may be seen, and pus cells may be present in severe infections.

2. Examination of prostatic fluid: Generally, there are more than 10 white blood cells or pus cells per high-power field, or although there are no more than 10 white blood cells or pus cells per high-power field, but clumps of pus cells can be seen, lecithin bodies are significantly reduced, and bacterial culture is performed.

3. Bacteriological localization examination of urine and prostatic fluid: can differentiate between prostatitis, urethritis, or urinary tract infection.

4. Semen analysis: In severe prostate infections, a large number of white blood cells and bacteria can be found in the semen. For those who are not suitable for prostate massage or whose massage has failed, semen analysis has some reference value.

5. pH measurement of prostatic fluid: In cases of chronic prostatitis, the pH value of the prostate is significantly increased, and the degree of cure of prostatitis is directly proportional to the return of the prostatic fluid pH value to normal.

6. Cystoscopy: Obvious congestion is found in the posterior urethra and bladder trigone, and the seminal colliculus and prostate are enlarged, congested, or hemorrhagic.

7. X-ray imaging: Urethral contrast imaging sometimes shows posterior urethral stricture. Although it cannot be a definitive diagnostic indicator, it has some diagnostic significance for more severe cases.