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PROSTATIC DISEASES - PART 5

Viêm tuyến tiền liệt sau khi điều trị với thuốc chủng ngừa vi khuẩn intravesical (BCG) Calmette-Guérin. Granulomata được xác định nằm rải rác có chứa các tế bào khổng lồ Langhans và caseation trung tâm thường xuyên | PATHOLOGY OF THE PROSTATE Figure 60 Prostatitis an inflammatory infiltrate can be seen surrounding a duct or acinus and infiltrating the atrophic epithelium Figure 61 Atrophy a shrunken lobule is associated with the presence of fibrosis and chronic inflammatory cells 53 AN ATLAS OF PROSTATIC DISEASES Figure 62 Granulomatous prostatitis the distorted ulcerated ducts or acini are surrounded by a dense inflammatory infiltrate producing a nodular appearance at low power. This condition is commonly associated with urinary tract infection Figure 63 Prostatitis after therapy with intravesical bacillus Calmette-Guérin BCG vaccine. The scattered well-defined granulomata contain Langhans giant cells and occasional central caseation 54 12 Bladder outlet obstruction Benign prostatic hyperplasia prostate cancer and acute or chronic prostatitis may all result in bladder outlet obstruction. In addition other non-prostatic disorders such as bladder neck dyssynergia and urethral stricture disease Figure 64 may also result in bladder outlet obstruction. In response to the changes associated with increased outflow resistance the detrusor muscle undergoes hypertrophy with the development of trabeculation. As a consequence of these changes lower urinary tract symptoms develop. The interrelationship between benign prostatic hyperplasia prostatic enlargement bladder outlet obstruction and lower urinary tract symptoms can be depicted in a Venn diagram Figure 65 . It should be recalled however that many factors other than benign prostatic hyperplasia can affect bladder function as men age Figure 66 . Although bladder wall hypertrophy which develops in response to the increased effort required Figure 64 A retrograde urethrogram showing a stricture of the bulbar urethra. In older men the bladder outflow obstruction resulting from such a stricture may mimic obstructive benign prostatic hyperplasia Figure 65 The three basic features of benign prostatic hyperplasia hyperplasia i.e. transitional