Consequences Of Prostatic Enlargement

Pathology of the prostate: conditions that may cause prostatic enlargement include…

• Benign prostatic hyperplasia

• Neoplasms of the prostate (e.g. adenocarcinoma of the prostate)

• Inflammatory conditions (e.g. prostatitis)

Consequences: vary according to the underlying pathology

Benign prostatic hyperplasia: (very common) refers to nodular overgrowth of both epithelial and fibromuscular components of the periurethral and transition zone of the prostate.

Manifestations include

• Prostatism:

• Irritative: dysuria, frequency, urgency and nocturia

• Obstructive: reduced force of urinary stream, hesitancy in initiating voiding, post voiding dribbling and sensation of incomplete emptying

• Bladder complications:

• Trabeculation and development of diverticula of the bladder

• Infection of urine and development of cystitis

• Renal complications:

  • Hydronephrosis

  • Pyelonephritis

  • Calculus formation

  • Renal failure

  • Systemic consequences

Adenocarcinoma of the prostate: nearly all prostatic neoplasms are adenocarcinomas.

Manifestations include:

• Early, often asymptomatic; initially indistinguishable from hyperplasia (prostatism – see above)

• Late manifestations include back pain and anaemia due to bone metastasis (common)

• Other consequences relates to spread of malignant tumour (locally to regional lymph nodes and distant metastasis)

Prostatitis: inflammation of the prostate, triggered by offending pathogenic infection.

Manifestations include:

• Acute:

  • Cause by E. coli and other Gram negative organisms, enterococci etc.

  • Presents with febrile illness (fever, chills) with urinary symptoms (dysuria)

• Chronic:

  • May involve ‘acute’ organisms (above) but may also be associated with STI (frequently in chronic ‘non-bacterial’ prostatitis), e.g. Chlamydia trachomatis, Trichomonas vaginalis etc.

  • May be asymptomatic or associated with ill defined pelvic pain (low back pain, suprapubic and perineal discomfort) and frequently recurrent UTI

• Other consequences may vary due to offending organism

Category: Pathology Notes