Doble, Andrew; (1992) Chronic inflammatory disease of the male lower genito-urinary tract. Masters thesis (M.S), University of London, Royal Free Hospital School of Medicine.

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Abstract

The underlying aetiology and pathophysiology of chronic abacterial prostatitis is poorly understood. The study of patients with chronic prostatitis and normal controls by transrectal ultrasound identified seven signs associated with a diagnosis of chronic prostatitis. A cohort of sixty patients with chronic abacterial prostatitis (CABP), based on standard localisation criteria, was constructed. These patients underwent transrectal ultrasound and subsequent guided biopsy of any parenchymal abnormalities, thereby overcoming the problem of urethral contamination. The tissue so obtained was submitted for microbiological, histological and immunological study. Within the cohort no organism was isolated consistently from either prostatic secretion or tissue. In particular Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum could not be identified. A chronic inflammatory infiltrate was detected in 85% of the cohort, yet no controls, thereby vindicating the biopsy technique. However, no specific histological pattern could be attributed to CABP. Immunological analysis of the prostatic tissue suggested the inflammatory process was stimulated by a persistent antigen and was in keeping with a cell mediated, type IV hypersensitivity reaction. Urinary flow rates were subnormal in 27% of the cohort. In selected cases, intraprostatic urinary reflux was demonstrated, and postulated, as being responsible for the transportation of the inciting antigen, whose nature remains unknown, yet probably is non-organismal. Serum PSA was unhelpful in diagnosis and management of CABP. No evidence of a psychological role in the aetiology of CABP was identified. A possible link between acute epididymitis and inflammatory prostatic disease was noted on transrectal ultrasound; intraprostatic and vasal reflux being a proposed unifying factor. In acute epididymitis the role of Chlamydia trachomatis and Enterobacteriaceae was confirmed, and Ureaplasma urealyticum discovered. Thus CABP* appears to be an active immunological reaction in response to a persistent antigen whose nature, although unknown, is possibly non-organismal and transported into the prostate by urinary reflux.

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