The key to the prostate’s role in the human body is that its glandular tissue can produce and secrete a fluid called prostatic fluid. It is also an exocrine gland that secretes 0.5-2ml of thin, milky white liquid every day. Prostate fluid is mixed with semen during ejaculation, accounting for about 13%-32% of the total semen, which contains fruit acids and amino acids, and is the energy source for sperm activity, and prostate fluid contains a large amount of raffinate, phosphate, potassium, sodium, magnesium, calcium and other substances that can make semen slightly alkaline and moderate the acidic environment of the vagina. This is a great way to improve the survival rate and vitality of sperm. In addition, the prostate gland is an endocrine gland that secretes acid phosphatase, which increases sharply after puberty and reaches peak levels to stabilize, and only when prostate cancer occurs does acid phosphatase increase significantly, so the medical diagnosis of prostate cancer is based on changes in acid phosphatase.
The prostate has a fairly rich blood supply, but the blood circuit in the prostate is not so smooth and has to pass through many tiny veins before it can flow into the internal iliac vein, so there is a lot of resistance to return flow. This is because of this feature, which makes it easy for other parts of the body to invade the prostate and difficult to remove, increasing the chances of damage to the prostate.
In addition, the prostaglandin secreted by the prostate gland can promote sperm growth and maturity, if each ML sperm contains less than llMG of prostaglandin E, sperm can not mature, it can be said that if there is no prostate gland, or the prostate gland has a serious disease, it is impossible to have normal sperm activity, and there is no way to talk about fertility.
The main physiological functions of the prostate gland
The physiological functions of the prostate gland can be summarized in four main areas.
First, it has an exocrine function. The prostate gland is the largest accessory gland in the male, and is also one of the human exocrine glands. It can secrete prostatic fluid, which is an important component of semen, has an important role in the normal function of sperm and is very important for fertility. The secretion of prostatic fluid is regulated by androgens.
Secondly, it has an endocrine function. The prostate is rich in 5α-reductase, which converts testosterone into the more physiologically active dihydrotestosterone. Dihydrotestosterone plays an important role in the pathogenesis of benign prostatic hyperplasia. By blocking the 5α-reductase enzyme, the production of dihydrotestosterone can be reduced, thus causing the hyperplastic prostate tissue to atrophy.
Thirdly, it has the function of controlling urination. The prostate gland wraps around the urethra and is close to the bladder neck, forming the proximal urethral wall, with its circular smooth muscle fibers surrounding the prostate part of the urethra, participating in the formation of the internal urethral sphincter. When the urge to urinate occurs, along with the contraction of the forceps, the internal sphincter relaxes, allowing urination to proceed smoothly.
Fourthly, it has a transport function. The prostate gland has a urethra and two ejaculatory ducts that pass through it. When ejaculation occurs, the muscles of the prostate gland and the seminal vesicle gland contract to press the contents of the vas deferens and the seminal vesicle gland through the ejaculatory ducts into the posterior urethra and then out of the body. In summary, the prostate has four important functions that play an important role in the human body.
Changes in the structure of the prostate gland over the course of a lifetime
The structure of the prostate gland changes with age throughout a person’s life. before the age of 10, the prostate gland is small, the glandular tissue is undeveloped and consists mainly of muscle tissue and connective tissue, with no real glandular ducts and only a germ. By about 10 years of age, on top of the germ, the glandular epithelial cells begin to increase and form glandular ducts. The prostate glandular ducts develop rapidly into alveoli during puberty as the testes develop, and the temporal mass also increases, reaching a peak in development around the age of 24. Around the age of 30, the epithelial cells fold into the alveoli, complicating the alveolar structure. The prostate gland is degenerating, but the glands around the urethra are proliferating, compressing the peripheral area and causing it to shrink, and eventually forming the so-called “surgical envelope”.
The structure of the prostate gland changes throughout the life, and in terms of volume, the size of the prostate gland is very small in early childhood, and can double in size during adolescence.
The relationship between the prostate and the urethra
The prostate is part of the male reproductive system and the urethra is part of the urinary system, but because of the close anatomical location of the male urogenital organs, the two are very closely related.
The prostate is located below the bladder and above the urogenital compartment. The urethra passes through the center of the prostate and the prostate is wrapped around the urethra. The section of the urethra that is surrounded by the prostate is called the urethral prostate, and it starts at the neck of the bladder and goes straight to the urogenital septum, with an average length of about 3 cm. This section of the urethra runs through the entire prostate from bottom to tip and is located within the prostate parenchyma, slightly narrowed at both ends and widened in the middle, which is the largest urethral canal diameter in men. In the posterior wall of the prostate section of the urethra, the median line is a longitudinal elevation called the urethral crest. The middle of the urethral ridge is enlarged into a rounded mound called the seminal mound. The central part of the seminal frenulum has a round or elongated longitudinal hole called the prostatic capsule. The lower part of the prostatic capsule is where the two ejaculatory ducts open. The grooves on both sides of the urethral crest, called the prostate sinuses, have many openings for the prostate excretory ducts, from which prostatic fluid can drain into the urethra.
The actual prostate gland is a large part of the urethra, which can be compressed by the enlarged prostate gland, making it tortuous and narrow, making it difficult to urinate. When the prostate is inflamed, it is often combined with inflammation of the urethral prostate. The same applies to the urethral prostate, which can also affect the prostate. Therefore, there is a close relationship between the prostate and the urethra, both anatomically, physiologically, and pathologically.
The relationship between the prostate gland and the seminal glands and ejaculatory ducts
The prostate gland wraps around the posterior part of the urethra and immediately behind it against the anterior rectal wall. Above the prostate, between the bottom of the bladder and the rectum, there are two pairs of organs that penetrate diagonally downward into the prostate, namely the paired seminal vesicle glands and the ejaculatory ducts.
The vesicoureteral glands are each about 4-5 cm long, flattened in front and behind, lobulated, and nearly inverted octagonal in shape between the posterior wall of the bladder and the rectum. The vesicoureteral gland contains a large number of compound vesicular glands with large cavities, and its excretory ducts converge with the end of the vas deferens and pass through the prostate into the prostatic part of the urethra, opening on the urethral crest. The ejaculatory ducts are extremely short, only 2 cm long, and are paired on the left and right side, formed by the confluence of the left and right seminal vesicle glands and the end of the left and right vas deferens. The two lateral ejaculatory ducts penetrate the prostate and open on the posterior urethral fossa. The ejaculatory ducts are the dividing line between the posterior and middle lobes of the prostate.
It is clear that the relationship between the prostate gland, the seminal vesicle gland and the ejaculatory duct is very close, and when the prostate gland is affected, it can often involve the seminal vesicle gland and lead to seminal vesicle inflammation. The three can affect each other in terms of physiology and pathology.
The classification of prostatitis
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Non-specific bacterial prostatitis: It can also be divided into acute prostatitis and chronic prostatitis. Acute prostatitis is an acute inflammation caused by non-specific bacterial infection of the prostate, mainly manifested as urinary urgency, frequency, painful urination, rectal and perineal pain. Chronic prostatitis is a chronic inflammation caused by non-specific bacterial infection of the prostate, mainly manifested as discomfort in the lesser abdomen, perineum and testicular area, white drip from the urethra, etc. It is common in young and strong men.
Idiopathic non-bacterial prostatitis: clinical symptoms such as prostate pain, abnormal urination, overflow of prostatic fluid from the urethra, etc. Prostate fluid leukocytes may increase, but bacterial cultures do not show bacterial growth.
Non-specific granulomatous prostatitis: clinically, it mainly shows symptoms such as frequent and painful urination, burning urethra, pain in the lower back or perineum, but the condition develops quickly and has concomitant symptoms such as increased prostate overflow and acute urinary retention, which is a foreign body reaction or allergic reaction caused by poorly soluble substances produced by the proliferation of the reticuloendothelial system, so it is divided into two categories: metaplasia (allergic) and non-metaplasia.
Prostate pain and prostate congestion: clinically with persistent urinary frequency, urinary urgency, difficulty urinating and discomfort in the prostate, or true prostate pain and other symptoms, no pus cells in the prostate fluid, and no obvious pathological changes of infection, is a kind of non-bacterial prostatitis.
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The causes of chronic prostatitis
The reason for this is the fact that the reason for chronic prostatitis has not been completely clarified, and there are many different opinions. The reason for this is that the cause of chronic prostatitis cannot be explained by a single theory so far. The analysis is related to the following factors.
(1) Prostate congestion: The prostate gland is congested due to various different reasons, especially passive congestion, which is an important pathogenic factor. Non-infectious, non-microbial prolonged congestion can create a non-specific inflammatory response. In addition, congestion is common in the following situations: ① abnormal sexual life: too frequent sexual life, forced interruption of sexual intercourse, or excessive masturbation, etc., can make the prostate abnormally congested. However, excessive moderation in sexual life can also produce prolonged auto-excitement and cause passive congestion. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. The actual fact is that you can get a lot more than just a few of the most popular and popular items. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things.
(2) microbial infection: various microorganisms, such as bacteria, protozoa, mold, virus, etc. can be the cause of infection, but bacteria are the most common. The invasive routes of bacteria include.
Bloodstream infection: More than 90% of bacterial prostatitis can be found as foci of infection.
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Direct spread: Bacteria in the urethra can lead directly to prostate infection.
(3) Autoimmune factors: Chronic prostatitis is related to autoimmune factors because of the presence of “anti-prostate antibodies” found in patients with arthritis; others have been found to have at least one positive antigen antibody system in their serum tests.
(4) Allergic reaction to a virus: this can also lead to inflammation.
(5) Psychosomatic factors: Some say this factor is as high as 50%. In conclusion, the cause of chronic prostatitis is multifaceted and cannot be emphasized one-sidedly on a particular factor, which should be analyzed depending on the specific patient.
The change of the prostate after chronic prostatitis
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There are varying degrees of plasma cells and macrophages and regional lymphocytes clustered in and around the prostate alveoli, with marked hyperplasia of fibrous tissue in the glandular lobes. Some patients have poor drainage and dilated vesicles due to obstruction of the glandular ducts by purulent material and exfoliated epithelial cells.
The prostate gland may be palpable and tender on rectal palpation. If the prostate is heavily fibrotic, the gland may atrophy and may extend to the posterior urethra, causing sclerosis of the bladder neck. The seminal vesicles and vas deferens also have chronic inflammatory changes with wall thickening and surrounding fibrous tissue hyperplasia.
In addition, the soft spot disease, although belonging to the granulomatous prostatitis, actually belongs to the category of chronic prostatitis, because the study confirmed that the soft spot disease is caused by the infection of Gram-negative bacilli, especially related to Escherichia coli. The histological manifestation is a granulomatous nodule consisting of a large number of macrophages and lymphocytes as well as plasma cells. A large number of Michalis?Gutman inclusions can be seen in the cytoplasm of the macrophages, which are round or ovoid in shape, and are positive for PSA and calcium staining.
Symptoms of chronic prostatitis
The symptoms of patients with prostatitis are diverse and complex, and the common clinical signs and symptoms are as follows.
(1) In acute attacks or when an abscess is formed, there is fever weakness weakness anorexia, nausea, chills, deficiency and other manifestations.
(2) Burning pain in the urethra during urination, discharge to the head of the penis, and unclean discharge from the urethra in the early morning.
(3) Dampness and sticky discomfort in the perineum and anus of the posterior urethra, a feeling of fullness and swelling with heavy pressure, heavy when sitting, squatting or defecating.
(4) Radiating pain can occur within the innervation of the thoracic 10 to sacral 3 nerves, with more pain in the lower back.
(5) Sexual dysfunction.
(6) A series of symptoms such as dizziness, tinnitus, blurred vision, insomnia and depression may occur.
(7) For some long-term untreated patients, it can cause systemic bone and joint and other metamorphic reactions or rheumatic changes, such as neuritis, arthritis, etc.
(8) When the prostate seminal vesicle infection is serious, it leads to a decrease in the number of sperm, and the semen is not liquefied triggering infertility.
The symptoms of chronic prostatitis are diverse, and the symptoms are not proportional to the severity of the inflammation, some patients have a large number of pus cells in the prostate fluid but no symptoms, while some patients have normal or nearly normal prostate fluid examination, but the clinical symptoms of performance are heavy, common symptoms can be summarized as the following categories.
Discomfort in urination: frequent urination and burning pain in the urethra may occur. Mucus, mucus filaments and pus secretion from the urethra can be seen in the morning, and cloudy urine or white flow after stooling. In severe cases, terminal hematuria and difficulty in urination may occur.
Local symptoms: discomfort, heavy pressure or fullness in the posterior urethra, perineum and anus, worse when squatting or defecating.
Radiation pain: The prostate or seminal vesicles are richly innervated by sympathetic nerves, and the increased tension within the gland when inflammation occurs can stimulate sympathetic nerves and cause transfer back pain, which can radiate to the penis, testicles, scrotum, groin, perineum, lower abdomen, thighs, buttocks, rectum, etc.
Sexual dysfunction: The main manifestations are hypoactive sexual desire, premature ejaculation, seminal emission, neurasthenia and depression in young unmarried people.
Other: chronic bacterial prostatitis can cause allergic reactions, such as iritis, arthritis and neuritis. It can also be complicated by neurosis, which manifests as weakness, blurred vision, dizziness, insomnia and depression.
Reasons for large differences in prostate fluid white blood cell count
If the massage force is too light, it cannot squeeze out most of the prostate fluid, making the cell count of the prostate fluid relatively reduced.
It is related to the nature of the lesion: in the congested phase of acute prostatitis, the prostate ducts and interstitial cells are only congested and edematous, so the number of cells in the prostate fluid is low. In contrast, more tiny abscesses are formed in the small vesicular stage, and in the parenchymal stage the small abscesses gradually increase in size, and the number of white cells in the prostatic fluid increases significantly. In chronic prostatitis, as the prostate becomes fibrous and the tubules are blocked by pus or epithelial cells, the white blood cell count in the prostate fluid can be normal.
In the case of chronic prostatitis, there are often focal changes, and irregularities on the surface of the prostate are often found during rectal finger examination, while limited hard nodules and limited tender areas can be palpated, so any one massage does not reflect the entire prostate.
The prostate gland is divided into two parts: the central zone and the peripheral zone. From the pathological statistics, there are more infections in the peripheral zone than in the central zone, but the discharge of secretions in the peripheral zone is more difficult than in the central zone, so the prostatic fluid obtained from prostate massage mainly comes from the central zone, not from the peripheral zone which is more susceptible to infection, so the prostate massage fluid examination cannot fully reflect the infection of the entire prostate.
The smear thickness varies because of the different viscosity and non-homogeneous nature of the prostate fluid, and in some fields of view you see heaps of overlapping white blood cells, while in another field of view you see only a few white blood cells, with an error of between 20% and 25%.
The danger of prostatitis and prostate enlargement to men’s health
The prostate gland is most common at the age of 20-70, 30-50. In recent years, there has been a division of prostate pain.
The actual prostate enlargement, also known as prostate hypertrophy, occurs in middle-aged and elderly patients, and was recorded in ancient medical books 2000 years ago, called “retention of urine”. In the pathology, the prostate gland is enlarged with hypertrophy, the enlargement itself is benign, but the enlarged gland compresses the posterior urethra leading to obstruction of the bladder neck, causing serious complications in the urinary tract above the obstruction due to long-term poor urination, such as in cases of prostate enlargement, about 10-25% can become cancerous and co-exist, directly threatening the health and life of the patient.
Signs and symptoms of prostate enlargement
Prostatic hyperplasia rarely shows symptoms before the age of 50, but the vast majority of patients experience a variety of symptoms as their condition worsens, the common ones being.
(1) Early on, the prostate enlargement irritates and even compresses the posterior urethra and bladder neck, causing frequent and urgent urination (patients who are treated at this stage have excellent results).
(2) Urinary urgency, but not rapid discharge, urination is not as smooth and long as before, there is a sense of incomplete urination, difficult to urinate and other manifestations.
(3) Urinary incontinence, especially urine loss during sleep.
(4) Dilatation or even rupture of blood vessels on the mucosal surface and bleeding, manifested as hematuria.
(5) Acute urinary retention, i.e., the prostate and bladder neck suddenly become congested and edematous due to alcohol, cold, exertion, intercourse, holding urine, etc. and cannot urinate on their own.
(6) Long-term bladder neck obstruction is likely to cause acute urinary tract infections, making the above symptoms worse.
(7) Hydronephrosis, renal insufficiency, clinical azotemia, loss of appetite, nausea, vomiting, anemia, etc.
(8) Other aspects, a few patients may develop bladder stones and interruption of urination. A few also develop hypersexuality, and sometimes frequent penile erections without the desire for sex. Frequent nighttime urination interferes with rest and excessive mental stress can cause symptoms such as increased blood pressure. The most important thing to do is to get an early diagnosis of prostatitis and prostate enlargement to get the best treatment so as not to delay the condition.
The most likely disease of the prostate and its harm to the human body
The most common of these is chronic prostatitis and prostate pain.
The incidence of prostate hyperplasia in men over 50 years of age is around 50%, and the trend is increasing with age.
The second is prostate stones and prostate cancer.
The above diseases can cause frequent, urgent, painful urination, difficult urination, increased nocturnal urination, perineal tenderness, swelling pain and other distressing symptoms, the seriousness of the condition will cause sexual dysfunction, bringing inconvenience and pain to the patient’s daily life and work.
The actual fact is that you can find a lot of people who have a lot of difficulties in urination, nighttime urination, frequent urination, urgent urination, painful urination, hematuria, and pain in the perineum.
The actual fact is that you can’t get a lot of time to stand up for urination, which has a big impact on your life, work, and spirit.
In addition, prostate disease can lead to infertility, because of the dry prostate fluid, sperm survival survival rate is not high, resulting in a decrease in the number of sperm caused by a long marriage infertility.
The second is that prostate disease can easily cause premature ejaculation, seminal emission, hemorrhage, loss of libido, impotence and loss of sexual function.
The diagnosis of benign prostatic hyperplasia
The International Prostate Symptom Score (1-PSS) is derived from answering seven questions about urinary symptoms. The answers are on a six-point scale from 0-5, and the patient selects one of the six scores based on the severity of symptoms, with the overall score ranging from 0-35 (asymptomatic – very severe symptoms). There are no definite criteria to date for classifying patients’ symptoms as mild, moderate, or severe, and they can be tentatively classified according to the following criteria.
-7 = mild symptoms
-19=moderate symptoms
-35=severe symptoms
Other: uroflowmetry, serum prostate-specific antigen, imaging, lower urinary tract endoscopy. Benign prostatic hyperplasia can cause difficulty in urination. In addition, it can interfere with the patient’s daily life, such as the need to reduce water intake before going out, the need to reduce water intake before going to bed, lack of sleep at night, limited access to public places without public toilets, and limited participation in outdoor activities.
Comorbidities of BPH
Lack of proper diagnosis and treatment is more likely to result in
◇Acute urinary retention
Urinary tract infection
Bladder stones
◇Neurasthenia and depression
Unexplained pain throughout the body
Urinary frequency and difficulty in urination
Prolapse, internal hemorrhoids
Decreased sexual function
High blood pressure
◇Cardiac and cerebrovascular accidents
Hydronephrosis
Urine poisoning
Physiological anatomy of the prostate
The shape of the prostate gland is like an upside down chestnut, which is often referred to as a cone in medical books, which seems less graphic than a chestnut. It is located below the neck of the bladder and wraps around the bladder opening and the urethra, so this part of the urethra is called the “urethral prostate”, which means that the tube formed in the middle of the prostate forms the upper part of the urethra.) It is possible to say that the prostate gland guards the upper entrance of the urethra, and this is the reason why urination is affected first when the prostate gland is ill.
The prostate is located at the bottom of the pelvis, above the bladder, below the urethra, in front of the pubic bone, behind the rectum, the doctor can touch the prostate in the rectal examination, the reason is this. The prostate gland is held in place by many ligaments and fascia, thus determining its hidden location.
The actual fact is that the prostate is divided into 5 lobes.
The prostate is divided into five lobes, called the anterior lobe, middle lobe, posterior lobe and both lobes, of which the anterior lobe is very small and is located between the left and right lobes and the urethra, which is not clinically important. The posterior lobe is located behind the middle lobe and both lobes, which is felt during the rectal examination, and has a physiological central sulcus, which is often used to determine whether the prostate is enlarged during the rectal examination based on whether this central sulcus becomes shallow or disappears. The main areas of the prostate that often produce hyperplasia are the middle lobe and the two lateral lobes.
The internal structure of the prostate: The prostate is composed of glandular tissue and smooth muscle, with 30 to 50 tubular glands buried in the muscle tissue, forming 15 to 30 excretory ducts opening in the middle of the prostate on both sides of the crypt, from which the prostatic fluid secreted by the prostate is discharged. If you consider the urethra of the prostate to be a longitudinal tube, the ejaculatory and excretory ducts are like thin horizontal tubes, both forming a “non” crossed structure, and this physiological position has led to many complications related to prostate disease.
The surface of the prostate gland is covered by a membrane and consists of three layers: 1. outer layer: rich veins and loose connective tissue. 2. fibrous sheath. 3. muscular layer. The muscular layer is connected to a large number of muscle fibers within the interstitial tissue. This is the reason why the prostate gland is not easily absorbed into the glandular tissue and therefore the efficacy is not satisfactory.
The prostate gland is a very rare body, with internal and external secretion function of the sexual secretion gland. This determines its importance in the sexual function activity. The so-called exocrine gland refers to the secretion through the ductal gland directly transported to certain parts, such as sweat glands, digestive glands, etc. The prostatic fluid secreted by the prostate gland is transported to the urethra via the excretory ducts, which is its most important function and thus has an exocrine function. The endocrine glands are also called ductless glands, where the secretions are carried directly into the bloodstream and then throughout the body with the blood circulation. The secretions of the endocrine glands are called “hormones”. The prostate also has an endocrine function, as recent studies have shown.
As an exocrine gland, the prostate gland secretes about 2 ml of prostatic fluid every day, which is the main component of semen, it is a homogeneous, thin, milky white plasma fluid, which is weakly alkaline (PH 7.2) when normal and contains many enzymes. The actual sperm is composed of seminal plasma and sperm suspended in seminal plasma, seminal plasma accounts for more than 95% of the total ejaculate, while prostatic fluid accounts for about 1/3 of the seminal plasma. The prostate fluid, together with the secretions of the seminal vesicles and vas deferens, is ejected together with the sperm. The alkaline fluid can neutralize the acidic secretions of the female vagina, making it suitable for the survival and activity of the sperm. The other small molecules and enzymes in the prostate fluid dilute the sticky secretions of the cervix, which facilitates the delivery of live sperm to the female reproductive organs for conception.