TUR-prostatitis. Histological and immunohistochemical observations on a special type of granulomatous prostatitis

On discussion of etiology and clinical significance of nonspecific granulomatous prostatitis versus specific forms, most recently in particular, nodular-histiocytic, granulomatous patterns have been described, which were found mainly after electrosurgical transurethral resection for prostatic hyperplasia. In our own studies, the different developmental stages of this type of granulomatous prostatitis were examined. In the initial stage, there is a superficial thermonecrosis with carbonizations, which, sometimes over a period of several months, is resorbed by a cell-rich granulation tissue and finally ends in a fibre-rich, sclerosed cicatrization. With iron stainings, in almost all cases characteristic carbonization inclusions can be detected. The differential diagnosis of centrally caseating tuberculosis and rheumatoid nodules is considered. Immunohistochemical analyses have shown that with increasing glandular destruction in the course of the purulent-granulomatous and sclerosing form of inflammation, the epithelial reaction to prostate specific antigen markers decreases. The diagnosis of the so-called TUR-caused granulomatous prostatitis is of clinical significance because, in this case, any nonspecific therapeutic management will be superfluous. On the other hand, the granulomatous, carbonized processes can be removed by so-called cold biopsies, and thus the cause of the chronic inflammatory process can be eliminated very soon.