Answer:

1. Acute prostatitis.

The picture is characterized by perineal and rectal discomfort, fever accompanied by urinary discomfort such as terminal dysuria, polyakiuria, urgency and urgency, and pain in ejaculation. Digital rectal examination reveals a painful prostate and, if it is fluctuating, a prostate abscess should be suspected, which may be associated with complete urinary retention.

Pathophysiology:

Prostatitis can be bacterial or, more often, non-bacterial. However, the differentiation between the two cases can be difficult, especially in chronic prostatitis.

Bacterial prostatitis can be acute or chronic and is usually caused by typical urinary pathogens (eg, Klebsiella, Proteus, Escherichia coli) and possibly Chlamydia. How these pathogens enter and infect the prostate is unknown. Chronic infections can be caused by trapped bacteria that antibiotics have not eradicated.

Non-bacterial prostatitis can be inflammatory or non-inflammatory. Its mechanism is unknown, but it may involve incomplete relaxation of the urinary sphincter and dyssynergic urination. The resulting elevated urinary pressure can cause urine backflow into the prostate (triggering an inflammatory response) or increased autonomic pelvic activity leading to chronic pain without inflammation.

2. Fournier's gangrene (necrotizing fasceitis).

It refers to the infectious and gangrenous process of the external genitalia and the perineum. It originates from a perirectal, urinary, or skin infection. The germs involved are multiple, corresponding mainly to gram-negative and anaerobic. It is a serious condition that has a mortality rate close to 50%.

Pathophysiology:

Fournier's gangrene begins as a necrotizing infection of the fascia; the spread of the infection depends on the anatomical aponeurotic planes. The perineum can be divided into two triangles: a urogenital or anterior triangle and an anorectal or posterior triangle. 24-26 The urogenital triangle is bounded posteriorly by an imaginary line connecting the tuberosities of both ischia, laterally by the ramus of the ischium and anteriorly by the pubis. The anorectal triangle is bounded posteriorly by the coccyx, laterally by the tuberosacral ligaments, and anteriorly by the imaginary line between the tuberosities of the ischium. Several aponeurotic planes are found in the perineal and genital regions, including Dartos's fascia, Buck's fascia, and Colles's fascia. They are related to each other by mixing their fibers or by immediate physical proximity; the aponeurotic planes of the genitalia continue to the anterior and posterior abdominal wall. Colles' fascia is attached laterally to the pubic ramus and fascia lata; it joins posteriorly with the inferior fascia of the urogenital diaphragm and extends anteriorly to envelop the fascia of Dartos in the scrotum and penis. At the penoscrotal junction, Colles' fascia joins the suspensory ligaments of the penis and then continues superiorly as Scarpa's fascia on the anterior wall of the abdomen.1

3. Epididymo-orchitis.

It corresponds to the infection that affects the epididymis and / or the testicle. It most often affects the epididymis and, later, affects the testicle. Acute infections that exclusively involve the testicle are rare. Orchitis generally occurs secondary to suppurative epididymitis.

It is produced by different causes. The first is due to urerethritis secondary to sexually transmitted diseases, generally due to N. gonorrhoeae and C. trachomatis. The second is related to UTIs and prostatitis and is mainly due to Enterobacteriaceae, in which hydrostatic pressure related to urination can force urine with pathogens from the bladder, urethra or prostate into the ejaculatory ducts and, through the vas deferens , it drags the germs until it reaches the epididymis. Pathogens can also be transmitted from the urethra or prostate secondary to instrumentation or prostate surgery. The third cause, although very rare, is epididymo-orchitis due to urinary TB.

Pathophysiology:

The origin of infections of the epididymis or the testicle can be in the bladder, in the prostate or in the vas deferens, which, by proximity, involves the epididymis or the testicle. In children, viral infections are the leading cause of epididymo-orchitis.

In other special populations, such as homosexuals, the main causative agents are bacterial, such as E. coli. There are eruptive diseases that can be associated with orchitis, such as mumps. In these cases, it is observed one week after the onset of the disease. 30% of these patients have testicular complications.