What Is Nonbacterial Prostatitis?

Chronic nonbacterial prostatitis is mainly manifested as pain in the pelvic region, which can be found in the perineum, penis, perianal region, urethra, pubic bone, or lumbosacral region. Abnormal urination can be manifested as urgency, frequent urination, dysuria, and increased nocturia. Its pathogenesis is unknown, and its etiology is very complicated, which is widely controversial. Chronic nonbacterial prostatitis lacks objective and specific diagnostic evidence. Clinical diagnosis should be differentiated from diseases that may cause pain in the pelvic region and abnormal urination. Patients with abnormal urination mainly should have no bladder outlet obstruction and Bladder dysfunction.

Basic Information

Visiting department: Urology
Common locations: Perineum, penis, perianal area, urethra, pubic area or lumbosacral area

Common causes: Pathogen infection, inflammation and abnormal pelvic floor neuromuscular activity and immune abnormalities, etc.
Common symptoms: Pain in the pelvic region, urgency, frequent urination, dysuria, and increased nocturia

Causes of chronic nonbacterial prostatitis

The etiology is very complicated. Most scholars believe that the main cause may be the result of pathogen infection, inflammation and abnormal pelvic floor neuromuscular activity and immune abnormalities.

Pathogen infection

Although this type of patients fails to isolate pathogens through routine bacterial examination, it may still be related to some special pathogens: such as anaerobic bacteria, L-shaped proteobacteria, nanobacteria, or Chlamydia trachomatis, mycoplasma and other infections.

2. Urinary dysfunction

Certain factors cause excessive contraction of the urethral sphincter, resulting in obstruction of the bladder outlet and residual urine formation, causing urine to flow back into the prostate, which can not only bring pathogens into the prostate, but also directly stimulate the prostate, and induce sterile "chemical prostatitis".

3. Psychological factors

More than half of patients with prolonged prostatitis have significant changes in psychosocial factors and personality characteristics. Such as: anxiety, depression, suspected illness, rickets, and even suicidal tendency. Changes in these mental and psychological factors can cause vegetative nerve dysfunction, cause posterior urethral neuromuscular dysfunction, cause pain in the pelvic region and dysuria; or cause changes in hypothalamic-pituitary-gonadal axis function and affect sexual function, further aggravating symptoms , Elimination of mental stress can relieve symptoms or heal. However, it is unclear whether the change is a direct cause or a secondary manifestation.

4. Abnormal immune response

Recent studies have shown that immune factors play a very important role in the occurrence and development of chronic nonbacterial prostatitis and the evolution of its course.

5. Oxidative stress

Patients with prostatitis have excessive production of oxygen free radicals and / or the effect of the free radical scavenging system is relatively reduced, thereby reducing the body's ability to respond to oxidative stress and increasing products or / and by-products of oxidative stress.

6. Pelvic related disease factors

Interstitial cystitis is a possible cause. Peripheral venous plexus dilatation, hemorrhoids, varicocele, etc., are one of the reasons for chronic prostatitis.

Clinical manifestations of chronic nonbacterial prostatitis

Mainly manifested as pain in the pelvic region, which can be found in the perineum, penis, perianal region, urethra, pubic bone or lumbosacral region. Abnormal urination can be manifested as urgency, frequent urination, dysuria, and increased nocturia. As chronic pain does not heal for a long time, patients' quality of life is reduced, and there may be sexual dysfunction, anxiety, depression, insomnia, memory loss and so on.

Chronic nonbacterial prostatitis examination

Physical examination

Digital rectal examination can understand prostate size, texture, nodules, tenderness and its scope and extent, pelvic floor muscle tension, pelvic wall tenderness, massage prostate to get prostate fluid.

2. Laboratory inspection

(1) Routine examination of prostate massage fluid. In normal prostate massage fluid, the white blood cell HP and lecithin bodies are uniformly distributed throughout the visual field, pH 6.3 to 6.5, red blood cells and epithelial cells are absent or occasional. When the number of leukocytes is more than 10 / HP, the number of lecithin bodies decreases, which is of diagnostic significance.

(2) Routine analysis and urine sediment examination Routine analysis and urine sediment examination are auxiliary methods to exclude urinary tract infection and diagnose prostatitis.

(3) Bacteriological examination recommends "two-cup method" or "four-cup method" pathogen localization test.

(4) Other laboratory examinations of patients with prostatitis may have abnormal semen quality, and some patients with chronic prostatitis may also have elevated PSA. Urine cytology has some value in distinguishing it from carcinoma in situ of the bladder.

3.B-ultrasound

It can be found that prostate echo unevenness, prostate stones or calcification, and perivenous plexus dilatation, etc., but the specific manifestations of B ultrasound diagnosis of prostatitis are still lacking, and B ultrasound can not be used to type prostatitis.

4. Urodynamics

Urinary flow rate The urinary flow rate test can roughly understand the patient's urination status, which is helpful to identify prostatitis and urination disorders related diseases. Urodynamic examination can find bladder urethral dysfunction.

5.CT and MRI examination

It has potential application value for identifying pelvic organ lesions such as seminal vesicles and ejaculation ducts, but the diagnostic value of prostatitis itself is still unclear.

A detailed medical history, a comprehensive physical examination (including digital rectal examination), and a routine examination of urine and prostate massage fluids are required. The NIH Chronic Prostatitis Symptom Index is recommended for symptom score. The "two-cup method" or "four-cup method" is recommended for pathogen localization tests.

To confirm the diagnosis and differential diagnosis, the optional tests are: semen analysis or bacterial culture, prostate-specific antigen, urinary cytology, abdominal or rectal B-ultrasound (including residual urine measurement), urine flow rate, urodynamics, CT, MRI, urethral cystoscopy and prostate biopsy.

Diagnosis of chronic nonbacterial prostatitis

Based on medical history, comprehensive physical examination (including digital rectal examination), routine examination of urine and prostate massage fluid, semen analysis or bacterial culture, prostate-specific antigen, urine cytology, abdominal or rectal ultrasound (including residual urine measurement) , Urine flow rate, urodynamics, CT, MRI, urethral cystoscopy and prostate biopsy.

Differential diagnosis of chronic nonbacterial prostatitis

Chronic nonbacterial prostatitis lacks objective and specific diagnostic evidence. Clinical diagnosis should be performed with diseases that may cause pain and abnormal urination in the pelvic region, such as benign prostatic hyperplasia, testicular epididymis and spermatic cord disease, overactive bladder, Differential diagnosis is made for qualitative cystitis, bladder tumor, prostate cancer, anorectal disease, lumbar spine disease, central and peripheral neuropathy, etc.

Treatment of chronic nonbacterial prostatitis

Chronic nonbacterial prostatitis should be treated comprehensively. The main goals of treatment are to relieve pain, improve symptoms of urination, and improve quality of life.

General treatment

Health education, psychological and behavioral counselling have a positive effect. Patients should quit drinking, avoid spicy food; avoid holding back urine, sitting for a long time, keep warm, and strengthen physical exercise.

2. Drug treatment

The most commonly used drugs are antibiotics, alpha-blockers, plant preparations, and non-steroidal anti-inflammatory analgesics. Other drugs also have varying degrees of efficacy in relieving symptoms.

(1) Antibiotics At present, in clinical practice for the treatment of chronic nonbacterial prostatitis, the most commonly used first-line drug is antibiotics, but only about 5% of patients with chronic prostatitis have a definite bacterial infection. The treatment of inflammatory antibiotics is mostly empirical. The theoretical basis is to speculate that some conventional culture-negative pathogens caused the occurrence of this type of inflammation. Therefore, it is recommended to first take antibiotics such as fluoroquinolone for 2 to 4 weeks, and then decide whether to continue antibiotic treatment based on the feedback of efficacy. Antibiotics should only be continued if clinical symptoms do decrease. The recommended total course of treatment is 4 to 6 weeks. Anti -inflammatory is not recommended for non-inflammatory type .

(2) Alpha-blockers Alpha-blockers can relax the smooth muscles of the prostate and bladder and improve lower urinary tract symptoms and pain, so they have become the basic drugs for the treatment of chronic prostatitis.

Different -blockers can be selected according to the condition of the patient. The recommended -blockers are: doxazosin, naftopidil, tamsulosin, and terazosin. Controlled studies have shown that the above drugs can cause urination symptoms, pain, and quality of life in patients. The index and so on have improved to varying degrees.

(3) Botanical preparations Botanical preparations have received increasing attention in the treatment of chronic prostatitis, and are recommended treatments. Botanical preparations mainly refer to pollen preparations and plant extracts, which have a wide range of pharmacological effects, such as non-specific anti-inflammatory, anti-edema, promoting bladder detrusor contraction and urethral smooth muscle relaxation. The recommended botanical preparations are: Persaltine, Sabah Palm and its extracts. Because there are many varieties, its usage and dosage depend on the specific condition of the patient. Usually, the course of treatment is monthly. Adverse reactions were minor.

(4) Non-steroidal anti-inflammatory analgesics Non-steroidal anti-inflammatory analgesics are empirical medications for the treatment of symptoms associated with chronic nonbacterial prostatitis. Its main purpose is to relieve pain and discomfort.

(5) M-receptor blockers For patients with prostatitis manifesting symptoms such as urgency, frequent urination, and nocturia, but without urinary tract obstruction, M-receptor blockers (such as tolterodine, etc.) can be used for treatment.

(6) Antidepressants and anxiolytics For patients with chronic prostatitis with mood disorders such as depression and anxiety, while treating prostatitis, they can choose to use antidepressants and anxiolytics. These drugs can both improve the symptoms of mood disorders and relieve physical symptoms such as abnormal urination and pain. Attention must be paid to the prescription and adverse reactions of these drugs during application. The choice of antidepressants and anxiolytic drugs is mainly selective serotonin reuptake inhibitors, tricyclic antidepressants and other drugs.

(7) Chinese medicine and traditional Chinese medicine are recommended to perform traditional Chinese medicine treatment of prostatitis according to the relevant regulations of the Chinese Medicine Society or the Institute of Integrated Traditional Chinese and Western Medicine.

3. Other treatments

(1) Prostate massage Prostate massage is one of the traditional treatment methods. Studies have shown that proper prostate massage can promote the emptying of the prostate glands and increase the local drug concentration, thereby alleviating the symptoms of patients with chronic prostatitis, so it is recommended to be chronic nonbacterial Adjuvant therapy for prostatitis.

(2) Biofeedback therapy studies have shown that patients with chronic prostatitis have synergistic dysfunction of the pelvic floor muscles or tension in the external urethral sphincter. Biofeedback combined with electrical stimulation can relax the pelvic floor muscles and make them more coordinated, while relaxing the external sphincter, thereby alleviating the perineal discomfort and urination of chronic prostatitis.

(3) Hyperthermia mainly uses the thermal effects produced by a variety of physical means to increase blood circulation of the prostate tissue, accelerate metabolism, help to eliminate inflammation and eliminate tissue edema, and relieve pelvic floor muscle spasm. Symptoms can be relieved in a short period of time, but the long-term effects are not clear. Not recommended for unmarried and unborn children.

(4) The efficacy and safety of transurethral prostate perfusion therapy for prostate injection have been confirmed.