What is Prostatitis?

Prostatitis is a prostate disease caused by a variety of complex causes, with urinary tract irritation and chronic pelvic pain as the main clinical manifestations. Prostatitis is a common disease in urology, and it ranks first among male patients under 50 in urology. Although the incidence of prostatitis is high, its etiology is still not clear, especially for nonbacterial prostatitis, so its treatment is mainly to improve symptoms. In 1995, the National Institutes of Health (NIH) developed a new classification method for prostatitis, type I: equivalent to acute bacterial prostatitis in traditional classification, and type II: equivalent to chronic bacterial in traditional classification. Prostatitis, type III: chronic prostatitis / chronic pelvic pain syndrome, type IV: asymptomatic prostatitis. Among them, non-bacterial prostatitis is far more common than bacterial prostatitis.

Basic Information

English name: prostatitis
Visiting department: Urology
Multiple groups: Men under 50
Common locations: prostate

Common causes: It is related to pathogen infection, frequent sexual life, excessive masturbation, dysuria, and psychological factors.
Common symptoms: Frequent urination, urgency, pelvic pain, sexual dysfunction, etc.
Contagious: no

Causes of Prostatitis

Only a few patients have an acute medical history, and most of them are chronic and recurrent. The main causative factor of type I and type II prostatitis is pathogen infection. The pathogenic bacteria are mainly Escherichia coli, Klebsiella, Proteus and Pseudomonas aeruginosa. The pathogens invade the prostate with urine and cause infection. Pathological anatomy confirms that prostatitis lesions are generally limited to the peripheral zone. Here, the vertical line of the glandular duct and the urine flow is reversely opened in the posterior urethra. An infection has occurred.

The prostate has as many as 15 to 30 catheter openings on both sides of the sperm, and the prostate epithelium has a strong secretory function. Small glands with strong secretory function and narrow ducts make the prostate suffer from pressure and occlusion of the ducts under the influence of various factors, which can easily cause congestion and accumulation of secretions, which creates conditions for the occurrence of infections, which also leads to Histological basis of prostatitis prone to recurrence. Excessive sexual life, excessive masturbation, sedentary, cycling, horse riding, alcoholism, spicy food, colds and colds can all be factors inducing it.

The pathogenesis of type III prostatitis is unknown, and the etiology is very complicated, which is widely controversial. Most scholars believe that the main causes may be pathogen infection, dysuria, psychiatric factors, neuroendocrine factors, abnormal immune response, oxidative stress theory, lower urothelial dysfunction and so on. Type IV prostatitis lacks research on the relevant pathogenesis, and may have the same etiology and pathogenesis as type III.

Prostate urinary reflux may have important significance for the occurrence of various types of prostatitis. Recent studies have found that uric acid in urine not only has a stimulating effect on the prostate gland, it can also precipitate into stones, block the glandular ducts, and serve as a shelter for bacteria. These findings can clarify that prostatitis syndrome is actually a common manifestation of many diseases, and the clinical manifestations are complex and changeable, which can produce various complications and also relieve itself.

Clinical manifestations of prostatitis

Type I prostatitis often occurs suddenly, with systemic symptoms such as chills, fever, fatigue, and weakness, accompanied by perineal and suprapubic pain, and may have symptoms of frequent urination, urgency, rectal irritation, and even acute urinary retention.

The clinical symptoms of type II and type III prostatitis are similar, with pain and abnormal urination. No matter what type of chronic prostatitis can show similar clinical symptoms, collectively known as prostatitis syndrome, including pelvic dysfunction, dysuria, and sexual dysfunction. The pelvic diaphragm pain is extremely complicated. The pain is generally located on the pubic bone, lumbosacral region and perineum. Radiation pain can be expressed as pain in the urethra, spermatic cord, testis, groin, and medial ventral area. Radiation to the abdomen is similar to acute abdomen. Radiation is exactly like renal colic and often leads to misdiagnosis. Abnormal urination manifests as frequent urination, urgency, dysuria, poor urination, bifurcation of the urethra, dripping after urination, nocturia, increased milky discharge from the urethra after urination or stool. Occasional complications of sexual dysfunction include decreased libido, premature ejaculation, pain in ejaculation, weakened erections, and impotence.

Type IV prostatitis is asymptomatic and evidence of inflammation is found only on prostate examinations.

Prostatitis examination

Digital rectal examination

Digital rectal examination of type I prostatitis can reveal enlarged prostate, tenderness, and increased local temperature. Note that prostate massage should not be done during acute prostatitis to prevent the spread of infection.

Digital rectal examination of type and type prostatitis can understand prostate size, texture, nodules, presence or absence of tenderness and its scope and degree, tension of pelvic floor muscles, and tenderness of the pelvic wall. Prostate fluid can be obtained by massaging the prostate. For laboratory inspection.

2. Routine examination of prostate fluid (EPS)

EPS routine examination usually uses wet picture method and blood cell count plate microscopy, the latter has better accuracy. The content of white blood cells in normal prostate fluid sediment should be less than 10 in each field of view of a high-power microscope. If the number of white blood cells in the prostate fluid is more than 10 per field of vision, prostatitis is highly suspected, and fat-containing macrophages are found in the prostate fluid, which can basically diagnose prostatitis. However, the number of white blood cells in the prostate fluid of some patients with chronic bacterial prostatic fluid may be visualized; in some normal men, the number of white blood cells in the prostate fluid is> 10 per field. Therefore, the examination of leukocytes in prostate fluid is only a supplementary method for prostatic fluid bacteriological examination.

3.Urine routine analysis and urine sediment examination

Urine routine analysis and urine sediment examination can be used to determine whether there is a urinary tract infection, and it is an auxiliary method for the diagnosis of prostatitis.

4. Bacteriological examination

Two cups or four cups are commonly used. These methods are particularly suitable before antibiotic treatment. Specific method: Before collecting urine, ask the patient to drink more water, and the foreskin should be turned up. After cleaning the penis head and urethral opening, the patient urinates and collects 10ml of urine; continues to urinate about 200ml and collects 10ml of middle urine; then stops urination, performs prostate massage and collects prostate fluid; finally collects 10ml of urine again. Microscopic examination and culture were performed on each specimen. By comparing the number of bacterial colonies in the above specimens, it was possible to identify whether there was prostatitis or urethritis.

5. Other inspections

Patients with prostatitis may have abnormal semen quality, such as leukocytosis, semen liquefaction, and changes in blood sperm and sperm motility.

B-ultrasounds can reveal signs of uneven prostate echo, prostate stones or calcification, and dilation of the venous plexus around the prostate.

Urine flow rate test can roughly understand the patient's urination status, which helps to distinguish prostatitis and dysuria related diseases.

Prostatitis diagnosis

A diagnosis can be made based on the patient's medical history, symptoms, digital rectal examination, prostate fluid examination, and four-cup test results. Because prostatitis is often secondary to other infections in the body, such as urinary tract infections, seminal vesiculitis, epididymitis, and inflammation near the rectum, a comprehensive examination of the urogenital system and rectum must be performed when prostatitis is diagnosed.

Prostatitis treatment

The first step is to conduct a clinical assessment, determine the type of disease, and choose a treatment for the cause. Misunderstanding of the disease, unnecessary anxiety, and excessive abstinence can exacerbate symptoms, so patients should be relieved of their thoughts. Prostatitis may be a mild or asymptomatic disease, it may be a self-limiting disease that can relieve itself, or it may be a complex disease that causes urinary tract infection, sexual dysfunction, infertility, etc. For the treatment of the disease, we must not only over-expose the harm of the disease to the patient, but also avoid adopting a simple, negative, blindly biased attitude towards antibiotic treatment for the disease. Individualized comprehensive treatment should be adopted.

Antibacterial treatment

The discovery of pathogenic pathogens in the culture of prostate fluid is the basis for choosing antibacterial treatment. If patients with nonbacterial prostatitis have signs of bacterial infection, they are not effective after general therapy, and antibacterial drugs can also be used appropriately. The selection of antibacterial drugs should pay attention to the existence of a prostate-blood barrier composed of lipid membranes between the prostate acinar and the microcirculation, which hinders the passage of water-soluble antibiotics from the barrier and greatly reduces the therapeutic effect. When prostate stones are present, stones can serve as a shelter for bacteria. The above factors constitute difficulties in the treatment of chronic bacterial prostatitis, require a longer course of treatment, and are prone to relapse.

At present, quinolone drugs such as ofloxacin or levofloxacin are often advocated. If not, continue to use for 8 weeks. Relapse with the same strain, use prophylactic doses to reduce acute attacks and reduce symptoms. If long-term application of antibiotics induces serious side effects, such as pseudomembranous enteritis, diarrhea, and growth of intestinal resistant strains, the treatment plan needs to be changed. It is still clinically debated whether nonbacterial prostatitis is suitable for antibacterial treatment. Patients with "sterile" prostatitis can also use drugs that are effective against bacteria and mycoplasma, such as quinolone drugs, SMZ-TMP or TMP alone, in combination with or at intervals with tetracycline and quinolone drugs. If antibiotic treatment is not effective and those with aseptic prostatitis are identified, antibiotic treatment is discontinued. In addition, using a double-balloon catheter to close the urethra of the prostate, and injecting an antibiotic solution from the urethral cavity into the prostate canal can also achieve the purpose of treatment.

Type I is mainly broad-spectrum antibiotics, symptomatic and supportive. Oral antibiotics are recommended for type , and sensitive drugs are selected. The course of treatment is 4 to 6 weeks. During this period, patients should be evaluated periodically. Type III antibiotics can be taken orally for 2 to 4 weeks before evaluating the efficacy. At the same time supplemented with non-steroidal anti-inflammatory drugs, alpha receptor antagonists, M receptor antagonists, etc. to improve micturition symptoms and pain. Type IV does not require treatment.

2. Anti-inflammatory and painkillers

Non-steroidal anti-inflammatory drugs can improve symptoms. Generally, indomethacin is taken orally or suppositories, and Chinese medicines use anti-inflammatory, heat-clearing, detoxifying, and soft-firm drugs. Allopurinol can reduce the concentration of uric acid in the whole body and prostate fluid. In theory, it can be used as a free radical scavenger. It can also remove active oxygen components, reduce inflammation and relieve pain. May be an optional adjuvant therapy.

3. Physical therapy

Prostate massage can empty the concentrated secretions in the prostate tube and drain the infection area of the gland obstruction area. Therefore, for antibiotics, prostate massage can be performed every 3 to 7 days. A variety of physical factors are used for prostate physiotherapy, such as microwave, radio frequency, ultrashort wave, medium wave, and hot water bath, which have certain benefits in relaxing the prostate, posterior urethral smooth muscle, and pelvic floor muscles, strengthening antibacterial efficacy and alleviating pain symptoms.

4.M receptor antagonist

Patients with prostatitis associated with overactive bladder function, such as urgency, frequent urination, nocturia, but no urinary tract obstruction, can be treated with M receptor antagonists.

5. Alpha receptor antagonist

Prostate pain, bacterial or non-bacterial prostatitis patients have increased tension in the prostate, bladder neck and urethral smooth muscles. Increased internal urethral pressure during urination causes urine to flow back into the prostate duct, which causes prostate pain, prostate stones and bacterial prostates. As an important cause of inflammation, the use of alpha receptor antagonists can effectively improve the symptoms of prostate pain and urination, help prevent the reflux of urine in the prostate, and is of great significance in preventing the recurrence of infection. It also plays an important role in the treatment of type III prostatitis. Alpha receptor antagonists should be used for a longer period of time to allow sufficient time to adjust smooth muscle function and consolidate the efficacy. Different alpha receptor blockers can be selected according to the patient's situation, mainly: doxazosin, naftopidil, Tamsulosin and terazosin.

6. Prostate massage and hyperthermia

Prostate massage is one of the traditional treatment methods. Studies have shown that proper prostate massage can promote the emptying of the prostate tube, increase the local drug concentration, and then alleviate the clinical symptoms of chronic prostatitis. Hyperthermia mainly uses the thermal effects produced by a variety of physical means to increase blood circulation in the prostate tissue, accelerate metabolism, help the effect and eliminate tissue edema, and relieve pelvic floor muscle spasms.

7. Surgical treatment

Surgical treatment can be used for recurrent chronic bacterial prostatitis. Prostatectomy can achieve cure, but it should be used with caution. Because prostatitis usually affects the peripheral glands of the glands, it is difficult to achieve the goal of treatment with transurethral resection of the prostate (TURP). TURP can remove stones in the prostate and bacterial infections near the prostate duct, which can help reduce reinfection of peripheral lesions.

8. Other treatments

Including biofeedback treatment, transperineal extracorporeal shock wave treatment, psychological treatment, traditional Chinese medicine and traditional Chinese medicine treatment.

Prostatitis daily care

1. Persist in treatment. Do not change medicines or treatments during the treatment, because the relief of symptoms often takes some time. Early treatment should be maintained for more than 2 weeks, and some infections should be 8-12 weeks. If the drug is changed casually, it may easily cause imbalance of the flora or produce drug resistance, leading to incomplete treatment.

2. Regular life, can not tolerate ejaculation, do not masturbate frequently, avoid unclean sex.

3. Properly understand prostatitis, maintain a good attitude, reduce psychological stress, so as not to exaggerate the symptoms and produce symptoms such as dizziness, decreased memory, anxiety, doubt, and insomnia.

4. Drink plenty of water, urinate frequently, keep your stools open, and stick to a hot bath or hot water pack to perineum.

5. Avoid tobacco and alcohol, do not eat spicy spicy food.

6. Avoid sitting for a long time, avoid cycling for a long time, insist on exercise, it is best to jog and add more lower body exercise to avoid strenuous exercise.