How Do I Choose the Best Chronic Prostatitis Treatment?

Chronic prostatitis refers to chronic inflammation of prostate tissue caused by various causes, and is the most common disease in urology. Including chronic bacterial prostatitis and non-bacterial prostatitis two parts. Among them, chronic bacterial prostatitis is mainly caused by pathogen infection, mainly retrograde infection, and the pathogen is mainly staphylococcus. There is often a history of repeated urinary tract infections or persistent pathogenic bacteria in prostate massage fluid. Non-bacterial prostatitis is a complex pathological change of inflammation, immunity, and neuroendocrine involvement caused by a variety of complex causes and inducements, leading to urinary tract irritation and chronic pelvic pain as the main clinical manifestations, and often complicated with psychosocial symptoms The clinical manifestations are diverse. The course of the disease is slow and it does not heal.

Basic Information

English name: Chronic prostatitis
Visiting department: Urology

Common causes: Mostly caused by pathogen infection, immune abnormalities, etc.
Common symptoms: Lower abdominal pain, bloating, frequent urination, urgency, and urethral burning

Causes of chronic prostatitis

Chronic bacterial prostatitis

The pathogenic factor is mainly pathogen infection, but the body is more resistant or / and the pathogen is less virulent, mainly retrograde infection. The pathogen is mainly Staphylococcus, followed by Escherichia coli, Corynebacterium and Enterococcus. Genus etc. Prostate stones and urine reflux may be important reasons for persistent pathogens and recurrence of infection.

2. Chronic nonbacterial prostatitis

The etiology is very complicated, and the main cause may be the combined effects of pathogen infection, inflammation and abnormal pelvic floor neuromuscular activity and immune abnormalities.

(1) Pathogen infection Although this type of patients cannot isolate pathogens through routine bacterial examination, they may still be related to some special pathogens, such as anaerobic bacteria, L-shaped proteobacteria, nanobacteria, or Chlamydia trachomatis, mycoplasma and other infections. Studies have shown that the detection rate of local prokaryotic DNA in this type of patients can be as high as 77%; certain "sterile" prostatitis, which is mainly chronic inflammation, recurrent or exacerbated, may be related to these pathogens. Other pathogens such as parasites, fungi, viruses, trichomoniasis, and Mycobacterium tuberculosis may also be important pathogenic factors of this type, but there is a lack of reliable evidence and there is no unified opinion so far.

(2) Urinary dysfunction Some 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 a sterile " "Chemical prostatitis" causes abnormal urination and pain in the pelvic region.

Many patients with prostatitis have multiple urodynamic changes, such as reduced urinary flow rate, functional urinary tract obstruction, and detrusor-urethral sphincter coordination disorders. These dysfunctions may be related to various underlying pathogenic factors.

(3) Psychological and psychological factors Studies have shown that more than half of patients with prolonged prostatitis have significant psychological and psychological 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) Neuroendocrine factors Patients with prostate pain are often prone to fluctuations in heart rate and blood pressure, indicating that they may be related to autonomic nervous responses. Its pain is characterized by internal organ pain, local pathological stimulation of the prostate and urethra, triggering spinal cord reflexes through the afferent nerves of the prostate, activating astrocytes in the lumbar and sacral spinal cord, and nerve impulses passing through the genital femoral and iliac inguinal nerves. Impulsive, sympathetic nerve endings release norepinephrine, prostaglandin, calcitonin gene-related peptide, substance P, etc., causing bladder and urethral dysfunction, and leading to abnormal perineal and pelvic floor muscle activity, continued to appear in the corresponding areas outside the prostate Pain and involved pain.

(5) Abnormal immune response Recent studies have shown that immune factors play a very important role in the development and progression of type III prostatitis. A patient's prostate fluid and / or seminal plasma and / or tissue and / or blood may appear Changes in some cytokine levels, such as: IL-2, IL-6, IL-8, IL-10, TNF-, and MCP-1, etc., and IL-10 levels are positively correlated with pain symptoms in patients with type III prostatitis , Application of immunosuppressive therapy has a certain effect.

(6) Oxidative stress theory Under normal circumstances, the generation, utilization and removal of oxygen free radicals in the body are in a state of dynamic equilibrium. In patients with prostatitis, excessive oxygen free radicals are produced or / and the effect of the free radical scavenging system is relatively reduced, thereby reducing the body's ability to respond to oxidative stress and increasing the products or / and by-products of oxidative stress. Pathogenesis one.

(7) Pelvic related disease factors Some patients with prostatitis are often accompanied by venous plexus dilatation, hemorrhoids, varicocele, etc., suggesting that some patients with chronic prostatitis may be related to pelvic vein congestion and blood stasis, which may also be related to Is one of the reasons for the long-term cure.

Classification of chronic prostatitis

There are many types of prostatitis classified by western medicine. At present, the 1995 National Institutes of Health (NIH) classification method is mostly used internationally. It is mainly divided into four categories: type acute bacterial prostatitis (ABP), type chronic bacterial prostatitis (CBP), type chronic nonbacterial prostatitis (CNP) / chronic pelvic pain syndrome (CP / CPPS), and this type is further divided into type IIIA and type IIIB; type IV asymptomatic inflammatory prostatitis (AIP). Chronic prostatitis is divided into: chronic bacterial prostatitis and chronic nonbacterial prostatitis, both of which are equivalent to type II and type III in the NIH classification of prostatitis.

Clinical manifestations of chronic prostatitis

Pain

Pain symptoms are mainly manifested in the pain of radiating the surrounding tissues with the prostate as the center, which is common in pain, swelling or discomfort in the scrotum, testes, lower abdomen, perineum, lumbosacral, medial thigh and other parts.

2. Abnormal urination

It manifests as frequent urination, urgency, dysuria, burning of the urethra, urinary leaching, or white secretions overflowing from the urethra in the morning, end of urine or stool.

3. Neuropsychiatric symptoms

Presented as dizziness, tinnitus, insomnia, anxiety and depression, or even impotence, premature ejaculation, and nocturnal emission.

Diagnosis of chronic prostatitis

Chronic prostatitis: detailed medical history, comprehensive physical examination (including digital rectal examination), routine examination of urine and prostate massage fluid. 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.

Specific diagnostic methods:

1. Medical history collection

2. 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. Digital rectal examination of the prostate can be normal size, or slightly larger or smaller, and palpation may have mild tenderness or nodules. Some prostates can show abnormalities such as uneven soft and hard or shrinking and hardening.

3. Laboratory inspection

(1) Routine examination of prostate massage fluid (EPS) Mainly observe the number of leukocytes and lecithin bodies in EPS. In normal EPS, leukocytes HP, no or occasional red blood cells, no pus cells. Lecithin bodies are uniformly distributed throughout the visual field, pH 6.3 to 6.5, red blood cells and epithelial cells are absent or rare. When the number of leukocytes is more than 10 / HP, the number of lecithin bodies decreases, which indicates the presence of inflammation in the prostate, which can be used as an auxiliary diagnostic item instead of the gold standard for diagnosis.

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

(3) Bacteriological examination The "two-cup method" or "four-cup method" pathogen localization test is recommended for chronic prostatitis. It is a commonly used method to distinguish bacterial and non-bacterial, and it has certain guiding significance for clinical use of CP.

(4) Other pathogen examinations include C. trachomatis and Mycoplasma.

4. Instrument inspection

(1) B-ultrasound examination Although B-ultrasound examination of prostatitis patients can find signs of uneven prostate echo, prostate stones or calcification, and dilation of the venous plexus around the prostate, the specific features of B-ultrasound diagnosis of prostatitis are still lacking and cannot be used. B-type prostatitis. It is not recommended to use the results of a single ultrasound examination as a basis for diagnosis.

(2) Urodynamics Urinary flow rate, urine flow rate examination can roughly understand the patient's urination status, which is helpful to identify prostatitis and urination disorders. Urinary flow rate measurement is a non-invasive and relatively cheap test . For most patients suspected of having lower urinary tract dysfunction, it is a preferred and essential screening program. Urodynamic examination is mainly used to find bladder and urethral dysfunction.

(3) CT and MRI have potential applications in identifying pelvic organ lesions such as seminal vesicles and ejaculation ducts, but the diagnostic value of prostatitis itself is still unclear.

Differential diagnosis of chronic prostatitis

Chronic 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 bladder outlet obstruction and abnormal bladder function. . Diseases to be identified include: benign prostatic hyperplasia, testicular epididymis and spermatic cord disease, overactive bladder, neurogenic bladder, interstitial cystitis, glandular cystitis, sexually transmitted diseases, bladder tumors, prostate cancer, anorectum Diseases, lumbar diseases, central and peripheral neuropathy, etc. The patient's symptoms do not resolve after treatment, and further examination should be selected according to the specific situation, except for the above diseases.

Chronic epididymitis

Painful discomfort in the scrotum and groin, similar to CP. However, chronic epididymitis can touch the nodules with mild tenderness.

2. Benign Prostatic Hyperplasia

Most of them occur in the elderly; frequent urination accompanied by dysuria, thinning of the urine line, increased residual urine; B-ultrasound, digital rectal examination can be identified.

3. Seminal vesiculitis

Seminal vesiculitis and CP often occur at the same time, in addition to symptoms similar to prostate inflammation, often have the characteristics of pain in blood and ejaculation.

4. Urethritis

Urethritis manifests as frequent urination, urgency, and dysuria. But prostatitis has perineal discomfort and bloating, and a digital rectal examination found that the prostate is full and tender.

5. Varicocele

The main reason is that the venous return of the spermatic cord is blocked or the venous valve fails. The blood reflux causes the tortuous and dilated spermatic cord venous plexus, and it may have pain in the scrotum. The diagnosis can be determined by palpation and ultrasound.

Chronic Prostatitis Treatment

The treatment of chronic bacterial prostatitis is mainly based on oral antibiotics, and sensitive drugs are selected. The course of treatment is 4 to 6 weeks. During this period, patients should be evaluated periodically. If the effect is not satisfactory, other sensitive antibiotics can be used instead. Alpha-blockers can be used to improve urination and pain. Botanicals, non-steroidal anti-inflammatory analgesics, and M-blockers also improve symptoms.

Chronic nonbacterial prostatitis: antibiotics can be taken orally for 2 to 4 weeks, and then whether to continue antibiotic treatment is determined based on the feedback of their efficacy. Alpha-receptor blockers are recommended to improve urination symptoms and pain. Plant preparations, non-steroidal anti-inflammatory analgesics, and M-receptor blockers can also be used to improve urination symptoms and pain.

The treatment goals of chronic prostatitis are mainly to relieve pain, improve symptoms of urination, and improve quality of life. The evaluation of curative effect should focus on improving symptoms.

General treatment

Patients should conduct psychological counseling themselves, maintain a cheerful and optimistic attitude towards life, quit drinking, avoid spicy food; avoid holding back urine, sitting for long periods of time, riding, riding, riding, 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 of treating prostatitis, the most commonly used first-line drug is antibiotics, but only about 5% of patients with chronic prostatitis have a definite bacterial infection.

Chronic bacterial prostatitis: Choose antibiotics based on bacterial culture results and the ability of the drug to penetrate the prostate. After the diagnosis of prostatitis, the course of antibiotic treatment is 4-6 weeks, during which the patients should be evaluated periodically. Treatment with antibiotics in the prostate is not recommended.

Chronic nonbacterial prostatitis: Antibiotic therapy is mostly empirical. The theoretical basis is to speculate that some conventional culture-negative pathogens cause 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.

(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 type II / type III 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 type II and type III 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 drugs Non-steroidal anti-inflammatory drugs are empirical drugs for the treatment of symptoms associated with type III prostatitis. Its main purpose is to relieve pain and discomfort.

(5) M-receptor blockers For patients with prostatitis with 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 chronic prostatitis patients with mood disorders such as depression and anxiety, antidepressants and anxiolytics can be selected for treatment of prostatitis. 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 It is recommended to perform traditional Chinese medicine and traditional Chinese medicine treatment of prostatitis in accordance with 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 type III prostate Adjuvant therapy for inflammation. Prohibition in patients with type 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 various 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) Efficacy and safety of prostate injection therapy / transurethral prostate perfusion therapy have not been confirmed.

Chronic prostatitis prevention

1. Avoid alcohol, avoid eating spicy and greasy food that is not easily digested.

2. Develop a good and regular lifestyle, strengthen exercise, work and rest, and avoid holding back urine, sitting for a long time or riding for too long.

3. The law of sexual life.

4. Keep your prostate gland warm.

5. Regulate emotions, maintain optimism, and massage the prostate moderately.