Prostatitis refers to a prostate disease caused by a variety of complex causes, mainly urinary tract irritation and chronic pelvic pain. Prostatitis is a common disease in urology, and it ranks first in urology male patients under the age of 50.
Although the incidence of prostatitis is high, the cause of the disease is still not apparent, especially non-bacterial 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 traditional bacterial classification in acute bacterial prostatitis,
type II: equal to chronic bacterial in conventional classification methods.
Prostatitis type III: chronic prostatitis/chronic pelvic pain syndrome. Type IV: asymptomatic prostatitis. Among them, non-bacterial prostatitis is more common than bacterial prostatitis.
Frequent urination, urgency, pelvic pain, sexual dysfunction and so on.
Only a small number of patients have an acute history and most often have a chronic or relapsed history. The primary pathogenic 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 confirmed prostatitis lesions are generally limited to the peripheral zone.
Where the vertical lines of the duct and urine flow reversely in the posterior urethra, prone to cause urine reflux, while the central band and the transition zone with the direction of the glandular duct and urine flow, not easy Infection.
There are as many as 15 to 30 catheters in the prostate opening on both sides of the spermatic epithelium, and the prostate epithelium has a robust secretory function. Small glands and strong secretion function, as well as narrow tracts, make the prostate under pressure and occlusion of the catheter under a variety of factors, it is easy to cause congestion and secretion deposition.
Thus creating conditions for the occurrence of infection, which is also the result Prostatitis is prone to recurrence histological basis. Sex life is too frequent, too much masturbation, sedentary, riding, riding, drinking, eating spicy, cold and cold, etc. can be its predisposing factors.
The pathogenesis of type III prostatitis is unknown, and the aetiology is very complicated. There is widespread controversy. Most scholars believe that the primary causes may be pathogen infection, urinary dysfunction, mental and psychological factors, neuroendocrine factors, abnormal immune response, oxidative stress theory, lower urinary tract dysfunction.
The lack of research on the pathogenesis of type IV prostatitis may be similar to part of the aetiology and pathogenesis of type III.
The reflux of urine in the prostate may have important significance for the occurrence of various types of prostatitis. Recent studies have found that urinary urate not only has a stimulatory effect on the prostate gland but also precipitates into stones, blocking the ducts and serving as a shelter for bacteria.
These findings can shed light on the fact that prostatitis syndrome is a common manifestation of many diseases, and the clinical signs are complicated and changeable, and can produce various complications and can also relieve itself.
Type I prostatitis often occurs suddenly, manifested as chills, fever, fatigue, and weakness and other systemic symptoms, accompanied by perineal and suprapubic pain, may have frequent urination, urgency and rectal irritation, and even acute urinary retention.
The clinical symptoms of type II and III prostatitis are similar, with pain and urination abnormalities. Regardless of which type of chronic prostatitis can present with similar clinical signs, collectively referred to as prostatitis inflammatory syndrome, including pelvic pain, dysuria, and sexual dysfunction.
Pelvic pain is incredibly complex. Pain is usually located on the public rim, lumbosacral region, and perineum. Radiant pain can be expressed as the urethra, spermatic cord, testis, groin, and ventral medial pain. Abdominal radiation resembles acute abdomen, along with the urinary tract.
Radiation resembles renal colic and often leads to misdiagnosis. Urinary abnormalities were manifested as urinary frequency, urgency, dysuria, poor micturition, urinary bifurcation, urinary leaching, increased nocturia, and urinary output of milky white discharge after urine or stool.
Occasional concurrency dysfunction, including loss of libido, premature ejaculation, ejaculation pain, impaired erection, and impotence.
Type IV prostatitis has no clinical symptoms, and evidence of inflammation was found only in the examination of the prostate.
1. Rectal examination
Type I prostatitis rectal examination can be found in prostate enlargement, tenderness, the local temperature increased. It should be noted that prostate prostatitis should not be used for acute prostatitis to prevent the spread of infection.
Type II and III prostatitis rectal examination can understand the size of the prostate, texture, nodules, with or without tenderness and its scope and extent, pelvic floor muscle tension, a pelvic wall with or without tenderness, massage prostate fluid can be obtained For laboratory tests.
EPS routine examinations are usually performed using a wet image method and a blood cell count plate method. The latter has better accuracy. The content of leukocytes in the normal prostatic fluid sediment should be less than 10 in each field of view of the high power microscope.
If the number of white blood cells in the prostatic fluid is >10/field, prostatitis is highly suspected.
In particular, fat-containing macrophages found in the prostatic fluid can be diagnosed as prostatitis. However, in some patients with chronic bacterial prostatic fluid, the number of white blood cells in the prostatic fluid may be a visual field; in other healthy men, the number of white blood cells in the prostatic fluid is more than 10/field.
Therefore, the examination of leukocytes in the prostatic fluid is only an aid to the bacteriological examination of the prostatic fluid.
Urine routine analysis and urinary sediment examination can be used to determine the presence of urinary tract infections and is an adjunct to diagnosing prostatitis.
Two cups or four cups are commonly used. These methods are especially suitable for antibiotic treatment. Specific methods: Before the collection of urine paralyzed patients drink more water, the foreskin is too long should turn the foreskin.
After cleaning the penis head and urethra, the patient urinates and collects 10 ml of urine; continue urination about 200 ml and then collect 10 ml of midstream urine; then stop urinating, make a prostate massage and collect prostatic fluid; finally collect 10 ml of urine again.
Each specimen was microscopically examined and cultured. By comparing the number of colonies of the above specimens, it was possible to identify whether there was prostatitis or urethritis.
Patients with prostatitis may have abnormal semen quality, such as leukocytosis, semen liquefaction, decreased blood refinement, and reduced sperm motility.
B-ultrasound can show uneven prostate echo, prostate calculus or calcification, expansion of the venous plexus around the prostate and other performance.
The urine flow rate test can roughly understand the patient’s urinary status and help identify the diseases related to prostatitis and urination disorders.
According to the patient’s medical history, symptoms, digital rectal examination, prostatic fluid examination and four-cup test, etc., the diagnosis can be made.
Since prostatitis is often secondary to other infectious lesions in the body, such as urinary tract infections, seminal vesiculitis, epididymitis, and inflammation around the rectum, when diagnosing prostatitis, a thorough examination of the genitourinary system and the rectum must be performed.
First, we must conduct a clinical assessment, determine the type of disease, and preferred treatment methods for the cause. Misunderstanding of the disease, unnecessary anxiety and excessive abstinence increase the symptoms, so the patient’s ideological concerns should be lifted.
Prostatitis may be a mild or all-symptom symptom, it may be a self-limiting self-limiting disease, or it may be a complicated symptom that causes urinary tract infections, sexual dysfunction, infertility, etc.
Diseases, the treatment of patients should not only give the patient the risk of overdrawing the disease but also to avoid the treatment of the abdominal to take a simple, negative, blindly biased attitude toward antibiotic treatment diarrhoea comprehensive treatment should essential.
Prostatic fluid culture found pathogenic pathogens is the basis for the selection of antimicrobial therapy. In patients with non-bacterial prostatitis, if they have signs of bacterial infection, they cannot be treated with general therapies.
They may also be treated with antibiotics. The choice of antibiotics should pay attention to the prostate-blood barrier formed by the lipid membrane between the prostate acini and the microcirculation, which prevents the passage of water-soluble antibiotics and dramatically reduces the therapeutic effect.
In the presence of prostate stones, stones can become a protective body of bacteria. The above factors constitute difficulty in the treatment of chronic bacterial prostatitis, require a longer course of treatment, and are prone to recurrence.
Quinolones such as ofloxacin or levofloxacin are currently advocated. If invalid, continue for 8 weeks. Recurrence and invariability of strains, switch to a preventive dose to reduce the acute attack so that the symptoms subsided.
If a long-term application of antibiotics induces serious side effects such as pseudomembranous colitis, diarrhea, and growth of intestinal drug-resistant strains, the treatment plan needs to be replaced.
Whether the non-bacterial prostatitis is suitable for the use of antibiotics is still controversial in clinical practice. Patients with “sterile” prostatitis can also use drugs that are effective against bacteria and mycoplasma, such as quinolones, SMZ-TMP, or TMP alone, in combination with tetracycline, quinolones, or at intervals. If antibiotic treatment fails to confirm aseptic prostatitis, antibiotic treatment is discontinued.
In addition, the double-balloon catheter is used to seal the prostatic urethra and inject the antibiotic solution from the urethra into the prostatic tube, which can also achieve therapeutic goals.
Type I is mainly broad-spectrum antibiotics, symptomatic treatment, and supportive care. The Type II recommendation is based on oral antibiotics. Select sensitive drugs. The course of treatment is 4 to 6 weeks.
Type III can first take oral antibiotics for 2 to 4 weeks and then evaluate the efficacy. Non-steroidal anti-inflammatory drugs, alpha-receptor antagonists, and M-receptor antagonists improve urinary symptoms and pain. Type IV requires no treatment.
Non-steroidal anti-inflammatory drugs can improve symptoms, generally, use indomethacin or suppository, USA medicine uses anti-inflammatory, heat, detoxification, soft-firm drugs also received a specific effect.
Allopurinol can reduce the concentration of uric acid in the systemic and prostatic fluids. In theory, it can be used as a free radical scavenger, and it can also remove active oxygen, reduce inflammation, and relieve pain. It is an optional supplemental treatment.
The prostate massage can evacuate the concentrated secretions in the prostate tube and infect the lesions in the area of glandular obstruction.
Therefore, in the case of stubbornness, prostate massage can be performed every 3 to 7 days while using antibiotics.
A variety of physical factors are used as prostate physiotherapies, such as microwave, radiofrequency, ultrashort wave, medium wave and hot water bath, which have particular benefits for relaxing prostate, posterior urethral smooth muscle and pelvic floor muscles, strengthening antibacterial efficacy and relieving pain symptoms.
4.M receptor antagonist
Patients with prostatitis associated with overactive bladder activity, such as urinary urgency, increased urinary frequency, and nocturia, but no urinary tract obstruction, can be treated with M-receptor antagonists.
5.α receptor antagonists
Prostatodynia, bacterial or non-bacterial prostatitis in patients with prostate, bladder neck and urethral smooth muscle tension increased, increased urethral pressure during urination caused by urine back into the prostate tube, is caused by prostate pain, prostate stones and bacterial prostate.
An important reason for inflammation, the use of alpha receptor antagonists to effectively improve the symptoms of prostatodynia and micturition, helps prevent urinary reflux within the prostate and is vital for preventing the recurrence of infection.
It also has an essential role in the treatment of type III prostatitis. It is advisable to use a longer course of alpha-adrenoceptor antagonists to allow sufficient time to adjust the smooth muscle function and consolidate the therapeutic effect.
Different alpha-blockers may be selected according to the patient’s condition, mainly doxazosin, naftopidil, Tamsulosin, and terazosin.
Prostate massage is one of the traditional methods of treatment. Studies have shown that proper prostate massage can promote the emptying of the prostate tube, increase the local drug concentration, and thus relieve the clinical symptoms of chronic prostatitis.
Hyperthermia mainly uses the thermal effects produced by various physical means to increase the blood circulation of the prostate tissue, accelerate the metabolism.
7. Surgical treatment
Surgical treatment can be used for recurrent chronic bacterial prostatitis. Prostatectomy can achieve the goal of healing, but it should be used with caution.
Since prostatitis usually affects the peripheral zone of the gland, it is difficult to achieve the purpose of treatment by prostate resection (TURP). TURP can remove the stones of the prostate and bacterial infections near the prostate duct, which helps to reduce the reinfection of peripheral lesions
9. Other treatments
Including biofeedback therapy, transperineal shock wave therapy, psychotherapy, Chinese medicine treatment.
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