The prostate is a part of the male reproductive system, shaped and sized like a chestnut, located in front of the rectum and under the bladder, and wraps around the beginning of the urethra. The prostate gland secretes prostatic fluid, which is a component of semen. Prostatitis, the inflammation that occurs in the prostate, is a fairly common, non-life-threatening condition that may resolve on its own in some patients, and not all patients require treatment.
There are three types of prostatitis with clinical symptoms.
Acute bacterial prostatitis, chronic bacterial prostatitis, and chronic non-bacterial prostatitis. Symptoms of prostatitis include, pain in the pelvic region such as perineum, perianal, urethra, suprapubic, inguinal, and lumbosacral regions, urinary symptoms such as frequency, urgency, and effort to urinate, but they may not be present in every patient.
The clinical manifestations of each type of prostatitis also have some individual characteristics. The actual fact is that you can find a lot of people who are not able to get a lot of money for the actual money. Chronic bacterial prostatitis: recurrent symptoms and laboratory tests prove that the bacteria are from the prostate. Chronic non-bacterial prostatitis: the vast majority of prostatitis falls into this category, with no evidence of bacterial infection. The white blood cell count of prostate massage fluid can be normal or abnormal, and the white blood cell count does not necessarily correlate with the severity of symptoms.
There is no sufficient evidence that prostatitis can be cancerous. Some patients with prostatitis are accompanied by symptoms of sexual dysfunction such as decreased libido, erectile dysfunction and premature ejaculation, but there is no evidence that prostatitis directly causes sexual dysfunction, and some patients with prostatitis can have abnormal semen parameters.
The goal of treatment for chronic prostatitis is to relieve pain, improve urinary symptoms, and improve quality of life, and the degree of symptom relief is the main basis for evaluating the effectiveness of treatment for chronic prostatitis. Although there are numerous treatment methods or drugs, none of them can achieve the goal of treating all patients or relieving all symptoms. The treatment of prostatitis should follow the medical advice and follow up on time. Patients with chronic prostatitis should pay attention to abstaining from alcohol, avoiding spicy and stimulating foods, drinking more water; avoiding holding urine, being sedentary and fatigue; paying attention to keeping warm and strengthening physical exercise; hot water sitz baths are beneficial for patients with chronic prostatitis. After the treatment is over, paying attention to the above matters will help prevent the recurrence of symptoms. The actual fact is that you will need antibiotics for acute and chronic bacterial prostatitis, and some chronic non-bacterial prostatitis patients can try antibiotic therapy. alpha-blockers, non-steroidal anti-inflammatory analgesics, and botanicals have varying degrees of effectiveness in relieving the symptoms of chronic prostatitis.
In 1995, the National Institutes of Health developed a new classification based on basic and clinical research on prostatitis: Type I is acute bacterial prostatitis. Type II is chronic bacterial prostatitis, which accounts for about 5-8% of chronic prostatitis. There are recurrent symptoms of lower urinary tract infection lasting more than 3 months, elevated leukocyte count in EPS/semen/VB3 and positive bacterial culture results. type III is chronic prostatitis/chronic pelvic pain syndrome, which is the most common type of prostatitis and accounts for about 90% of chronic prostatitis. The main manifestation is long-term, recurrent pain or discomfort in the pelvic region lasting more than 3 months, which can be accompanied by varying degrees of urinary symptoms and sexual dysfunction, seriously affecting the patient’s quality of life; negative EPS/seminal fluid/VB3 bacterial culture results. type IV is asymptomatic prostatitis. There are no subjective symptoms and only evidence of inflammation is found during examinations concerning the prostate (EPS, semen, prostate tissue biopsy and pathological examination of prostatectomy specimens, etc.).
The key to the treatment of prostatitis is: comprehensive treatment for the cause. The principle of treatment is: good birth talk + reasonable medication. The reason is that the occurrence of prostatitis is in many cases related to bad habits, so it is important to be open-minded, calm, eat a reasonable diet, drink plenty of water, do not smoke, drink less alcohol, do not eat spicy food, have a regular sex life, do not strain, ride a bicycle for a long time, etc. Medication is an important tool, and the principle of rational use of medication must always be kept in mind. This includes the use of antibiotics that are sensitive to bacteria, the identification and treatment of Chinese medicine, and the use of antispasmodics to improve symptoms.
There are more than a dozen varieties of antibiotics, but all of them have their own more targeted strains, and if conditions permit, bacterial culture and drug sensitivity tests should be done, and according to the results of drug sensitivity tests or bacterial culture to choose the appropriate antibiotics. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. The following is an introduction according to the typology of prostatitis.
Type I.
Mainly broad-spectrum antibiotics, symptomatic treatment and supportive treatment. Antibiotic treatment is necessary and urgent and should be applied as soon as the clinical diagnosis or blood or urine culture results are obtained. At the beginning, antibiotics can be applied intravenously, such as: broad-spectrum penicillin, third-generation cephalosporins, aminoglycosides or fluoroquinolones, etc. When the patient’s fever and other symptoms improve, switch to oral medications (e.g., fluoroquinolones) for a minimum of 4 weeks. Patients with milder symptoms should also take oral antibiotics for 2 to 4 weeks.
Type II.
Treatment is based on antibiotics, and sensitive drugs are selected. If the efficacy is not satisfactory, other sensitive antibiotics can be used instead. Alpha-blockers can be used to improve urinary symptoms and pain. Botanical preparations, non-steroidal anti-inflammatory analgesics and M-blockers can also improve the associated symptoms. Antibiotics are selected based on bacterial culture results and the ability of the drug to penetrate the prostate envelope. The ability of a drug to penetrate the prostate envelope depends on its degree of ionization, lipid solubility, protein binding rate, relative molecular mass and molecular structure. The commonly used antibiotics are fluoroquinolones such as ciprofloxacin, levofloxacin and lomefloxacin. After the diagnosis of prostatitis, antibiotic therapy is maintained for at least 4-6 weeks, during which the patient should be evaluated for stage efficacy. Intraprostatic antibiotic injections are not recommended as a treatment.
Type III.
Oral antibiotics may be given for 2 to 4 weeks, and then the decision to continue antibiotic therapy is based on feedback on its efficacy. Alpha-blockers are recommended to improve urinary symptoms and pain. NSAIDs, botanicals and M-blockers are also available. Antibiotic therapy is mostly empirical and is based on the theory that certain pathogens that are routinely culture-negative are presumed to cause this type of inflammation. Therefore, oral antibiotics such as fluoroquinolones are recommended for 2 to 4 weeks, and then the decision to continue antibiotic therapy is based on feedback of efficacy. Continuation of antibiotics is recommended only if the patient does experience a reduction in clinical symptoms. The recommended total course of treatment is 4 ~ 6 weeks. Some patients with this type of disease may have intracellular pathogens such as Chlamydia trachomatis, Mycoplasma solium or Mycoplasma humanum, and may be treated with oral antibiotics such as macrolides. alpha-blockers are essential for the treatment of type II/III prostatitis because they relax the smooth muscle in the prostate and bladder and improve lower urinary tract symptoms and pain. Different alpha-blockers can be selected according to the individual patient. The main recommended alpha-blockers are: alfuzosin, doxazosin,, tamsulosin and terazosin, etc. The results of controlled studies have shown that the above-mentioned drugs have different degrees of improvement on patients’ urinary symptoms, pain and quality of life index. The treatment should be aware of adverse effects such as vertigo and postural hypotension caused by these drugs. α-blockers should be given for at least 12 weeks. α-blockers can be used in combination with antibiotics for the treatment of type III prostatitis and the combination should be given for at least 6 weeks. Non-steroidal anti-inflammatory analgesics are used empirically to treat the symptoms associated with type III prostatitis. Their primary purpose is to relieve pain and discomfort. To date, only a few randomized, placebo-controlled studies have evaluated the efficacy of these drugs. Controlled clinical studies have confirmed the effectiveness of celecoxib in improving pain and other symptoms in patients with type III prostatitis.
Type IV: No treatment is generally required.
Other drugs: The therapeutic role of botanical agents in type II and III prostatitis is gaining attention as an optional treatment. The botanical preparations mainly refer to pollen-based preparations and plant extracts, which have a wide range of pharmacological effects, such as non-specific anti-inflammatory, anti-edema, and promote bladder forced urinary muscle contraction and urethral smooth muscle relaxation. Commonly used botanical preparations include: Pulcitol, quercetin, sabal palm and its infusion. Due to the large number of varieties, their dosage depends on the specific condition of the patient, and the course of treatment is usually measured in months. Adverse effects are minor. The results of a recently completed multicenter controlled study showed that the combination of Pulsatilla and levofloxacin was significantly more effective than levofloxacin monotherapy in the treatment of type III prostatitis. Results from another randomized, double-blind, placebo-controlled study showed that long-term (6-month) treatment with Pulsatilla significantly reduced pain and urinary symptoms in patients with type III prostatitis compared to placebo. Patients with prostatitis with manifestations of overactive bladder disorder such as urinary urgency, frequency and nocturia but without urinary obstruction can be treated with the M-blocker tolterodine.
Antidepressants and anxiolytics.
For patients with chronic prostatitis combined with depression and anxiety, depending on their condition, they can choose to use antidepressants and anxiolytics while treating their prostatitis. These medications can significantly improve both the patient’s mood disorder symptoms and also the physical discomfort and pain. It is important to be aware of the adverse effects of these drugs when applying them clinically. The main antidepressants and anxiolytics available are tricyclic antidepressants, selective 5-hydroxytryptamine reuptake inhibitors, and benzodiazepines.
Traditional Chinese Medicine (TCM).
It is recommended to carry out TCM treatment of prostatitis in accordance with the specifications of the Chinese Medicine Association or the Society of Integrative Chinese and Western Medicine, taking the method of clearing heat and dampness, invigorating blood circulation and draining urine and lung. The patient can choose the soup or Chinese medicine according to the patient’s diagnosis and type, such as Weng Li Tong, prostate security suppository, Zegui retention capsule, Long Jin Tong Lian capsule, etc.