First of all, after patients present with urinary frequency and urgency, painful urination, testicular perineal pain, perineal discomfort, sexual confusion and visit urology and male outpatient clinics, medical history condition understanding, routine physical examination, laboratory urine routine, rectal finger examination, routine microscopy and culture of prostate fluid, and if necessary, prostate ultrasound. Middle-aged and elderly people with severe urinary frequency and urgency further need cystoscopy to rule out bladder disease. According to the condition of the choice of observation, antibiotics, proprietary Chinese medicine and phytomedicine medication, etc. The new classification method for prostatitis is four types: Type I: acute bacterial prostatitis, Type II: chronic bacterial prostatitis, Type III: chronic non-bacterial prostatitis, which is subdivided into Type IIIa infectious and Type IIIb non-infectious, and Type IV: asymptomatic prostatitis. The vast majority of prostatitis belongs to type III. Chronic prostatitis is a fairly common, non-directly life-threatening disease, but can seriously affect a patient’s quality of life, and some patients can go into remission on their own. A. How is prostatitis diagnosed? In addition to type IV incidentally in doing prostate fluid examination for diagnosis, other types of prostatitis should be divided into types in order to lay a good foundation for treatment. Type I: Clinical manifestations are chills, fever, fatigue, lower back pain with perineal and suprapubic pain, urinary frequency, urinary urgency, urinary pain and difficulty in urination. Rectal palpation may reveal an enlarged prostate with significant tenderness. Urine culture or blood culture and drug sensitivity test can be done. This type is rare. Types II and III: The clinical presentation is similar, mostly with pain and abnormal urination. The pain is mostly in the pelvic region and can be seen in the perineum, penis and urethra. Urination abnormalities may be present, including painful urination, urgency, frequency, increased nocturia and incomplete urination. Due to chronic pain, coupled with incorrect and prolonged treatment, patients have a decreased quality of life and may experience sexual dysfunction, anxiety, depression, insomnia, and memory loss. During physical examination, rectal prostate finger examination and obtaining prostate fluid through prostate massage can identify perineal, rectal and neurological lesions or other diseases of the prostate. The normal prostate fluid has less than 10 white cells per high magnification field of view under the microscope and lecithin vesicles covering the entire field of view. In type II and type IIIa, there is an increase in white blood cells in the prostate fluid, and if you do an ultrasound examination you can see uneven prostate echogenicity, prostate stones or calcification, and dilated periprostatic plexus, among other manifestations. As for type IV, it should be asymptomatic and found by chance when doing prostate fluid examination. The actual type II prostate fluid bacterial culture has bacterial growth. How to treat prostatitis? Prostatitis should be treated in a comprehensive manner: type I prostatitis, treatment with antibiotics is necessary and urgent. Once the bacterial culture results are obtained, antibiotics should be used immediately. Types of antibiotics: cephalosporins, fluquinolones, etc. Change to oral after fever and other symptoms improve. The course of treatment should be at least four weeks. Timely treatment is curable. Type II and III: treatment is more complicated and there are many methods, including the following: 1. General treatment: abstain from alcohol, avoid spicy food, avoid holding urine, sedentary, pay attention to warmth, strengthen physical exercise, hot water sitz bath, etc.; 2. Antibiotic treatment: antibiotic treatment for type II can be used ciprofloxacin, levofloxacin, lomefloxacin, etc. The course of treatment should be at least 4-6 weeks. Patients should be evaluated in stages when medication is administered, and antibiotics should be replaced if the efficacy is unsatisfactory. Type IIIa is treated empirically with antibiotic degrees. The recommended antibiotics are the same as type II, but after 2-4 weeks, the decision to continue antibiotics is made based on the effectiveness of treatment. The total course of treatment is 4-6 weeks. Some patients may have chlamydia and mycoplasma infections and should be treated with erythromycin and tetracycline for 6-8 weeks. Type IIIb can be treated without antibiotics; 3. alpha-blockers: alpha-blockers can relax smooth muscle in the prostate and bladder and other parts of the body to improve lower urinary tract symptoms. It is the basic method of treating type II and III prostatitis. Different drugs can be chosen according to individual differences. Pro? bed are mainly: doxazosin, terazosin, alfuzosin, napalcidil and tamsulosin. After application, patients have different degrees of improvement in urinary symptoms, pain and quality of life. However, the course of treatment is at least 12 weeks. 4, botanical preparations: the role of botanical preparations for type II and type III prostatitis is increasingly valued and can be used as optional adjuvant medication. The common botanical preparations are: Pulsatilla (Serniton), Quercetin, Sabal palm and its infusion (Benoit), etc. There are many varieties, the amount and method of medication need to be determined according to the specific condition of the patient, the course of treatment in months, with few adverse reactions. 5.Patients with urinary urgency, urinary frequency and nocturia without obstruction can be treated with tolterodine; 6.Chinese herbal medicine: it can be used for dialectical treatment, to clear heat and dampness, invigorate blood circulation and drain urine and laxative. The application of soup or Chinese medicine and acupuncture treatment; 7, prostate massage: is the traditional treatment method, more applicable to type III prostatitis, 4-6 weeks of treatment, 2-3 times a week. Other methods: biofeedback can be used, as well as heat therapy and other methods. In conclusion, although there are many treatments or drugs for chronic prostatitis (mostly according to type III), none of them can achieve the goal of treating all patients or relieving all symptoms. The goal of chronic prostatitis treatment is to relieve pain and improve urinary tract symptoms and improve quality of life. Patients should follow their doctor’s orders for regular follow-up appointments during treatment. Avoid unnecessary over-treatment resulting in high costs and increased psychological burden. The majority of patients’ symptoms can disappear or be relieved, and some patients are prone to recurrent episodes. Be sure to pay attention to prevention and treatment at the same time. Such as abstaining from alcohol, avoiding spicy food, avoiding holding urine, being sedentary, strengthening physical exercise, paying attention to warmth, and taking hot water sitz baths. No matter what treatment modality our urologists choose will respect the patient’s wishes. The choice of treatment should take into account the doctor’s personal experience, the patient’s opinion, the degree and characteristics of prostatitis, as well as the patient’s concomitant diseases and general condition.
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