1. How should prostate stones be treated?
Prostate stones lack effective treatment, currently symptomatic treatment is the main focus.
①Observation follow-up Stationary asymptomatic prostate stones can be left untreated and reviewed regularly to observe the changes in stones. Xie Hui, Department of Urology, The First Hospital of Wenzhou Medical University
② Symptomatic treatment Symptomatic treatment is available for symptomatic but not serious infection, control of infection, prostate massage, etc. If the stone is accompanied by chronic prostatitis, hot water sitz bath, antibiotics and urinary tract antispasmodic can be used to relieve the symptoms of posterior urinary tract irritation.
③Surgical treatment There are three methods.
(1) Transurethral resection of the prostate and stones, the surgery is less invasive and this is the most commonly used method, but the stones tend to remain.
(2) Suprapubic bladder prostate and stone removal, for larger patients with prostate enlargement.
(3) Trans-perineal prostatectomy, for deep stones or multiple stones. Surgical treatment does not necessarily guarantee complete improvement of the patient’s clinical symptoms, and post-prostate surgery may affect sexual function, retrograde ejaculation, sperm quality changes, etc. Caution is needed, especially in young prostate patients.
2. What is the relationship between prostatitis and seminal vesicles?
The reader may not be familiar with the seminal vesicles, so before talking about this issue, let us first understand the anatomy and function of the following seminal vesicles.
The sperm vesicle is an accessory male gland, a gland, so the accurate name should be the seminal vesicle gland. In adults, the seminal vesicle glands are a pair of long oval shaped organs, wide at the top and narrow at the bottom, slightly flattened at the front and back, with an uneven surface (see figure). The reason for the unevenness of the seminal vesicle glands is that they are made of extremely curved glandular ducts that are coiled. If it is straightened, each side of the seminal vesicle gland is a glandular duct about 15 cm long. The lower end of the seminal vesicle gland straightens into an excretory duct that joins the end of the vas deferens to form the ejaculatory duct, which passes through the prostate into the urethra. The size of the seminal vesicles varies from person to person and varies from left to right in the same person. In newborns, the seminal vesicles are small and rapidly increase in size to form a sac in adolescence. In older people, they gradually shrink as their sexual function decreases and their walls become thinner.
The seminal vesicle gland is located behind the prostate, outside the ejaculatory duct, between the lower posterior bladder and the rectum. When the doctor massages the prostate, a grape-sized sac can be touched on both sides of the prostate, which is the seminal vesicle.
In the past, it was thought that the sperm vesicle gland was the reservoir of mature sperm, but now it is clear that the storage site of sperm is mainly the tail of the epididymis, and 60% to 70% of the sperm discharged by normal men during ejaculation comes from the epididymis. The main role of the spermatophore gland is the seminal fluid it secretes. The seminal fluid consists of sperm and seminal plasma, and in seminal plasma, the seminal vesicle fluid accounts for about 60% and the prostate fluid accounts for about 30%. The optimal ratio of the two is important for the physiological function of sperm.
This shows that the prostate gland and the seminal vesicle gland are anatomically located next to each other and their physiological functions complement each other, and they are quite closely related.
The other one is often involved when one of them is inflamed, so some people jokingly call them “difficult brothers and sisters”. The clinical symptoms of chronic vesiculitis are similar to those of chronic prostatitis, but vesiculitis has its own special clinical manifestation – bloody semen. The imaging examination is preferred to transrectal ultrasound.
3. What is the relationship between prostatitis and urinary tract infection?
Prostatitis type I and II (bacterial prostatitis) are closely related to urinary tract infections, and they can be mutually beneficial.
The two can cause each other. Prostatitis type I (acute bacterial prostatitis) can cause acute urinary tract infections, and prostatitis type II (chronic bacterial prostatitis) can cause recurrent urinary tract infections. The acute urinary tract infection caused by prostatitis type I is aggressive, but because of the high concentration of many antibiotics in the urine, and because of the diffuse inflammation of the prostate tissue, the drugs are also easily diffused into the prostate tissue, so antibiotic therapy is usually effective.
The bacteria in the prostate in prostatitis type II are sometimes not easily killed in their entirety due to
(1) The entry of antibiotics into the prostate alveoli is blocked by the blood-prostate barrier. The blood-prostate barrier is a special anatomical structure that acts like a wall. The wall becomes soft and soft when the tissue is diffusely congested and edematous in acute prostatitis, and antibiotics can easily enter the prostate tissue, while the wall becomes hard when the prostate tissue is fibrotic and scarred in chronic prostatitis, and antibiotics cannot penetrate easily.
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The history of urinary tract infection is clinically important in identifying prostatitis type II and type III.
The clinical symptoms of prostatitis type II, type IIIa and type IIIb, which are previously classified as chronic bacterial prostatitis, chronic non-bacterial prostatitis, and prostate pain, are similar. Although prostatitis type II can have recurrent episodes of urinary tract infections, there are usually fewer episodes of urinary tract infections. The clinical difference in symptoms cannot generally be used to identify the different types of chronic prostatitis. ultrasound, CT, and MRI also do not help in the typing of prostatitis.
The distinction between different types of chronic prostatitis relies on leukocyte examination of prostate fluid, semen or urine after prostate massage and localized culture of bacteria in the lower urinary tract. In prostatitis type II, there is an increase in leukocytes in the prostate fluid, semen or urine after prostate massage, and localization of bacteria in the lower urinary tract suggests that the bacteria are located in the prostate. In prostatitis type IIIa, there is an increase in leukocytes in the prostate fluid, semen or urine after prostate massage, but no bacterial growth in the bacterial culture. In the case of prostatitis type IIIb, the white blood cells in the prostate fluid, semen or urine after prostate massage are normal, and there is no bacterial growth in the bacterial culture.
5. Is there an asymptomatic prostatitis?
Prostatitis can be without any symptoms, clinically known as asymptomatic inflammatory prostatitis, i.e. prostatitis type IV. The patient has no symptoms of prostatitis and is seen for other diseases and is occasionally found by performing prostate tissue biopsy, or urine examination after prostate fluid, semen, or prostate massage. It is mostly seen clinically in prostate tissue biopsies performed for suspected prostate cancer and in physical examinations of infertile patients. The real clinical significance of this needs further study, but it is generally believed that no treatment is needed unless it affects fertility.
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The meaning of infection and inflammation is different. Infection refers specifically to pathological processes caused by various pathogens. Infection can cause an inflammatory response, or there can be no obvious inflammatory response, such as carriers of various pathogens.
By clarifying the meaning of infection and inflammation, it is easy to understand that prostatitis is not necessarily an infection of the prostate, for example, urinary reflux can cause chemical prostatitis. Prostatitis can be caused by many factors, which we have already talked about in the etiology of prostatitis. Prostatitis caused by a definite pathogenic infection only accounts for 5-10% of prostatitis.
7. Is all prostatitis caused by bacteria?
The actual fact is that you can find a number of factors that can cause prostatitis, but bacterial infection is only part of the cause of prostatitis. 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.
(1) A localized bacterial culture of the lower urinary tract confirms that the bacteria is located in the prostate;
The patient has recurrent urinary tract infections and the bacterium is also the cause of the urinary tract infection. According to statistics, bacterial prostatitis caused by a definite bacterial infection only accounts for 5% to 10% of prostatitis, but with the improvement of diagnostic techniques in recent years, especially the application of molecular biology techniques, many bacteria were found that previously could not be detected with conventional culture techniques, so some experts believe that the actual incidence of bacterial prostatitis is much higher than previously recognized. However, in the present day, only a portion of prostatitis has been proven to be caused by bacteria.
8. What bacterial infections can cause prostatitis?
The actual fact is that you will find a lot of people who are very concerned about the bacteria that are infecting them, and they are often convinced that they are infected with this bacteria once they see the bacteria on the bacterial culture report sheet. In fact, not all bacteria will cause prostatitis, the bacteria that cause chronic prostatitis is mainly E. coli, accounting for 70-90%. Some bacteria will not cause prostatitis, is the normal flora that resides in the urethra, urethral opening, glans, foreskin, in the bacterial culture, will be mixed in the specimen, and later will appear on the bacterial culture report card, medically called contamination.
According to the available information on the pathogenic role of bacteria on prostatitis, some experts classify the bacteria causing prostatitis into 4 categories.
① Known pathogenic bacteria such as Enterobacteriaceae (E. coli), Klebsiella, Pseudomonas;
②Likely pathogenic bacteria, such as Enterococcus, Staphylococcus aureus;
③ Possible pathogenic bacteria, such as coagulase-negative Staphylococcus, Chlamydia, Mycoplasma, anaerobic bacteria, mycobacteria, Trichomonas, etc.;
④ known (subject to further evidence of actual) non-pathogenic bacteria, such as rod-shaped bacteria, lactobacilli.