(A) Traditional classification method
The first standardized method of classifying prostatitis was using the Meares-Stamey “four-cup method”, which compares initial urine (voided bladderone, VB1), intermediate urine (voided bladder two, VB2), prostatic secretion (expressed prostatic secretion, EPS), and post-prostate massage urine (voided bladder three, VB3). The results of the four cups of prostatic secretion (EPS) and post-prostate massage urine (voided bladder three, VB3) were used to classify prostatitis as follows
1, acute bacterial prostatitis (ABP).
2, chronic bacterial prostatitis (chronic bacterial Pprostatitis, CBP).
3, chronic non-bacterial prostatitis (chronic nonbacterial prostatitis, CNP).
4.Prostatodynia (PD).
The method is cumbersome, expensive and has limited clinical guidance.
(II) New classification methods
In 1995, the National Institutes of Health (NIH) developed a new classification based on the basic and clinical research on prostatodynia at that time.
Type I: Equivalent to ABP in the traditional classification. rapid onset, may present as a sudden febrile illness with persistent and obvious symptoms of lower urinary tract infection, elevated white blood cell count in the urine, and positive bacterial cultures in the blood or/and urine.
Type II: Equivalent to CBP in the traditional classification method and accounts for approximately 5-8% of chronic prostatitis. There are recurrent lower urinary tract infection symptoms lasting more than 3 months, elevated leukocyte count in EPS/semen/VB3, and positive bacterial culture results.
Type III: chronic prostatitis/chronic pelvic pain syndromes (CP/CPPS), equivalent to CNP and PD in the traditional classification method, is the most common type of prostatitis, accounting for about 90% or more 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/semen/VB3 bacterial culture results.
The type can be subdivided into two subtypes, IIIA (inflammatory CPPS) and IIIB (non-inflammatory CPPS), according to the results of routine microscopic examination of EPS/semen/VB3: the number of leukocytes in EPS/semen/VB3 is elevated in type IIIA patients; the leukocytes in EPS/semen/VB3 are in the normal range in type IIIB patients. The two subtypes IIIA and IIIB each account for about 50% of the cases.
Type IV: asymptomatory inflammatory prostatitis (AIP). The only evidence of inflammation is found on examination of the prostate (EPS, semen, prostate tissue biopsy and pathology of prostatectomy specimens).
The International Prostatitis Collaborative Network (IPCN), after 3 years of clinical application, concluded that the classification method is a great improvement over the traditional classification method and has certain guiding significance in clinical application, but there are still shortcomings that need further improvement. However, there are still shortcomings and further improvement is needed.
Pathogen localization test operation method
1.”Four-cup method”
First wash and disinfect the head of the penis and foreskin, and place a sterile test tube directly at the urethral opening to collect urine. Collect the initial 10 ml of urine stream discharged (VB1); continue to urinate 100~200 ml and collect 10 ml of middle urine with the sterile test tube (VB2); have the prostate massaged by the doctor and collect the prostate massage fluid from the urethra orifice (EPS); collect the first 10 ml of urine discharged after the massage (VB3). The four specimens collected were subjected to microscopic examination and bacterial culture.
2. “Two-cup method”
Expose the external urethral orifice, and if there is prepuce, the foreskin should be turned up. Disinfect the external urethral opening carefully. Ask the patient to urinate about 100-200ml and collect the middle urine (pre-massage urine) with a sterile test tube; the prostate massage will be performed by the doctor; then ask the patient to urinate again and collect the initial 10ml of urine (post-massage urine). The 2 specimens collected were subjected to microscopic examination and bacterial culture.