Chronic Prostatitis (CP) is a disease characterized by pain or discomfort in the pelvic region and abnormal urination in the prostate gland due to the action of pathogens or some non-infectious factors. For this disease, there are still problems such as complex causative factors, diverse clinical symptoms, controversial diagnostic methods and efficacy criteria, and inconsistent length of treatment. The common types of prostatitis are type II, type IIIA and type IIIB. Type IV is rarely seen due to the lack of obvious symptoms, but reports show a high incidence in male infertility patients. Clinical symptoms of prostatitis Patients often show varying degrees of lower urinary tract symptoms (LUTS), such as frequent urination, urgent urination, painful urination, incomplete urination, burning in the urethra; a small amount of white discharge from the urethra in the morning, at the end of urination or during defecation; pain and discomfort in the perineum, external genital area, lower abdomen, pubic area, lumbosacral and perianal areas; waiting for urination, weakness in urination, thinning of the urinary line, bifurcation or interruption of urination and The duration of urination may be prolonged. Some patients may also experience dizziness, fatigue, memory loss, abnormal sexual function, ejaculatory discomfort or pain, and mental depression and anxiety. Physical examination 1. Local examination: check the lower abdomen, lumbosacral region, perineum, penis, scrotum, urethral orifice, testicles, epididymis, spermatic cord, etc. for abnormalities, which can help in differential diagnosis. 2, prostate finger examination: including size, boundary, texture, central groove, local temperature of the prostate, pressure pain, pressure pain and trigger points of the pelvic floor muscles and lesions of the anorectum itself. It is recommended that urine be retained for urinalysis prior to performing prostate finger examination. Laboratory tests 1, routine urine analysis and urine sedimentation test: Retaining urine for urinalysis before prostate massage is an auxiliary method to rule out urinary tract infections and diagnose prostatitis, which can detect or rule out some related diseases such as bacterial infections and malignant tumors of the genitourinary system. 2. prostate massage fluid examination: it is generally believed that the number of WBCs increases in EPS in patients with type II and IIIA prostatitis, but not in type IIIB WBCs. the correlation between WBC count and severity of symptoms is unclear. the cytoplasm of macrophages in EPS contains components such as engulfed lecithin vesicles or cellular debris, which are unique to prostatitis. The main tests are ultrasound, uroflow rate, urodynamics, cystourethroscopy, serum PSA, CT and MRI, prostate aspiration, etc. Ultrasound examination can reveal uneven echogenicity of the prostate, calcification, stones, dilated ducts, changes in the seminal vesicles, and changes in pelvic venous congestion, but the use of ultrasound findings alone is not recommended as a basis for diagnosis. All of the above-mentioned ancillary tests are mainly used to exclude other diseases that may exist in the genitourinary system as well as in the pelvic organs. Differential diagnosis The disease needs to be differentiated from benign prostatic hyperplasia, testicular epididymal and spermatic cord disease, overactive bladder, neurogenic bladder, interstitial cystitis, adenocystitis, genitourinary tuberculosis, genitourinary stones, sexually transmitted diseases, bladder tumors, prostate cancer, anorectal disease, lumbar spine disease, central and peripheral neuropathy, and other diseases that may cause pain and abnormal urination in the pelvic region Differentiation was performed. CP/CPPS Clinical Phenotypic Classification System The establishment of the NIH classification of prostatitis and the NIH-CPSI symptom scoring system, with symptom improvement as the goal of prostatitis treatment, has been largely agreed upon. the UPOINT six-category phenotypic classification system can provide a good assessment of CP/CPPS and advocates a comprehensive intervention for several factors of CP, which can effectively relieve symptoms and achieve clinical cure. Table 1 shows the UPOINT phenotypic classification and clinical manifestations, and Table 2 shows the steps and items of CP/CPPS assessment. CP/CPPS is associated with a lack of disease awareness and poor diet and lifestyle behaviors. Receiving health education, psychological and behavioral counseling has a positive effect. Patients should be advised to avoid alcohol and spicy stimulating foods; avoid holding urine, being sedentary, keeping warm, and strengthening physical exercise. Avoid impure sexual behavior and frequent sexual excitement. Maintain moderate and regular sexual activity, but should not hold back sperm without ejaculation. Hot water baths or local hot compresses can help relieve painful symptoms, but those who have not had children should pay attention to the adverse effects of long-term hot water baths on the spermatogenic function of the testicles. 2, prostate massage: prostate massage can promote prostate blood circulation, gland emptying, promote drainage, and increase the local drug concentration, and thus relieve the symptoms of CP patients, so it is recommended as an adjuvant therapy for type II and III prostatitis, combined with other treatments can effectively shorten the course of the disease. For those who can’t tolerate prostate massage, regular seminal discharge can be as effective as prostate massage. The most common three drugs are alpha-blockers, antibiotics, non-steroidal anti-inflammatory drugs, other drugs (M-blockers, botanicals, antidepressants), anti-anxiety drugs, and drugs to improve local microbiology. , anxiolytics, and drugs to improve local microcirculation) are also effective to varying degrees in relieving symptoms. Targeted treatment for each phenotype of the UPOINT system significantly improved the symptoms and quality of life of patients, a finding confirmed by a recent prospective study in China. 1. α-blockers: α-blockers can reduce tension in the bladder, posterior urethra, and prostate by antagonizing α-receptors in the bladder neck and prostate, or by acting directly on α1A/1D receptors in the central nervous system, relaxing the bladder neck and posterior urethra and improving voiding function. Commonly used alpha-blockers include terazosin, alfuzosin, doxazosin, and tamsulosin. A foreign systematic review and network meta-analysis showed that alpha-blockers significantly improved pain, voiding, quality of life, and overall symptom scores in patients, but controversy remains and there is not enough evidence-based medical evidence to justify it. Symptom improvement may be more pronounced in patients with a shorter history who are given a longer course of alpha-blocker therapy. Based on current evidence, alpha-blockers cannot yet be recommended as the drug of choice for the treatment of CP/CPPS. Alpha-blockers are recommended for the treatment of patients with CP/CPPS with a disease duration <1 year and may be used in combination with other drugs for a course of treatment that should not be less than 6 weeks. Be aware of adverse effects such as vertigo and postural hypotension caused by this drug. 2, antibiotics: type II prostatitis should be based on the results of bacterial culture to select a sensitive antibiotic with a high concentration of drugs in the prostate gland, commonly used fluoroquinolones, treatment should be maintained for at least 4-6 weeks, during which the patient should be evaluated for stage efficacy, and those who are not satisfied with the efficacy can be switched to other sensitive antibiotics. Type IIIA can be empirically treated with antibiotics for 2-4 weeks. Empirical antimicrobial therapy for CP/CPPS can improve symptoms in some patients and is therefore widely used, but bacterial culture, leukocyte and antibody status of prostate-related specimens do not predict the response of CP/CPPS patients to antimicrobial therapy, and the results of bacterial culture of prostate biopsy specimens from CP/CPPS patients compared with asymptomatic ones The differences were not statistically significant. Treatment with a single antimicrobial agent (quinolone or tetracycline) for at least 4-6 weeks is recommended for patients with CP/CPPS with a disease duration <1 year and a simple treatment history. If more than 6 weeks is ineffective, other treatment options should be chosen. For the clear presence of specific infections such as Chlamydia trachomatis, Ureaplasma lysis or Mycoplasma humanum, oral antibiotics such as macrolides and tetracyclines can be used for treatment. NSAIDs are empirical drugs used to treat symptoms associated with CP/CPPS, with the main purpose of relieving pain and discomfort. Celecoxib has some efficacy, but further confirmation in bulk studies is needed. The use of this class of drugs must consider the adverse effects associated with their long-term use. 4. Other drugs: botanicals (Pulsatilla, quercetin, saw palmetto extract), M-blockers, antidepressants and anxiolytics can also be used according to clinical conditions. When treating CP clinically, patients' psychiatric symptoms should be carefully evaluated and noted. Targeted psychotherapy for patients can effectively reduce patients' mental stress and eliminate the vicious circle caused by physical and mental disorders, so that their symptoms can be significantly improved, which also plays an important role in the prevention of CP. CP patients should also adjust their mood, keep the perineum clean and hygienic, eliminate impure sex, have moderate sex life, sedentary people should move regularly, drink alcohol in moderation, urinate at the right time to reduce the pressure of the bladder urethra, etc. Also take other preventive measures, such as drinking more water, exercising regularly, understanding some physiological knowledge and eating less spicy and stimulating food will help to reduce the symptoms of CP and prevent recurrence.