Prostatitis is a group of clinical syndromes that are characterized by a burning sensation in the urethra, frequent urination, painful urination, incomplete urination, and dribbling of urine. Sometimes the urine stream becomes thin and weak, and there is pain or discomfort in the perineum, suprapubic, inguinal, and lumbosacral areas.
I. Epidemiology and etiology
Prostatitis is common in young and middle-aged people and rarely involves prepubescent children. The number of outpatient visits for prostatitis is much higher than the latter two, and the incidence and prevalence is 5% to 8%.
The current belief is that prostatitis is not a single disease, but a general term for several different types of diseases, and their etiology and clinical manifestations vary.
The classification of prostate syndrome that is generally applied at present divides prostatitis into.
Type I: Acute bacterial prostatitis;
Type II: Chronic bacterial prostatitis;
Type III: chronic non-bacterial prostatitis/chronic pelvic pain syndrome, which can be further divided into Type IIIA (inflammatory chronic pelvic pain syndrome) and Type IIIB (non-inflammatory chronic pelvic pain syndrome);
Type IV: asymptomatic inflammatory prostatitis.
1. Acute bacterial prostatitis
Most are caused by urethral upstream bacteria, the causative organisms are mostly gram-negative bacilli or pseudomonas, but also staphylococci, gonococci, chlamydia, mycoplasma, etc.
2, chronic bacterial prostatitis
Most of them do not have an acute process, but are also mainly caused by retrograde infection of bacteria through the urethra, the main pathogenic bacteria are Escherichia coli, Proteus, Staphylococcus, Streptococcus, etc.
3. chronic non-bacterial prostatitis/chronic pelvic pain syndrome
The majority of prostatitis belongs to this type. The cause is unclear and the causative organism may be an unidentifiable pathogenic microorganism. Recent studies have found that Chlamydia and Mycoplasma may be the main causative organisms. It has also been speculated that the development of chronic adenoprostatitis may be related to urinary reflux as well as other non-infectious factors. This disease may be related to long distance cycling, long term seat work, irregular sex life, excessive alcohol consumption and spicy food can aggravate the symptoms.
4, asymptomatic inflammatory prostatitis
The patient has no conscious symptoms and is found incidentally during a prostate puncture biopsy, the etiology and clinical importance of which is not yet known.
II. Pathology
The majority of these are purulent bacterial infections, and the pathological changes are mainly interstitial inflammatory congestion and edema of the prostate, enlargement of the glandular vesicles, infiltration of polymorphonuclear leukocytes visible around them, and necrosis of the glandular duct contents.
The pathological changes of chronic prostatitis mainly appear in the peripheral area, histologically manifested as lymphocytes and monocytes-based non-specific inflammation with varying degrees of fibrous tissue hyperplasia, some of the glands and ducts can be seen as cystic expansion, the cystic cavity has most amyloid vesicles and secretions, and sometimes calcified amyloid vesicles can be seen, prolonged inflammation resulting in the destruction of the glandular structure, fibrosis, once the fibrosis spreads to the posterior urethra Once the fibrosis spreads to the posterior urethra and the bladder neck opening, it can lead to fibrosis and contracture of the bladder neck opening.
The clinical manifestations of various types of prostatitis are different.
1. Acute bacterial 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. Rectal examination can reveal a swollen prostate with obvious tenderness and a tough irregular gland. It is important to note that prostate massage is not done in the acute stage in principle to avoid bacteremia or sepsis.
2, chronic 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. There can be body discomfort, back pain and fatigue. Many patients have white discharge from the urethra after urination or defecation, and there may be hematospermia when combined with vesiculitis. Many patients also have decreased libido and erectile dysfunction. There are many similarities between chronic bacterial prostatitis and chronic non-bacterial prostatitis in terms of clinical manifestations, and both have increased white blood cells in the prostate massage fluid, but non-bacterial prostatitis patients have negative bacterial culture results in the prostate fluid. The prostate massage fluid leukocytes are normal in patients with prostate pain.