The treatment of chronic prostatitis is a very difficult clinical task. The reasons for this are related to the following factors, in addition to the complex etiology of the disease, which is not yet fully understood.
1, anatomical factors
The prostate tissue can be divided into central and peripheral areas, the central area of the prostate duct and ejaculatory duct parallel into the urethra, the secretions are easily discharged. The prostatic ducts in the peripheral zone enter the urethra at right angles or obliquely, and secretions are not easily discharged smoothly; on the contrary, pathogenic microorganisms can easily enter the gland retrogradely.
② Focal inflammation within the prostate is not easy to diagnose and is often due to scarring around the lesion and lack of blood vessels, which is one of the reasons for the poor effectiveness of drug therapy.
The inflammatory lesions in the prostate are not necessarily connected to the urethra, so poor drainage makes it difficult for the inflammation to subside.
2, physiological pathological factors
The actual fact is that there is a lipid envelope on the surface of the prostate gland, and most antibiotics are difficult to get through this envelope to play a therapeutic role in the prostate.
The cause of prostate infection is not yet clear, so prevention and treatment are difficult.
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. It is obvious that the non-bacterial infection caused by prostatitis and sterile prostatitis with antibiotic treatment is certainly ineffective, which is an important reason why clinicians are accustomed to antibiotic treatment of chronic prostatitis is not effective.
The actual fact is that the actual actual fact is that the particular person is not a person.
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.
R. Lastly, alpha1-blockers.
Urodynamic studies have found that patients with prostatitis all have varying degrees of functional lower urinary tract obstruction,. This is mainly due to increased excitability of the sympathetic nervous system and increased excitability of the lower urinary tract alpha1-adrenergic receptors. The functional lower urinary tract obstruction causes increased pressure in the urethra, leading to the return of urethral contents (chemicals, pathogenic microorganisms, etc.) to the peripheral area of the prostate, resulting in various types of prostatitis.
The local inflammatory response of the prostate, as well as the systemic dysfunction of the vegetative nerves and psychological disorders, can increase the local alpha1- receptor excitability. It is currently believed that urinary reflux in the prostate is the primary factor in prostatitis, and that urethral hypertonicity followed by enhanced adrenergic stimulation is the underlying pathophysiological mechanism, while bacterial infection is a secondary event. Therefore, theoretically, alpha1-blockers can achieve their therapeutic purpose by blocking the cascade response in the development of prostatitis.
The alpha1-blockers not only act directly on the adrenergic innervated muscles to relieve the spasm of the internal urethral sphincter and relieve urethral hypertension, but also improve the laminar flow of urine, thus reducing urinary reflux in the prostate. In addition, it is believed that alpha1- receptor blockers play a role in improving the stability of the forced urinary muscles, which can significantly improve urinary symptoms such as frequency and urgency in patients with prostatitis.
The most effective L-activated (controlled, i.e., slow release) alpha1A receptor blocker is Cordova [doxazosin mesylate controlled release tablets].
S. Urinary reflux theory.
Urinary reflux in the prostate is one of the important causes of chronic prostatitis. Some scholars have injected a solution of black charcoal particles into the bladder of patients undergoing prostate removal before surgery, and the following day, when the prostate was surgically removed, it was found that the gland was covered with M charcoal particles, indicating that urine was returning to the prostate.
Chronic prostatitis is closely related to functional urethral obstruction. Studies through urodynamic examinations have confirmed that most patients with chronic prostatitis have varying degrees of functional urethral obstruction, which is caused by:
The local congestion of the prostate in patients with chronic prostatitis excites this receptor and triggers contraction of the smooth muscle of the prostate and bladder neck. The result is a high pressure in the urethra at the top of the bladder and the prostate, leading to reflux of urine in the prostate;
(2) The infection stimulates the nerves that innervate the sphincter, causing dysmotility of the sphincter. In order to counteract the resistance of the sphincter, the contraction of the bladder muscles causes high pressure in the urethra of the prostate, leading to reflux of urine in the prostate;
(3) Because the glandular ducts in the peripheral area of the prostate are thick and lateral to the direction of urinary flow, or even enter the urethra at right angles, urine tends to reflux into the glandular ducts in the surrounding area. The reflux of urine in the prostate causes a large number of chemicals in the urine, such as uric acid, to enter the prostate, resulting in thickening of the prostate peritoneum. The glandular ducts open day fibrosis, dilation of the glandular ducts, inflammatory exudate in the lumen and a large number of microscopic stones lead to chemical prostatitis, resulting in a series of symptoms such as lumbosacral, lower abdominal and perineal pain. These painful symptoms can cause muscle spasms in the pelvic floor, aggravating the reflux of urine within the prostate, forming a vicious cycle. The urine reflux within the prostate not only causes chemical prostatitis, but also can bring pathogenic Hugh into the prostate.
T. Autonomic dysfunction theory.
Patients with chronic prostatitis often have autonomic dysfunction, which manifests as mood disorders characterized by anxiety and depression, as well as a series of sexual dysfunctions such as decreased libido, premature ejaculation, impotence, etc. Autonomic dysfunction can lead to increased excitability of alpha-adrenergic receptors, which can lead to or exacerbate posterior urethral neuromuscular dysfunction. The dysfunction of the bladder neck and spasm of the pelvic muscle groups increase the urethral pressure in the prostate department during urination and cause the disease by backflow of urine into the prostate.
Prostatodynia is a manifestation of dysfunction of the forced urinary muscle an external urethral sphincter, or pelvic floor muscle tension pain. As part of the urethra near the seminal mound is surrounded by the sphincter of the semicone, which continues with the external urethral sphincter at the tip of the prostate, the stimulation of infection causes spasm of this sphincter, and the urethral closure pressure rises, thus producing pain in the perineum. The pain in turn aggravates the patient’s emotional response, creating a vicious cycle.
Theoretically, super-selective blockade of a-1A receptors can relax the smooth muscles of the prostate and bladder neck, thereby decreasing the resistance of the posterior urethra, increasing the urinary flow rate, reducing urinary reflux in the prostate during urination, and achieving the purpose of etiological treatment. Since the painful symptoms of patients with chronic prostatitis are related to the spasm of the smooth muscles of the prostate and bladder neck, the relaxation of these smooth muscles will relieve the painful symptoms.
The alpha-adrenergic receptor blockers used in the past, phenazopyridine and prazosin, have been replaced by a new generation of alpha IA receptor blockers because of their poor selectivity and adverse effects. These drugs include terazosin, doxazosin and tamsulosin because they have little effect on the receptors in other parts of the body rarely have adverse effects such as postural hypotension and have significant efficacy in chronic prostatitis.
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