The demonized prostatitis

  Whenever a new friend knows my identity as a urologist, after a meaningful smile, he or she often has to say, you are treating prostatitis, right? The reason for this is that I think the “popularization” of the medical advertisements that have been honored on the telephone poles in recent years and have made their way into the newspapers and television is the most important.      The actual fact is that you can find a lot of people who have a lot of money to spend on the internet. I once saw a few “experts” in a TV nightly so-called health program and also a blonde American Army “Colonel”, discussing seriously about prostatitis leading to “impotence” and infertility.   The actual fact is that it is necessary to clear up a few misconceptions before further explaining the prostate. The first is that most prostatitis, especially chronic prostatitis, is not a sexually transmitted disease; second, despite the long treatment period, chronic prostatitis itself is not a serious disease, and there is no evidence that it can lead to cancer; third, although changes in the physicochemical properties of the prostatic fluid may have an effect on sperm activity, there is no direct evidence that prostatitis causes infertility; fourth, insomnia, weakness, decreased sexual function and other generalized discomfort is often associated with excessive anxiety.   The most important thing is that the patient’s body is not only a result of the disease, but also a result of the disease. The clinical guidelines in China, Europe and the United States all tend to use the classification developed by the National Institutes of Health (NIH) in 1995: Type I: equivalent to the traditional classification of ABP. Before treatment with broad-spectrum antibiotics, a mid-stage urine culture or blood culture should be performed. If the condition does not improve after 36 hours of standardized treatment, the patient should be advised to undergo transrectal ultrasound and other tests to fully evaluate the lower urinary tract lesion.  Type II: equivalent to the traditional classification of CBP, accounting for approximately 5% to 8% of chronic prostatitis. It presents with recurrent urinary symptoms for no less than 3 months, elevated white blood cell count in clinical specimens such as prostatic fluid (EPS)/ semen/ urine after prostate massage (VB3), and positive bacterial culture results. The treatment is based on oral antibiotics and the selection of sensitive drugs according to the drug sensitivity test. The course of treatment is 4-6 weeks, during which the patient should be evaluated in stages of efficacy. If the efficacy is unsatisfactory, other sensitive antibiotics can be used instead. Alpha-blockers can be used to improve urinary symptoms and pain. Botanical preparations, non-steroidal anti-inflammatory analgesics and M-blockers can also improve the associated symptoms.  Type III: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), equivalent to CNP and PD in the traditional classification, accounts for about 90% or more of chronic prostatitis. The main manifestation is pain or discomfort in the pelvic region lasting for more than 3 months, which may be accompanied by varying degrees of urinary symptoms and sexual dysfunction; their EPS/semen/VB3 bacterial culture results are negative. According to the results of routine microscopic examination of EPS/semen/VB3, the type can be subdivided into two subtypes, type IIIA (inflammatory CPPS) with elevated leukocyte count and type IIIB (non-inflammatory CPPS) with leukocytes in the normal range, each of which accounts for about 50%. For type IIIA, oral antibiotic treatment is recommended for 2-4 weeks, and then the decision to continue antibiotics is made based on the efficacy; alpha-blockers are recommended, or where appropriate, botanicals, NSAIDs and M-blockers can also be chosen to improve urinary symptoms and pain. And type IIIB: medications such as alpha-blockers, botanicals, NSAIDs and M-blockers are recommended.  Type IV: asymptomatic prostatitis (AIP). The patient has no subjective symptoms and only evidence of inflammation is found during examinations concerning the prostate (EPS, semen, prostate tissue biopsy and pathology of prostatectomy specimens, etc.), and generally no treatment is required. This is a very good way to get the most out of your life.  In the clinic, the main problem for patients is chronic prostatitis, which is the aforementioned type II and type III. Urine and prostate fluid examination is an important diagnostic basis for this, and at the doctor’s discretion, semen or urine after prostate massage may also be used to assist in the diagnosis. Adequate courses of standardized medication are the first and primary treatment for chronic prostate. It is important to mention that many patients are quite reluctant to have prostate massage due to the fact that there is indeed some painful discomfort. However, it is important to know that regular prostate massage is also an important adjunctive treatment recommended by the guidelines as a necessary means of obtaining prostate fluid. In addition, biofeedback therapy is basically non-invasive and can be considered for selective use in some patients. Although there are some reports on the application of heat therapy by physical means such as microwave, radiofrequency and laser via the urethra, rectum and perineum, there is a lack of long-term follow-up data and its use is not recommended for unmarried and infertile patients. In contrast, there is a lack of valid evidence regarding the efficacy and safety of treatments such as prostate injection therapy/transurethral prostatic insufflation. Procedures such as transurethral cystotomy and transurethral resection of the prostate should only be considered with caution if there is an indication for surgery for a combination of prostate related conditions.   Other suggestions include: drink more water, control smoking and alcohol, eat less stimulating food, eat more vegetables and fruits; have regular rest and rest, do not stay up late, exercise more, do not be sedentary; no special abstinence, proper and regular sexual life is beneficial to the relief of symptoms.  The actual fact is that you will be able to get a lot more than just a few of the most popular and most popular items. The actual fact is that, just like any disease, there is a possibility of recurrence, if you are not worried about how many times you may encounter a cold in your life, I think you should be relieved about the above problem. 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.