Prostatitis is a common disease in urology and accounts for the largest proportion of male urological patients under 50 years of age. in 1995 the NIH developed a new classification of prostatitis, Type I: equivalent to acute bacterial prostatitis in the traditional classification, Type II: equivalent to chronic bacterial prostatitis in the traditional classification, Type III: chronic prostatitis/chronic pelvic pain syndrome, and Type IV. Asymptomatic prostatitis. Among them, non-bacterial prostatitis is far more common than bacterial prostatitis.
The main causative factor for type I and type II prostatitis is pathogenic infection, where pathogens invade the prostate with the urine, leading to infection. The main cause of prostatitis is a pathogenic infection. The pathogenesis of type III is unknown, and the etiology is very complex and widely debated. Most scholars believe that the main etiology may be pathogenic infection, urinary dysfunction, psychosomatic factors, neuroendocrine factors, abnormal immune response, oxidative stress theory, and lower urinary tract epithelial dysfunction, etc. Type IV lacks relevant pathogenesis studies and may share some of the etiology and pathogenesis with type III. Recent studies have also found that uric acid salts of urine not only have an irritating effect on the prostate, but can also precipitate into stones that block the glandular ducts and serve as a shelter for bacteria. These findings can clarify that prostatitis syndrome is actually a common manifestation of multiple diseases and has a complex and variable clinical presentation that can produce a variety of complications or resolve on its own.
The clinical manifestations of type I often have a sudden onset, manifesting as general symptoms such as chills, fever, fatigue and weakness, accompanied by pain in the perineum and suprapubic area, and even acute urinary retention. Type II and III have similar clinical symptoms, mostly pain and abnormal urination. The most important thing is that you can have the same clinical symptoms as any other type of chronic prostatitis, collectively known as prostatitis syndrome, including pelvic-sacral pain, abnormal urination and sexual dysfunction. The pain is usually located in the suprapubic, lumbosacral and perineal areas. The radiating pain can be manifested as pain in the urethra, spermatic cord, testicles, groin and medial abdomen, radiating to the abdomen like an acute abdomen and radiating along the urinary tract like renal colic, which often leads to misdiagnosis. Abnormal urination manifests as frequent urination, urgent urination, painful urination, poor urination, bifurcation of the urine line, dripping after urination, increased frequency of nocturnal urination, and milky discharge from the urethra after urination or during stool. Occasionally, it is complicated by sexual dysfunction, including loss of libido, premature ejaculation, painful ejaculation, weakened erection and impotence. type IV has no clinical symptoms.
I. Examination
1, EPS routine examination EPS routine examination is usually performed by wet picture method and microscopic examination by hematocrit plate method, the latter having better accuracy. The amount of white blood cells in the normal prostate fluid sediment should be less than 10 in each field of view of a high magnification microscope. If the number of leukocytes in the prostate fluid is >10 per field of view, it is highly likely to be prostatitis, especially if fatty macrophages are found in the prostate fluid, which basically confirms the diagnosis of prostatitis. However, some patients with chronic bacterial prostate fluid have a number of leukocytes in the prostate fluid that may field; some other normal men have a number of leukocytes in their prostate fluid >10/field. Therefore, the examination of leukocytes in the prostate fluid is only an auxiliary method of bacteriological examination of the prostate fluid.
2, urine routine analysis and urine sediment examination urine routine analysis and urine sediment examination is an auxiliary method to rule out urinary tract infection and diagnose prostatitis.
3. Bacteriological examination is commonly done by the two-cup method or the four-cup method. These methods are especially suitable before antibiotic treatment. The specific method: Before collecting urine ask the patient to drink more water, the foreskin should be turned up if the foreskin is too long. The patient will have to urinate and collect 10ml of urine after cleaning the penis head and urethral orifice; continue to urinate about 200ml and then collect 10ml of middle urine; then stop urinating, do prostate massage and collect prostate fluid; finally collect 10ml of urine again. do microscopic examination and culture of each specimen separately, through the comparison of the number of bacterial colonies in the above specimens, it can identify whether there is prostatitis or urethritis.
4. Other laboratory tests for patients with prostatitis may show abnormalities in semen quality, such as increased leukocytes, non-liquefaction of semen, hematospermia and decreased sperm viability and other changes.
Second, clinical assessment
Determine the type of disease and choose the treatment method for the cause. Misunderstanding of the disease, unnecessary anxiety and excessive abstinence can aggravate the symptoms. Prostatitis may be a disease with mild or no symptoms, or a self-limiting disease that can resolve itself, or a disease with complex symptoms that lead to urinary tract infections, sexual dysfunction, infertility, etc. The treatment of patients should avoid both over-rendering the danger of the disease to the patient, and avoiding a simple, negative, blindly biased attitude towards antibiotic therapy for the treatment of the disease, and should use The actual fact is that you can find a lot of people who are not able to get a good deal on this.
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It is now mostly advocated for quinolones such as ofloxacin or levofloxacin. If ineffective continue with 8 weeks. Relapse and the strain remains the same, change to a prophylactic dose to reduce acute attacks and make the symptoms subside. Long-term application of antibiotics that induce serious side effects, such as pseudomembranous enteritis, diarrhea, and growth of intestinal drug-resistant strains of bacteria, requires a change in treatment regimen. The actual fact is that there is still a clinical debate as to whether or not non-bacterial prostatitis is suitable for treatment with antibacterial drugs. Patients with “aseptic” prostatitis can also be treated with drugs that are effective against bacteria and mycoplasma, such as quinolones, SMZ-TMP or TMP alone, in combination with or at intervals with tetracyclines and quinolones. If antibiotic therapy is ineffective and confirmed as aseptic prostatitis, antibiotic therapy is discontinued. In addition, treatment can be achieved by closing the urethra of the prostate with a double balloon catheter and injecting antibiotic solution from the urethral lumen back into the prostatic duct.
Type I is mainly broad-spectrum antibiotics, symptomatic treatment and supportive therapy. Type II is recommended to be treated with oral antibiotics, choosing sensitive drugs for 4-6 weeks, during which the patient should be evaluated in stages of efficacy. Type III can be treated with oral antibiotics for 2-4 weeks before evaluating the efficacy. Type IV does not require treatment.
2, anti-inflammatory, painkilling drugs NSAIDs can improve symptoms, generally using anti-inflammatory pain internal or suppositories, Chinese medicine using anti-inflammatory, clearing heat, detoxification, soft drugs also received a certain effect. Allopurinol can reduce the concentration of uric acid in the whole body and in the prostate fluid. Theoretically, it acts as a free radical scavenger and also scavenges reactive oxygen components, reducing inflammation and relieving pain. It’s not a bad choice for a complementary treatment.
3, physical therapy prostate massage can empty the prostate duct of concentrated secretions as well as drain the infection foci in the area of glandular obstruction, so for recalcitrant cases can do prostate massage every 3 to 7 days while using antibiotics. A variety of physical factors are used as prostate physiotherapy, such as microwave, radiofrequency, ultrashort wave, medium wave and hot water sitz baths, which are beneficial in relaxing the prostate, posterior urethral smooth muscle and pelvic floor muscles, enhancing antibacterial efficacy and relieving painful symptoms.
4. M-receptor antagonists can be used to treat prostatitis patients with overactive bladder manifestations such as urinary urgency, urinary frequency, increased nocturia but no urinary obstruction.
The alpha receptor antagonist is an important cause of prostate pain, prostate stones and bacterial prostatitis. It is advisable to use a longer course of alpha receptor antagonists to allow enough time to adjust smooth muscle function and consolidate the therapeutic effect.
The main use of heat therapy is the thermal effect produced by a variety of physical means to increase the blood circulation of the prostate tissue and accelerate metabolism, which is conducive to the effect and eliminate tissue edema and relieve pelvic floor muscle spasm, etc.
7, surgical treatment surgical treatment can be used for recurrent chronic bacterial prostatitis. Prostate removal can achieve a cure, but it should be used with caution. Since prostatitis usually involves the peripheral zone of the gland, prostate electrosurgery is difficult to achieve a cure TURP can remove stones from the prostate and foci of bacterial infection near the prostatic ducts, which is beneficial in reducing reinfection of the peripheral zone lesions. Chronic bacterial prostatitis can lead to recurrent urinary tract infections and infertility.
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