Chronic prostatitis (CP) is a group of diseases characterized by pain or discomfort in the pelvic region and abnormal urination when the prostate is affected by pathogens or some non-infectious factors.
The pathogenesis and pathophysiological changes of CP, especially non-bacterial prostatitis (NBP), are not well understood. It is a disease that belongs to the category of “seminal turbidity”, “gonorrhea” and “white turbidity” in Chinese medicine. Long-term clinical practice shows that the combination of Chinese and Western medicine has obvious advantages in the treatment of this disease.
Western medicine diagnosis
1, the new classification of prostatitis type I: that is, acute prostatitis (ABP), the onset of acute, with continuous and obvious symptoms of lower urinary tract infection, elevated number of white blood cells in the urine, positive bacterial culture in the blood and/or urine. Type II: that is, chronic bacterial prostatitis (CBP) with recurrent lower urinary tract infection symptoms, elevated leukocyte count in prostatic fluid (EPS) or semen or post-massage urine (VB3), and positive bacterial culture results. Type III: This is chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), equivalent to chronic non-bacterial prostatitis (CNP) and prostatodynia (PD) in the traditional classification method, mainly presenting with long-term, recurrent pain or discomfort in the pelvic region lasting for more than 3 months, with negative bacterial culture of EPS or semen or VB3; according to routine EPS or semen or VB3 On microscopic examination, the type is subdivided into two subtypes, type IIIA (inflammatory CPPS) and type IIIB (non-inflammatory CPPS), that is, patients with type IIIA have elevated numbers of leukocytes in EPS or semen or VB3, and patients with type IIIB have leukocytes in EPS or semen or VB3 in the normal range. Type IV: asymptomatic prostatitis, no subjective symptoms, only evidence of inflammation found during examinations concerning the prostate.
2, clinical symptoms patients show varying degrees of urinary frequency, urinary urgency, painful urination, incomplete urination, urethral burning, a small amount of white discharge from the urethra in the morning, at the end of urination or during defecation; perineum, external genital area, lower abdomen, suprapubic area, lumbosacral and perianal swelling pain discomfort. There may also be waiting for urination, weakness of urination, thinning or interruption of the urine line and prolonged urination time. The NIH2CPSI is recommended for symptom assessment in the diagnosis of chronic prostatitis and consists of three parts with nine questions (0-43 points). The first part assesses the site, frequency and severity of pain, and consists of questions 1-4 (0-21 points); the second part assesses the severity of dysuria and frequency of urination, and consists of questions 5-6 (0-10 points); the third part assesses the impact on quality of life, and consists of questions 7-9 (0-12 points).
3.Physical examination
(1) Local physical examination: check the patient’s lower abdomen, lumbosacral region, perineum, penis, urethral orifice, testes, epididymis, spermatic cord, etc. for abnormalities, which can help in differential diagnosis.
(2) Prostate finger diagnosis: texture: full gland, or hard and soft, or nodules, or hard texture; pressure pain: may have limited pressure pain; size: may be mildly enlarged or normal.
4.Laboratory examination
4.1 Routine urinalysis and urine sediment examination is an auxiliary method to rule out urinary tract infection and diagnose prostatitis.
The number of WBCs in EPS is controversial, but it is generally believed that the number of WBCs in EPS increases in patients with type II and type IIIA prostatitis, but not in type IIIB. The WBC count does not necessarily correlate with the severity of symptoms. The WBC count does not necessarily correlate with the severity of symptoms, and the cytoplasm of the macrophages in EPS contains components such as phagocytosed lecithin vesicles or cellular debris that are unique to prostatitis.
The WBC count correlates with the severity of symptoms. The sample collection methods are:
(1) Four-cup method: VB1 and VB2 for primary and intermediate urine, which have localization significance for urethral and bladder infections, and VB3 and EPS to locate the prostate. However, it is generally less used because of its complexity, time consuming and high cost.
(2) The two-cup method is recommended: only the middle urine before prostate massage (VB2) and the urine after massage (VB3) are taken, which can obtain similar results as the four-cup method.
The ultrasound examination can show uneven echogenicity of the prostate, calcification, stones, dilation of the ducts, changes in the seminal vesicles, and changes in pelvic vein congestion, but it is not recommended to use the ultrasound findings alone as a basis for diagnosis. The above-mentioned auxiliary examinations are mainly used to exclude other diseases that may exist in the genitourinary system and pelvic organs.
The differential diagnosis of type III prostatitis needs to be differentiated from benign prostatic hyperplasia, testicular epididymal and spermatic cord disease, overactive bladder, neurogenic bladder, interstitial cystitis, adenocystitis, 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.
Chinese medicine identification
1. The basic pathogenesis of chronic prostatitis is that damp-heat infiltration occurs in the early stage of the disease, damp-heat stagnation in the middle stage, and spleen and kidney deficiency in the late stage.
The main reason for this is that it is not a good idea to have a good idea of what to expect. The main reason for this is that it is a very good idea to have a good understanding of the symptoms of chronic prostatitis.
2.1 Basic symptoms
2.1.1 Damp-heat infusion primary symptoms: burning and astringent pain in the urine, urinary frequency and urgency. Secondary symptoms: yellow urine, short and red urine, dripping after urination, white and cloudy urine, dampness of the scrotum, irritability and dryness of the mouth, foul breath and abdominal swelling. Tongue and pulse: yellow and greasy tongue coating, slippery pulse or stringiness.
2.1.2 Primary symptoms: pain in the perineum, or external genital area, or lower abdomen, or suprapubic area, or lumbosacral and perianal areas, and swelling in the above areas. Secondary symptoms: dripping after urination, stinging pain in urination, dripping urine. Tongue and pulse: dull tongue or petechiae or ecchymosis, stringent or astringent pulse.
2.1.3 The main symptoms of liver qi stagnation: perineum, or external genital area, or lower abdomen, or suprapubic area, or lumbosacral and perianal swelling and discomfort, the above parts seem to be painful but not painful, and depression. Secondary symptoms: dysuria, chest tightness, anxiety, suspicion and fear of disease. Tongue and pulse: light red tongue, string pulse.
2.1.4 Deficiency of kidney yang main symptom: fear of cold, softness or pain in the waist and knees. Secondary symptoms: dripping after urination, mental depression, impotence or low libido. Tongue and pulse: pale tongue with thin white coating and sunken or weak pulse.
2.2 Combination of evidence
2.2.1 Dampness and heat stagnation main symptoms: frequent urination, urgent urination, painful urination, difficulty in urination, perineum or anal swelling or pain, milky discharge from the urethra. Secondary symptoms: incomplete urination, residual urine drainage, yellow urine, burning sensation in the urethra; bitter and dry mouth, damp scrotum. Tongue and pulse: red tongue, yellowish greasy coating, string or slippery pulse.
2.2.2 Yin deficiency of the liver and kidneys. Main symptom: softness or pain in the waist and knees, irritable heat in the five hearts, insomnia and dreaminess. Secondary symptoms: white and cloudy urine like rice slop or short red, seminal emission, premature ejaculation, hypersexuality or Yang strength. Tongue and pulse: red tongue with little coating, sunken and thin pulse or thin strings.
2.3 Other types of evidence: cold clotting in the liver, liver depression and fire, liver depression and spleen deficiency, spleen and kidney yang deficiency, deficiency of middle energy, etc. The symptoms can be identified according to the TCM identification factor points method.
Treatment
Treatment principle:The comprehensive treatment of chronic prostatitis with TCM and Chinese and Western medicine is mainly aimed at improving symptoms. In addition to the individualized treatment, the patient’s quality of life and correction of poor lifestyle should be taken into account.
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The three most commonly used drugs are antibiotics, α2-blockers and non-steroidal anti-inflammatory analgesics, and other drugs have different degrees of efficacy in relieving symptoms.
2.1 Antibiotics Currently, the most common first-line drug used in the clinical practice of treating prostatitis is antibiotics, but only about 5% of patients with chronic prostatitis are found to have a definite bacterial infection. If the results are not satisfactory, other sensitive antibiotics can be used. The treatment of intraprostatic injection of antibiotics is not recommended.
Type IIIA: Antibiotic treatment of this disease is mostly empirical, based on the theory that certain pathogens that are currently undetectable in routine cultures are responsible for this type of inflammation. Therefore, oral fluoroquinolone antibiotics are recommended for 2-4 weeks, and then the decision to continue antibiotic therapy is based on efficacy feedback, and continued antibiotics are recommended only if the patient’s clinical symptoms do decrease, with a recommended total course of 4-6 weeks. Some patients may have pathogenic infections such as Chlamydia trachomatis, Mycoplasma solium or Mycoplasma humanum, and may be treated with oral antibiotics such as macrolides.
Type IIIB: Antibiotic treatment is not recommended.
2.2 Alpha 2 blockers can relax the smooth muscles of the prostate and bladder and improve the symptoms and pain in the lower urinary tract, thus becoming the basic drug for the treatment of type II or type III prostatitis. The choice of alpha 2 blockers can vary according to the individual patient. The first of these is the use of the alpha2 blocker to treat type IIIA prostatitis in combination with an antibiotic, which should be used for more than 6 weeks.
2.3 Non-steroidal anti-inflammatory analgesics are empirical medications used to treat symptoms associated with type III prostatitis, and their main purpose is to relieve pain and discomfort.
3. Other drugs can also be used according to clinical conditions such as botanicals, M2 blockers, antidepressants and anxiolytics.
4.TCM diagnosis and treatment
4.1 Damp-heat injection treatment: clear heat and dampness. Combination of Chinese and Western medicine: Type III can be treated with Chinese medicine alone, and Western medicine can be added if necessary. Under the premise of diagnosis and treatment, western medicine can be selected according to specific conditions to improve the efficacy, for example, when VB3 bacterial culture is positive, oral fluoroquinolone antibiotics are recommended for at least 4-6 weeks; type IIIA oral fluoroquinolone antibiotics for 2-4 weeks, when the patient’s clinical symptoms have been reduced, then continued antibiotic treatment is recommended, the total course of treatment is 4-6 weeks; type IIIB western medicine treatment can also be used according to the need for α2 receptor blockers as needed.
4.2 Qi stagnation and blood stasis treatment: move Qi and blood… The main symptom of Qi stagnation and blood stasis is pain. Type III is treated with traditional Chinese medicine alone, and western medicine can be added if necessary. Alpha 2 blockers and non-steroidal anti-inflammatory analgesics can be used. Antibiotics can be used if necessary.
4.3 Treatment of liver qi stagnation: de-stress the liver and relieve depression. Combination of Chinese and Western medicine: This type can be treated with Chinese medicine alone, and when the mental symptoms are serious, such as anxiety and depression, antidepressants and anxiolytics can be used according to clinical needs. The appropriate use of α2-blockers and non-steroidal analgesics can help improve the efficacy.
4.4 Treatment for deficiency of kidney yang: tonify the kidney and strengthen yang. Combination of traditional Chinese and Western medicine treatment: to support the positive and dispel the evil.
4.5 Treatment of dampness and heat stagnation: clear heat and dampness, resolve stasis and relieve pain. Combination of Chinese and Western medicine: Type II can be treated with Chinese and Western medicine, Type III with Chinese medicine alone, and if necessary, with Western medicine. Under the premise of diagnosis and treatment, fluoroquinolone antibiotics can be used orally if there is clear infection. Alpha 2 blockers and non-steroidal anti-inflammatory analgesics can also be used according to clinical needs.
4.6 Liver and kidney Yin deficiency treatment: nourish Yin and clear heat.
5.External treatment
(1) Chinese herbal medicine enema: 50-100mL of Chinese herbal medicine decoction at 37-38℃ is recommended to be kept after defecation before bedtime.
(2) Chinese herbal ion introduction, Chinese herbal sitz bath, Chinese herbal fumigation, Chinese herbal compress can also achieve therapeutic effect.
6, acupuncture treatment acupuncture has a better effect on the symptoms of chronic prostatitis pain. Recommended acupuncture points: Zhongji, Guangyuan, Qihai, or take the second, upper, middle, lower, Huiyin, Huiyang and other points alternate treatment
7.Physical therapy
7.1 Heat therapy mainly uses the heat generated by various physical methods to promote blood circulation in the prostate tissue, which helps to eliminate tissue edema and relieve pelvic floor muscle spasm, and has a certain effect on relieving symptoms. The use of microwave, radiofrequency, laser and other physical means via the urethra and perineum route is not supported by evidence-based medical evidence. It is not recommended for unmarried and infertile people.
7.2 Prostate Massage Prostate massage can promote prostate blood circulation, gland emptying, promote drainage, and thus relieve the symptoms of patients with chronic prostatitis, so it is recommended as an adjuvant therapy for type II and III prostatitis, and combined with other treatments can effectively shorten the course of the disease.
Health Education
The actual fact is that it is not related to acute prostatitis.
The actual fact is that you can find a lot of people who are not able to get a good deal on this. 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.
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. 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.
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