I. Concept and Incidence
Prostatitis is a common disease in adult men, with a high number of outpatients. Some data show that about 50% of men will be affected by prostatitis at some point in their lives, and prostatitis has a great impact on the spirit and quality of life of young and middle-aged men. 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.
Chronic prostatitis is a group of diseases characterized by pain or discomfort in the pelvic region, abnormal urination and other symptoms in the prostate under the action of pathogens or (and) certain non-infectious factors.
The pathogenesis and pathophysiological changes of chronic prostatitis are not well understood. At present, it is believed that chronic prostatitis is a clinical synthesis consisting of a group of diseases with their own unique etiology, clinical features and outcome.
II. Typing
In 1995 the National Institutes of Health developed a new classification based on the basic and clinical research on prostatitis at that time.
Type I: Equivalent to acute bacterial prostatitis in the traditional classification method. It has an acute onset and may present as a sudden febrile illness with persistent and marked symptoms of lower urinary tract infection, elevated white blood cell count in the urine, and positive bacterial culture in the blood or (and) urine.
Type II: Equivalent to chronic bacterial prostatitis in the traditional classification method, accounting for about 5% to 8% of chronic prostatitis. There are recurrent symptoms of lower urinary tract infection lasting more than 3 months, elevated white blood cell count in EPS/semen/VB3, and positive bacterial culture results.
Type III: Chronic prostatitis/chronic pelvic pain syndrome, equivalent to chronic non-bacterial prostatitis and prostatodynia in the traditional classification method, is the most common type of prostatitis, accounting for about 90% or more of chronic prostatitis. The main manifestation is long-term, recurrent pain or discomfort in the pelvic region lasting more than 3 months, which can be accompanied by varying degrees of urinary symptoms and sexual dysfunction, seriously affecting the patient’s quality of life; negative EPS/semen/VB3 bacterial culture results.
Based on the results of routine EPS/semen/VB3 microscopy, the type can be subdivided into 2 subtypes IIIA (inflammatory CPPS) and IIIB (non-inflammatory CPPS): type IIIA patients have elevated white blood cell counts in EPS/semen/VB3; type IIIB patients have white blood cells in the normal range in EPS/semen/VB3. Subtypes IIIA and IIIB each account for about 50% of the cases.
Type IV: Asymptomatic prostatitis. There are no subjective symptoms and only evidence of inflammation is found during examinations concerning the prostate (EPS, semen, prostate tissue biopsy and pathological examination of prostatectomy specimens, etc.).
Clinical manifestations
When diagnosing prostatitis, a detailed history should be taken to understand the causes or triggers of the disease; to inquire about the nature, characteristics, location, degree of pain and abnormal urination and other symptoms; to understand the treatment and recurrence; to evaluate the impact of the disease on quality of life; to understand past history, personal history and sexual life.
Type I: often with sudden onset, manifested by general symptoms such as chills, fever, fatigue and weakness, accompanied by pain in the perineum and suprapubic area, urinary tract irritation and difficulty in urination, and even acute urinary retention.
Types II and III: The clinical symptoms are similar, mostly with pain and abnormal urination. Type II may manifest as recurrent lower urinary tract infections. Type III mainly manifests as pain in the pelvic region, which can be seen in the perineum, penis, perianal area, urethra, pubic bone or lumbosacral area. Abnormal urination may manifest as urinary urgency, frequency, painful urination and increased nocturia. As chronic pain remains untreated for a long time, the patient’s quality of life decreases and may have sexual dysfunction, anxiety, depression, insomnia and memory loss.
Type IV: no clinical symptoms.
Fourth, the principle of treatment
Prostatitis should be treated in a comprehensive manner.
Type Ⅰ: mainly broad-spectrum antibiotics, symptomatic treatment and supportive treatment. Those with urinary retention can use fine tube catheterization or suprapubic cystocentesis to drain urine, and those with prostate abscess can take surgical drainage.
Type II: Treatment is based on oral antibiotics, choosing sensitive drugs, and 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, NSAIDs and M-blockers can also improve the associated symptoms.
Type IIIA: Oral antibiotics can be given for 2 to 4 weeks, and then the decision to continue antibiotic therapy is based on their efficacy feedback. Alpha-blockers are recommended to improve urinary symptoms and pain, and NSAIDs, botanicals and M-blockers are also available.
Type IIIB: Treatment with alpha-blockers, NSAIDs, botanicals and M-blockers are available.
Type IV: No treatment is generally required.
The clinical progressiveness of chronic prostatitis is not clear enough to threaten the life and vital organ function of patients, and not all patients require treatment. The goal of treatment for chronic prostatitis is mainly to relieve pain, improve urinary symptoms and improve quality of life, and efficacy evaluation should be based on symptom improvement.