Prostatitis is one of the common diseases among adult men. Although it is not a direct life-threatening disease, it seriously affects the quality of life of patients. At the same time, its large patient population and high medical costs impose a huge economic burden on public health. As the pathogenesis and pathophysiological changes of prostatitis are not well understood, many physicians find it tricky in the clinical diagnosis and treatment of prostatitis. The actual fact is that there is no clear standard for the understanding of prostatitis, the judgment of the severity of the condition, the choice of treatment methods and the evaluation of the efficacy. This is why it is necessary to regulate the clinical behavior of prostatitis. The Urology Section of the Chinese Medical Association hired relevant experts, based on domestic and international evidence-based medical data, reference to Wu Jieping Urology and relevant foreign guidelines, combined with the actual clinical situation in China, repeated discussions, and completed China’s “Prostatitis Clinical Diagnosis and Treatment Guidelines (Trial Version)”, in order to provide useful guidance for clinicians in China to choose a reasonable diagnosis and treatment of prostatitis.
Chapter 1 Overview
I. Concept and classification
Prostatitis is a group of diseases characterized by pain or discomfort in the pelvic region and abnormal urination in the prostate gland under the action of pathogens or/and certain non-infectious factors. Acute prostatitis is an acute infectious disease localized in the prostate gland with obvious symptoms of lower urinary tract infection and systemic symptoms such as chills, fever, myalgia, elevated white blood cell count and even pus cells in the urine and prostate fluid. The pathogenesis and pathophysiological changes of chronic prostatitis are not well understood. At present, it is believed that chronic prostatitis is a clinical syndrome consisting of a group of diseases with their own unique etiology, clinical features and outcome.
(A) Traditional classification The Meares-Stamey “four-cup method” was the first standardized method of classifying prostatitis [1], by comparing the initial urine (voided bladder one, VB1), the middle urine The results of the four cups of urine (VB1), middle urine (VB2), prostatic secretion (EPS), and post-massage urine (VB3) were compared. The number of leukocytes in the specimens and the results of bacterial culture were classified as: acute bacterial prostatitis (ABP), chronic bacterial prostatitis (CBP), chronic nonbacterial prostatitis (CNP), and chronic bacterial prostatitis. The method is cumbersome and expensive. The method is cumbersome, expensive, and has limited clinical guidance ].
（In 1995, the National Institutes of Health (NIH) developed a new classification based on the basic and clinical research on prostatitis: Type I: equivalent to ABP in the traditional classification. It may be characterized by a sudden onset of febrile illness with persistent and marked symptoms of lower urinary tract infection, elevated white blood cell count in the urine, and positive bacterial cultures in the blood or/and urine. Type II: equivalent to CBP in the traditional classification method and accounts for about 5-8% of chronic prostatitis;. There are recurrent symptoms of lower urinary tract infection lasting more than 3 months, elevated leukocyte count in EPS/semen/VB3, and positive bacterial culture results. Type III: chronic prostatitis/chronic pelvic pain syndromes (CP/CPPS), equivalent to CNP and PD 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. According to the results of routine EPS/semen/VB3 microscopy, the type can be subdivided into two subtypes, IIIA (inflammatory CPPS) and IIIB (non-inflammatory CPPS): type IIIA patients have elevated leukocyte counts in EPS/semen/VB3; type IIIB patients have leukocytes in EPS/semen/VB3 in the normal range. accounted for 50%; approximately. Type IV: asymptomatory inflammatory prostatitis (AIP). The only evidence of inflammation is found on examination of the prostate (EPS, semen, prostate biopsy and pathology of prostatectomy specimens). The International Prostatitis Collaborative Network (IPCN), after 3 years of clinical use, concluded that this classification is a great improvement over the traditional classification and has some guidance in clinical use, but there are still shortcomings that need further improvement. However, there are still shortcomings and further improvement is needed.
Epidemiology
Prostatitis is a common disease in adult men. Some data show that about 50% of men are affected by prostatitis at some point in their lives. Some cases of prostatitis may seriously affect the quality of life of patients and impose a significant economic burden on public health.
(i) Prevalence Patients with prostatitis account for 8-25% of urology outpatients. The prevalence in the general population The prevalence of prostatitis reported in the literature varies widely due to the application of different epidemiological survey methods and the structure of the population selected for investigation. In the Americas, the prevalence of prostatitis in men aged 20-79 years is 2.2%; ~16%, in Europe, the prevalence of prostatitis in men aged 20-59 years is 14.2%; and in different Asian countries and regions, the prevalence of prostatitis in men aged 20-79 years is 2.67%; ~8.7%;. Prevalence in autopsy According to autopsy reports, the prevalence of prostatitis was 24.3%; ~44%.
(B) Factors influencing the onset of prostatitis Prostatitis can affect adult men of all ages. the prevalence is higher in adult men under 50 years of age. In addition, the onset of prostatitis may also be related to season, diet, sexual activity, inflammation of the genitourinary tract, benign prostatic hyperplasia or lower urinary tract syndrome, occupation, socioeconomic status, and psychosomatic factors.
Chapter 2 Etiology and Pathogenesis
A. Type I prostatitis Pathogenic infection is the main causative factor. The main pathogen is Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Aspergillus, Pseudomonas, etc. The majority of these are single pathogen infections.
The main pathogenic factors are also pathogenic infections, but the body is more resistant or/and pathogens are less virulent, mainly retrograde infections, the pathogens are mainly Staphylococcus spp, followed by Escherichia coli, Corynebacterium spp and Enterococcus spp. The prostate stones and urinary reflux may be important reasons for the persistence of the pathogens and the recurrence of the infection.
The pathogenesis of type III prostatitis is unknown and the etiology is very complex and widely debated: it may be a combination of etiologies with one or more playing a key role; or many different diseases with the same or similar clinical manifestations; or even these diseases have been cured and the damage and pathological changes caused by it continue to act independently. Most scholars believe that the main etiology may be a combination of pathogenic infection, inflammation, and abnormal pelvic floor neuromuscular activity.
(i) Pathogenic infections Although routine bacterial examination fails to isolate pathogens in this type of patient, they may still be associated with certain pathogenic infections such as bacteria, Chlamydia trachomatis, and mycoplasma, and some studies have shown that their local prokaryotic DNA detection rate can be as high as 77%;.
Many patients with prostatitis have a variety of urodynamic changes, such as reduced urinary flow rate, functional urinary tract obstruction, and dysfunctional forced urinary muscle-sphincter synergy. Abnormal urethral sphincter function may be the main cause of urinary abnormalities in patients. If the contractility of the urethral sphincter is low it can lead to frequent and incomplete urination, which are also common clinical symptoms of prostatitis. These functional abnormalities may only be an important phenomenon, and their nature may be related to various other pathogenic factors.
These changes in mental and psychological factors can cause plant nerve dysfunction, resulting in posterior urethral neuromuscular dysfunction, leading to pain in the pelvic region and dysfunctional urination. Elimination of mental stress can lead to symptom relief or healing. However, it is not clear whether psychosomatic changes are the direct cause or secondary manifestation.
(iv) Neuroendocrine factors The pain of patients with prostatodynia is characterized by pain in internal organs. Local pathological stimulation of the prostate and urethra triggers spinal reflexes through the transmitter nerves of the prostate, activation of astrocytes in the lumbar and sacral medulla, nerve impulses transmitted through the genitofemoral nerve and iliac inguinal nerve, and release of norepinephrine, prostaglandin, calcitonin gene-related peptide, and substance P from sympathetic nerve endings, causing vesicourethral dysfunction and leading to abnormal contraction of perineal and pelvic floor muscles in (v) Abnormal immune response
(v) Abnormal immune response Some scholars believe that prostatitis may be an allergic inflammatory response or an autoimmune disease. Some seminal plasma protein antigens of prostate origin such as PSA can act as autoantigenic substances; residual debris or necrotic tissue of pathogens can also act as antigens, inducing an immune response in the prostate, resulting in deposition of antigen-antibody complexes, leading to a series of clinical manifestations. Studies have shown that the cytosolic immunosuppressive factor (IAP) in the prostatic fluid of some patients with chronic prostatitis is significantly reduced, while the level of immunoglobulin is significantly increased, and the application of immunosuppressive therapy is significantly effective, suggesting that abnormal enhancement of local immune factors in the prostate and complex changes in the level of cytokine gene expression may be involved in the pathogenesis.
(F) The theory of oxidative stress Under normal circumstances, the production, utilization, and scavenging of oxygen free radicals in the body are in dynamic balance. The excessive production of oxygen free radicals or/and the relative decrease in the role of the free radical scavenging system in prostatitis patients, which reduces their response capacity against oxidative stress and increases the products or/and by-products of oxidative stress, may be one of the pathogenic mechanisms.
(vii) Pelvic-related disease factors Some patients with prostatitis are often accompanied by dilated venous plexus in the peripheral zone of the prostate, hemorrhoids, varicose veins of the spermatic cord, or the presence of chronic pelvic congestion caused by sedentary and inappropriate sexual activity, suggesting that the symptoms of some patients with chronic prostatitis may be related to pelvic venous congestion, which may be one of the reasons for the persistence of treatment. Some patients with a clinical diagnosis of prostatitis may have manifestations that are due to interstitial cystitis.
Chapter 3 Diagnosis
Section I Diagnostic principles
It is recommended to diagnose prostatitis according to NIH typing. Type I: The diagnosis mainly relies on history, physical examination and bacterial culture results of blood and urine. Rectal examination of the patient is mandatory, but prostate massage is contraindicated. Before applying antibiotic treatment, a midstream urine culture or blood culture should be performed. When the patient’s condition does not improve after 36 hours of standardized treatment, transrectal ultrasound and other tests are recommended to fully evaluate the lower urinary tract lesions and to clarify the presence of prostatic abscesses. Chronic prostatitis (type II and III): A detailed history, comprehensive physical examination (including rectal examination), routine urine and prostate massage fluid examination are required. The NIH chronic prostatitis symptom index (NIH-CPSI) is recommended for scoring symptoms. The “two-cup method” or “four-cup method” is recommended for pathogen localization testing. For patients with predominantly urinary symptoms, urine flow rate and residual urine measurements are recommended. For diagnosis and differential diagnosis, the following tests are available: semen analysis or bacterial culture, prostate-specific antigen (PSA), urine cytology, transabdominal or transrectal ultrasound, urodynamics, CT, MRI, urethral cystoscopy, and prostate puncture biopsy. Type IV: Asymptomatic, detected during prostate massage fluid (EPS), semen, urine after prostate massage, prostate tissue biopsy and pathological examination of prostatectomy specimens.
Section II Diagnostic methods Prostatitis diagnosis methods specifically include.
I. Clinical symptoms 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 symptoms such as abnormal urination; to understand the treatment and recurrence; to evaluate the impact of the disease on quality of life; and 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, lumbosacral area and other areas. Abnormal urination may manifest as urinary urgency, frequency, painful urination, and increased nocturia. Due to the chronic pain that is not cured 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. Prostatitis symptom score Due to the relative lack of objective indicators and many controversies in diagnosing chronic prostatitis, the NIH-CPSI is recommended for symptom assessment [2].The NIH-CPSI consists of three main 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 is urinary symptoms and 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). It has been translated into several languages and is widely used to assess the symptoms and outcome of chronic prostatitis.
II. Physical Examination To diagnose prostatitis, a thorough physical examination should be performed, focusing on the genitourinary system. Check the patient’s lower abdomen, lumbosacral region, perineum, penis, external urethral opening, testes, epididymis and spermatic cord for any abnormalities, which can help in differential diagnosis. Rectal finger examination is very important for the diagnosis of prostatitis and helps to identify perineal, rectal, neuropathy or other diseases of the prostate, while EPS is obtained by prostate massage. Type I: Physical examination may reveal suprapubic pressure and discomfort, and in those with urinary retention, the suprapubic bulging bladder may be palpated. Rectal finger examination may reveal enlargement of the prostate, tenderness, elevated local temperature, and irregular shape. Massage of the patient’s prostate is contraindicated. The prostate gland should be massaged to obtain EPS. before rectal examination, it is recommended to retain urine for routine analysis or optionally for urine bacterial culture.
III. Laboratory tests
(i) EPS routine examination EPS routine examination is usually performed by wet smear method and microscopic examination by hematocrit plate method, the latter having better accuracy. A normal EPS with <;10 leukocytes ph=";"; >;10/HP and a reduced number of leukocytes vesicles is diagnostic. Macrophages containing components such as phagocytosed lecithin vesicles or cellular debris in the cytoplasm are also characteristic of prostatitis. When the prostate is infected with pathogens such as bacteria, mycobacteria and trichomonas, these pathogens can be detected in the EPS. In addition, in order to clearly distinguish between components such as leukocytes in EPS, the EPS can be identified using methods such as Gram staining. If EPS cannot be collected after prostate massage, it is not advisable to repeat the massage several times, and the patient can be allowed to retain the urine after prostate massage for analysis.
(B) Routine urine analysis and urine sediment examination Routine urine analysis and urine sediment examination are auxiliary methods to exclude urinary tract infection and diagnose prostatitis.
(C) Bacteriological examination 1. Type I Stain microscopy, bacterial culture and drug sensitivity test of the middle urine, as well as blood culture and drug sensitivity test should be performed. The two-cup method or the four-cup method is recommended to locate the pathogen. (1) “Four-cup method” In 1968, Meares and Stamey proposed the use of sequential collection of segmental urine and EPS for separate culture (referred to as the “four-cup method”) to differentiate between urethral, bladder and prostate infections in men. (2) “Two-cup method (2) “Two-cup method” The “four-cup method” is complicated, time-consuming and expensive, so the “two-cup method” is usually recommended in clinical practice. “The two-cup method is used to obtain urine before and after prostate massage for microscopic examination and bacterial culture.
（The test methods for Chlamydia trachomatis (Ct) include culture, immunofluorescence, spotted gold immunofiltration, polymerase chain reaction (PCR) and ligase chain reaction (LCR). reaction (LCR), etc. The culture method only detects live Ct and is not recommended for clinical application due to cost, time and technical level. At present, the nucleic acid component of Ct is mainly detected by PCR and LCR techniques with high sensitivity and specificity. The main mycoplasma that may cause prostate infection are Ureaplasma urealyticum (Uu) and Mycoplasma hominis (Mh). The culture method is the gold standard for Uu and Mh detection, and in combination with drug sensitivity testing can provide clinical diagnosis and treatment; immunological testing and nucleic acid amplification techniques are also used for mycoplasma detection. Since Chlamydia trachomatis and mycoplasma may also be present in the male urethra, it is recommended that a urethral swab be taken for testing, and after urethral infection is ruled out, EPS testing is performed to further clarify whether the infection is prostate. In addition, for other pathogens in EPS, such as fungi, the detection methods are mainly direct smear staining microscopy and isolation culture; virus detection is usually done by prostate tissue culture or PCR techniques.
(v) Other laboratory tests Patients with prostatitis may have abnormal semen quality, such as leukocytosis, semen non-liquefaction, hematospermia, decreased sperm quality and other changes. Elevated PSA may also be seen in some patients with chronic prostatitis. Urine cytology has some value in differentiating from bladder cancer in situ, etc.
The following are some of the most important tests that can be performed
(a) Ultrasound Although ultrasound examination of patients with prostatitis can reveal uneven prostate echogenicity, prostate stones or calcifications, and dilated periprostatic plexus, there is still a lack of specific performance of ultrasound for diagnosing prostatitis, and it is not possible to use ultrasound for typing prostatitis. However, ultrasound can provide a more accurate picture of the kidneys, bladder and residual urine in patients with prostatitis, which is helpful in excluding organic lesions of the urinary tract. Transrectal ultrasound is valuable for identifying prostate, seminal vesicle and ejaculatory duct lesions as well as diagnosing and draining prostate abscesses.
(b) Urodynamics 1. Uroflow rate Uroflow rate examination can give a general idea of the patient’s urinary status and help to differentiate prostatitis from diseases related to urinary disorders. The study showed that invasive urodynamic examinations in patients with prostatitis can reveal bladder outlet obstruction, functional urethral obstruction, hypocontraction of the bladder forceps or no reflex of the forceps, instability of the forceps and other vesicourethral dysfunctions. In case of clinical suspicion of the above-mentioned voiding dysfunction or significant abnormalities in urinary flow rate and residual urine, invasive urodynamic testing can be chosen to clarify the diagnosis.
(iii) Cystourethroscopy Cystourethroscopy is an invasive test and is not routinely recommended for patients with prostatitis. In some cases, such as patients with hematuria, significant abnormalities in urinalysis, and other tests suggesting cystourethral lesions, cystourethroscopy may be chosen to clarify the diagnosis.
(iv) CT and MRI have potential applications for identifying lesions of the seminal vesicles, ejaculatory ducts and other pelvic organs, but the diagnostic value for prostatitis itself remains unclear. Section III Differential diagnosis Type III prostatitis lacks an objective and specific diagnostic basis. The clinical diagnosis should be differentiated from diseases that may cause pain in the pelvic region and abnormal urination, and patients with predominantly abnormal urination should be clearly identified with or without bladder outlet obstruction and abnormal bladder function. Diseases to be differentiated include: 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, etc.
Chapter 4 Treatment
Section I. Principles of treatment
Prostatitis should be treated in a comprehensive manner.
Type I: mainly broad-spectrum antibiotics, symptomatic treatment and supportive therapy. Those with urinary retention should apply suprapubic cystostomy to drain urine, and those with prostate abscesses can be surgically drained.
Type II: The treatment is based on antibiotics and the selection of sensitive drugs, and the treatment is maintained for at least 4-6 weeks, during which time the patient should be evaluated in stages of efficacy. If the results are unsatisfactory, other sensitive antibiotics can be used instead. The type of prostatitis can be treated with alpha-blockers to improve urinary symptoms and pain. Botanicals, non-steroidal anti-inflammatory analgesics and M-blockers can also improve the symptoms.
The main goals of treatment for type III prostatitis are to relieve pain, improve urinary symptoms, and improve quality of life.
Type III A: Oral antibiotics may be given for 2-4 weeks and then the decision to continue antibiotic therapy is based on feedback on its efficacy. Alpha-blockers are recommended for this type of prostatitis to improve urinary symptoms and pain, as well as NSAIDs, botanicals and M-blockers.
Type III B: Alpha-blockers, NSAIDs, botanicals, and M-blockers may be used.
Type IV: Generally no treatment is needed, but if combined with elevated serum PSA or infertility, antibiotic treatment can be tried with reference to type IIIA.
The treatment is usually not necessary. Section II
The first is the type I.
The antibiotic treatment of type I prostatitis is necessary and urgent. The antibiotics should be applied as soon as the clinical diagnosis or blood or urine culture results are available. In the beginning, antibiotics can be applied intravenously, such as: broad-spectrum penicillin, triple cephalosporins, aminoglycosides or fluoroquinolones. After the patient’s fever and other symptoms improve, the patient should be switched to oral medications for at least 4 weeks. Patients with milder symptoms should also take oral antibiotics for 2 to 4 weeks.
For acute bacterial prostatitis with urinary retention, avoid transurethral catheterization and use suprapubic cystostomy to drain the urine. For those with abscess formation, transrectal ultrasound-guided fine needle aspiration drainage, transurethral resection prostatic abscess drainage or perineal aspiration drainage may be used. II. Type II and III
(i) General treatment
Patients with chronic prostatitis should abstain from alcohol and spicy stimulating foods; avoid holding urine, sitting for a long time, keeping warm and strengthening physical exercise. Hot water baths can help relieve painful symptoms.
(ii) Drug treatment
The three most common drugs used to treat type II and type III prostatitis are antibiotics, alpha-blockers and non-steroidal anti-inflammatory analgesics, while other drugs have varying degrees of efficacy in relieving the symptoms of prostatitis.
1. Antibiotics
Currently, the most commonly used first-line drug in clinical practice for the treatment of prostatitis is antibiotics, but only about 5% of patients with chronic prostatitis have a definite bacterial infection.
Type II: Antibiotics are selected based on bacterial culture results and the ability of the drug to penetrate the prostate envelope. The ability of the drug to penetrate the prostate envelope depends on its degree of ionization, lipid solubility, protein binding rate, relative molecular mass and molecular structure. After the diagnosis of prostatitis, antibiotic treatment should be maintained for at least 4-6 weeks, during which time the patient should be evaluated for stage efficacy. If the efficacy is unsatisfactory, the patient may be switched to other sensitive antibiotics. Intraprostatic antibiotic injections are not recommended as a treatment.
Type III A: Antibiotic therapy is mostly empirical and the rationale for its application is based on the presumption that certain pathogens that are routinely culture-negative contribute to the development of this type of inflammation. Therefore, oral antibiotics are recommended for 2 to 4 weeks, followed by a decision to continue antibiotic therapy based on feedback on its efficacy. Continuation of antibiotics is recommended only if the patient does show a reduction in clinical symptoms. The recommended total course of treatment is 4-6 weeks. Some patients with this type may have intracellular pathogenic infections such as Chlamydia trachomatis, Ureaplasma lysis or Mycoplasma humanum, which can be treated with oral macrolide antibiotics.
Type III B: Antibiotic treatment is not recommended.
2 The Alpha-blockers
Alpha-blockers are essential for the treatment of type II/III prostatitis because they relax the smooth muscles in the prostate and bladder to improve lower urinary tract symptoms and pain.
Different α-blockers can be used depending on the individual patient. The results of controlled studies have shown varying degrees of improvement in urinary symptoms, pain and quality of life index.
The duration of treatment with alpha-blockers should be at least 12 weeks. If antibiotics or alpha-blockers alone are not effective for type IIIA prostatitis, a combination of both can be used.
3. Non-steroidal anti-inflammatory analgesics
NSAIDs are used empirically to treat the symptoms associated with type III prostatitis. Their primary purpose is to relieve pain and discomfort. To date, only a few randomized, placebo-controlled studies have evaluated the efficacy of these drugs. Controlled clinical studies have demonstrated the effectiveness of celecoxib in improving pain and other symptoms in patients with type IIIA prostatitis.
4 The Botanicals
The role of botanicals in the treatment of type II and type III prostatitis is gaining attention as an optional adjunctive therapy. The botanicals mainly refer to pollen-based preparations and plant extracts, which have a wide range of pharmacological effects, such as non-specific anti-inflammatory, anti-edema, and promoting bladder contraction and urethral smooth muscle relaxation.
The dosage of the commonly used botanical preparations depends on the patient’s specific condition due to their variety, and the course of treatment is usually measured in months. Adverse effects are minor.
The results of a recently completed multicenter controlled study showed that the combination of Pulsatilla and levofloxacin was significantly more effective than levofloxacin monotherapy in the treatment of type IIIB prostatitis. Another randomized, double-blind, placebo-controlled study showed that long-term (6 months) treatment of patients with type III prostatitis with Pulsatilla was superior to placebo in terms of symptom relief.
5 ．M- receptor blockers
Non-selective M-blockers can be used in patients with prostatitis with overactive bladder (OAB) manifestations such as urgency, frequency and nocturia without urinary obstruction.
6 ． The most important thing is that the patient should be able to use the antidepressants and anxiolytics.
For patients with chronic prostatitis who have combined depression and anxiety, antidepressants and anxiolytics can be used in conjunction with prostatitis treatment according to their condition. These drugs can significantly improve both the patient’s mood disorder symptoms and also the physical discomfort and pain. The adverse effects of these drugs must be taken seriously when applied clinically. The main antidepressants and anxiolytics available are tricyclic antidepressants, selective 5-hydroxytryptamine reuptake inhibitors, and benzodiazepines.
7 The Allopurinol
Small randomized controlled clinical trials have confirmed the efficacy of allopurinol in chronic non-bacterial prostatitis. Allopurinol is the drug of choice for the treatment of chronic non-bacterial prostatitis.
8 ． Chinese herbal medicine
The treatment of prostatitis with Chinese herbal medicine is recommended to be carried out in accordance with the specifications of the Chinese Medicine Association or the Association of Integrative Medicine, taking the method of clearing heat and dampness, invigorating blood circulation and draining urine and lung. According to the patient’s diagnosis and classification, we can choose soup or Chinese medicine.
(C) Other treatments
The prostate massage is one of the traditional treatments. Studies have shown that proper prostate massage can promote the emptying of the prostate ducts and increase the local concentration of drugs, thus relieving the symptoms of patients with chronic prostatitis, so it is recommended as an adjuvant therapy for type III prostatitis. The combination of other treatments can be effective in shortening the duration of the disease. The recommended course of treatment is 4 to 6 weeks, 2 to 3 times a week. type I prostatitis patients are prohibited.
Biofeedback therapy requires the patient to actively participate in the treatment through the biofeedback instrument. This is a non-invasive and optional treatment.
The main use of heat therapy is to increase the blood circulation of the prostate tissue and accelerate the metabolism, which helps to reduce inflammation and eliminate tissue edema and relieve pelvic floor muscle spasm. There are reports of heat therapy using microwave, radiofrequency, laser and other physical means via urethral, transrectal and perineal routes. Although it has a certain effect on symptom relief in the short term, long-term follow-up data are lacking. It is not recommended for unmarried and infertile patients.
4 The Prostate injection therapy / transurethral prostate irrigation treatment is still lack of evidence-based medical evidence.
5 The Surgical treatment Transurethral cystotomy, transurethral resection of the prostate or radical prostatectomy is hardly curative for chronic prostatitis and should only be chosen when there is an indication for surgery for combined prostate related diseases.