Chronic prostatitis is a very high incidence (4-25%) and confusing disease, with close to 50% of men experiencing symptoms of prostatitis at some point in their lives. The fact that the cause, pathological changes, and clinical symptoms are complex and varied, and have an impact on the sexual and reproductive functions of men, seriously affects the quality of life of patients and makes them suffer mentally and physically. Many doctors feel tricky in the process of diagnosing and treating prostatitis, and generally lack self-confidence in the disease and the ability to diagnose it accurately, which ultimately leads to failure to treat it rationally, resulting in a huge waste of medical and human resources. Important advances have been made in recent years in the study of chronic prostatitis, especially with the use of molecular techniques to more easily identify pathogenic microorganisms, the diagnosis and classification of prostatitis has been redefined, clinical features have been adequately characterized, and many encouraging new findings have emerged, all of which suggest that prostatitis will once again become an important area of research for urogynecologists.
NIH’s approach to disease classification
In 1995, the National Institutes of Health (NIH) reclassified prostatitis into the following categories: Type I prostatitis (acute bacterial prostatitis), Type II prostatitis, and Type III prostatitis. prostatitis), type II prostatitis (chronic bacterial prostatitis), type III prostatitis (chronic non-bacterial prostatitis/chronic pelvic pain syndrome, CP/CPPS) and type IV prostatitis (asymptomatic inflammatory prostatitis, AIP). Of these, type III prostatitis (CP/CPPS) is further differentiated into type IIIA (inflammatory chronic pelvic pain syndrome, also known as chronic non-bacterial prostatitis) and type IIIB (non-inflammatory chronic pelvic pain syndrome, also known as prostatodynia.) This NIH classification is more meaningful in the classification of inflammatory or painful inflammatory conditions of the prostate, however, studies have found that 54% of The classification fails to consider the pelvic floor and lower urinary tract as a functional whole.
Clinical epidemiological investigations
At present, there are few epidemiological studies related to prostatitis reported in the literature, and the exact epidemiological data and the huge economic burden of the disease on public health are difficult to estimate accurately. Some countries and regions have conducted large-scale epidemiological surveys of chronic prostatitis in the community population, and preliminary results show that prostate infection can occur in all age groups, with adult men being the most common, being 50 years old. The most common reason for urological visits in men under 50 years of age, but it is inappropriate to rely solely on age factors to determine prostatitis, as many studies suggest that the incidence of prostatitis in middle-aged and older men can also be high. A number of conditions are clearly associated with chronic prostatitis, such as benign prostatic hyperplasia (BPH), inflammatory diseases of the genitourinary tract (especially sexually transmitted diseases), varicocele, hemorrhoids, and dilated prostatic plexus. Although there is no direct evidence that prostatitis is associated with prostate cancer, some retrospective analyses in recent years have shown a correlation between a history of prostatitis and the development of prostate cancer, but the data from this profile analysis are not perfect and cannot exclude detection bias.
Etiology and Pathogenesis
The etiology of chronic prostatitis is complex, and although there is a considerable degree of understanding of its numerous pathogenesis, none of it has been groundbreaking. It is now believed that chronic prostatitis may be due to primary or secondary diseases of the prostate and its surrounding tissues and organs, muscles and nerves, and that even after these diseases have been cured or completely eradicated, the damage and pathological changes caused by it(them) continue to act independently, and that the etiology may center on a combination of infection, inflammation and abnormal pelvic floor neuromuscular activity. Therefore, the role of one factor cannot be emphasized unilaterally; no single organ or single pathogenesis can reasonably explain the many complex clinical manifestations of prostatitis, but is often the result of multiple factors acting together through different mechanisms, one or more of which may play a key role. The development of chronic prostatitis may also be associated with genetic susceptibility, and some evidence does exist for genetic differences between patients with chronic prostatitis and healthy men. In-depth study of the altered genetic characteristics of chronic prostatitis may reveal the causes of susceptibility to chronic prostatitis, reveal some of the pathogenesis of prostatitis, predict the prognosis of prostatitis, provide a basis for individualized treatment of prostatitis, and lay the foundation for finding a specific gene(s) expression alteration(s) or abnormality(s) for gene prevention and treatment of prostatitis.
Changes in the levels of certain cytokines, such as interleukin 1β (IL-1β), tumor necrosis factor alpha (TNFα), IL-6, IL-8, IL-10, etc., can often be found in the prostate fluid of patients with prostatitis, and their expression correlates with symptoms and treatment response, suggesting that immune responses are involved in the pathogenesis of chronic prostatitis, and providing a basis for immunotherapy of prostatitis. The results show that the immune response is involved in the pathogenesis of chronic prostatitis and provides a basis for immunotherapy of prostatitis. Inflammatory changes in the prostate are inevitably accompanied by changes in local anatomy and function, or chronic prostatitis itself is the result of changes in local anatomy and function. Abnormalities in the function of the pelvic floor muscles as well as local physical injuries, long-term congestion, urethral strictures, hypertrophy of the seminal frenulum, prostate tumors, benign prostatic hyperplasia, obstruction of the ejaculatory duct orifice, bladder neck hypertrophy and other anatomical abnormalities of the posterior urethra can induce local bacterial infections, pelvic floor neuromuscular tension, urinary reflux in the prostate and other unfavorable factors, which are all important factors in causing local pain and inflammatory response.
Objective evaluation of clinical symptoms
In order to evaluate the clinical symptoms of chronic prostatitis objectively and accurately and to apply them to uniform analysis and scientific research, the National Institutes of Health (NIH) has developed and proposed an objective scale of clinical symptoms of chronic prostatitis: the chronic prostatitis symptom index (CPSI), which can be The CPSI can be used to study three important symptoms of prostatitis: pain (location, severity and frequency), urinary abnormalities (urinary irritation and obstructive symptoms) and impact on quality of life, with a total of 9 questions, and is objective, simple, convenient, quickly accepted by patients, and has stability, repeatability, high discrimination and certain psychological test nature.
Diagnostic features of chronic prostatitis
There is no “gold standard” for diagnosing chronic prostatitis, and the methodological implications for clinical research are very limited, with less than 5% of clinicians using few objective bases to diagnose prostatitis. The actual fact is that you can get a good idea of what you’re looking for, and you’ll be able to get a good idea of what you’re looking for. Therefore, chronic prostatitis is often an exclusionary or deficient diagnosis, and the classification is also based on exclusionary methods, i.e. lack of positive features of other types of prostatitis. There is no doubt that some basic traditional diagnostic methods and treatment options still have important applications, but they must be given a new and broader meaning and their role re-evaluated.
A new understanding of leukocytes in prostatic fluid
The clinical diagnosis of chronic prostatitis has long been based on elevated levels of leukocytes in the prostatic fluid and the staging of disease based on the presence of bacteria. However, recent studies have shown that increased leukocytes in prostate fluid do not necessarily indicate the presence of bacterial infection, and that the number of leukocytes in prostate fluid is not related to clinical symptoms and is not very helpful in selecting treatment and estimating prognosis. The significance of leukocytes in the prostate fluid of patients with chronic prostatitis needs to be reassessed.
The optimal combination of treatment methods
There are numerous treatments for chronic prostatitis, including Chinese and Western medicine, systemic and local, internal and external, etc. Antibiotics are no longer the most important, but no method is a panacea and there are certain indications. As there may be multiple causes of chronic prostatitis, comprehensive treatment is often used when choosing a treatment method, and it is difficult to obtain satisfactory results with any single treatment method or drug. Although many domestic and foreign scholars have recommended a variety of preferred options for comprehensive treatment methods, for a specific patient, a detailed analysis of the patient’s medical history characteristics, clinical symptoms, physical examination, laboratory analysis, and previous treatment experience should be taken to individualize treatment, which is a guarantee to avoid drug abuse and improve treatment efficiency.
Topical treatment
The most important thing is to make sure that you have a good understanding of the situation. The most important thing is that the drug can be administered in a more effective way. The main local treatment methods include (1) local medication (direct local injection in the prostate, transurethral instillation, injection through the vas deferens, transrectal administration, submucosal injection); (2) prostate massage; (3) hot water sitz bath; (4) local physical therapy (transurethral laser, radiofrequency, conduction and transrectal prostate microwave heat therapy; (5) biofeedback technology.
The adjustment of psychological state
Therefore, in-depth communication between doctors and patients is very important and often requires appropriate antidepressant and anti-anxiety treatment and psychological adjustment, especially for patients with severe psychiatric symptoms.
Functional holistic medicine and complementary alternative medicine
Holistic medicine (HCM) views health and illness as dynamic processes in which physical, psychosocial and environmental factors interact; complementary and alternative medicine (CAM) is a range of health care activities that complement and supplement traditional treatment approaches. Functional holistic medicine and CAM are a new attempt to prevent and assist in the treatment of various chronic and persistent diseases, including chronic prostatitis, through mind-body medicine consultation, dietary regime improvement, lifestyle habit adjustment, phytomedicine treatment, vitamin and mineral supply, and nutrient supplementation, and have achieved good results, but their treatment experience has yet to be systematically summarized.
There is no satisfactory treatment and prevention is extremely important
The actual fact that there is a high incidence of prostatitis, but not all men suffer from prostatitis, only in some special groups such as alcoholics, over-indulgers, sexually promiscuous people, car drivers, people with low immunity, indicates that many bad habits in daily life and some other aspects of unfavorable conditions are high-risk factors for triggering prostatitis. The actual fact that there is no very satisfactory treatment for chronic prostatitis, so the prevention of the disease is very necessary and important, in daily life will learn to reasonable, scientific self-regulation is the key measures to prevent the occurrence of prostatitis.