Etiology and treatment of prostatitis

       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. In this case, 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 the 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.  Clinical manifestations Type I often has a sudden onset and presents with 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.  The 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 per field of view in 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 possible field of view of the number of leukocytes in the prostate fluid; some other normal men have a number of leukocytes >10/field of view in their prostate fluid. Therefore, the examination of leukocytes in the prostate fluid is only an auxiliary method of bacteriological examination of the prostate fluid.  The actual urinalysis and urine sediment examination is an auxiliary method to rule out urinary tract infection and diagnose prostatitis.  3. Bacteriological examination The two-cup method or four-cup method is commonly used. These methods are especially suitable before antibiotic treatment. Specific methods: 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 head of the penis and urethral orifice; continue to urinate about 200ml and 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 and identify whether there is prostatitis or urethritis by comparing the number of bacterial colonies in the above specimens.  4, other laboratory tests Patients with prostatitis may have abnormal semen quality, such as increased white blood cells, semen non-liquefaction, hematospermia and decreased sperm viability and other changes.  Treatment The first step is to perform a clinical assessment to determine the type of disease and choose a treatment method for the cause. Misunderstanding of the disease, unnecessary anxiety and excessive abstinence can worsen symptoms. Prostatitis may be a disease with mild or no symptoms at all, a self-limiting disease that resolves on its own, or a disease with complex symptoms that lead to urinary tract infections, sexual dysfunction, and infertility, etc. Treatment of patients should avoid both over-representation of the dangers of the disease to patients and a simple, negative, and blindly biased attitude toward antibiotic treatment of the disease. The individualized comprehensive treatment.   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 choice of antimicrobial drugs should be noted that there is a prostate-blood barrier consisting of a lipid-like membrane between the prostate alveoli and the microcirculation, which prevents the passage of water-soluble antibiotics and greatly reduces the effectiveness of treatment. When prostate stones are present, the stones can become a refuge for bacteria. The above factors make it difficult to treat chronic bacterial prostatitis, which requires a long course of treatment and is prone to relapse.  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 and analgesic drugs Non-steroidal anti-inflammatory drugs can improve the symptoms, generally using anti-inflammatory pain internally or suppositories, Chinese herbal medicine using anti-inflammatory, antipyretic, detoxifying and softening drugs also received certain effect. Allopurinol can reduce the concentration of uric acid throughout the body and in the prostate fluid. Theoretically, it acts as a free radical scavenger and can also scavenge reactive oxygen species, reducing inflammation and relieving pain. It’s a great way to get the most out of your life.  The actual prostate massage can empty the concentrated secretions in the prostate duct as well as drain the infection foci in the obstructed area of the gland, therefore for stubborn cases you can do prostate massage every 3 to 7 days along with the use of 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 For patients with prostatitis with overactive bladder manifestations such as urinary urgency, urinary frequency, increased nocturia but no urinary tract obstruction, M-receptor antagonists can be used for treatment.  The use of alpha-receptor antagonists 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.  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, beneficial in reducing reinfection of the peripheral zone lesions. Chronic bacterial prostatitis can lead to recurrent urinary tract infections and infertility.  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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