(A) Type I prostatitis
The main causative factor is pathogenic infection. The actual fact is that the actual body’s resistance is low, the more virulent bacteria or other pathogens infect the prostate and rapidly grow and multiply, mostly bloodstream infection, retrograde infection through the urethra. The pathogens are mainly Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Aspergillus, Pseudomonas spp. The majority of these are single pathogen infections.
(B) Type II prostatitis
The pathogenic factors are also mainly pathogenic infections, but the body is more resistant or/and pathogens are less virulent to retrograde infection, the pathogens are mainly Staphylococcus spp, followed by Escherichia coli, Corynebacterium spp and Enterococcus spp. Prostate stones and urinary reflux may be important reasons for the persistence of pathogens and recurrence of infection.
(C) Type III prostatitis
The etiology is complex and widely controversial: it may be caused by a single initiating factor, or it may be multifactorial from the beginning, with one or more playing a key role and interacting with each other; or it may be a number of different diseases that are difficult to identify but have the same or similar clinical manifestations; or even these diseases have been cured and the damage and pathological changes caused by them continue to act independently. Most scholars believe that the main etiology may be the same or similar. Most scholars believe that the main etiology may be the result of a combination of pathogenic infection, inflammation and abnormal pelvic floor neuromuscular activity and immune abnormalities.
1. Pathogenic infections In this type of patient, although routine bacterial examination fails to isolate the pathogen, it may still be associated with some specific pathogens: such as anaerobic bacteria, L-type Aspergillus, nanobacteria, or Chlamydia trachomatis, mycoplasma and other infections. Some studies have shown that the rate of local prokaryotic DNA detection in patients with this type of disease can be as high as 77%;
Some clinical “aseptic” prostatitis that is predominantly chronic, recurrent or exacerbated by inflammation may be associated with these pathogens. The other pathogens such as parasites, fungi, viruses, trichomonas, and Mycobacterium tuberculosis may also be important causative factors for this type, but there is a lack of reliable evidence and no unified opinion to date.
Many patients with prostatitis have a variety of urodynamic changes, such as reduced urinary flow rate, functional urinary tract obstruction, and dysfunction of the detrusor-urethral sphincter synergy. These functional abnormalities may only be a clinical phenomenon, and their nature may be related to various underlying pathogenic factors.
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. 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; or cause changes in the function of the hypothalamic-pituitary-gonadal axis and affect sexual function, further aggravating the symptoms, eliminating mental tension can make the symptoms ease or heal. However, it is unclear whether the psychosomatic changes are the direct cause or secondary manifestations.
4, neuroendocrine factors Prostate pain patients are often prone to fluctuations in heart rate and blood pressure, indicating that it may be related to the autonomic response.
Their pain has the characteristics of visceral organ pain. Local pathological stimulation of the prostate and urethra triggers spinal reflexes through the afferent nerves of the prostate, activates astrocytes in the lumbar and sacral medulla, and nerve impulses send impulses through the genitofemoral and ilioinguinal nerves, and sympathetic nerve endings release norepinephrine, prostaglandins, calcitonin gene-related peptides, substance P, etc., causing vesicourethral dysfunction, and This leads to abnormal activity of the perineum and pelvic floor muscles and persistent pain and involvement pain in the corresponding areas other than the prostate.
5. abnormal immune response Recent studies have shown that immune factors play a very important role in the development and evolution of type III prostatitis. Changes in the levels of certain cytokines, such as IL-2, IL- 6, IL-8, IL-10, TNF-α and MCP-1, can occur in the prostatic fluid and/or seminal plasma and/or tissues and/or blood of patients [45-52]. Moreover, IL-10 levels were positively correlated with pain symptoms in patients with type III prostatitis, and the application of immunosuppressive therapy was effective.
This suggests that type III prostatitis may be an allergic inflammatory response or an autoimmune disease, a chain reaction mediated by cytokines. Inflammation in the role of initiating factors, such as: the prostate produces certain seminal plasma protein antigens such as PSA can be used as autoantigenic substances; residual fragments of pathogens or necrotic tissue can also be used as antigens, which in turn leads to the body to produce pro-inflammatory cytokines, these cytokines can upregulate the expression of chemokines, expression products through their respective mechanisms in the prostate local immune response to the body.
6, oxidative stress theory Under normal circumstances, the body’s oxygen free radical production, utilization, removal in a dynamic balance. The prostatitis patient oxygen free radical production or / and the role of the free radical scavenging system is relatively reduced, so that the body’s ability to respond to oxidative stress is reduced, oxidative stress products or / and by-products increase, may also be one of the pathogenesis.
7, pelvic-related disease factors Some patients with prostatitis are often accompanied by dilated venous plexus in the peripheral zone of the prostate, hemorrhoids, and varicose veins of the spermatic cord, suggesting that the symptoms of some patients with chronic prostatitis may be related to pelvic venous congestion and blood stagnation, which may also be one of the causes of prolonged treatment [16]. Some patients with a clinical diagnosis of chronic prostatitis may also have an etiology due to interstitial cystitis.
(iv) Type IV prostatitis
Because there are no clinical symptoms and it is often detected during examination for other related diseases, there is a lack of research data related to the pathogenesis, which may be partially the same as the etiology and pathogenesis of type III prostatitis [65].
(E) Predisposing factors of prostatitis
Important predisposing factors for the development of prostatitis include: smoking, alcohol consumption, spicy food, inappropriate sexual activity, prolonged congestion of the prostate caused by sedentary and long-term chronic extrusion of the pelvic floor muscles, cold, fatigue, etc. resulting in decreased body resistance or idiosyncratic body composition.