Post Date April, 15 2023
Chronic prostatitis is a common male disease with complex and diverse clinical symptoms, including frequent urination, urgency of urination, and urethral burning pain. It is difficult to cure and is prone to relapse. The common causes of chronic prostatitis can be divided into two aspects.
1. Chronic bacterial prostatitis
The main pathogenic factor is also pathogen infection, but the resistance of the body is strong or/and the virulence of the pathogen is weak, mainly due to retrograde infection. The main pathogens are Staphylococcus, followed by Escherichia coli, Corynebacterium, and Enterococcus. Prostate stones and urine reflux may be important reasons for the persistence of pathogens and the recurrence of infection.
2. Chronic non bacterial prostatitis
The etiology is very complex, and its main cause may be a combination of pathogen infection, inflammation, abnormal pelvic floor neuromuscular activity, and immune abnormalities.
(1) Although patients with this type of pathogen infection cannot be isolated by routine bacterial testing, they may still be associated with certain special pathogens, such as anaerobes, L-form proteases, nanobacteria, or infections such as Chlamydia trachomatis, and mycoplasma. Studies have shown that the detection rate of local prokaryotic DNA in patients with this type of disease can be as high as 77%; Some clinical "aseptic" prostatitis characterized by chronic inflammation, recurrent attacks, or exacerbation may be related to these pathogens. Other pathogens such as parasites, fungi, viruses, trichomonas, and Mycobacterium tuberculosis may also be important pathogenic factors for this type of disease, but there is a lack of reliable evidence and there is still no consensus.
(2) Urinary dysfunction Some factors cause excessive contraction of the urethral sphincter, leading to bladder outlet obstruction and residual urine formation, causing urine to flow back into the prostate, not only bringing pathogens into the prostate, but also directly stimulating the prostate, inducing sterile "chemical prostatitis," causing abnormal urination and pelvic pain.
(3) Research on psychosocial factors has shown that more than half of patients with chronic prostatitis have significant changes in psychosocial factors and personality characteristics. Such as anxiety, depression, hypochondriasis, hysteria, and even suicidal tendencies. Changes in these mental and psychological factors can cause autonomic nervous dysfunction, resulting in neuromuscular dysfunction of the posterior urethra, pelvic pain, and dysuria; "Or cause changes in the function of the hypothalamus pituitary gonad axis that affect sexual function, further exacerbating symptoms, and eliminating mental tension can alleviate or heal symptoms.". However, it is unclear whether psychosocial changes are the direct cause or secondary manifestation.
(4) Patients with prostate pain due to neuroendocrine factors are often prone to fluctuations in heart rate and blood pressure, indicating that it may be related to autonomic nervous responses. Its pain is characterized by pain in internal organs. Local pathological stimulation of the prostate and urethra triggers spinal cord reflexes through the afferent nerves of the prostate, activating astrocytes in the lumbar and sacral medulla. Nerve impulses transmit impulses through the genitourinary and ilioinguinal nerves. Sympathetic nerve endings release norepinephrine, prostaglandins, calcitonin gene related peptide, substance P, etc., causing dysfunction of the bladder and urethra, and leading to perineum Abnormality of pelvic floor muscle activity results in persistent pain and involved pain in corresponding areas outside the prostate gland.
(5) Recent studies have shown that immune factors play a very important role in the occurrence and progression of type III prostatitis. Changes in the levels of certain cytokines can occur in patients' prostate fluid and/or seminal plasma, and/or tissues and/or blood. Moreover, the level of IL-10 is positively correlated with the pain symptoms of patients with type III prostatitis, and immunosuppressive therapy has certain effects.
