Post Date April, 15 2023
What is prostatitis?
Prostatitis is a common disease in urology. Among male patients in urology, the group under 50 years old is the first. Prostatitis is divided into four categories and five types, namely, acute bacterial prostatitis, chronic bacterial prostatitis, chronic pelvic pain syndrome (inflammatory and non-inflammatory), and asymptomatic prostatitis. Nonbacterial prostatitis is more common than bacterial prostatitis.
2、 Clinical manifestations of male prostatitis
Chronic prostatitis can be characterized by similar clinical symptoms, which are collectively referred to as prostatitis syndrome, including pelvic sacral pain, dysuria and sexual dysfunction. Pelvic sacral pain is extremely complex. The pain is usually located in the pubis, lumbosacral and perineum. Radiation pain can be manifested as pain in urethra, spermatic cord, testis, groin and ventromedial side. Radiation to the abdomen is similar to acute abdomen, and radiation along the urinary tract is similar to renal colic, which often leads to misdiagnosis. Urination interference is manifested by frequent urination, urgency, pain, poor urination, bifurcated urinary line, post-urination excretion, increased number of nocturnal urination, and milky white secretion from the urethra after urination or during defecation. Occasionally complicated with sexual dysfunction, including anorexia, premature ejaculation, ejaculation pain, erectile dysfunction and impotence. The above symptoms can be caused by prostatitis or other diseases of the urogenital tract.
3、 Prostatitis examination
1. Four cup test
Specific method: Before collecting urine, tell the patient to drink more water, and the patient with long foreskin should turn over the foreskin. After cleaning the penis head and urethral orifice, the patient urinated and collected 10ml of urine; Continue to urinate about 200 ml and collect 10 ml of middle urine; Then stop urinating, massage the prostate and collect prostate fluid; Finally, 10ml of urine was collected. Conduct microscopic examination and culture on each sample, and identify whether there is prostatitis or urethritis by comparing the number of bacterial colonies in the above samples.
2. Check white blood cells in prostate fluid
The content of white blood cells in normal prostatic fluid sediment should be lower than 10 times of microscope. If there are 10 white blood cells/field of vision in the prostatic fluid, the height of prostatitis can be prostatitis, especially the fat macrophages found in the prostatic fluid. However, some patients with chronic bacterial prostatic fluid may have a visual field of white blood cells in the prostatic fluid; In addition, the number of white blood cells in prostate fluid of some normal men is>10/field.
3. Others
Bacteriological or leukocyte examination of urine before and after prostate massage is also a relatively simple method, which can even replace the above four cup test. This method is especially suitable for the treatment of prostate antibiotics.
4、 Treat prostatitis
First of all, clinical evaluation should be carried out to determine the type of disease, and treatment methods should be selected according to the etiology. Psychotherapy and regulating sexual life should run through the whole treatment process.
1. Antibacterial treatment of prostatitis
The known pathogens of urinary tract are the basis for the selection of antimicrobial treatment. Rare pathogens or symbiotic bacteria found in the genitourinary tract cannot be identified as pathogenic pathogens. If the patients with non-bacterial prostatitis have signs of bacterial infection and are ineffective after general treatment, antibacterial drugs are also applicable. In the selection of antibacterial drugs, attention should be paid to the prostate blood barrier between prostate acini and microcirculation, which hinders the passage of water-soluble antibiotics and greatly reduces the therapeutic effect. Some bacteria secrete glycoprotein matrix, preventing antibiotics from approaching bacteria. In the presence of calculus in the gland, the calculus can become a shelter for bacteria.
2. Prostatitis anti-inflammatory and analgesic drugs
Non-steroidal anti-inflammatory drugs can improve symptoms. Generally, anti-inflammatory drugs or suppositories are used. Traditional Chinese medicine also has certain effects by using anti-inflammatory, antipyretic, detoxification and soft drugs. Allopurinol can reduce the concentration of uric acid in the whole body and prostate fluid. In theory, as a free radical scavenger, it can also remove reactive oxygen species and reduce inflammation and pain.
3. Physical therapy for prostatitis
Prostate massage can empty the concentrated secretion in the prostate tube and drain the infection focus in the obstruction area of the gland, so prostate massage can be performed every 3 to 7 days while using antibiotics. Prostate physiotherapy uses a variety of physical factors, which is beneficial to relax the prostate, posterior urethral smooth muscle and pelvic floor muscle, enhance antibacterial effect, and relieve pain symptoms.
4. Receptor antagonists
In patients with prostate pain, bacterial or non-bacterial prostatitis, the tension of the smooth muscle of the prostate, bladder neck and urethra increases, and the increase of the pressure of the urethra causes the urine to flow back to the prostate tube, which is an important cause of prostate pain, prostate calculus and bacterial prostatitis. The application is of great significance to prevent the recurrence of infection. A long course of treatment should be used to make the receptor antagonist have enough time to regulate the smooth muscle function and consolidate the curative effect.
5. Surgical treatment of prostatitis
Chronic bacterial prostatitis can be used for surgical treatment. Prostatectomy can be cured, but it should be used with caution. Because prostatitis usually involves the peripheral zone of the gland, the purpose of TURp treatment is to achieve the treatment goal of TURp prostate stone and bacterial infection disease near the prostate duct, which is beneficial to reduce the reinfection of the peripheral zone. Chronic bacterial prostatitis can lead to repeated urinary tract infection and infertility.
