Prostatitis is a common male disease, which may be caused bybacterial infectionOr other factors, includingAcute bacterial prostatitis、Chronic bacterial prostatitis、chronic prostatitis (chronic pelvic pain syndrome).35% - 50% of men from adolescence to old age will be affected by prostatitis. Unclean sexual life, sedentary and unhealthy eating habits, such as excessive drinking and hot food, may all be factors inducing prostatitis.
The symptoms of the disease vary from acute pain, frequent urination tosexual dysfunctionAnd psychosocial disorders.Acute bacterial prostatitis is often manifested as frequent urination, urgency of urination, urethral burning pain, etc. Chronic prostatitis (chronic pelvic pain syndrome) may have long-term pain and discomfort in the pelvic region, urethral discomfort during urination, sexual dysfunction, and psychological problems.
The treatment varies according to the type of disease.Acute bacterial prostatitis usually has a good response to antibiotics, and inflammation is controlled by immediate intravenous injection of broad-spectrum antibiotics.According to the results of bacterial culture and drug sensitivity test, appropriate antibiotics were selected for chronic bacterial prostatitis.The treatment of chronic prostatitis includes lifestyle adjustment, medication, psychotherapy, local physical therapy, etc., mainly to improve symptoms, improve quality of life and promote the recovery of related functions.
Prostatitis is a common disease, the key lies in early detection and accurate diagnosis, and then select the most effective treatment.At the same time, adjusting lifestyle and eating habits, as well as regular physical examination, are also effective ways to prevent and control prostatitis.
Bacterial infection is the main pathogenic factor.
The route of infection can be blood line infection. Bacteria stay in the prostate through blood circulation, causing acute inflammatory reaction of the prostate;
It can also be infected retrogradely through the urethra. When the urinary tract is blocked and the urine is blocked, the bacteria in the urine will flow back toprostateCauses prostatitis.
The cause is unknown.Most scholars believe that the main causes may be pathogen infection, inflammation, urination dysfunction, in addition, there may be psychological factors, immune abnormalities and other joint effects.
Because of no clinical symptoms, it is often found in other disease examinations, so there is a lack of relevant research data on the pathogenesis, which may be the same as part of the etiology of type III prostatitis.
Predisposing factors
Irregular sex life
Excessive and frequent sexual life or masturbation will cause the prostate to be in a repeated and continuous state of congestion and edema;However, if sexual life is interrupted for a long time, prostatic fluid and metabolites cannot be discharged regularly.
In addition, "endure ejaculation without ejaculation" or interrupt sexual intercourse before orgasm and ejaculation in sexual life, so as not to ejaculate, and this repeated will also cause chronic congestion of the prostate.The excessive congestion and edema of the prostate is conducive to the pathogen infecting the urethra and diffusing into the prostate through the urethra.
Unclean sexual intercourse
Caused by pathogens through sexual intercourseurethritis, secondary infection of prostate.
Bad lifestyle
Sitting and straddling for a long time can oppress the prostate, resulting inpelvic cavityCongestion and edema of the prostate can lead to accumulation of local metabolites, obstruction of prostate ducts, and poor excretion of prostatic fluid.
Bad eating habits
Excessive drinking and consumption of spicy and irritant food can cause dilation and congestion of blood vessels in the urethra and prostate, and aggravate inflammatory reaction.
Local coldness
It may cause blood circulation disorder and muscle spasm in the pelvic region, and promote the onset of symptoms.
symptom
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Acute bacterial prostatitis, frequently occurring suddenly, is characterized by acute pain, accompanied by abnormal urination related symptoms and fever.
Chronic prostatitis (chronic pelvic pain syndrome) has many and complex clinical manifestations, most of which are pelvic pain, frequency of urination, pain in urination, urethral secretion abnormalities, sexual dysfunction, mental and psychological disorders and other symptoms.
Type IV prostatitis (asymptomatic prostatitis) lacks obvious clinical symptoms.
Typical symptoms
Acute bacterial prostatitis
Systemic symptoms
suddenlyfever、shiver、weak, weakness, anorexia, nausea, vomiting, etc.
Local symptoms
perineumOr the pressure on the upper pubic region extends to the waist, lower abdomen, back, thigh, etc., making the patient restless.
Urinary tract symptoms
Frequency of urination, urgency of urination, urethral burningUrinalysisAnd purulent urethral secretions, bladder neck edema can cause poor urination, thinning or interruption of the urinary line, and even urinary retention in severe cases.
Rectal symptoms
The rectum is full, the stool is urgent or blocked, and the urethra is white when defecating.
Chronic bacterial prostatitis and chronic prostatitis (chronic pelvic pain syndrome)
Systemic symptoms
Not obvious, chronic bacterial prostatitis may be manifested as recurrent urinary tract infection, and fever may occur when acute prostatitis occurs.
Pelvic pain symptoms
Pain and discomfort in the pelvic region, such as swelling pain and dull pain in perineum, suprapubic bone, perianalscrotum, inner side of thigh root, penis and other parts.
Lower urinary tract symptoms
Frequency of urination, urgency of urination, pain in urination, urethral discomfort or burning sensation during urination, waiting for urine and endless urination, etc.
Excessive mental tension, anxiety, frequent dizziness, memory loss, paranoia, insomnia, depression, etc.Patients are also often over sensitive to physical discomfort and pain.
It is often accompanied by urinary tract whitening, fatigue, insomnia, dizziness, etc.
Medical treatment
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When there is pain or discomfort in the pelvic area, with or without frequent urination, urgency of urination, painful urination, incomplete urination, and white urethral orifice, and a few people can be accompanied by sudden high fever, they should go to the hospital in time.
Diagnostic process
The doctor can make a diagnosis based on the patient's previous disease history, rectal digital examination, blood, urine, prostatic fluid examination (no prostatic fluid in case of fever), bacterial culture and other examination results.
Visiting department
Urology, andrology.
If the nervous system symptoms are serious, they can be referred to the Department of Psychiatry.
The prostate is characterized by swelling, smooth surface, obvious tenderness, local temperature increase and other symptoms. If there is an abscess, it can form a palpable wave feeling.The spread of infection can causeSeminal vesiculitis、Epididymitis、BacteremiaTherefore, it is forbidden to do prostate massage or puncture.
Leukocytosis is common, and bacteria often grow in urine culture.
chronic prostatitis
Digital rectal examination
The prostate is plump, enlarged, soft and slightly tender.In patients with a long course of disease, the prostate gland shrinks, hardens, unevenly, and has small induration.
Examination of prostatic fluid
The number of white blood cells in prostatic fluid>10/high power field indicates that there is inflammation in the prostate (it may be chronic bacterial prostatitis or type IIIA prostatitis, namely inflammatory chronic pelvic pain syndrome), but it needs to be combined with bacterial culture for further typing;
If the prostatic fluid is normal and there is no bacterial growth in the culture, it is called prostatodynia;
The number of lecithin bodies has no clear significance, so it is not recommended to attach importance to this indicator;
The number of white blood cells in the prostatic fluid of patients with chronic pelvic pain syndrome has nothing to do with the severity of symptoms, and should not be used as an indicator to evaluate the therapeutic effect.
"Four cup method" staged urine and prostatic fluid culture examination
Segmented urine and prostatic fluid were collected for bacterial culture to diagnose chronic bacterial prostatitis.
Supplementary Examination
B-ultrasonic examination is not the diagnostic basis of prostatitis, but its significance is differential diagnosis, excluding other diseases.In addition,Urodynamics、Cystoscope、CT、Magnetic resonance imaging(MRI) can be used as a means of differential diagnosis of prostatitis.
Acute bacterial inflammation of renal pelvis and renal parenchyma.Acute pyelonephritis is more common in women than in men;Low back pain is mostly in one side of the kidney, and the percussion pain is obvious, while the frequency, urgency and pain of urine in acute prostatitis are more obvious.
Generally, symptoms appear after the age of 50, with progressive dysuria as the typical manifestation. Frequent urination is the most common early symptom.The digital rectal examination of BPH shows that the bilateral lobes of the prostate are enlarged, or the middle sulcus disappears, while prostatitis is characterized by fullness and tenderness of the prostate.
Mainly after 50 years old.The surface of the rectal digital examination gland is uneven, and stone like nodules can be felt. However, sometimes chronic prostatitis can also be found in the rectal digital examination that the prostate is hard and has nodules.
Prostate specific antigen (PSA) is elevated, and space occupying lesions can be found by B-ultrasound, magnetic resonance imaging (MRI), etc., which can be identified by the aforementioned examination combined with prostate biopsy.
treatment
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Acute bacterial prostatitis responds well to antibiotics and should be injected intravenously immediatelyBroad-spectrum antibiotic, quickly control inflammation.
For chronic bacterial prostatitis, appropriate antibiotics should be selected according to the results of bacterial culture and drug sensitivity test.
The treatment of chronic prostatitis (chronic pelvic pain syndrome) includes lifestyle adjustment, medication, psychotherapy, local physiotherapy, etc., with the main purpose of improving symptoms, improving quality of life and promoting the recovery of related functions.
Acute treatment
Acute bacterial prostatitis should be treated with antibiotics to control infection, relieve fever and pain, and encourage patients to stay in bed actively and drink more water.
A few patients with urinary retention can use catheterization or suprapubic cystostomy to drain urine.
A few cases of prostatic abscess need surgical incision and drainage.
It should be noted that the acute stage must be treated thoroughly, otherwise it is easy to turn into chronic prostatitis.
The utility model relates to a method of inserting a catheter into a urethra for bladder decompression.
Suprapubic cystostomy
Suprapubic cystostomy is suitable for patients with contraindication or failure of transurethral catheterizationUroschesispatient.Compared with transurethral catheterization, this method has a relatively low incidence of urinary tract infection and does not cause urethral stricture.Another advantage is that the tube can be clamped without pulling out the tube to try to urinate, so as to avoid placing the tube again after urination failure.
General treatment
Abstain from alcohol and spicy food;
Avoid holding urine and sitting for a long time, and pay attention to bed rest;
Softening stool treatment;
Regular prostate massage (forbidden for patients with acute prostatitis);
Pay attention to keeping warm. If necessary, perform perineum hot compress, hot water sitz bath, physiotherapy, etc. under the guidance of a doctor;
Learn more about the diagnosis and treatment of prostatitis, and conduct psychological and behavioral counseling when necessary.
medication
According to the classification of prostatitis, the main points of drug treatment are as follows.
Acute bacterial prostatitis (type I)
Immediate intravenous injection of broad-spectrum antibiotics can quickly control inflammation. Common antibiotics includeBroad-spectrum penicillin, third-generation cephalosporinsAminoglycosidesOr fluoroquinolones.
After obtaining the results of patient's bacterial culture, choose more targeted and sensitive antibiotics for intravenous injection.
After the fever symptoms improve, oral antibiotics can be used instead.
It can be used in combination or alternatively to prevent drug resistance.
Antibacterial drugs should be used according to the doctor's advice, in sufficient quantity and with sufficient treatment duration, to avoid abuse.
chronic prostatitis
Type II: chronic bacterial prostatitis
According to the results of bacterial culture and drug sensitivity test, select sensitive antibiotics to control inflammation.Common antibiotics includeLevofloxacin、Azithromycin、DoxycyclineEtc.
Oral alpha blockers (e.gTamsulosin Hydrochloride 、Doxazosin）6~12 weeks, improve pain or urination symptoms.In the treatment, attention should be paid to the adverse reactions such as vertigo and postural hypotension caused by such drugs.
Non steroidal anti-inflammatory drugs (e.gCelecoxib）It is used empirically to help improve pain or discomfort.
M receptor blocker can be used for patients with overactive bladder and no urinary tract obstructionTolterodineorSolinacineTreatment, improve urination symptoms.
Type III: chronic prostatitis/chronic pelvic pain syndrome
Plant medicine (such as Sabal serrulata fruit extract) can improve pain and urination symptoms for 6-12 weeks.
Patients with overactive bladder and no urinary tract obstruction can be treated with M receptor blocker tolterodine or sorinaxin to improve urination symptoms.
Depression, anxiety, chronic fatigue syndrome and other neurological symptoms can be treated with antidepressants (such asfluoxetineEtc.), anti anxiety drugs (such asdiazepam And so on).
In addition, after further classification of type III prostatitis, the treatment plans are different.
Type IIIA: refers to inflammatory chronic pelvic pain syndrome, and the number of microscopic white blood cells in urine after prostate fluid/semen/prostate massage increases.Experiential oral use of fluoroquinolones and other antibacterial drugs can be conducted for 2-4 weeks. If the symptoms are alleviated, they can continue to be used. The total course of treatment is 4-6 weeks.If the whole course of treatment still fails, unless the patient does have urinary tract infection, the patient should not be treated with antibiotics again.
Type IIIB: Antibacterial treatment is not recommended.
Type IV: asymptomatic prostatitis
Generally, no treatment is needed.
If infertility is complicated or serum prostate specific antigen (PSA) is elevated, the treatment method of type III prostatitis can be referred to.
surgical treatment
Acute bacterial prostatitis
Acute bacterial prostatitis complicated with abscess should be cut and drained through rectum or urethra if conservative treatment fails;If the abscess is confined to the prostate, urethroscopy can be used for prostate puncture and drainage, and then broad-spectrum antibiotics can be injected.
Incision and drainage
Transrectal incision and drainage of the prostate is applicable to abscesses around the posterior lobe. Under the rectal mucosa, incision and drainage are conducted at the place with obvious fluctuations during digital examination, and pus flows out from the anus.
The operation is simple and convenient, with little damage, complete drainage, and no need to change dressing after operation. However, in very few cases, careless operation may lead to urinary fistula.
Puncture and drainage of prostate
Transrectal or perineal puncture of prostate tissue to absorb pus can not only extract tissue for cytological examination, but also discharge pus, and can inject local drugs to prostate tissue.
chronic prostatitis
Chronic prostatitis itself does not need surgery, and surgical treatment is limited to chronic prostatitis with other prostate diseases and surgical indications, such as with benign prostatic hyperplasia.
Common surgical methods include transurethral resection of prostate.
Transurethral resection of prostate
The purpose of the operation is to remove hyperplastic prostate tissue.It is suitable for patients with benign prostatic hyperplasia with operation indications, and has a good effect on improving the symptoms of benign prostatic hyperplasia.
This operation is not recommended for the treatment of prostatitis only.
TCM treatment
The TCM treatment of the disease is not supported by evidence-based medical evidence, but some TCM treatment methods or drugs can alleviate symptoms, so it is recommended to go to regular medical institutions and treat under the guidance of doctors.
In addition to oral medication, commonly used external treatment includes suppository anal tamponade, traditional Chinese medicine hip bath, traditional Chinese medicine external applicationretention enema 、acupunctureEtc.
It can promote prostate blood circulation, gland emptying and drainage, and increase local drug concentration. Therefore, it is recommended as an adjuvant therapy for chronic prostatitis, which can effectively shorten the course of disease in combination with other treatments.
For patients who cannot tolerate prostate massage, regular ejaculation can also achieve the same effect.
It is forbidden for patients with acute bacterial prostatitis.
Physical hyperthermia
The thermal effect produced by microwave, radio frequency, laser and other physical means is mainly used to accelerate the blood circulation of prostate tissue, promote metabolism, help diminish inflammation, eliminate tissue edema, and alleviate pelvic floor muscle spasm.
It can alleviate symptoms in the short term, but the long-term effect is not clear.
It is not recommended for unmarried and childless people.
Biofeedback and electrical stimulation therapy
Perineal muscle training, bladder function training and other methods can improve and coordinate the functional status of local muscles and organs, have a synergistic effect on chronic prostatitis, can significantly improve pain and discomfort symptoms, and improve the quality of life.
psychotherapy
Psychological intervention can improve patients' pain symptoms and quality of life.
Targeted psychotherapy is recommended for chronic prostatitis patients with obvious psychological distress.
prognosis
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The prognosis of different types of prostatitis is different, but most patients have good prognosis after timely and effective treatment.
Curative
The prognosis of acute/chronic bacterial prostatitis is good. Most patients can be cured after timely treatment, and few patients complicated with prostatic abscess can be cured after incision and drainage.
If the treatment of acute bacterial prostatitis is not thorough, it can be converted to chronic prostatitis.
Chronic prostatitis (chronic pelvic pain syndrome) itself can also be cured, but some patients' symptoms can recur, which is closely related to the patients' lifestyle and work habits. Some patients themselves have depression or anxiety, and local pain is secondary.These reasons make it difficult for some patients to "cure" their symptoms. For these patients, general treatment and psychotherapy are more important than medication.
Patients will suddenly have symptoms related to bladder filling and swelling due to inability to urinate.This is because acute prostatitis causes local congestion and swelling, which can lead to dysuria after pressing the urethra, and even acute urinary retention in severe cases.
The acute inflammation of the prostate is easy to spread to the seminal vesicle, causing acute seminal vesiculitis, often accompanied by perineum pain and blood sperm.At the same time, bacteria can enter the wall layer and outer sheath of vas deferens retrogradely through lymphatic vessels, leading to vasculitis or epididymitis, which is characterized by redness, swelling, hard nodules and tenderness in the epididymis.
Prostatitis hyperemia and edema may affect the patient's sexual function, which is manifested as decreased libido, erectile dysfunction, painful erection of penis, sexual intercourse pain, ejaculatory pain, blood sperm, etc.
chronic prostatitis
Chronic seminal vesiculitis
Chronic seminal vesiculitis is the most common complication of chronic prostatitis.
Chronic inflammatory changes caused by infection of seminal vesicles.
The seminal vesicle is anatomically related to the prostateVas deferens, urethra and bladder are close to each other and communicate with each other, so seminal vesiculitis is often secondary to urethro genital system infection.
Both often exist at the same time and affect each other, which can lead to sexual dysfunction.
Prostatitis can affect sexual function.On the other hand, in patients with chronic prostatitis, their mental and psychological factors may affect the life of couples, leading to erectile problems.
Inflammation of the male reproductive system, including the prostate, may lead to infertility.Patients with chronic prostatitis (chronic pelvic pain syndrome) may have a temporary decrease in semen quality, but there is no evidence that it will cause long-term infertility.
Posterior urethritis
Chronic prostatitis is often associated with posterior urethritis. This is because the urethra will pass through the prostate. When there is prostatitis, especially prostatitis caused by urinary system infection, it will also invade the urethra of the prostate, leading to urethritis.
Epididymitis
Prostatitis and seminal vesiculitis coexist. Inflammation can invade the epididymis and cause chronic epididymitis.
Various types of cystitis
Inflammation of the prostate can spread to the bladder, and then lead to various types of cystitis. When prostatitis occurs, there are obvious symptoms of urinary irritation, mostly caused by various types of concurrent cystitis.
Daily health care
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Adhere to treatment. During the treatment, do not change the dressing or change the treatment method at random, because it often takes a period of time to relieve symptoms. The early treatment should last more than 2 weeks, and some infections take 8 to 12 weeks.It is easy to change the dressingDysbacteriosisOr drug resistance, leading to incomplete treatment.
lawsex life, can not bear the essence, do not masturbate frequently, and avoid unclean sexual intercourse.
Correctly understand prostatitis, maintain a good attitude, and reducePsychological pressureTo avoid exaggerating symptoms and causingdizzy、Memory decline, anxiety, paranoia, insomnia and other symptoms.
Drink more water, urinate frequently and keepSmooth stool, stick to hot water sitz bath orhot-water bagHot compress the perineum.
Avoid smoking and drinking, and do not eat spicy and stimulating food.
Avoid sitting for a long time, avoid cycling for a long time, and stick to exercise. It is better to jog and do more lower body exercises to avoidStrenuous exercise。
