prostatitis
Introduction
Introduction to prostatitis Prostatitis refers to systemic or local symptoms caused by acute and chronic inflammation caused by prostate specific and non-specific infections. Prostatitis can be divided into non-specific bacterial prostatitis, idiopathic bacterial prostatitis (also known as prostate disease), specific prostatitis (caused by Neisseria gonorrhoeae, tuberculosis, fungi, parasites, etc.), non-specific granuloma Prostatitis, other pathogens (such as viruses, mycoplasma, chlamydia, etc.) caused by prostatitis, prostate congestion and prostate pain. basic knowledge The proportion of illness: 0.01%-0.03% (probability of disease over 50 years old 0.5%-1%) Susceptible people: male Mode of infection: non-infectious Complications: seminal vesiculitis epididymitis orchitis libido premature ejaculation
Cause
Causes of prostatitis
Infection factor (30%):
In bacterial prostatitis, pathogenic microorganisms are similar to pathogenic bacteria causing genitourinary tract infections. Common pathogenic bacteria are Escherichia coli (E. coli), and a few are Proteus, Klebsiella, Enterococcus, etc. Gram-positive bacteria have few chances of infection. Absolute anaerobic bacteria rarely cause prostate infection. The role of Gram-positive bacteria in etiology is still controversial. Most researchers agree that enterococci cause chronic prostatitis, but other leathers Blue-positive bacteria such as Staphylococcus, Streptococcus, Artococcus, and diphtheria have a pathogenic effect on prostatitis.
Chemical factors (10%):
The causes and pathogens of non-bacterial prostatitis are still unclear. Pathogenic bacteria may be pathogenic microorganisms that cannot be determined. In recent years, clinical studies have found that chlamydia and mycoplasma may be the main pathogens of chronic prostatitis, or it is not Infectious diseases, it is speculated that it may be caused by the backflow of urine into the prostate causing "chemical" prostatitis.
Immunity factor (15%):
Immunological studies on prostatitis can be traced back to the initial study of immunoglobulins in prostatic fluid, the discovery of antibody-coated bacteria, and the presence of anti-prostate antibodies. The recent application of animal models to successfully model prostatitis is an autoimmune response. Encouragingly, the study found that bacterial products provide initial antigenic stimulation during the onset of prostatitis, causing subsequent immune responses.
Other relevant factors (20%):
Previous studies have found that sex hormone nutrition, past urinary tract infection history, stress level, mental factors, allergies and sexual life, etc., are all potential factors for prostatitis. In the following related factors, European and American studies There are many studies, but there is still no systematic research in China.
(1) Causes of the disease
The causes of prostatitis are diverse. Different prostatitis types have different causes. Infectious factors are dominant in the pathogenesis of bacterial prostatitis. In the pathogenesis of non-bacterial prostate and prostate pain, the infection factor may be an induced or Initial factors, not infectious factors, may predominate.
The factors that may play a role in the pathogenesis of prostatitis are as follows:
Infection factor
(1) Bacteria: Many scholars still hold questions. Recently, some researchers believe that Gram-positive bacteria rarely cause obvious prostatitis except for Enterococcus. In China, Staphylococcus aureus is still common in patients with prostatic fluid culture. Bacteria, whether they are different from foreign countries, are still contaminated by urethra. It needs to be further clarified that most prostate infections are caused by single-consistent bacteria, but those caused by two or more strains or types of bacteria also occur. .
Bacterial prostatitis may be caused by retrograde or reflux infection of urine after bacterial infection. Infected urine can be invaded through the prostate duct opening in the posterior urethra. It is common for urine to flow into the prostate, and it must be caused by bacterial prostatitis. The original aspect plays an important role. Some researchers have analyzed the crystalline morphology of prostatic stones and found that many components in the stone do not appear in normal prostatic fluid but only in the urine.
Others may include the spread of bacteria in the rectum through direct or lymphatic spread and blood-borne infections.
Some researchers have found that some patients with chronic bacterial prostatitis have the same pathogens as the vaginal secretions of their female sexual partners. This suggests that bacterial prostatitis may be retrograde through the external urethra during sexual intercourse. As a result of infection, patients with Neisseria gonorrhoeae (N. gonorrhoeae) or non-gonococcal urethritis combined with Neisseria gonorrhoeae prostatitis are sexual contact diseases, and anorectal contraception without condom protection may cause urethritis due to intestinal bacterial infection. Genitourinary tract infections or epididymitis can also cause bacterial prostatitis.
Many bacterial prostatitis are the result of transurethral catheterization of the urinary tract and urinary tract infection.
The route of infection for non-bacterial prostatitis and bacterial prostatitis may be:
1 ascending urinary tract infection;
2 rows of infection of the posterior urethra to the prostate tube;
3 rectal bacteria directly spread or spread through the lymphatic vessels into the prostate;
4 blood-borne infections.
(2) Mycoplasma and Chlamydia: Chronic non-bacterial prostatitis is an unexplained inflammatory lesion. It has been shown that non-bacterial prostatitis is 8 times more than bacterial prostatitis. Some people think that it is decomposed into ureaplasma (ureaplasmas). Urealyticum and Chlamydia trachomatis may be the causative factors of non-bacterial prostatitis, but the evidence is still insufficient.
Many scholars believe that the decomposition of urea urinary tract may be the cause of this prostatitis, or it may be a saprophytes, whether Chlamydia trachomatis is a causative factor of prostatitis, there is still controversy, 40% of men are non-gonococcal Both urethritis and most acute epididymitis under the age of 35 are caused by Chlamydia trachomatis infection, and about 1/3 of patients with non-bacterial prostatitis have urethritis. Therefore, it may be the cause of non-bacterial prostatitis, but many Studies have proven that even if there are, it is not an important factor.
(3) Fungi and parasites: Fungal infections caused by prostate are mainly found in AIDS patients. The patient's resistance is severely damaged, and fungal prostatitis occurs. Parasites causing prostatitis mainly include Trichomonas vaginalis and Schistosomiasis.
2. Chemical factors
In recent years, studies have found that patients with chronic prostatitis have urinary reflux in the prostate, which may be important for the occurrence of various types of prostatitis. In addition, many adult males have found the presence of stones in the prostate through B-ultrasound examination, but It can not be detected on the X-ray, and the analysis of the stone component is found to be a component in the urine rather than a component in the prostatic fluid. Therefore, it is speculated that the formation of the prostate stone is related to the reflux of the urine, and the stone after the infection can exist in the gland for a long time. As the infection lesion is not easy to eliminate, some people have studied to inject the carbon powder solution into the bladder of the patient before the prostatectomy, and later found the gland in the gland and the catheter in the prostate specimen; the non-bacterial prostatitis patient first injected the carbon powder into the bladder. Solution, 3 days later, after prostate massage, there are many macrophages in the prostatic fluid containing carbon particles; non-bacterial prostatitis and prostate pain patients undergoing urinary bladder urethra angiography, found that urine reflux is very serious, prostate and ejaculation The development is visible in the tube, so the chemical factor caused by the reflux of urine in the prostate may be non-bacterial. Prostatitis important cause of morbidity.
Studies have shown that urine reflux into the prostate is an important factor, affecting the metabolism of pyrimidine and purine, increasing the concentration of uric acid and causing prostatitis, the incidence of non-bacterial prostate and uric acid levels in prostate secretion, according to the above theory, use Sterols have a therapeutic effect on non-bacterial prostatitis, but some studies have concluded that contrary to the above results.
3. Immunity factors
(1) Immunoglobulin-coated bacteria: In 1979, Thomas published an article stating that by detecting antibodies coated in urine, pyelonephritis can be distinguished from cystitis, 35 patients with pyelonephritis In 34 cases, antibody-coated bacteria were detected, and in 20 patients with cystitis, only one antibody-coated bacteria was detected. This method can distinguish upper urinary tract from lower urinary tract infection, and subsequent research 14 In the normal population and 51 cases of prostatitis patients, 25 cases of prostate patients were found to be able to detect antibody-coated bacteria. In 25 cases, 24 cases found IgA antibodies, and 10 cases found IgG antibodies, which were not found in the semen of normal people. The antibody is coated with bacteria.
Bacterial-specific antibodies in plasma: A later study was conducted to evaluate the titer of anti-Escherichia coli (E. coli) antibodies in plasma of patients with prostatitis, and Meares et al. studied the plasma of prostatitis patients caused by 25 cases of Escherichia coli (E. coli). The titer of agglutinated antibodies was significantly higher than that of the control group. In this study, the dilution titer of the control group was determined to be non-responsive. Subsequent studies found that in patients with prostatitis, the antibody titers gradually decreased. To normal, and those treatments did not heal, the antibody titer gradually decreased to normal, and those who did not heal, the antibody titer remained high.
(2) Immunoglobulins in prostatic fluid: Many research groups have studied immunoglobulins in prostate secretions. The initial study began in 1963, and Chodirker and Tomasi first confirmed and qualitatively determined IgG and IgA in normal human prostatic fluid. Subsequent researchers have used different techniques to demonstrate the presence of systemic and local immune responses in bacterial prostatitis.
Shortliffe et al. used solid-phase radioimmunoassay (RIA) to study the immune response in human acute and chronic prostatitis. They found a clear local antibody response in prostatic fluid, mainly secretory IgA, which is independent of plasma reaction. And is specific for the antigen of the infectious agent. In the early stage of acute prostate infection, the antigen-specific IgG is elevated in the plasma and prostatic fluid, and gradually decreases after drug treatment for 6 to 12 months. The antigen-specific IgA in the prostatic fluid. The level rises immediately after infection and decreases slowly after 12 months of treatment; however, elevated plasma IgA levels in the early stages of infection decrease only 1 month, in chronic bacterial prostatitis, despite antigen in prostatic fluid Specific IgA and IgG were elevated, but there was no positive immunoglobulin in plasma. After treatment with chronic bacterial prostatitis, IgA in prostatic fluid increased for 1 year, while IgG lasted for 6 months without cure. In patients with chronic bacterial prostatitis, prostatic fluid antigen-specific IgG has been maintained at an elevated level, and determination of antigen-specific IgA and IgG levels in prostatic fluid not only helps Help diagnose prostatitis, but also helps to clear the effectiveness of treatment.
The increase in total immunoglobulin is clarified, and the next step is to study changes in bacterial specific antibodies.
Early studies used bacterial profiles to find elevated levels of bacterial-specific antibodies in prostatic fluid. The study found that immunoglobulins (including IgA and IgG) in the prostatic fluid of patients with non-bacterial prostatitis were moderately elevated but could not be detected. Bacterial specific antibodies.
In order to determine the true specificity of antibacterial immunoglobulins, studies have examined the specificity of antibodies using the patient's own infectious bacteria. The researchers identified bacterial immunoglobulins by detecting secretory immunoglobulins, including detection of mid-stage urine and prostate. The immunoglobulin in the urine after massage included 14 cases of bacterial prostatitis, 8 cases of non-bacterial prostatitis, and 11 cases of uninfected population. In all groups, IgA and IgG increased after prostate massage. However, after detecting specific antibacterial immunoglobulins, it was found that in normal people and non-bacterial prostatitis patients, the immunoglobulin is mainly elevated in IgG, and in patients with bacterial prostatitis, the immunoglobulin includes Both IgA and IgG were significantly elevated.
Immunoglobulin histological localization: There is a localization study on the immunoglobulin in the prostate between the normal control group and benign prostatic hypertrophy. The study found that IgG is mainly in the cytoplasmic basal part of the glandular cells and the ductal lumen In the secretory granules, IgA was only found in the differentiated granules of the lumen, and later the immunoglobulin in prostatitis was studied. Unlike the previous studies, only one of the 21 normal controls detected immunoglobulin, 57%. In patients with prostatitis, immunoglobulin is detected in prostate tissue. IgM is the main immunoglobulin, accounting for 85%. The main deposition sites are around the glandular cells, blood vessel walls and gland cells, which are reduced in turn, and can be detected in 35% of patients. IgA, and 44% of patients detected C4, and they failed to detect IgG.
(3) Other characteristics of altered immune status: Prostatic infection is considered to be a fatal factor in male infertility. Huleihel M et al. recently studied cytokines and cytokines in seminal plasma of infertile men with reproductive male and reproductive lineage history. At the level of receptors, the study detects levels of IL-1, IL-6, INF- and its receptors in semen, which are produced by macrophage responses to foreign antigens as a result of activation of immunoglobulins. In the chronic inflammatory response, these immune responses can be controlled by soluble cytokine receptors (including TNF receptors and IL-2 receptor antagonists), and the authors did not detect changes in IL-1, IL-6 and TNF levels, However, when TNF-1 receptor and IL-1 receptor antagonist were detected, it was found that the incidence of TNF-1 receptor was decreased in patients with a history of infection, while the concentration of IL-1 receptor antagonist was significantly increased. Soluble TNF-1 Receptors tend to rise in the immune response, which can be considered prostatitis is an altered immune response process, other studies have found that IL-8 is significantly elevated in the semen and prostatic fluid of patients with oligozoospermia.
(4) Autoimmune response: The discovery of anti-prostate antigen antibodies may be considered as evidence that non-bacterial prostatitis is an autoimmune disease. Studies have found that there is a prostate in prostate tissue of BPH patients. Specific antigen (PSA) antibody.
(5) Animal model: In 1984, Pacheco-Rupil confirmed that during the development of prostatitis, T lymphocytes were obtained by reinjecting the spleen cells of rats that had been immunized with prostate extract 30 days before Winstar rats. Required, subsequent studies confirmed that prostatitis was not initiated by antibody immunization against prostate extracts. Using the same model, it was found that during the inflammatory response, mast cell activation and degranulation were present in Winstar rats. In spontaneous prostatitis, prostate nerve fiber density, mast cell density and inflammatory response increase with age, and the degranulation of nerve fibers adjacent to mast cells is particularly obvious, and when mast cells are away from nerve fibers, this phenomenon This phenomenon does not occur, suggesting a process of neuroimmunomodulation.
PSA is a tissue-specific antigen. The interaction between tissue-specific antigens and thymus T lymphocytes is mainly due to the absence or non-response of related clones. Using this concept, Tagneli et al., at birth, survived for 3 days after birth. Survival for 7 days after birth, excision of mouse thymus, only those rats that were removed from the thymus 3 days after birth developed prostatitis, and these corresponding mice produced anti-prostate IgG antibodies, so the initial immune process was by T lymph Cell-mediated, and followed by antibody production, further studies found that these 3 days after birth, mice were returned to normal adult mouse CD4 + T spleen cells, can prevent the occurrence of prostatitis, but spleen cells of adolescent male rats No such effect.
(6) Effect of immune factors on treatment: Using animal models that form an autoimmune response, steroid technology and androgens can be successfully used in a model of recurrent prostatitis (Lewis rats) to reduce the extent of inflammatory reactions.
Since the role of granules and histamine release of mast cells in the pathogenesis of prostatitis has been noted, a small amount of hydrosysin can be used in the treatment.
4. Other factors:
(1) Age: Many studies have found that the incidence of prostatitis is higher in young men than in older men. Recently, it has been found that prostatitis can be seen in teenagers before the age of 20, but some studies have found that older patients than young people are likely to be due to senior citizens. There is prostatic hypertrophy, the symptoms of the two are similar and were mistaken by the clinic.
(2) Race: White and black Americans had no statistically significant difference in the incidence of prostatitis.
(3) Region: A statistic in the United States from 1990 to 1994 found that the incidence of prostatitis in the southern United States is twice that of the northeast. Is it due to climatic factors or sexual activity factors? Because of the definition and treatment of prostatitis In terms of inconsistency, the difference in regional morbidity cannot be satisfactorily explained.
(4) Sexual activity: Some patients with chronic prostatitis have longer sexual life intervals and fewer sexual life than the control group. More studies have shown that unclean sex is an important factor. However, there are also studies that use the Internet to make a question-based survey to find that sexual life is not a factor influencing prostatitis.
(5) Prostate biopsy: Prostate infection is a complication of prostate biopsy. A current study found that prophylaxis of antibiotics in 491 patients undergoing rectal biopsy was significantly better than 1 time for 2 times/d for 1 week. d The same course of treatment, indwelling catheter and diabetic complications are risk factors for prostate infection after prostate biopsy.
(6) prostate congestion: prostate due to various reasons for congestion, especially passive congestion, is an important pathogenic factor, non-infectious, non-microbial long-term congestion, can form a non-specific inflammatory response, congestion is common in the following Several situations:
1 sexual life is not normal, sexual life is too frequent, sexual intercourse is forced to interrupt, or excessive masturbation, can make the prostate abnormally congested, but excessive inhibition of sexual life, will also produce long-repressed excitement, causing passive congestion,
2 directly oppress the perineum, riding a bicycle, riding a horse, sitting for a long time, etc. can make the prostate congestion, especially riding a bicycle,
3 drinking, drinking can make the reproductive organs congestion and cause sexual excitement,
4 massage too heavy, prostate massage when the method is too heavy or too frequent, etc. can make the prostate congestion, can be iatrogenic congestion,
5 cold and cold, the prostate is rich in -adrenal receptors, after the cold, can cause sympathetic nerve activity, leading to increased intraurethral pressure, hindering excretion, the prostate also obstructs excretion due to contraction, resulting in stasis congestion.
(7) An allergic reaction to a virus can also cause inflammation.
(8) Factors in physical and mental health: Some people say that this factor is as high as 50%.
(two) pathogenesis
Only 5% of patients with prostatitis have evidence of bacterial infection, and some patients with no evidence of infection have leukocytosis of prostate secretion in some patients. These evidences suggest that the inflammatory response in the prostate (although no infection) is the cause of prostatitis symptoms. Other patients with prostatitis did not even have inflammatory changes. Brunner's study showed that there were inflammatory and non-inflammatory manifestations in patients with prostatitis symptoms, accounting for 64% and 31%, respectively.
Acute bacterial prostatitis: Acute bacterial prostatitis causes significant inflammation in some or all of the prostate, roughly divided into three stages:
1 hyperemia period: posterior urethra, prostatic tube and its surrounding interstitial tissue showed hyperemia, edema and round cell infiltration, there are lobular granulocytes, glandular epithelial cells have hyperplasia and desquamation,
2 vesicle period: inflammation continues to develop, prostatic tube and vesicle edema and congestion are more obvious, prostate tubules and acinar swell, forming many small abscesses,
3 The parenchymal phase: The tiny abscess gradually enlarges and invades more parenchyma and surrounding stroma. This situation is more common with staphylococcal infection.
Simple acute prostatitis without any pathological manifestations of chronic prostatitis is uncommon, accounting for only 13.1% to 20% of prostatitis, and most cases coexist with chronic prostatitis.
The pathogenic bacteria of prostatitis are mainly Escherichia coli, accounting for about 80%, followed by Proteus, Klebsiella, Enterobacter, Pseudomonas, Serratia, Gram-positive bacteria except Enterococcus. Very few diseases, in addition, Neisseria gonorrhoeae, tuberculosis, fungi, trichomoniasis can also lead to related prostatitis, Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis, etc., the pathogenic effect on prostatitis is still controversial, gonococcus The incidence of prostatitis has gradually increased in recent years.
Prevention
Prostatitis prevention
Nine methods for personal maintenance of prostate patients:
1. Drink more water, drink more water will urinate more, high concentration of urine will produce some stimulation of the prostate, long-term bad stimulation is harmful to the prostate, more drinking water can not only dilute the blood, but also effectively dilute the concentration of urine.
2. Do not urinate. Once the bladder is full of urine, it should be urinated. It is not good for the bladder and prostate. Before taking the long-distance bus, you should empty the urination and then take the bus. If you are urinating on the way, you should greet the driver. Car urination, do not be hard.
3. Moderate life, prevention of prostatic hypertrophy, need to start from the young and middle-aged, the key is to have a moderate sexual life, do not want to abstain from sex, frequent sexual life will make the prostate long-term congestion, and even cause prostate enlargement, so especially It is necessary to pay attention to the restraint life in the youthful period of sexual desire, avoid the repeated congestion of the prostate, and give the prostate full recovery and dressing time. Of course, excessive abstinence will cause discomfort and discomfort, which is also unfavorable to the prostate.
4. More relaxation, life stress may increase the chance of prostate enlargement. Clinically, when the pressure of life slows down, the symptoms of the prostate will be relieved, so you should try to stay relaxed as usual.
5. Washing the warm bath, washing the warm bath can relieve the tension between the muscles and the prostate, slow down the symptoms of discomfort, and often wash the warm bath is undoubtedly very beneficial for patients with prostate disease. If you use the warm water to bathe the perineal 1-2 times a day, you can also receive Good results.
6. Keep clean, male scrotum is more flexible, more sweat secretion, plus poor vaginal ventilation, easy to hide dirt, local bacteria often take advantage of the virtual, which will lead to prostatitis, prostatic hypertrophy, sexual function decline, if If you do not pay attention in time, serious infections will occur. Therefore, adhering to the perineum is an important part of preventing prostatitis. In addition, it is necessary to wash the external genitalia every time in the same room.
7. Prevent cold, do not sit on the cool stone for a long time, because the cold can make the sympathetic nerves increase, causing the urethral pressure to increase and causing reflux.
8. Avoid friction, the perineal friction will aggravate the condition of the prostate, and make the patient obviously uncomfortable. In order to prevent local harmful friction, you should ride less bicycles, and you should not ride bicycles or motorcycles for long or long distances.
9. Adjust life, try not to drink alcohol, eat less pepper, ginger and other spicy and irritating foods, to avoid repeated congestion of the prostate and bladder neck, aggravating the feeling of local pain, because the constipation may aggravate the prostate bulge Symptoms, so usually eat more fruits and vegetables, reduce the occurrence of constipation, if necessary, use Ma Ren Pills to ease bowel movements to help discharge stool.
How to maintain the prostate in daily life:
The prostate is the largest accessory gonad in the male reproductive organs. The prostatic fluid secreted by it is an important part of semen. The prostate is also sick like other organs in the body. The most common is chronic prostatitis. Clinical findings, 25 % to 50% of men have suffered from this disease. To protect the prostate, men must pay attention to the following problems:
Check if the foreskin is too long. If you are too long, you should do circumcision as soon as possible to prevent bacteria from hiding and retrograde into the prostate through the urethra.
Remove chronically infected lesions from other parts of the body in time to prevent bacteria from entering the prostate from the blood.
Establish a correct concept of sexuality, avoid excessive frequency of sexual life, and release energy by exercise to prevent the prostate from being over-frequency due to sexual life.
Develop a habit of urinating in time, because urine can cause urine to flow back into the prostate.
Sit and ride a bicycle for a long time to avoid poor blood flow to the prostate.
Strengthen the character cultivation, talk more about the heart, make friends, be open-minded, and be optimistic.
Develop good habits, no smoking, and less alcohol.
In addition, there is a song of "eight more than eight less". You may wish to learn from: less smoke and more tea, less alcohol and more water, less sugar and more fruits, less meat and more vegetables, less salt and more vinegar, less anger and more laughter, less medicine and more practice. , less cars and more steps.
Patients with prostatitis should pay attention to:
First, regular sexual life.
Second, avoid alcohol and eat a lot of spicy food.
Third, do not sit or ride for a long time.
Fourth, pay attention to local warmth.
Fifth, enhance the body's immunity and disease resistance.
6. Do not abuse antibiotics.
7. Avoid unnecessary medical examinations and operations.
Eight, cultivate a good way to cope.
9. Popularize knowledge about prostate diseases.
Ten, preventive measures for patients after prostatitis cure.
XI, to establish confidence in the fight against disease, chronic prostatitis is not an incurable disease, but the course of disease is prone to recurrence, but as long as comprehensive treatment can still be cured.
12. Pay attention to daily life and develop good habits; prevent excessive fatigue and prevent colds; stop smoking, avoid spicy and stimulating diet; ride bicycles less, do not sit in wet places; Do not abstain from sex.
Thirteen, develop their own hobbies, conduct appropriate physical exercise to transfer the psychological burden of chronic prostatitis, eliminate anxiety and prevent mental symptoms.
Complication
Prostatitis complications Complications, seminal vesiculitis, epididymitis, testicular inflammation, libido, premature ejaculation
1. The complications caused by acute prostatitis are mainly as follows
(1) Acute urinary retention: Acute prostatitis causes local congestion, swelling, and compression of the urethra, resulting in difficulty in urinating or causing acute urinary retention.
(2) acute seminal vesiculitis or epididymitis and vas deferens: acute inflammation of the prostate easily spread to the seminal vesicle, causing acute seminal vesiculitis, while the bacteria can retrograde through the lymphatics into the wall and sheath of the vas deferens leading to epididymitis.
(3) The lymph nodes of the spermatic cord are swollen or tender: the prostate and the spermatic cord have traffic branches in the pelvis, and the acute inflammation of the prostate affects the spermatic cord, causing the lymph nodes of the spermatic cord to be swollen and accompanied by tenderness.
(4) Sexual dysfunction: acute inflammatory phase of prostate congestion, edema or small abscess formation, may have ejaculation pain, painful erection, loss of libido, sexual pain, impotence, blood essence and so on.
(5) Others: Acute coronitis may be accompanied by renal colic.
The above symptoms are not present in all cases, and some early fever, urinary tract burning, mistaken for a cold, acute bacterial prostatitis can also be complicated by orchitis, seminal vesiculitis and vas deferens.
2. Complications of chronic prostatitis include
(1) Effects on sexual function and fertility: mainly manifested as sexual dysfunction, such as short room time or premature ejaculation, may be related to inflammatory stimulation of the prostate, the relationship between impotence and prostatitis is not certain, chronic prostatitis is not Directly impairing the neuro-vascular function of the penile erection, long-term discomfort creates pressure on the patient's mind, causing them to suppress and worry, especially for patients who do not understand the disease, they often think that their sexual function is problematic, and may cause mentality over time. Sexual impotence, prostatitis complicated with seminal vesiculitis can occur.
The main component of semen is prostatic fluid, and the sperm excreted from the testis and epididymis must be preserved by seminal plasma including prostatic fluid. It has the ability to bind to the egg. The semen routine of patients with chronic prostatitis often shows the vitality of sperm. Lower, the mortality rate is higher, the incidence of infertility in patients with prostatitis is significantly higher than the normal population.
(2) The impact on the whole body: In addition to the symptoms of local urinary system, chronic prostatitis can also be manifested as allergic iritis, arthritis, endocarditis, myositis and so on.
Patients with chronic prostatitis often show obvious mental symptoms. Patients are emotionally stressed and have high mental stress. In the long run, they can cause general malaise, insomnia, multiple dreams, fatigue, suspicion and anxiety. These patients often pay too much attention to their health. And many aspects of finding evidence to prove that no matter how patiently patiently explain, it is difficult to change their suspected psychology. Although patients are often skeptical about the interpretation and treatment of physicians, the psychological treatment is quite urgent, prostatitis and spirit. The relationship between symptoms is still unclear. Why does mental stress lead to prostatitis? How does prostatitis produce neuropsychiatric symptoms? It is worthy of further study. The neurological symptoms are directly related to the individual's personality characteristics, so different individuals with chronic prostatitis The degree of manifestation of mental symptoms can vary widely.
Symptom
Prostatitis symptoms Common symptoms Urinary dysfunction urination pain urinary urinary urgency Urinary urinary frequency Male abdominal pain Male abdominal pain White urine pain
1. Acute bacterial prostatitis: sudden onset, chills and high fever, frequent urination, urgency, dysuria, dysuria or acute urinary retention, clinically often associated with acute cystitis, prostate swelling, tenderness, local temperature rise High, smooth surface, forming a abscess is full or fluctuating.
2. Chronic bacterial prostatitis: frequent urination, urgency, dysuria, urinary tract discomfort or burning when urinating, often after the urination and after the white secretions from the urethra, sometimes there may be blood, perineal pain, sex Dysfunction, mental and neurological symptoms, the prostate is full, enlarged, soft, mild tenderness, the disease is long, the prostate is shrinking, hardening, the surface is incomplete, there is a small induration.
3. Chronic non-bacterial prostatitis and prostate pain: clinical manifestations similar to chronic bacterial prostatitis, but no history of repeated urinary tract infections, mainly urinary tract irritation, dysuria symptoms, especially the performance of chronic pelvic pain syndrome, some Mycoplasma, chlamydia can be cultured in the prostatic fluid of some patients.
Examine
Prostatitis check
Commonly used prostatitis check:
1. Rectal examination of the prostate is full, enlarged, soft texture, mild tenderness, long-term disease, the prostate will become smaller, harder, uneven texture, small induration, while using prostate massage to obtain Prostatic fluid, do a routine check.
2. Prostatic fluid examination The white blood cells in the prostatic fluid are more than 10 in the microscope high-power field, and the lecithin body is reduced, which can be diagnosed as prostatitis. If the bacteria culture is also carried out at the same time, the diagnosis and classification of chronic prostatitis can be made, such as prostate. The positive result of bacterial culture of inflammatory liquid is to diagnose chronic bacterial prostatitis; otherwise, it is chronic non-bacterial prostatitis.
3. B-ultrasound shows that the structure of the prostate tissue is unclear and disordered, which may indicate prostatitis.
4. Urodynamic examination: The main manifestations are decreased urine flow rate, bladder neck-urethral external muscles incomplete relaxation, and maximum urethral closure pressure abnormally increased.
In addition to clinical manifestations, rectal examination can touch swelling, full prostate, tenderness is obvious, when there is abscess formation, bilateral gland leaves are asymmetrical, there may be local fluctuations, acute prostate avoidance prostate massage, prevent infection to epididymis, testicular spread , or bacteria enter the blood to cause bacteremia, urethral secretions can be smear microscopy and bacterial culture, urine microscopic examination is more common red blood cells or piles of pus cells, the first cup of urine in the three cups test micro-mix, mirror The white blood cells were detected, the second cup of urine was clear, there was no white blood cells, the third cup of urine was turbid, and there were a lot of white blood cells and pus cells.
Auxiliary examination of acute prostatitis:
For patients with the above symptoms, it is necessary to make a digital rectal examination, which can touch the prostate enlargement, the surface is smooth, the tension is large, and there is obvious tenderness. The acute prostatitis can only be used for the examination of the prostate. Do not perform prostate massage to prevent the spread of inflammation. Urine examination can be seen in pus cells, red blood cells, B-ultrasound is also helpful for diagnosis.
Auxiliary examination of chronic prostatitis:
For one or more of the above symptoms, the rectal examination touches the prostate massage, and the urine and prostatic fluid are segmented and positioned for the diagnosis of chronic prostatitis, and also has certain value. The pH of the prostatic fluid increases during chronic prostatitis. The reduction in zinc content is also helpful for diagnosis.
Diagnosis
Prostatitis diagnosis and identification
diagnosis
Acute bacterial prostatitis is easy to make diagnosis because of its clinical manifestations and typical; the clinical features of chronic prostatitis syndrome vary greatly, and it is not clear. Many symptoms, signs and pathological examinations in chronic bacterial prostatitis, non- Bacterial prostatitis and prostate pain are often indistinguishable. Radiology and urethroscopic cystoscopy may be helpful for diagnosis, but it is not certain for diagnosis. Prostate histology is only found in some rare types of prostatitis, such as granuloma. Prostatitis is only needed. The histological changes in chronic bacterial prostatitis are not specific for determining the cause of inflammation as a bacterial cause. One group of 162 consecutive cases of benign prostatic hyperplasia were surgically removed, and the incidence of prostatitis was found to be 98%. Six kinds of clear were observed. Inflammatory morphological type, but there is no significant difference between positive and negative culture of prostate bacterial infection. In most cases, the inflammatory reaction is focal, involving only a small part of the whole prostate. Therefore, prostate biopsy has little guiding significance in the treatment of prostatitis. Prostate biopsy specimen tissue culture is very valuable for the diagnosis of chronic prostatitis .
Differential diagnosis
1. Differential diagnosis of acute bacterial prostatitis
(1) acute pyelonephritis: also manifested as acute chills, fever, frequent urination, urgency and dysuria, usually also manifested as side acid, low back pain; not pubic, perineal pain, and no dysuria, rectum There was no prostate tenderness and the prostate fluid was normal.
(2) pus and kidney: also manifested as acute chills, fever, frequent urination, urgency and dysuria, but also manifested as obvious side-lying low back pain; and shameless bone, perineal pain, no dysuria, rectal examination No prostate tenderness, normal prostate fluid examination.
(3) prostate abscess: also manifested as acute chills, fever. Frequent urination, urgency and dysuria, is the result of the development of acute prostatitis, through the rectal B-ultrasound, CT examination can be seen in the prostate with liquid occupying, puncture Taking out the pus can confirm the diagnosis.
2. Differential diagnosis of chronic bacterial prostatitis
(1) Prostate cancer: late also manifested as urination discomfort, may have frequent urination, urgency, difficulty urinating, rectal examination found that the prostate texture is hard, may have nodules; serum PSA is significantly elevated, visible rectal B ultrasound in the prostate There are heterogeneous light groups, prostate biopsy can confirm the diagnosis.
(2) Prostatic tuberculosis: also manifested as frequent urination, urgency, dysuria with urethral drip, abdominal pain and perineal pain, usually have a history of genitourinary tuberculosis, rectal examination can be found in the prostate with irregular nodules, prostate Acid-fast bacilli can be found in the liquid.
(3) Chronic aseptic prostatitis: also manifested as urinary frequency with urethral drip, with lower abdomen and perineal pain, both of which are mainly identified by bacterial culture of VB1, EPS, VB3, VB1, EPS of aseptic prostatitis The bacterial culture of VB3 was negative.
(4) benign prostatic hyperplasia: also manifested as urinary frequency with poor urination, mostly in older men, mainly due to poor urination, rectal examination revealed a significant increase in prostate, and prostate fluid is generally no white blood cells.
(5) seminal vesiculitis: also manifested as frequent urination, urgency, dysuria with urethral drip, pain in the lower abdomen and perineum, often blood, and the red blood cells and white blood cells can be seen in the seminal fluid examination.
(6) Chronic cystitis: also manifested as frequent urination, urgency, dysuria accompanied by lower abdomen and perineal pain, VBl, VB3 can be seen white blood cells, cultured bacteria growth, but EPS examination is normal.
3. Differential diagnosis of aseptic prostatitis
(1) Chronic bacterial prostatitis: also manifested as frequent urination, urgency, dysuria with urethral drip, abdominal pain and perineal pain, both of which are mainly identified by bacterial culture of VB1, EPS, VB3, chronic bacterial prostate Inflammatory VB1 may or may not have bacteria, EPS usually has bacterial growth, and VB3 is positive for bacterial culture; while chronic nonbacterial prostatitis VB1, EPS, and VB3 are negative for bacterial culture.
(2) Chronic cystitis: also manifested as frequent urination, urgency, dysuria with lower abdomen and perineal pain, but chronic cystitis VB1, VB3 bacterial culture is positive, while EPS has no bacterial growth.
(3) Chronic urethritis: also showed frequent urination, urgency, dysuria, VB1 bacterial culture was positive, while VB3, EPS bacterial culture had no bacterial growth.
4. Differential diagnosis of prostate pain
Chronic bacterial prostatitis: also manifested as frequent urination, urgency, with lower abdomen and perineal pain, both mainly based on bacterial culture of VB1, EPS, VB3, chronic bacterial prostatitis with VB1 with or without bacteria, EPS There is usually bacterial growth, and the bacterial culture of VB3 is positive; while the bacterial culture of VB1, EPS, and VB3 in patients with prostate pain is negative.
