By SunnyJasrotia, 1st Aug 2012 | Follow this author | | Short URL http://nut.bz/8lgtt__d/Posted in Wikinut>Health>General Health>Diseases & Infections Prostatitis is a widespread disease. Men from 20 till 45 years are predisposed to this illness. Some elderly men suffer from it. The etiology of prostatitis is the progression of adenoma and increasing of hypostatic stagnation in the pelvic organs.
This disease is caused by bacteria, viruses, mycoplasmas, chlamydiae, trichomonads, fungi.
Such social habits can provoke prostatitis: inactive way of life, excessive heat (sauna), hyperthermia, constipation, alcohol and smoking.
Prostatitis means the prostate with pathogen infection and (or) some non-infectious factors that stimulate the emergence of the pelvic region, pain or discomfort, and voiding abnormalities, sexual dysfunction and other clinical manifestations.
Traditional classification methods
Comparison of the initial number of leukocytes in the urine, midstream urine, prostatic, prostatic massage urine specimens and bacterial culture results will be divided into prostatitis: acute bacterial prostatitis (acutebacterial prostatitis ABP), chronic bacterial prostatic inflammation (chronicbacterial prostatitis, CBP,), chronic non-bacterial prostatitis (chronicnonbacterial prostatitis, CNP), prostate pain (prostatodynia PD).
New classification
Basic and clinical research in prostatitis, the 1995 U.S. National Institutes of Health (NationalInstitutes of Health, NIH) to develop a new classification method:
?: the ABP equivalent to the traditional classification methods.
?: the equivalent of the traditional classification methods CBP, about 5% to 8% of the chronic prostatitis.
?: chronic prostatitis / chronic pelvic pain syndrome (chronicprostatitis / chronic prostatitis chronic pelvic pain syndromes, CP / CPPS), is equivalent to the traditional classification of CNP and PD is the most common type of prostatitis, accounting for about more than 90%.
EPS / semen / VB3 routine microscopic examination of the results of this type can be further divided into two kinds of subtypes of ? A (inflammatory) and III B (non-inflammatory): ? A patient's EPS / semen / VB3 in white blood cell count increased; patients with type ? B EPS / semen / VB3 in white blood cells in the normal range. ? A and ? B is about 50%.
?: asymptomatic prostatitis (the asymptomatic inflammatoryprostatitis AIP). No subjective symptoms, only about prostate examination found evidence of inflammation.
Type ? prostatitis
Pathogens as the main risk factors. As the immune system declines, the virulent bacteria or other pathogens prostate and caused a rapid and massive growth and reproduction, and more blood infection, retrograde infection through the urethra. Followed by Staphylococcus aureus, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas and other pathogens, mainly Escherichia coli, the vast majority of a single pathogen infection.
Type II chronic prostatitis
Causal factor for pathogen infection, but the body more resistant and / or weak pathogen virulence, retrograde infection, the pathogen Staphylococcus, followed by Escherichia coli, Corynebacterium and Enterococcus spp. Prostatic calculi and urine reflux may be an important reason for pathogen persistence and infection recurrence.
Type ? prostatitis
The pathogenesis is unknown, very complex etiology, there is widespread controversy: It may be caused by an initiating factor, may also be the beginning is the multi-factor, of which one or several play a key role and influence each other; it may be many difficult to identify the different diseases, but with the same or similar clinical manifestations; even these diseases have been cured, and it causes damage and pathological changes continued independent work. Most scholars believe that the major cause of pathogen infection, inflammation and abnormal pelvic floor neuromuscular activity and immune abnormalities together result.
1.Pathogens of this type in patients with routine bacteriological examination of the failure to isolate the pathogen, but may still be some of the special pathogens: anaerobes, L-Proteobacteria, nano-bacteria, Chlamydia trachomatis, Mycoplasma infection. Research has shown that up to 77% of the patients with partial prokaryotic DNA detection rate; Clinical some of the main chronic inflammation, recurrent or aggravated "aseptic prostatitis may be associated with these pathogens. Other pathogens such as parasites, fungi, viruses, trichomonas, tuberculosis mycobacteria may be the important risk factors, but the lack of reliable evidence, so far no consensus.
2. Certain factors of voiding dysfunction caused by excessive contraction of the urethral sphincter, resulting in bladder outlet obstruction and residual urine formation, resulting in urine reflux prostate, not only the pathogens into the prostate, can directly stimulate prostate induced aseptic chemical prostate inflammation, causing voiding dysfunction and pelvic region pain.
Many patients with prostatitis in a variety of urodynamic changes, such as: urine flow rate, functional urinary tract obstruction, detrusor - urethral sphincter dyssynergia. The dysfunction may be only a clinical phenomenon, its essence may be associated with various potential risk factors.
3.. Psychological factors : more than half of the patients with prostatitis prolonged unhealed psychological factors and personality traits change. Such as: anxiety, depression, hypochondria, hysteria, and even suicidal tendencies. These lines, changes in psychological factors can cause autonomic dysfunction, caused by posterior urethral neuromuscular dysfunction, resulting in pain and voiding dysfunction of the pelvic region; or cause changes in the hypothalamic - pituitary - gonadal axis affecting sexual function, and further aggravate the symptoms to eliminate mental stress can relieve symptoms or cure. But it is unclear the psychological changes is the direct cause of or secondary to performance.
4. Neuroendocrine factors prostate pain patients are often prone to heart rate and blood pressure fluctuations that may be related to the autonomic nervous response. Their pain has the characteristics of the internal organs, pain, stimulate the local pathology of the prostate, urethra, prostate afferent spinal reflex is triggered, the activation of the lumbar and sacral spinal cord astrocytes, nerve impulses pass through the genitofemoral nerve and ilioinguinal nerve impulse, the sympathetic nerve endings to release norepinephrine, prostaglandin, calcitonin gene-related peptide, P substances, causing the dysfunction of the bladder and urethra, and lead to the abnormal activity of the perineum, the pelvic floor muscles, and the corresponding region of sustained outside of the prostate pain and referred pain.
5. . Abnormal immune response in recent years studies have shown that immune factors play a very important role in the development and course of evolution of type III prostatitis in patients with prostatic fluid and / or seminal plasma and / or organization and / or blood, there may be some cells changes in factor levels, such as: IL-2, IL-6, IL-8, IL-10, TNF-alpha and MCP-1, etc., and IL-10 levels with type III prostatitis patients with pain symptoms was positively correlated, the application immunosuppressive therapy have a certain effect.
6. Oxidative stress doctrine , the body of oxygen free radicals, use, clear in a state of dynamic equilibrium. Prostatitis patients of oxygen free radicals excessive and / or free radical scavenging system, the role of relatively lower body so that the anti-oxidative stress response to reduce oxidative stress products or / and by-products increased, but also may be one of the pathogenesis.
7. Pelvic disease factors that part of the prostatitis patients is often accompanied by expansion of the prostate peripheral zone venous plexus hemorrhoids, varicocele, suggesting that some patients with chronic prostatitis symptoms may be associated with pelvic venous congestion, blood stagnation related, which may be the cause Persistent one of the reasons.
Type IV prostatitis
No clinical symptoms, often due to the examination of other related diseases were found, so the lack of pathogenesis-related studies may be related to the same part of the etiology and pathogenesis of type III prostatitis.
Predisposing factors in prostatitis
An important incentive for the pathogenesis of prostatitis include: smoking, drinking, addicted to spicy food, inappropriate sexual activity, sedentary cause long-term prostate congestion and chronic pelvic floor muscle squeeze, cold, fatigue, resulting in decreased body resistance or specific physical.
? (acute bacterial prostatitis)
Rapid onset, manifested as chills, fever, accompanied by sustained and significantly lower urinary tract infection symptoms such as urinary frequency, urgency, dysuria, urination, burning sensation, difficulty urinating, urinary retention, urinary tract, anus, perineal area fall expansion does not apply. Elevated white blood cell count, blood and urine culture was positive.
? (chronic bacterial prostatitis)
There are recurrent lower urinary tract infection symptoms (see above), the duration of more than three months.
? (chronic prostatitis)
Mainly for the pain of the pelvic region, seen in the perineum, penis, perianal Ministry, urethra, pubic, or lumbosacral region and other parts. Voiding dysfunction can be expressed urgency, increased urinary frequency, dysuria, and nocturia. , And may permanently due to chronic pain, reduced quality of life in patients with sexual dysfunction, anxiety, depression, insomnia, memory loss, and so on.
? (asymptomatic prostatitis)
No subjective symptoms, only about prostate examination found evidence of inflammation.
Recommended diagnosis of prostatitis in accordance with the NIH points
Type ? (acute bacterial prostatitis): diagnosis rely on history, physical examination and blood and urine bacterial culture results. Patients with digital rectal examination is necessary, but the taboo of prostate massage. Before antibiotic therapy, urine culture or blood culture.
Type II and III (chronic prostatitis): to be asked in detail about the history, comprehensive physical examination (including digital rectal examination), urine and prostatic routine examination. Recommended application NIH chronic prostatitis symptom index, symptom score. Recommended two cups of law "or" cup "the pathogens experiment.
A clear diagnosis and differential diagnosis, choice of check: semen analysis or bacterial culture, prostate specific antigen, urine cytology, abdominal or transrectal B ultrasound (including residual urine), urinary flow rate, urodynamics, CT, MRI, urethral cystoscopy and prostate biopsy and so on.
Type ? (asymptomatic prostatitis): asymptomatic prostatic (EPS), semen, urine after prostatic massage, prostate tissue pathological examination of the biopsy and prostatectomy specimens were found.
Specific diagnostic methods
(1) history taking
(2) physical examination rectal examination the diagnosis of prostatitis is very important, and helps to identify the perineum, rectum, neuropathy, or prostate to other diseases.
?: physical examination may find tenderness, suprapubic discomfort, urinary retention may touch the bulging of the bladder in the suprapubic. Digital rectal examination can be found in the prostate enlargement, tenderness, local temperature and irregular in shape. The taboo conducted prostate massage.
? and ?: digital rectal examination prostate size, texture, with or without nodules, with or without tenderness, its scope and extent of pelvic floor muscle tension, pelvic wall with or without tenderness, prostate massage prostate fluid can understand.
(3) laboratory tests
(1) prostate massage fluid (EPS) routine examination: normal EPS leukocytes <10 / HP, lecithin uniformly distributed in the entire field of vision, pH6.3 ~ 6.5 does not exist or occasionally red blood cells and epithelial cells. WBC> 10 / HP, lecithin reduce the number of diagnostic significance.
(2) urine analysis and urine sediment examination: urine analysis and urinary sediment to rule out urinary tract infection, diagnosis of prostatitis helper method.
(3) bacteriological examination
1) ? type: urine staining, bacterial culture and susceptibility testing, as well as blood culture and susceptibility testing.
2) chronic prostatitis (type II and III type): Recommended "two cups" or "four cup pathogens experiment.
(3) check of other pathogens: Chlamydia trachomatis and Mycoplasma check.
4 equipment inspection
(1) B-: B ultrasonic examination of patients with prostatitis can be found in the prostate echo uneven, the performance of prostatic stones or calcification around the prostate venous plexus dilation, but there is still a lack of specific performance of the B ultrasound diagnosis of prostatitis, and can not use B super prostatitis typing.
(2) Urodynamics: ? urinary flow rate, urinary flow rate check can be a general understanding of the urination situation help prostatitis identify with voiding dysfunction related diseases; the ? urodynamic studies, can be found in the bladder and urethra dysfunction.
(3) CT and MRI for the identification of seminal vesicle, ejaculatory duct and other pelvic organs lesions have a potential value, but the diagnostic value for prostatitis remains unclear.
4 equipment inspection
(1) B-: B ultrasonic examination of patients with prostatitis can be found in the prostate echo uneven, the performance of prostatic stones or calcification around the prostate venous plexus dilation, but there is still a lack of specific performance of the B ultrasound diagnosis of prostatitis, and can not use B super prostatitis typing.
(2) Urodynamics: (a). urinary flow rate, urinary flow rate check can be a general understanding of the urination situation help prostatitis identify with voiding dysfunction related diseases;
(b). urodynamic studies, can be found in the bladder and urethra dysfunction.
(3) CT and MRI for the identification of seminal vesicle, ejaculatory duct and other pelvic organs lesions have a potential value, but the diagnostic value for prostatitis remains unclear.
Differential diagnosis
Type ? prostatitis lack of objective, specific diagnosis is based on clinical diagnosis should be, and may lead to pelvic area pain and voiding dysfunction diseases, differential diagnosis, mainly to the voiding dysfunction in patients with bladder outlet obstruction and bladder function should be clear whether the exception. The need to identify the disease include: benign prostatic hyperplasia, testis and epididymis and spermatic cord disease, overactive bladder, neurogenic bladder, interstitial cystitis, glandular cystitis, sexually transmitted diseases, bladder cancer, prostate cancer, anorectal disease, lumbar diseases, central and peripheral neuropathy.
Type III prostatitis in patients with symptoms after treatment, no relief should be based on specific circumstances, to select for further examination, except for the above-mentioned diseases.
Treatment of disease
Principles of treatment
Prostatitis should adopt an integrated treatment.
?: a broad-spectrum antibiotics, symptomatic treatment and supportive care. With urinary retention can be thin tube catheterization or suprapubic bladder puncture nephrostomy drainage of urine with prostatic abscess can be taken to the surgical drainage.
?: treatment with oral antibiotics, select sensitive drugs, treatment for four to six weeks, during which the response in patients with stage efficacy evaluation. Efficacy are not satisfied, could switch to other sensitive antibiotics. ?-blockers can be used to improve urinary symptoms and pain. Plant preparations, non-steroidal anti-inflammatory analgesic and M-receptor blockers, etc. can also improve related symptoms.
Type ? A certificate type: the first oral antibiotics for two to four weeks, then decide whether to continue antibiotic treatment according to their efficacy feedback. ?-receptor blocker is recommended to improve urinary symptoms and pain can also choose to plant preparations, non-steroidal anti-inflammatory analgesic and M-receptor blockers improve urinary symptoms and pain.
Type ? B: Recommended the use of a-receptor blocker, plant preparations, non-steroidal anti-inflammatory analgesic and M-receptor blockers such as drug treatment.
?: generally no treatment.
Treatment
? type
I type prostatitis antibiotic treatment is necessary and urgent. Once the clinical diagnosis or blood, urine culture results, antibiotics immediately. The recommended start intravenous antibiotics, to be the patient's fever and other symptoms improve after the recommended use of oral drugs, treatment for at least four weeks.
Acute bacterial prostatitis with urinary retention can be a suprapubic bladder puncture nephrostomy drainage of urine, may also have a thin tube catheterization, indwelling catheter should not be more than 12 hours. With abscess formation can take transrectal ultrasound guided fine needle aspiration drainage, transurethral incision of prostate abscess drainage or perineal puncture drainage.
Type ? and ?
The goals of treatment of chronic prostatitis pain relief and improved urinary symptoms and improve quality of life, efficacy evaluation should be the main symptom improvement.
1. General treatment of health education, psychological and behavioral counseling has a positive effect. Patients should stop drinking to avoid hot and spicy food; avoid holding back urine, sedentary, keep warm, increasing physical activity.
2. The medication most commonly used drugs are antibiotics, a-blockers, botanicals and non-steroidal anti-inflammatory analgesics and other drugs to alleviate the symptoms, there are varying degrees of efficacy.
(1) antibiotics: Currently, in clinical practice in the treatment of prostatitis, the most commonly used first-line drugs is antibiotics, but only about 5% of patients with chronic prostatitis have a clear bacterial infection.
Type ?: The choice of antibiotics based on results of bacterial culture and drug ability to penetrate the prostate. After diagnosis of prostatitis, antibiotic treatment is four to six weeks, during which the response in patients with stage efficacy evaluation. Injection of antibiotic treatment is not recommended within the prostate.
Type ? A: Antibiotic treatment is mostly empirical treatment of the theoretical basis is speculated that some of the conventional culture-negative pathogens has led to the occurrence of this type of inflammation. Therefore, it is recommended that the first 2 to 4 weeks of oral antibiotics such as fluoroquinolones, and then decide whether to continue antibiotic treatment according to the efficacy of feedback. Only when clinical symptoms really have to reduce, and recommends the continued application of antibiotics. The recommended treatment for four to six weeks.
Type ? B: not recommended to be treated with antibiotics.
?-blockers (2): a-receptor blockers prostate and bladder and other parts of the smooth muscle relaxation and improve lower urinary tract symptoms and pain, and thus become essential drugs to the treatment of type ? / type III prostatitis.
Choose a different alpha-blockers according to the patient's condition. Recommended alpha-blockers: doxazosin (doxazosin), naftopidil (naftopidil), tamsulosin (tamsulosin) and terazosin (terazosin), the control results show that of these drugs in patients with urinary symptoms, pain and quality of life index improved to varying degrees.
(3) plant preparations: the role of plant preparations in the treatment of type ? and ? prostatitis is an increasingly important drug for the recommended treatment.
Galenical preparations of pollen and plant extracts, its pharmacological effects are more extensive, such as non-specific anti-inflammatory, anti-edema, and promote the role of the detrusor contraction and urethral smooth muscle relaxation. Recommend the use of plant preparations: universal Thailand, Sabah brown extract. More varieties, the usage amount of need based on the patient's illness, usually a course of treatment in months. Adverse reactions is small.
(4) non-steroidal anti-inflammatory analgesics: non-steroidal anti-inflammatory analgesic empirical therapy for the treatment of type III prostatitis-related symptoms. Its main purpose is to relieve pain and discomfort.
(5) M-receptor blockers: performance, such as urgency, urinary frequency and nocturia but no urinary tract obstruction in patients with prostatitis, you can use the M-receptor blocker (tolterodine) treatment.
(6), antidepressants and anxiolytics: chronic prostatitis patients with depression, anxiety and other mood disorders, while in the treatment of prostatitis, you can choose to use antidepressants and antianxiety medication.
These drugs can improve symptoms of patients with mood disorders, but also to alleviate the physical symptoms of voiding dysfunction and pain. The application should be noted that the prescribing of these drugs and adverse drug reactions. Choice of antidepressants and anxiolytics selective 5 - HT reuptake inhibitors, tricyclic antidepressants, etc. drugs.
(7) Chinese medicine: Chinese medicine treatment of prostatitis learn the relevant norms recommended in accordance with the Institute of Traditional Chinese Medicine or Western.
3. Other treatments
1. Prostate massage prostate massage is one of the traditional treatment methods, studies have shown that prostate massage to promote the emptying of the prostate gland and increase the local concentration of the drug, in order to alleviate the symptoms of chronic prostatitis patients, it is recommended auxiliary type ? prostatitis therapy. Type ? patients with prostatitis disabled.
2. Biofeedback studies have shown that chronic prostatitis patients with pelvic floor muscle synergies disorders or urethral sphincter tension. The merger of biofeedback electrical stimulation of the pelvic floor muscle relaxation therapy can make it tend to co-ordination and relaxation of sphincter to alleviate perineal discomfort and urinary symptoms of chronic prostatitis.
3. Hyperthermia main thermal effects arising from the use of a variety of physical means, increase the blood circulation of prostate tissue, speed up metabolism, inflammatory and elimination of tissue edema and relieve pelvic floor muscle spasm. Relieve symptoms in the short term, but long-term effects are not clear. For the unmarried and has not given birth is not recommended.
4. Prostate injections / infusion therapy efficacy and safety of transurethral are to be confirmed.
Type IV
Generally do not need treatment. Should be noted that patients with elevated serum PSA or infertility, differential diagnosis and treated accordingly.
Disease Care
Patients should be self-psychological counseling, to maintain a cheerful and optimistic attitude towards life, should stop drinking, avoid spicy food; avoid urinating, sedentary and long cycling, horseback riding, keep warm, increasing physical activity.
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