specific prostatitis
Introduction
Introduction to specific prostatitis Specific prostatitis, caused by pathogens such as Mycobacterium tuberculosis, fungi, Neisseria gonorrhoeae, Chlamydia, Mycoplasma, Candida albicans, Trichomonas, etc., except for tuberculosis infection, other sequelae of prostatitis caused by sexually transmitted diseases, also known as Prostatitis. About 50% of men are affected by prostatitis at some point in their lives. Prostatitis can affect adult males of all ages, and adult males under 50 years of age have a higher prevalence. The onset of prostatitis may also be related to the season, diet, sexual activity, genitourinary tract inflammation, benign prostatic hyperplasia or lower urinary tract syndrome, occupation, socioeconomic status, and mental and psychological factors. Although this type of patient fails to isolate the pathogen by routine bacterial examination, it may still be associated with certain specific pathogens such as anaerobic bacteria, L-formed bacteria, nanobacteria, or Chlamydia trachomatis, Mycoplasma and other infections. Studies have shown that the local prokaryotic DNA detection rate of this type of patients can be as high as 77%, some clinically, chronic inflammation, recurrent or exacerbated "aseptic" prostatitis may be related to these pathogens. Other pathogens such as parasites, fungi, viruses, trichomoniasis, Mycobacterium tuberculosis, etc. may also be important pathogenic factors of this type, but lack reliable evidence, so there is no consensus. basic knowledge The proportion of illness: 0.001% Susceptible people: male Mode of infection: non-infectious Complications: urinary retention, sexual dysfunction
Cause
Specific prostatitis cause
Pathogen infection (30%):
Although this type of patient fails to isolate the pathogen by routine bacterial examination, it may still be associated with certain specific pathogens such as anaerobic bacteria, L-formed bacteria, nanobacteria, or Chlamydia trachomatis, Mycoplasma and other infections. Studies have shown that the local prokaryotic DNA detection rate of this type of patients can be as high as 77%, some clinically, chronic inflammation, recurrent or exacerbated "aseptic" prostatitis may be related to these pathogens. Other pathogens such as parasites, fungi, viruses, trichomoniasis, Mycobacterium tuberculosis, etc. may also be important pathogenic factors of this type, but lack reliable evidence, so there is no consensus.
Urinary dysfunction (25%):
Some factors cause excessive contraction of the urethral sphincter, leading to bladder outlet obstruction and residual urine formation, causing urine to flow back into the prostate, not only bringing the pathogen into the prostate, but also directly stimulating the prostate, inducing sterile "chemical prostatitis". Causes abnormal urination and pain in the pelvic region.
Mental and psychological factors (20%):
More than half of patients with prolonged prostatitis have significant changes in mental and psychological factors and personality traits. Such as: anxiety, depression, suspected illness, rickets, and even suicidal tendencies. These changes in mental and psychological factors can cause autonomic dysfunction, causing dysuria of the posterior urethra, leading to pain in the pelvic region and dysfunction of the urinary tract, or causing changes in the function of the hypothalamic-pituitary-gonadal axis, which may affect sexual function and further aggravate symptoms. Eliminate mental stress and relieve or heal symptoms. However, it is still unclear whether mental and psychological changes are the direct cause or secondary performance.
Prevention
Specific prostatitis prevention
1, drink more water, do not urinate, in order to keep the urinary tract unobstructed, and is conducive to the discharge of prostate secretions.
2, pay attention to daily life, develop good habits, prevent excessive fatigue, prevent colds, and carry out effective physical exercise.
3, regulate sexual life, do not frequent masturbation, and should pay attention to sexual health, to prevent excessive hyperemia of the prostate and genital infections.
4, avoid alcohol and tobacco, do not eat spicy spicy food.
5, for acute genitourinary infections, such as acute prostatitis, acute epididymitis, acute seminal vesiculitis, etc., should be given active and thorough treatment to prevent its conversion to chronic prostatitis.
6. For patients with chronic prostatitis who have been cured, they should also take a hot bath every night to improve the blood supply of the prostate and prevent recurrence of inflammation.
Complication
Specific prostatitis complications Complications, urinary retention, dysfunction
(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 spreads to the seminal vesicle, causing acute seminal vesiculitis. At the same time, the bacteria can retrograde through the lymphatic vessels into the parietal wall and sheath of the vas deferens leading to epididymitis.
Symptom
Specific symptoms of prostatitis Common symptoms Male sexual dysfunction, poor urination, testicular pain, frequent urination, urgency and dysuria, lumbosacral pain, libido, ejaculation, dying, dizziness, dizziness, dizziness
1. Acute bacterial prostatitis: sudden onset, chills and high fever, frequent urination, urgency, and dysuria. Dysuria or acute urinary retention can occur. Clinically, it is often accompanied by acute cystitis. The prostate is swollen, tender, and the local temperature rises, the surface is smooth, and the abscess is full or fluctuating.
2. Chronic bacterial prostatitis: frequent urination, urgency, dysuria, urinary discomfort or burning when urinating. White secretions often flow from the urethra after urination and after the stool. Sometimes there may be blood, perineal pain, sexual dysfunction, and mental symptoms. The prostate is full, enlarged, soft, and tender. In the long course of the disease, the prostate shrinks, hardens, the surface is incomplete, and there is a small induration.
Examine
Specific prostatitis check
Common diagnostic tools:
1. Digital rectal examination: the prostate is full, enlarged, soft, with mild tenderness. If the disease is long, the prostate will become smaller, harder, uneven in texture and have a small induration. At the same time, the prostatic fluid is obtained by applying the prostate massage method, and a routine examination is performed.
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 bacterial culture is performed at the same time, a clear diagnosis and classification of chronic prostatitis can be made. If the bacterial culture result of prostatitis is positive, the diagnosis of chronic bacterial prostatitis, and vice versa, chronic non-bacterial prostatitis.
3. B-ultrasound: It shows that the structure of the prostate tissue is unclear and disordered, which may prompt 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.
Diagnosis
Diagnosis and identification of specific prostatitis
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 suffering from back pain, low back pain rather than suprapubic, perineal pain, and no dysuria. There was no prostate tenderness in the rectal examination, and the prostate fluid was normal.
(2) pus and kidney: also manifested as acute chills, fever, frequent urination, urgency and dysuria. Also manifested as obvious ipsilateral low back pain, but no shame on the bone, perineal pain, no dysuria, rectal examination without prostate tenderness. Prostatic fluid examination is normal.
(3) prostate abscess: also manifested as acute chills, fever with frequent urination, urgency and dysuria, is the result of the development of acute prostatitis. After rectal B-ultrasound and CT examination, there is a liquid occupying position in the prostate. Puncture and pus extraction can confirm the diagnosis.
2. Differential diagnosis of chronic bacterial prostatitis
(1) Prostate cancer: The late stage also manifests as urination discomfort, which may have frequent urination, urgency, and difficulty urinating. Rectal examination revealed that the prostate texture was hard, there may be nodules, serum PSA was significantly elevated, and there was an inhomogeneous light group in the prostate through rectal B-ultrasound. A prostate biopsy can confirm the diagnosis.
(2) Prostate tuberculosis: also manifested as frequent urination, urgency, dysuria with urethral drip, pain in the lower abdomen and perineum. There is usually a history of genitourinary tuberculosis. Rectal examination can reveal irregular nodules in the prostate, and acid-fast bacilli can be found in the prostatic fluid.
