Prostatitis

　　Different patients with prostatitis may manifest different comprehensive symptoms in clinical practice, and these syndromes have their unique etiologies. Although at present, the medical profession still lacks a comprehensive and accurate understanding of the etiology of most chronic prostatitis, and the treatment effect is not satisfactory, but recent studies have shown that the occurrence of prostatitis is closely related to the following five factors.

　　1. Prostate congestion

　　Congestion caused by various different reasons, especially passive congestion, is an important pathogenic factor of prostatitis. Patients often do not develop the disease due to bacterial infection or invasion of microorganisms, but they will form an inflammatory reaction and induce prostatitis. It is very common in life to cause congestion.

　　Over-frequency of sexual activity and interruption of sexual intercourse can cause abnormal congestion of the prostate. Direct compression of the perineum. Activities such as riding a bicycle, horseback riding, and prolonged sitting can all lead to repeated injury to the perineum and congestion of the prostate, especially long-term bicycle riding is the most common. Traditional Chinese medicine believes that bad habits such as excessive drinking and eating greasy foods can easily lead to endogenous damp-heat, accumulate in the reproductive organs and cause congestion and sexual excitement. External stimulation caused by inappropriate medical practices such as prostate massage, such as heavy手法 or excessive frequency, can also cause prostate congestion. Catching a cold and feeling cold can cause sympathetic nervous system excitement in the human body, leading to increased intravesical pressure, contraction of the prostate ducts, and obstruction of the excretion of prostatic fluid, resulting in stagnation congestion.

　　II. Urine stimulation

　　Medically, urine irritation is referred to as a chemical factor. Urine contains various acidic and alkaline chemical substances. When the patient's local neuroendocrine disorder causes excessive pressure in the posterior urethra and damage to the opening of the prostate duct, it will cause irritant chemical substances such as uric acid to reflux into the prostate,诱发慢性前列腺炎.

　　III. Pathogenic microorganism infection

　　Various microorganisms such as bacteria, protozoa, fungi, and viruses can become sources of infection leading to prostatitis, among which bacteria are the most common, such as gonococci, nongonococci, etc. The main routes of bacterial invasion are three. The first is hematogenous infection, and it has been found in clinical practice that more than 90% of bacterial prostatitis is caused by microbial infection. The second is lymphatic infection, such as lower urinary tract infections and inflammation of the colon and rectum can infect the prostate through the lymphatic vessels, causing inflammation. The third is direct extension, when men urinate, urine passes through the prostate, and bacteria in the urine can directly enter the prostate, leading to prostatitis.

　　IV. Anxiety, depression, fear

　　50% of patients with prostatitis have symptoms of excessive tension such as anxiety, depression, fear, and pessimism. Patients with prostatitis accompanied by pain and neurasthenia often exaggerate their physical discomfort and pain, and their自觉 symptoms are often greater than their actual condition, which is called 'tense prostatitis'. And psychological factors are related to age, with younger patients having a significant psychological burden compared to older patients, which often directly affects the effectiveness of drug treatment.

　　V. Immune factors, allergy

　　Prostatitis is related to autoimmune factors to some extent. Some experts have found the presence of 'anti-prostate antibodies' in some patients with arthritis. These patients are often caused by congenital or acquired immune deficiencies to produce anti-prostate antibodies, leading to tissue damage of the prostate. If no evidence of bacterial, viral, or mycoplasma infection is found in the patient after examination, the existence of immune factors can be considered.

　　Acute prostatitis often accompanies other diseases, and the main complications that are easy to cause include:

　　1. Acute urinary retention

　　Acute prostatitis can cause local congestion, swelling, and urethral compression, leading to difficulty in urination or acute urinary retention.

　　2. Acute seminal vesiculitis, epididymitis, and vas deferens inflammation

　　Acute prostatitis can easily spread to the seminal vesicle, causing acute seminal vesiculitis. At the same time, bacteria can retrogradely enter the wall and sheath of the vas deferens through the lymphatic vessels, leading to epididymitis.

　　3. Enlarged testicular lymph nodes or tenderness

　　The prostate and testicular lymphatics communicate in the pelvis. During acute prostatitis, the testicles may be affected, leading to enlargement of the testicular lymph nodes and tenderness.

　　4、性功能障碍

　　Acute inflammatory phase of prostatitis may involve congestion, edema, or the formation of small abscesses, and may cause pain during ejaculation, painful erections, impotence, decreased libido, dyspareunia, and hematospermia.

　　5、其他

　　急性前列腺炎严重时可伴有肾绞痛。

　　上述症状并非所有病例均存在，有的早期只有发热、尿道灼感，被误为感冒。急性细菌性前列腺炎也可并发睾丸炎，精囊炎和输精管炎。

　　不论哪一类型的前列腺炎都可表现为相似临床症状，统称为前列腺炎症候群，包括盆骶疼痛，排尿扰乱和性功能障碍。盆骶疼痛表现极其复杂，疼痛一般位于耻骨上、腰骶部及会阴部，放射痛可表现为尿道、精索、睾丸、腹股沟、腹内侧部疼痛，向腹部放射酷似急腹症，沿尿路放射酷似肾绞痛，往往导致误诊。排尿扰乱表现为尿频、尿急、尿痛、排尿不畅、尿线分叉、尿后沥滴、夜尿次数增多，尿后或大便时尿道流出乳白色分泌物等。偶尔并发性功能障碍，包括性欲减退、早泄、射精痛、勃起减弱及阳痿。上述症状可因前列腺炎所致，也可因泌尿生殖道其他疾病所引起。

　　1、排尿不适

　　可出现膀胱刺激症，如尿频、排尿时尿道灼热、疼痛并放射到阴茎头部。清晨尿道口可有粘液等分泌物，还可出现排尿困难的感觉。

　　2、局部症状

　　后尿道、会阴和肛门处坠胀不适感，下蹲、大便及长时间坐在椅凳上胀痛加重。

　　3、放射性疼痛

　　前列腺炎的疼痛并不止局限在尿道和会阴，还会向其附近放射，以下腰痛最为多见。另外，阴茎、精索、睾丸阴囊、小腹、腹股沟区、大腿、直肠等处均可受累。需要指出的是，前列腺炎引起的腰痛在下腰部，与骨科原因的腰痛如肌筋膜炎、腰肌劳损等虽易混淆，但后者多在系皮带处附近，较前列腺炎引起的腰痛位置偏高，可以鉴别。

　　4、性功能障碍

　　前列腺炎可引起性欲减退和射精痛，射精过早症，并影响精液质量，在排尿后或大便时还可以出现尿道口流白，合并精囊炎时可出现血精。

　　5、其它症状

　　前列腺炎可合并神经衰弱症，表现出乏力、头晕、失眠等，长期持久的前列腺炎症甚至可引起身体的变态反应，出现结膜炎、关节炎等病变。

　　前列腺是男性生殖器官最大的一个附属性腺。它所分泌的前列腺液，是精液的重要组成部分。前列腺与身体其他脏器一样，也会生病，最常见的是慢性前列腺炎。要想保护好前列腺，男性必须注意以下问题。男性的阴囊伸缩性大，分泌汗液较多，加之阴部通风差，容易藏污纳垢，局部细菌常会乘虚而入。这样就会导致前列腺炎、前列腺肥大、性功能下降。若不及时注意还会发生危险。春冬季节天气寒冷，因此应该注意防寒保暖。

　　Sexual activity is an important part of conjugal life. A harmonious and satisfying sexual life is a natural need for both men and women's physiology and one of the important means to maintain physical and mental health and close marital feelings. Maintaining a moderate and regular sexual life or controlling the frequency of masturbation, regularly discharging prostatic fluid, can relieve the sense of fullness in the prostate, promote the continuous renewal of prostatic fluid, and help the normal function of the prostate and the recovery of patients with abnormal prostate function.

　　On the other hand, some young people are沉迷于性生活，often have the phenomenon of excessive sexual activity or masturbation, which is also very harmful to the prostate. Excessive sexual activity can easily cause functional contraction of the prostate tissue, leading to active or passive congestion of the prostate, which is also a factor in the injury of the prostate tissue and the induction of prostatitis. It can also greatly reduce the effectiveness of the treatment for patients already suffering from prostatitis. People once named the prostatitis that newlyweds develop during the honeymoon as 'Honeymoon Prostatitis' because it is induced by the significant congestion of the prostate due to frequent and excessive sexual activity.

　　Therefore, to avoid the occurrence of prostatitis, one should pay attention to moderate sexual activity, but the frequency of sexual activity should be treated differently for each individual and cannot be generalized.

　　Prostatitis is a serious threat to male health and a highly prevalent disease. After a male develops prostatitis, he may exhibit some obvious symptoms. It is best for male friends to actively seek relevant examinations and diagnoses in regular hospitals for targeted treatment. The examination items for prostatitis include:

　　1. Bacteriological examination

　　Male patients with prostatitis need to undergo bacteriological examination to help diagnose the disease and provide targeted treatment. A positive result from a bacterial culture can be diagnosed as bacterial prostatitis.

　　2. X-ray examination

　　In further examination of prostatitis, some male patients may need to undergo X-ray examination. This method is of great value in the diagnosis of prostatitis and can help determine whether there is benign prostatic hyperplasia or prostatic lesions, etc.

　　3. Rectal examination

　　Prostatitis patients need to undergo rectal examination. During the examination, inflammatory patients may find that their prostate is of unequal size, with an irregular surface, part of the gland hardening or having small hard nodules, and most having mild tenderness.

　　4. Examination of prostatic fluid

　　For prostatitis patients, the examination of prostatic fluid is to determine whether there is an inflammatory manifestation through the diagnosis of leukocytes and related components. However, a negative result from a single test cannot easily exclude the disease, while a positive result can generally make a diagnosis of prostatitis.

　　Prostatitis can be divided into acute and chronic types. The symptoms of this disease can have a significant impact on the daily life and work of male patients, so seeking medical attention in a timely manner is crucial. During treatment, choosing some effective dietary methods can also enhance the therapeutic effect, and it is advisable for patients to give it a try.

　　First, acute prostatitis

　　During acute prostatitis, patients may present with frequent urination, urgency, and pain during urination, and may appear symptoms such as dribbling urine, terminal hematuria,坠胀 pain in the perineum, and can radiate to the perineum, sacrum, or thigh, and may appear symptoms such as high fever, chills, headache, whole body pain, fatigue, loss of appetite, and so on.

　　1. Plantain seed sugar water: Use 100 grams of plantain seed (400 grams of fresh), 10 grams of bamboo leaf heart, 10 grams of raw licorice, and appropriate amount of yellow sugar each time. When making it, first put the plantain seed, bamboo leaf heart, and raw licorice in a pot, add some clear water, and cook the water with medium heat for about 40 minutes, then add the yellow sugar, and cook for a while, and it can be taken as tea every day.

　　2. Light heart flower bitter melon soup: Use 6 bundles of light heart flower and 200 grams of fresh bitter melon each time. When making it, first wash the bitter melon, remove the pith and seeds, and cut it into small pieces, and then decoct the soup with light heart flower for drinking.

　　3. Winter melon and seaweed congee: Use 250 grams of fresh winter melon, 50 grams of raw Coix seed, and 100 grams of seaweed each time. When making it, first wash the winter melon and cut it into coarse pieces, wash the Coix seed, and cut the seaweed into thin slices. Put the above three ingredients in a pot, add some clear water, and cook the soup for eating.

　　Second, chronic prostatitis

　　The symptoms of chronic prostatitis vary in severity, with some patients showing no symptoms. However, most patients may experience pain or discomfort in the perineum or rectum. The pain can radiate to the sacrum or pubic bone, inguinal area, etc., and may have symptoms such as discomfort during urination, burning sensation during urination, and milk white secretion at the urethral opening.

　　1. Mud Eel Stewed Tofu: 500 grams of live mud eel, 250 grams of fresh tofu, salt, ginger, and monosodium glutamate as needed. When making it, first cut the mud eel open, remove the gills and internal organs, wash it, and put it in a stewing pot with salt, ginger, and appropriate amount of water. First boil it with strong fire, then stew it with gentle fire until it is five degrees of maturity. Then add tofu pieces to the stewing pot, and stew it with gentle fire until the mud eel meat is tender, and add seasonings for eating.

　　2. White Magnolia Pork Soup: 30 grams of fresh white magnolia, 150 grams of fresh lean pork. When making it, first wash the lean pork and cut it into pieces, and put it in a pot with white magnolia, add some clear water, and cook the soup with medium heat. After the soup is cooked, add a little salt to taste.

　　3. Astragalus and茅root drink: 30 grams of raw Astragalus, 30 grams of white root, 20 grams of Cistanche, 60 grams of watermelon peel, and appropriate amount of sugar. When making it, first cut the Astragalus and white root into pieces, and put them in a pot with Cistanche and watermelon peel, and cook the soup with medium heat for drinking. Drink 2-3 times a day.

　　For the dietary treatment of prostatitis, whether it is acute prostatitis or chronic prostatitis, it is advisable to choose cool and nourishing foods in food selection. It is forbidden to eat or eat less fried, fried, and spicy and hot foods, as well as drinks such as coffee, cocoa, strong alcohol, and cigarettes.

　　The dietary methods introduced above can all play an effective role in health preservation, and these are all locally sourced, allowing patients to choose their favorite foods to eat. Of course, they can also be alternated. The editor thinks that as long as patients actively cooperate with the doctor's treatment, the recovery of physical health is just around the corner.

　　The first step in treating prostatitis is to conduct a clinical evaluation, determine the type of disease, choose a treatment method for the cause, and integrate psychological treatment and adjustment of sexual life throughout the treatment process. Misunderstanding of the disease, unnecessary anxiety, and excessive abstinence can worsen symptoms. Prostatitis may be a disease with mild symptoms or no symptoms at all, which may be a self-limiting disease that can resolve spontaneously, or it may be a disease with complex symptoms that can lead to urinary tract infections, sexual dysfunction, infertility, and greatly reduce the quality of life. The treatment of patients with prostatitis should avoid overemphasizing the dangers of the disease and avoid taking a simple, negative, and blind preference for antibiotic treatment. Treatment should start from the cause and be comprehensive.

　　1. Antibacterial treatment

　　The culture of prostatic fluid is the basis for selecting antibacterial drugs when known urinary tract pathogenic organisms are found. If rare pathogens or symbiotic bacteria are found in the urogenital tract, they cannot be confirmed as pathogenic organisms. Non-bacterial prostatitis patients with signs of bacterial infection, who are ineffective with general therapy, are also suitable for the use of antibacterial drugs. The selection of antibacterial drugs needs to pay attention to the existence of a prostatic-blood barrier composed of a lipid membrane between the prostatic acini and microcirculation, which hinders the passage of water-soluble antibiotics and greatly reduces the therapeutic effect. Some bacteria secrete a glycoprotein matrix, which hinders the approach of antibiotics to bacteria. When prostatic calculi are present, they can become a shelter for bacteria. These factors constitute the difficulties in the treatment of chronic bacterial prostatitis, requiring a longer course of treatment and a higher risk of recurrence.

　　Drugs commonly used in the past, such as sulfamethoxazole-trimethoprim, have a broad antibacterial spectrum but cannot concentrate in the prostate, and the efficacy is still unsatisfactory after 2 months of continuous use. Currently, it is mostly recommended to take oral quinolone drugs such as ofloxacin or levofloxacin. If it is ineffective, continue for another 8 weeks. If recurrence occurs and the bacterial strain remains unchanged, switch to a prophylactic dose to reduce acute attacks and alleviate symptoms. If long-term use of antibiotics induces serious adverse reactions, such as pseudomembranous colitis, diarrhea, and the growth of intestinal resistant strains, a change in treatment plan is needed. Another option is to start with tetracycline, and if symptoms improve, extend it to 28 days; if symptoms do not improve, switch to quinolone drugs.

　　Whether non-bacterial prostatitis is suitable for the use of antibacterial drugs is still controversial in clinical practice. There is evidence that patients who have used quinolone drugs in the past may have false-negative results in urine cultures after prostatic fluid or prostate massage. Chlamydia trachomatis and mycoplasma can cause prostatitis, but routine cultures will not show positive results. Moreover, patients with prostatic symptoms who use a course of antibiotic treatment can achieve efficacy in about 40% of cases, therefore, patients with 'aseptic' prostatitis are also suitable for the use of drugs effective against bacteria and mycoplasma, such as quinolones, SMZ-TMP, or TMP alone, in combination with tetracyclines or used alternately. If antibiotic treatment is ineffective, and the patient is confirmed to have aseptic prostatitis, antibiotic treatment should be discontinued. The use of a double-balloon catheter to seal the prostatic urethra, and to inject antibiotic solution from the urethral lumen into the prostatic duct, can also achieve the therapeutic goal.

　　2. Anti-inflammatory and Analgesic Drugs

　　Non-steroidal anti-inflammatory drugs can improve symptoms, and indomethacin is usually used orally or as a suppository. Traditional Chinese medicine uses drugs for inflammation, heat-clearing, detoxification, and softening hardness, which also has a certain effect. Allopurinol can reduce the uric acid concentration in the body and prostate fluid, theoretically acting as a free radical scavenger, it can also remove reactive oxygen species, reduce inflammation, and alleviate pain. It is a selectable adjuvant treatment method.

　　3. Physical Therapy

　　Prostate massage can empty the concentrated secretions in the prostate duct and drain the infection foci in the obstructed area of the gland. Therefore, for refractory cases, prostate massage can be performed every 3 to 7 days while using antibiotics. A variety of physical factors are used for prostate physiotherapy, such as microwave, radiofrequency, ultrashort wave, medium wave, and hot sitz bath, which can relax the prostate, posterior urethral smooth muscle, and pelvic floor muscles, enhance antibacterial efficacy, and alleviate pain symptoms to some extent.

　　4. Alpha-Adrenergic Antagonists

　　The smooth muscle tension of the prostate, bladder neck, and urethra in patients with prostatodynia, bacterial, or non-bacterial prostatitis increases, and the increased intraluminal pressure of the posterior urethra during urination causes urine reflux into the prostate duct, which is an important cause of prostatodynia, prostatic calculi, and bacterial prostatitis. The use of alpha-adrenergic antagonists can effectively improve prostatodynia and urinary symptoms, which is of great significance for preventing recurrence of infection. Commonly used drugs include alfuzosin, terazosin, tamsulosin, or zolmitriptan. Alpha-adrenergic antagonists should be used for a longer course of treatment to allow sufficient time to adjust smooth muscle function and consolidate the efficacy.

　　5. Surgical Treatment

　　Surgical treatment can be used for recurrent chronic bacterial prostatitis. Prostatectomy can achieve the purpose of cure, but it should be used with caution. Since prostatitis usually involves the peripheral zone of the gland, transurethral resection of the prostate is difficult to achieve the therapeutic purpose. Transurethral resection of the prostate can remove the prostatic calculi and bacterial infection foci around the prostate duct, which is beneficial to reduce the recurrence of peripheral zone foci. Prostatitis can lead to recurrent urinary tract infections and infertility.