Bacterial prostatitis

　　1. Direct extension, the urine containing pathogenic bacteria refluxes into the prostate duct and retrogradely to the gland, which is the most common infection route;

　　2. Hematogenous infection, pathogenic bacteria spread from other parts of the body through the blood stream into the prostate;

　　3. Lymphatic infection, bacteria from the rectum spread through the lymphatic vessels to invade the prostate. Clinical manifestations: (1) General symptoms: Most patients may have systemic infection toxic symptoms, including sudden fever, chills, muscle and joint pain, and general discomfort, and may also have nausea, vomiting, anorexia, etc. (2) Local symptoms: Pain in the lumbar sacral and perineal areas is the main manifestation, accompanied by frequent urination, urgency, urethral burning, and difficulty in urination, and frequent nocturia. Sometimes, terminal hematuria may occur, and occasionally acute urinary retention. Acute bacterial prostatitis is usually accompanied by varying degrees of cystitis.

　　Urethral infection and bacterial epididymitis may also be complications of chronic bacterial prostatitis, and they can also form infectious prostatic calculi, leading to drug-resistant chronic infections. Sometimes, chronic bacterial prostatitis can be complicated by bladder neck stenosis, resulting in bladder-urethral obstruction, but whether there is a causal relationship between them is not clear.

　　(1) Symptoms: The symptoms of chronic prostatitis are complex. Some patients have no symptoms, and their diagnosis is obtained based on asymptomatic bacteriuria discovered occasionally. Most patients have varying degrees of bladder irritation symptoms (such as frequent urination, urgency, increased nocturia, and dysuria) and discomfort or pain in the lumbar sacral or perineal area. Rarely, there may be chills and fever, which suggest an acute exacerbation of chronic prostatitis. Occasionally, myalgia and arthralgia may occur.

　　(2) Signs: Rectal examination of the prostate can be normal, uneven, or locally hard nodules. When there are larger prostatic calculi present, a sensation of friction can be felt. There may be initial or terminal hematuria, blood seminal fluid, or urethral discharge occasionally. Sometimes, epididymitis may occur concurrently.

　　(3) The pain of bacterial prostatitis is not limited to the urethra and perineum, but also radiates to nearby areas, with low back pain being the most common. In addition, the penis, spermatic cord, testicular scrotum, lower abdomen, inguinal area (groin), thigh, rectum, and other areas can be affected in patients with bacterial prostatitis.

　　1. Exercise to strengthen the body, enhance physical fitness, and improve the ability to resist diseases.

　　2. Actively treat the primary disease focus, such as urethritis, cystitis, pyelonephritis, gingivitis, tonsillitis, etc.; remove the predisposing factors, such as urethral stricture, bladder neck obstruction, prostatic hyperplasia, prostatic calculi, etc.

　　3. Abstain from smoking and drinking, and avoid spicy, fatty, and sweet刺激性 foods to reduce the degree of prostatic congestion.

　　4. Avoid long-term compression of the perineum, such as cycling, horseback riding, or prolonged sitting.

　　5. Drink plenty and evenly, ensuring smooth defecation and urination.

　　6. Married individuals should not avoid sexual activity and ensure regular sexual life. However, whether married or unmarried, regular prostate massage should be performed during treatment, once a week. Because it is difficult to expel seminal fluid through sexual activity or masturbation due to the obstruction of gland ducts by inflammation, only through massage can it promote smooth excretion.

　　7. Those who have depression should face the illness, adjust their emotions, and actively cooperate with treatment.

　　Imaging diagnosis

　　In chronic prostatitis, the prostate capsule reflection in B-ultrasound is usually not smooth, the internal reflection is normal or reduced, and the general morphology, left-right contrast, changes in each section, and attenuation are generally normal.

　　Laboratory diagnosis

　　1. The white blood cells in EPS microscopic examination are ≥10 per HP, or there is a clumping phenomenon in white blood cells, which can be diagnosed. In severe cases, there are a large number of clumped white blood cells, or white blood cells fill the field of vision. The lecithin bodies are significantly reduced, and in some cases, they disappear. If there is inflammation in one gland duct, it is often seen that a small cluster of white blood cells is present. 2. EPS culture requires first emptying the urine, cleaning the glans, massaging to obtain EPS, and placing it in culture medium for cultivation. In the case of chronic bacterial prostatitis, a large number of bacteria can be found in the culture medium, common ones include Escherichia coli, Enterococcus, and Staphylococcus aureus. However, it should be noted that negative results can be due to factors such as the culture method and intermittent discharge, and asymptomatic prostatitis does not necessarily mean there are no pathogens.

　　Spicy and irritating foods

　　Patients with non-bacterial prostatitis should strictly avoid spicy and刺激性 foods. Experts point out that spices such as pepper and Sichuan pepper, as well as fried foods and grilled foods, will cause repeated congestion of the prostate and bladder neck, exacerbate the local swelling and pain in patients, and are unfavorable for treatment.

　　Reduce water intake

　　One of the most common symptoms of non-bacterial prostatitis is frequent urination. Many patients choose to drink less water to reduce the frequency of urination, but experts point out that this is absolutely wrong. Reducing water intake directly leads to the exacerbation of prostatitis. It is recommended that patients drink warm water and drink less strong tea.

　　Eat fewer frozen foods

　　Patients with non-bacterial prostatitis should pay attention to eating fewer frozen foods, such as ice cream, ice water, etc. Experts say that for patients with non-bacterial prostatitis, although frozen foods are not completely contraindicated, eating too much can lead to the exacerbation of the condition, so it is advisable to eat and drink less.

　　① Medical Treatment: Pharmacokinetic studies and clinical experience have proven that only a few antibiotics can reach effective therapeutic concentrations in prostate secretions under non-acute prostatitis conditions. TMP can penetrate into the prostatic fluid and has been proven to successfully cure chronic bacterial prostatitis caused by sensitive bacteria. Long-term treatment (12 weeks) is more effective than short-term therapy (2 weeks). Interruption will lead to re-infection of bladder urine, and symptoms will reappear.

　　② Surgical Treatment: Whether chronic prostatitis can be cured by internal medicine, surgical treatment can be carried out. Since it is difficult to cure prostatitis complicated with calculi with antibiotics alone, chronic prostatitis and prostatic calculi are often indications for surgery. However, unfortunately, surgical complications (sexual dysfunction and urinary incontinence) limit the choice of this surgery. If transurethral resection of the prostate can completely remove the infected tissue and calculi, prostatitis can be cured, but it is difficult to achieve this effect because there are also a large number of infected foci around the prostate.