Non-bacterial prostatitis

　　The etiology of chronic non-bacterial prostatitis is very complex. Most scholars believe that the main etiology may be the combined effect of pathogen infection, inflammation, abnormal pelvic floor neuromuscular activity, and immune abnormalities.

　　1. Pathogen Infection

　　Although routine bacterial examinations have not isolated the pathogen in this type of patient, it may still be related to certain special pathogens: such as anaerobic bacteria, L-form bacteria, nanobacteria, or chlamydia trachomatis, mycoplasma, and others.

　　2. Urinary Dysfunction

　　Certain factors can cause overcontraction of the urethral sphincter muscle, leading to bladder outlet obstruction and the formation of residual urine, causing urine to reflux into the prostate. This not only brings pathogens into the prostate but can also directly stimulate the prostate, triggering aseptic 'chemical prostatitis'.

　　3. Mental and Psychological Factors

　　More than half of the patients with prostatitis that does not heal for a long time have obvious changes in mental and psychological factors and personality traits. These include anxiety, depression, hypochondria, hysteria, and even suicidal tendencies. These changes in mental and psychological factors can cause disorders of autonomic nervous function, leading to dysfunction of the posterior urethral neuromuscular function, causing pelvic area pain and urinary dysfunction; or it can cause changes in the hypothalamus-pituitary-gonadal axis function, affecting sexual function, further aggravating the symptoms. Relief or cure of symptoms can be achieved by eliminating mental tension. However, it is still unclear whether the change in mental and psychological factors is the direct cause or a secondary manifestation.

　　4. Abnormal Immune Response

　　Recent studies have shown that immune factors play a very important role in the occurrence, development, and course evolution of chronic non-bacterial prostatitis.

　　5. Oxidative Stress

　　The excessive production of oxygen free radicals or/and the relative decrease in the scavenging system of free radicals in patients with prostatitis leads to a decrease in the body's ability to respond to antioxidant stress and an increase in the products or/and by-products of oxidative stress.

　　6、盆腔相关疾病因素

　　6, Pelvic-related disease factors

　　It is not clear whether non-bacterial prostatitis can cause other complications, but patients with recurrent symptoms often have anxiety, depression, and other mental abnormal reactions, which affect their daily lives.

　　Non-bacterial prostatitis is mainly manifested as pelvic pain, which can be seen in the perineum, penis, perianal area, urethra, pubic area, or lumbar sacral region. Abnormal urination can manifest as urgency, frequency, dysuria, and increased nocturia. Due to chronic pain that does not heal, the quality of life of patients may decrease, and they may have sexual dysfunction, anxiety, depression, insomnia, and decreased memory.

　　1, Urethral and perineal坠胀

　　In the early stage of prostatitis, men often have symptoms such as a feeling of坠胀 in the posterior urethra, perineum, and anal area, which may worsen during squatting, defecation, or sitting for a long time on chairs and stools.

　　2, Sexual dysfunction

　　Once men get prostatitis, it can lead to a decrease in libido, seminal pain, premature ejaculation, and other symptoms, and damage the quality of semen. After urination or defecation, it may be found that white discharge comes from the urethral orifice, and hematospermia may occur when combined with seminal vesiculitis.

　　3, Uncomfortable urination

　　Patients with prostatitis will have prominent reactions in the urinary system, including detailed bladder irritation symptoms, such as frequent urination, burning and pain during urination, and radiation to the head of the penis. In the morning, there may be mucus and other secretions at the urethral orifice, and there may also be a feeling of difficulty in urination.

　　4, Urinary system symptoms

　　After getting prostatitis, it will cause damage to the patient's urinary system, affecting the patient's urethra. The patient may have mild frequency of urination, urgency, and dysuria, and some patients may even find terminal hematuria. Before morning urination or during defecation, there may be mucus or purulent secretions discharged from the urethral orifice.

　　5, Pain

　　After men get prostatitis, the most prominent symptom is pain. The patient's posterior urethra may have a burning sensation and creeping sensation, and the pain in the perineum and anal area may radiate to the lumbar sacral region, inguinal region, suprapubic area, penis, testicles, etc., and occasionally may radiate to the abdomen.

　　6, Neurotic disorders

　　Many patients with prostatitis, due to a lack of accurate understanding of the disease and long-term inability to be cured, may have symptoms such as depression, fatigue, and insomnia.

　　When it comes to non-bacterial prostatitis, many men may feel unfamiliar with it, because most people only have some understanding of prostatitis diseases. In fact, non-bacterial prostatitis is also one of the prostatitis diseases, which brings great trouble to men. Since chronic non-bacterial prostatitis is a common disease among men, the following experts will introduce the prevention methods of non-bacterial prostatitis for men:

　　1. Avoid excessive sexual activity or abuse of aphrodisiacs;

　　2. Avoid frequent interruption of sexual intercourse or holding back seminal fluid without ejaculation;

　　3. Avoid long-term abstinence from sexual life;

　　4. Avoid overeating spicy foods and other irritants, and do not drink alcohol in large quantities.

　　Reminding: In the busy work of daily life, we are prone to ignore our own physical health. We should regularly make a comprehensive inventory of our physical condition to achieve early detection, early diagnosis, and early treatment of non-bacterial prostatitis.

　　For the diagnosis of chronic non-bacterial prostatitis, it is necessary to inquire about the medical history in detail, conduct a comprehensive physical examination (including digital rectal examination), and perform routine urine and prostatic massage fluid examinations. For clear diagnosis and differential diagnosis, optional examinations include semen analysis or bacterial culture, prostate-specific antigen, urine cytology, transabdominal or transrectal ultrasound (including residual urine measurement), urinary flow rate, urodynamic examination, CT, MRI, urethral bladderoscopy, and prostate biopsy, etc.

　　1. Physical examination

　　Digital rectal examination can understand the size, texture, nodules, tenderness and range and degree of the prostate, the tension of the pelvic floor muscles, whether there is tenderness in the pelvic wall, and obtain prostatic fluid by massaging the prostate.

　　2. Laboratory examination

　　(1) Routine examination of prostatic massage fluid Normal prostatic massage fluid contains white blood cells HP, lipids are uniformly distributed throughout the field, pH 6.3～6.5, red blood cells and epithelial cells are absent or occasionally seen. When the number of white blood cells is >10/HP, the number of lipids decreases, which has diagnostic significance.

　　(2) Urinalysis and urine sediment examination Urinalysis and urine sediment examination are auxiliary methods for excluding urinary tract infection and diagnosing prostatitis.

　　(3) Bacteriological examination recommends the 'two-cup method' or 'four-cup method' for pathogen localization tests.

　　(4) Other laboratory tests patients with prostatitis may have abnormal seminal fluid quality, and in some patients with chronic prostatitis, PSA elevation may also occur. Urine cytology examination has certain value in distinguishing from bladder carcinoma in situ and other diseases.

　　3. Ultrasound examination

　　It can be found that the echo of the prostate is uneven, there are prostate calculi or calcification, and the venous plexus around the prostate is dilated, but there is still a lack of specific manifestations of B-ultrasound in diagnosing prostatitis, and it is also impossible to use B-ultrasound to classify prostatitis.

　　4. Urodynamic examination

　　① Urinary flow rate examination can roughly understand the patient's urination condition, which is helpful in distinguishing prostatitis from related diseases with urinary disorders;

　　② Urodynamic examination can detect bladder and urethral dysfunction.

　　5. CT and MRI examination

　　The potential application value of distinguishing seminal vesicle, ejaculatory duct and other pelvic organ lesions is unclear for the diagnosis of prostatitis itself.

　　In addition to general treatment, patients with non-bacterial prostatitis can also relieve symptoms through dietary therapy.

　　1. Kiwi drink

　　Ingredients: Kiwi 50 grams, Plantago asiatica 15 grams, Talcum 10 grams, Liquorice 6 grams.

　　Preparation: Wash kiwi, mash it and take the juice for later use. Boil Plantago asiatica and Liquorice in water, take the juice, and mix it with kiwi juice, drink it as tea.

　　2. Prunella cucumber soup

　　Ingredients: Cucumber 50 grams, Prunella vulgaris 15 grams, Polygonum aviculare 10 grams, Dianthus corymbosus 10 grams, monosodium glutamate. Salt and sesame oil are appropriate in amount.

　　Preparation: Boil Prunella vulgaris, Polygonum aviculare, and Dianthus corymbosus in water, remove the residue, and take the juice. Boil the juice again, add cucumber slices, and add seasonings before eating.

　　Chronic non-bacterial prostatitis should adopt comprehensive treatment. The main treatment goal is to relieve pain, improve urinary symptoms, and improve the quality of life.

　　1. General treatment

　　Health education, psychological and behavioral counseling have a positive effect. Patients should abstain from alcohol, spicy and刺激性 food; avoid holding urine, prolonged sitting, pay attention to keeping warm, and strengthen physical exercise.

　　2. Drug treatment

　　The most commonly used drugs are antibiotics, α-receptor blockers, plant preparations, and non-steroidal anti-inflammatory analgesics, with other drugs also having varying degrees of efficacy in alleviating symptoms.

　　(1) Antibiotics: In the clinical practice of treating chronic non-bacterial prostatitis, antibiotics are the most commonly used first-line drugs, but only about 5% of chronic prostatitis patients have clear bacterial infections.

　　① The treatment of inflammatory types with antibiotics is mostly empirical, with the theoretical basis being the speculation that certain routine culture-negative pathogens cause the occurrence of this type of inflammation. Therefore, it is recommended to take oral fluoroquinolones and other antibiotics for 2 to 4 weeks first, and then decide whether to continue antibiotic treatment according to the feedback of the therapeutic effect. Antibiotics are only recommended to be continued when there is a significant reduction in clinical symptoms. The recommended total course of treatment is 4 to 6 weeks.

　　② It is not recommended to use antibiotics for non-inflammatory types.

　　(2) α-receptor blockers: α-receptor blockers can relax the smooth muscles of the prostate and bladder and improve lower urinary tract symptoms and pain, thus becoming the basic drug for the treatment of chronic prostatitis.

　　Different α-receptor blockers can be chosen according to the patient's condition. The recommended α-receptor blockers mainly include doxazosin, naphthiprazine, tamsulosin, and terazosin, and comparative study results show that these drugs can improve the patient's urinary symptoms, pain, and quality of life index to varying degrees.

　　(3) Plant preparations: The therapeutic effects of plant preparations in chronic prostatitis are increasingly valued and recommended as treatment drugs. Plant preparations mainly refer to pollen preparations and plant extracts, with a relatively wide range of pharmacological effects, such as nonspecific anti-inflammatory, anti-edema, promoting bladder detrusor contraction and urethral smooth muscle relaxation, and so on. Recommended plant preparations include: Prasteron, Sabal palm and its extracts, etc. Due to the variety of species, their usage and dosage should be determined according to the specific condition of the patient, usually with a course of treatment measured in months. Adverse reactions are minimal.

　　(4) Nonsteroidal Anti-inflammatory Analgesics: Nonsteroidal anti-inflammatory analgesics are empirical drugs for the treatment of symptoms related to chronic non-bacterial prostatitis. Their main purpose is to relieve pain and discomfort.

　　(5) M-Receptor Antagonists: M-receptor antagonists (such as tolterodine) can be used to treat prostatitis patients with symptoms such as urgency, frequency, and nocturia without urinary tract obstruction.

　　(6) Antidepressants and Antianxiety Drugs: For patients with chronic prostatitis who have mood disorders such as depression and anxiety, antidepressants and antianxiety drugs can be used for treatment at the same time as prostatitis is treated. These drugs can not only improve the symptoms of mood disorders in patients but also alleviate somatic symptoms such as abnormal urination and pain. It is necessary to pay attention to the prescription regulations and adverse reactions of these drugs when used. The main antidepressants and antianxiety drugs that can be chosen include selective serotonin reuptake inhibitors, tricyclic antidepressants, and other drugs.

　　3. Other Treatments

　　(1) Prostatic Massage: Prostatic massage is one of the traditional treatment methods. Studies have shown that appropriate prostatic massage can promote the emptying of prostatic ducts and increase the local drug concentration, thereby alleviating the symptoms of patients with chronic non-bacterial prostatitis, so it is recommended as an adjuvant therapy for chronic non-bacterial prostatitis.

　　(2) Biofeedback Therapy: Studies have shown that patients with chronic prostatitis have pelvic floor muscle synergy disorders or urethral sphincter tension. Biofeedback combined with electrical stimulation therapy can relax the pelvic floor muscles, make them tend to be coordinated, and at the same time relax the external sphincter, thereby alleviating the perineal discomfort and urinary symptoms of chronic prostatitis.

　　(3) Thermal Therapy: Mainly utilizes the thermal effect produced by various physical means to increase the blood circulation of the prostatic tissue, accelerate metabolism, and is conducive to inflammation and elimination of tissue edema, and relieve pelvic floor muscle spasm, etc. It has a certain symptomatic relief effect in the short term, but the long-term effect is unclear. It is not recommended for unmarried and childless individuals.

　　(4) Prostatic Injection Therapy: The efficacy and safety of transurethral prostatic perfusion therapy have been confirmed.