Non-gonococcal prostatitis

　　一、西医对于慢性非细菌性前列腺炎的病因并不十分清楚，目前认为可能存在的因素有：

　　1、感染性因素

　　（1）支原体感染。

　　（2）病毒感染。

　　（2）衣原体感染。

　　2、非感染因素

　　（1）前列腺反复充血：有认为频繁且过度的性刺激引起前列腺的反复充血是导致青壮年患者慢性前列腺炎的原因之一；

　　（2）尿液返流，因为，很多成年男性通过B超检查发现前列腺内有结石，但X线平片不能检出；

　　（3）免疫因素：许多学者研究发现，慢性前列腺炎患者前列腺液中的IgA、IgG、IgM升高，特别是IgA升高明显；

　　（4）紧张因素：有研究认为紧张可引起非淋菌性前列腺炎，不用药物、不进行前列腺按摩，而仅仅施行以放松为目的的行为疗法治疗非淋菌性前列腺炎，甚至提出以“紧张性前列腺炎”来命名这一类疾病。但同样的问题是紧张是始动因素（原因）还是终结表现（结果），目前尚缺乏足够的依据。

　　二、中医病因学认为：

　　1、房室因素：中青年男性，思想活跃，性欲旺盛。若有过度而频繁的性刺激，致使阴茎持续性勃起，但无正常、完整的射精过程者。

　　2、有过非婚性行为：淋菌性病毒的感柒。治疗后期不注意保健。

　　3、饮食因素：嗜食辛辣刺激性食物，过度饮酒等，不仅滋生湿热，而且酒后易致乱性。

　　4、起居因素：驾车、办公等久坐不起；或饮水较少；或小便忍持。

　　5、其他不良因素：涉水、淋雨、感冒风寒等。

　　一、急性前列腺炎的并发症

　　1、急性尿潴留：急性前列腺炎引起局部充血、肿胀、压迫尿道，以致排尿困难或导致急性尿潴留。

　　2、急性精囊炎或附睾炎及输精管炎：前列腺的急性炎症很容易扩散至精囊，引起急性精囊炎。同时细菌可逆行经淋巴管进入输精管的壁层及外鞘导致附睾炎。

　　3、精索淋巴结肿大或有触痛：前列腺与精索淋巴在骨盆中有交通支，前列腺急性炎症时波及精索，引起精索淋巴结肿大且伴有触痛。

　　4, Sexual dysfunction:During the acute inflammatory phase, the prostate may become congested, swollen, or form small abscesses, with symptoms such as dysuria pain, painful erection, decreased libido, sexual pain, impotence, and hematospermia.

　　5, Other:Severe acute prostatitis can be accompanied by renal colic.

　　Not all symptoms mentioned above are present in all cases. Some early cases may only have fever and urethral burning, mistakenly considered as a cold. Acute bacterial prostatitis can also be complicated with orchitis, seminal vesiculitis, and epididymitis.

　　Second, complications of chronic prostatitis

　　1, Effects on sexual function and fertility:Mainly manifested as decreased sexual function, such as short foreplay time or premature ejaculation, which may be related to inflammatory stimulation of the prostate. The relationship between impotence and prostatitis is not yet certain. Chronic prostatitis does not directly damage the neural-vascular function of penile erection. Long-term discomfort can produce psychological pressure on patients, causing inhibition and worry, especially for patients who are not familiar with the disease, often thinking that there is a problem with their sexual function. Over time, it may lead to psychogenic impotence. When prostatitis is complicated with seminal vesiculitis, it can cause hematospermia.

　　The main component of seminal fluid is prostatic fluid, and the sperms discharged from the testicles and epididymis must be nourished and transported by seminal plasma including prostatic fluid to have the ability to combine with the ovum. Patients with chronic prostatitis often show low sperm motility and high mortality rate in their routine seminal fluid tests. The incidence of infertility in patients with prostatitis is significantly higher than that in the normal population.

　　2, Effects on the whole body:Chronic prostatitis, in addition to local urinary system symptoms, can also manifest as变态反应性虹膜炎、关节炎、心内膜炎、肌炎等.

　　Patients with chronic prostatitis often show obvious mental symptoms, such as tension and stress, which can lead to general weakness, insomnia, frequent dreams, easy fatigue, hypochondria, and anxiety over time. These patients tend to pay excessive attention to their health status and seek evidence from various aspects to confirm it. No matter how patient the doctors are in their explanations, it is difficult to change their hypochondriacal psychology. Although patients often hold a suspicious attitude towards doctors' explanations and treatments, their desire for treatment is quite urgent. The relationship between prostatitis and mental symptoms is not yet clear. Why does mental stress lead to prostatitis, and how does prostatitis produce mental and neurological symptoms, which are worthy of further study. Mental and neurological symptoms have a direct and intrinsic connection with individual personality characteristics, so the degree of mental symptoms in different individuals with chronic prostatitis can vary greatly.

　　1, Abnormal urination:Urgency, frequency, pain, incomplete urination, urethral burning; when defecating or at the end of urination, there may be white cloudy discharge from the urethral orifice, commonly known as leukocyturia.

　　2, Pain:Commonly occurs in the lumbar sacral region, lower abdomen, perineum, pubic bone, inguinal region, testicles, and spermatic cord, with mild pain and mostly intermittent.

　　3, Low sexual function:Reduced libido, impotence, premature ejaculation, pain during ejaculation, etc.

　　4, Symptoms of neurasthenia:Symptoms such as headache, dizziness, insomnia, frequent dreams, and depression.

　　1. Keep clean:The scrotum of males has a large range of flexibility and secretes a lot of sweat. Added to the poor ventilation of the perineum, it is easy to hide dirt and bacteria, and the local bacteria often enter the body, leading to prostatitis, benign prostatic hyperplasia, decreased sexual function, and if not paid attention to in time, serious infection may occur.

　　2. Do not hold urine:Once the bladder is full and there is a desire to urinate, you should urinate. Holding urine is harmful to the bladder and prostate. Before taking a long-distance bus, you should empty your bladder first and then take the bus. If you feel an urgent need to urinate during the journey, you should greet the driver, get off the bus, and urinate. Never hold it in.

　　3.节制sex life:To prevent benign prostatic hyperplasia, it is necessary to start paying attention from the youth. The key is to have moderate sex life, neither overindulgence nor abstinence. Frequent sex life can cause the prostate to be in a state of congestion for a long time, leading to prostate enlargement. Therefore, especially during the period of strong sexual desire in the youth, attention should be paid to节制sex life, to avoid repeated congestion of the prostate, and to give the prostate sufficient time for recovery and repair. Of course, excessive abstinence can cause a feeling of fullness and discomfort, which is also not good for the prostate.

　　I. Laboratory tests

　　1. Routine prostatic fluid examination:Decreased lecithin bodies in prostatic fluid (usually +/HP), or although the white blood cell count is less than 7.0).

　　2. Urinalysis:No obvious changes.

　　3. Prostatic fluid bacterial culture:No bacterial growth.

　　4. Culture or PCR detection of mycoplasma and chlamydia in prostatic fluid:Positive or negative.

　　5. B-ultrasound examination:There may be no obvious changes, or there may be manifestations such as uneven prostate light points, light spots or light masses, abnormal prostate capsule, low echo area in the glandular substance, and low or no echo area around the gland.

　　6. Bacterial localization culture and colony counting (urine four-cup method)

　　Prostate rectal examination: The prostate may show changes such as fullness, asymmetry, soft texture, tough texture, hard texture, nodules, tenderness, and pain. During massage, there may be a feeling of tension and poor discharge.

　　II. Other examinations

　　1. Prostatic tissue biopsy:Prostatic tissue biopsy can be obtained through perineal or urethral resection. It is generally only used when it is necessary to differentiate from prostatic cancer.

　　2. Computerized Tomography (CT) examination:CT is not sensitive in diagnosing chronic non-bacterial prostatitis, but this examination can be performed when it is necessary to differentiate chronic non-bacterial prostatitis from benign prostatic hyperplasia, prostatic cysts, prostatic tuberculosis, and prostatic cancer, etc.

　　3. Magnetic Resonance Imaging (MRI) examination:MRI, like CT, is not sensitive to the diagnosis of chronic non-bacterial prostatitis and is only used for differential diagnosis with other diseases.

　　4. Urodynamic examination:This examination can be performed when there is a suspicion of lower urinary tract obstruction.

　　Pay attention to developing good eating and living habits, eat more fruits and vegetables, avoid spicy foods, and have early sleep and rise early with moderate exercise. It is recommended to adopt a diet therapy, eat more foods with high melanin content, such as black beans, black rice, black sesame seeds, walnuts, black fungus, etc.

　　1. Physical Therapy

　　Physical therapy mainly utilizes the thermal effect produced to make the deep tissue engorged, improve blood circulation, strengthen the nourishment of local tissues, accelerate the absorption and clearance of inflammatory products, and is conducive to the dispersion of inflammation.

　　2. Ultrasonic Therapy

　　Ultrasonic waves refer to vibration waves with a frequency above 20000 cycles per second, which cannot cause auditory response in normal people. Clinically, the frequency commonly used is 800~1000 kilocycles per second. Medical ultrasonic waves can improve local fluid and lymphatic circulation, enhance local metabolism, change the acidity and alkalinity of the tissue, pH towards alkalinity, reduce local acidosis, alleviate or eliminate pain. Ultrasonic therapy is suitable for patients with chronic prostatitis with significant urinary tract irritation symptoms and a high number of leukocytes in the prostatic fluid examination.

　　3. Shortwave Therapy

　　This is a high-frequency current therapy, and the current used is called shortwave current, with a frequency of 3*10^6 to 3*10^7 hertz, the wavelength is 10~100 meters, and the voltage during treatment is 90~120 volts. The bactericidal effect of shortwave is not direct, but an indirect effect produced by the shortwave enhancing the body's immune defense mechanism. The operation of shortwave therapy is simple, using two electrodes during treatment, one placed on the buttocks and the other on the upper part of the pubic bone in the lower abdomen, for 15~30 minutes each time, once a day, with a two-week course. This therapy is suitable for acute and chronic prostatitis and patients with a high number of leukocytes in the prostate examination.

　　4. Ultrashortwave Therapy

　　This is another method of treatment using high-frequency current, with a higher current frequency, generally 30~300 megahertz, the wavelength is 10-1 meters, the voltage during treatment is 40~50 volts. Its mechanism of action and indications are the same as those of shortwave therapy, but its ability to penetrate tissues and kill microorganisms is much greater than that of shortwave therapy.

　　5. Microwave Therapy

　　It is a new high-frequency electrotherapy method. The frequency is 2450 megahertz, the wavelength is 12.5 centimeters, which is easier to penetrate deep into the tissue than shortwave and ultrashortwave, and has strong microorganism-killing ability in deep tissues, and the characteristic that it does not overheat the subcutaneous tissue and produces uniform heat. The method of use is to place the microwave emission probe 5~6 centimeters deep into the rectum, and irradiate the prostate through the rectal wall, for 8~12 minutes each time, once a day or every other day, with a two-week course. Under normal doses, microwaves are generally harmless to the human body, but the testicles are very sensitive to microwaves, so it is necessary to protect the testicles from irradiation during the treatment of prostatitis. Patients with infertility caused by prostatitis should be more cautious when using this method.

　　6. Direct Current Drug Iontophoresis Method

　　This method utilizes direct current to allow drug ions to diffuse into the tissue through the skin or mucosa, aiming to treat diseases. The main route for drugs to enter the human body is through the openings of the skin and sweat gland ducts, and they gradually enter the blood and lymphatic system; the treatment is a synergistic effect of direct current and drugs. Both Chinese and Western medicine can be used for iontophoresis, such as 1% streptomycin solution, 10% Scutellaria baicalensis liquid, etc. Before the operation, the patient should defecate cleanly, infuse the drug solution into the rectum through the anus, and then apply direct current, allowing the drug components to渗透 into the tissue. This treatment is administered once a day, for 20 minutes each time, with a two-week course. This method is suitable for patients with severe pain in chronic prostatitis and significant bladder irritation symptoms.

　　7. Magnetic Therapy

　　Unlawful is to achieve the purpose of treating diseases by using the magnetic field to act on the body. Experimental evidence shows that magnetic sheets with a magnetic field strength of 1500~3000 gauss have a certain killing or inhibitory effect on Escherichia coli and other bacteria, and can increase local blood circulation, lead to the absorption and dispersion of exudates, and play a role in reducing swelling and pain. Generally, magnetic sheets are pasted on the skin surface near the prostate, such as the perineal acupoint and Guanyuan acupoint. This method is suitable for various types of chronic prostatitis.

　　8. Green Comprehensive Therapy

　　The green light wave high-energy treatment system treats prostatitis through targeted penetration with classic drugs, achieving the three major advantages of strong drug penetration, antibacterial without drug resistance, and repairing damage; oral kidney-tonifying drugs reach the lesion directly through the blood circulation, and have a comprehensive synergistic therapeutic effect on renal anterior glands and many complications; severe cases are matched with the light magnetic field awakening therapy, which walks through meridians and biological information induction, regulates balance, enhances immunity; these three have no overlap in terms of dosage form, mode of use, or emphasis on efficacy, and are a strong, complementary, multi-target comprehensive, and highly synergistic therapeutic combination.

　　9. Non-thermal effect high-frequency wave therapy

　　The high-intensity penetration non-thermal effect high-frequency waves and periodic magnetic pulse alternate to penetrate the prostate body, through the fatty envelope of the outer layer of the prostate, so that the high-frequency energy reaches the deep layer of the tissue, effectively improves the metabolism of cell tissue, improves the microcirculatory system, and enhances the activity of local blood and lymphatic tissues and phagocytes, etc., in the immune system, so as to achieve the purpose of improving the body's immunity, repairing pathological tissues, improving microcirculation, anti-inflammatory, analgesic, and eliminating the hyperplastic tissue of the prostate. It has a significant therapeutic effect on acute and chronic prostatitis, benign prostatic hyperplasia (hypertrophy), urinary obstruction, urethritis, sexual dysfunction and other diseases.