Patient's question:
Main symptoms: Frequent urination, Urgent urinationOnset time: May 2009
Laboratory test results: Not examined
Doctor's answer:
Hello, I suggest you go to the hospital to rule out the possibility of a urinary tract infection. The occurrence of urinary frequency and urgency is one of the symptoms of prostatitis.Symptoms of Prostatitis
1. Acute Bacterial Prostatitis
- Onset is sudden with chills and high fever.
- Symptoms include urinary frequency, urgency, and dysuria.
- Difficulty urinating or acute urinary retention may occur.
- Often accompanied by acute cystitis.
- The prostate is swollen, tender, and locally warm.
- If an abscess forms, it may feel full or have a fluctuating sensation.
2. Chronic Bacterial Prostatitis
- Symptoms include urinary frequency, urgency, and dysuria.
- Discomfort or burning sensation in the urethra during urination.
- White discharge from the urethral orifice after urination and defecation.
- Occasional hematospermia.
- Pain in the perineum.
- Impaired sexual function and neuropsychiatric symptoms.
- The prostate is full, enlarged, soft, and mildly tender.
- In long-term cases, the prostate shrinks, becomes hard, and has an uneven surface with small hard nodules.
3. Chronic Non-Bacterial Prostatitis and Prostatodynia
- Clinical manifestations are similar to chronic bacterial prostatitis but without a history of recurrent urinary tract infections.
- Primarily characterized by urinary irritation and difficulty urinating, especially in cases of chronic pelvic pain syndrome.
- In some patients, mycoplasma and chlamydia can be cultured from the prostatic fluid.
Diagnostic Methods
1. Digital Rectal Examination
- The prostate appears full, enlarged, soft, and mildly tender.
- In long-term cases, the prostate may shrink, become hard, and have an uneven surface with small hard nodules.
- Prostatic fluid is obtained through massage for routine examination.
2. Prostatic Fluid Examination
- Prostatitis is diagnosed if white blood cells exceed 10 per high-power field under a microscope and phospholipid bodies are reduced.
- Bacterial culture of prostatic fluid can provide a definitive diagnosis and classification.
- A positive result indicates chronic bacterial prostatitis, while a negative result suggests chronic non-bacterial prostatitis.
3. Ultrasound Examination
- Blurred or disorganized prostate tissue structure may suggest prostatitis.
4. Urodynamic Examination
- Key findings include decreased urine flow rate, incomplete relaxation of the bladder neck-urethral external sphincter, and abnormally elevated maximum urethral closure pressure.
Treatment Principles
1. General Treatment
- Rest in bed for 3-4 days.
- Increase fluid intake.
- Avoid alcohol and irritating foods.
- Hot Sitz baths or perineal heat application.
- Maintain regular bowel movements.
- Abstain from sexual activity.
2. Antibiotic Treatment
1) When systemic symptoms are prominent, with high fever and significantly elevated white blood cell count, intravenous antibiotics should be administered for one week, followed by oral medication for one month.
2) Broad-spectrum antibiotics that can diffuse into the prostate and act rapidly should be used to control symptoms and prevent chronic prostatitis.
- Commonly used broad-spectrum antibiotics include cephalosporins and fluoroquinolones.
- Commonly used intravenous drugs:
- Supperzan 2.0g IV every 2-3 times a day.
- Xepan 3.0g IV every 2 times a day.
- Levofloxacin 2.0g IV every 2 times a day.
- Moxifloxacin (Avelox) 400mg IV once a day.
- Commonly used oral drugs:
- Dalin 0.5g twice a day.
- Lixin 0.2g twice a day.
- Moxifloxacin (Avelox) 0.4g once a day.
3. Symptomatic Treatment
1) For high fever, antipyretics such as Indomethacin suppository 1/2 tablet PRN or Ibuprofen 1 tablet PRN may be given.
2) For significant bladder irritation, options include:
- Dorzolamide 0.2g PO three times a day.
- Harle 0.2mg PO once a day.
3) If urinary retention or difficulty urinating occurs, temporary suprapubic cystostomy may be performed for urine drainage, or a soft silicone catheter may be left in place.
4. Surgical Treatment
- If acute prostatitis has developed into a prostatic abscess, drainage should be performed via the rectum or perineum.
- If the abscess is localized within the prostate, a urethral scope may be used for prostatic puncture and abscess drainage, followed by the injection of broad-spectrum antibiotics.