Patient's question:
IntroductionEdit this section: Prostate hyperplasia and prostatitis are common diseases of the male prostate. Prostate hyperplasia is one of the common diseases among elderly men. As men age, they may experience prostate hyperplasia to some extent. Studies have shown that prostate hyperplasia begins after the age of 40, but it is more common in people over 60. The main symptoms of prostate hyperplasia include difficulty urinating. Mild cases may involve frequent nighttime urination, a feeling of incomplete urination, or a small amount of urine remaining after urination. Severe cases may involve a narrowed urinary stream or even the inability to urinate. It is often accompanied by symptoms such as lower back pain, weakness in the limbs, and nocturnal emissions. This section is edited by "Henan Public Security Hospital."
Symptoms
Edit this section: The prostate is the most common site of problems in the male reproductive and urinary system. Prostatitis, common in men of all ages, can be acute or chronic. It is usually caused by bacterial infections from other parts of the body invading the prostate. Prostatitis can completely or partially obstruct urine flow from the bladder, leading to urine retention. This can cause bladder distension, weakness, and increased susceptibility to infection (due to the accumulation of bacteria in the urine). Bladder infections can easily spread to the kidneys through the ureters. The symptoms of acute prostatitis include pain between the scrotum and rectum, fever, frequent urination with a burning sensation, and blood or pus in the urine. The symptoms of chronic prostatitis include frequent urination with a burning sensation, blood in the urine, lower back pain, and impotence. The more severe the prostatitis, the more difficult it is to urinate.
Common symptoms include:
1. Pain: The posterior urethra may have a burning or crawling sensation. Pain in the perineum, anus, and rectum can radiate to the lumbar-sacral region, groin, suprapubic area, penis, and testicles. Occasionally, it can radiate to the abdomen.
2. Urinary system symptoms: Inflammation affecting the urethra may cause mild frequent urination, urgency, and dysuria. Some patients may also experience terminal hematuria. Mucus or purulent secretions may be discharged from the urethral meatus before morning urination or during defecation. The urine may be cloudy, or white discharge may occur after defecation. Severe cases may lead to terminal hematuria, difficulty urinating, or urinary retention.
3. Physiological dysfunction: This may include reduced libido, impotence, premature ejaculation, painful ejaculation, increased nocturnal emissions, and blood in the semen. In some cases, infertility may result from inflammation of the spermatic ducts.
4. Neurological symptoms: Due to a lack of understanding of the disease or prolonged treatment, patients may experience depression, fatigue, insomnia, and dizziness.
5. Secondary symptoms: Allergic reactions caused by bacterial toxins may lead to conjunctivitis, iritis, arthritis, and neuritis.
Prostate enlargement, difficulty urinating, including weakness and intermittent urination, frequent urination (especially at night), fatigue, dripping urine, or inability to empty the bladder.
Acute prostatitis: Frequent urination, difficulty urinating, burning sensation during urination, chills and fever, pain in the lower back and posterior scrotum, and blood in the urine.
Chronic prostatitis: Frequent urination, difficulty urinating, pelvic and genital pain, painful ejaculation, white semen, and sexual dysfunction.
Symptoms of chronic prostatitis
Chronic prostatitis: Frequent urination, difficulty urinating, pelvic and genital pain, painful ejaculation, white semen, and sexual dysfunction.
1. Pain: The posterior urethra may have a burning or crawling sensation. Pain in the perineum, anus, and rectum can radiate to the lumbar-sacral region, groin, suprapubic area, penis, and testicles. Occasionally, it can radiate to the abdomen.
2. Urinary system symptoms: Inflammation affecting the urethra may cause mild frequent urination, urgency, and dysuria. Some patients may also experience terminal hematuria. Mucus or purulent secretions may be discharged from the urethral meatus before morning urination or during defecation.
3. Physiological dysfunction: This may include reduced libido, impotence, premature ejaculation, painful ejaculation, increased nocturnal emissions, and blood in the semen. In some cases, infertility may result from inflammation of the spermatic ducts.
4. Neurological symptoms: Due to a lack of understanding of the disease or prolonged treatment, patients may experience depression, fatigue, insomnia, and dizziness.
5. Secondary symptoms: Allergic reactions caused by bacterial toxins may lead to conjunctivitis, iritis, arthritis, and neuritis.
Symptoms of bacterial prostatitis
1. Urinary discomfort: Frequent urination, burning pain in the urethra, which can radiate to the head of the penis. Mucus, mucus threads, and purulent secretions may be present in the urethral meatus in the morning or after defecation. The urine may be cloudy, or white discharge may occur after defecation. Severe cases may lead to terminal hematuria, difficulty urinating, or urinary retention.
2. Sexual dysfunction: Due to the prolonged course of the disease and high stress on patients, some may experience reduced libido or loss of libido, painful ejaculation, blood in the semen, premature ejaculation, impotence, nocturnal emissions, and infertility.
3. Local symptoms: Discomfort, pressure, or a sense of fullness in the posterior urethra, perineum, and anus, which may worsen when squatting or defecating.
4. Radiating pain: The prostate and seminal vesicles are richly innervated by autonomic nerves. During inflammation, increased tension in the gland can stimulate these nerves, causing referred pain that radiates to the penis, testicles, scrotum, groin, perineum, lower abdomen, thighs, buttocks, and rectum. The pain is dull or aching.
5. Other: Chronic prostatitis can lead to neurosis,、、、. This section is edited by "Henan Public Security Hospital."
Traditional classification methods
Edit this section: Prostatitis is classified by comparing the number of white blood cells and bacterial culture results in initial urine, midstream urine, expressed prostatic secretion (EPS), and post-EPS urine. It is divided into: acute bacterial prostatitis (ABP), chronic bacterial prostatitis (CBP), chronic nonbacterial prostatitis (CNP), and prostatodynia (PD). This section is edited by "Jingzhou Wenjie Hospital."
New classification methods
Edit this section: In 1995, the National Institutes of Health (NIH) developed a new classification system based on the current understanding of the basic and clinical research of prostatitis:
Type I: Equivalent to ABP in traditional classification.
Type II: Equivalent to CBP, accounting for 5%–8% of chronic prostatitis.
Type III: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), equivalent to CNP and PD in traditional classification. It is the most common type of prostatitis, accounting for more than 90% of chronic prostatitis. Based on EPS/sperm/voided bladder 3 (VB3) routine microscopic examination results, this type can be further divided into subtypes IIIA (inflammatory) and IIIB (non-inflammatory): IIIA patients have elevated white blood cell counts in EPS/sperm/VB3, while IIIB patients have normal white blood cell counts. IIIA and IIIB account for about 50% each.
Type IV: Asymptomatic inflammatory prostatitis (AIP). No subjective symptoms, but inflammation is detected during prostate-related examinations. This section is edited by "Jingzhou Wenjie Hospital."
Pathogenesis
Edit this section: Type I prostatitis
The primary pathogenic factor is infection by pathogens. Due to weakened immunity, highly virulent bacteria or other pathogens infect the prostate and rapidly multiply, causing the condition. This is usually due to hematogenous infection or retrograde urethral infection. The main pathogens are Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Proteus, and Pseudomonas. Most cases involve a single pathogen.
Type II prostatitis
The primary pathogenic factor is also infection by pathogens, but the host's resistance is stronger or/and the pathogens are less virulent, with retrograde infection being the main route. The main pathogens are Staphylococcus, followed by E. coli, Corynebacterium, and Enterococcus. Prostate stones and urine reflux may be important reasons for persistent infection and recurrence.
Type III prostatitis
The pathogenesis is unclear, and the etiology is highly complex and controversial. It may be caused by a single initiating factor or multiple factors, with one or more playing a key role and interacting with each other. It may also be many indistinguishable different diseases but with similar clinical manifestations. Even if these diseases are cured, the damage and pathological changes they caused may continue to act independently. Most scholars believe that the main etiology may be the combined result of pathogen infection, inflammation, abnormal pelvic floor neuromuscular activity, and immune abnormalities.
Doctor's answer:
Hello, the causative pathogens of chronic prostatitis are often Gram-negative bacteria. Antibiotics that can penetrate the prostatic capsule mainly include sulfonamides and macrolides. Clinically, commonly used antibiotics include clarithromycin, azithromycin, roxithromycin, ofloxacin, and norfloxacin.Pay attention to maintaining a calm mindset, drink plenty of water, follow a regular lifestyle and diet, adhere to moderate exercise, avoid alcohol, reduce spicy and irritating foods, and maintain a regular sexual life.