Understanding the symptoms and treatments of prostatitis to protect men's health.

Acute Prostatitis

Acute bacterial prostatitis is a common urological emergency. It is mostly caused by Gram-negative bacteria, and the main clinical manifestations are urinary urgency, frequency, and dysuria, accompanied by high fever and peripheral blood leukocytosis. Patients often have precipitating factors before the onset of the disease, such as excessive fatigue, exposure to cold, or alcohol consumption. The clinical symptoms vary depending on the route of infection. If it is a hematogenous or lymphatic infection, the onset is sudden, with high fever and elevated peripheral blood leukocytosis as the main manifestations, followed by urinary urgency, frequency, and dysuria. If it is caused by urethral bacteria, urinary tract symptoms appear first, followed by fever and elevated white blood cell count.

Urinalysis of patients with acute prostatitis may reveal a large number of white blood cells, and sometimes a large number of red blood cells. Digital rectal examination reveals tenderness in the prostate. It should be noted that prostate massage should not be performed during the acute phase of acute prostatitis to avoid the spread of local acute inflammation and worsening of the condition.

Patients with acute prostatitis should be hospitalized promptly for intravenous antibiotic treatment. Patients unable to be hospitalized should strictly adhere to bed rest, take effective oral antibiotics, and drink plenty of water to promote urination and excretion of inflammatory secretions.

Chronic Prostatitis

1. Chronic bacterial prostatitis can develop from prolonged acute bacterial prostatitis or be caused by urinary tract bacterial infection. Most patients experience urinary discomfort symptoms such as frequent urination and painful urination, sometimes accompanied by soreness in the perineum and lumbosacral region. Routine urine and prostatic fluid examinations often reveal a large number of white blood cells, and sometimes red blood cells.

The diagnosis of chronic prostatitis mainly relies on medical history and prostatic fluid examination. If the prostatic fluid examination reveals an abnormally high number of white blood cells or a large number of pus cells, the diagnosis can be established. Otherwise, the diagnostic evidence is insufficient, and patients should not be readily diagnosed with chronic prostatitis. This can cause unnecessary psychological stress and tension for the patient, affecting and aggravating local discomfort symptoms. Chronic prostatitis is a pathological change in the prostate tissue that occurs in many men, but the degree of reaction to this change varies greatly. Some men react more sensitively and strongly to this change, experiencing more severe clinical symptoms, which can lead to many other problems (mainly caused by psychological factors), such as general fatigue and weakness, and the perception of sexual dysfunction. Other patients, however, show no reaction to this change and their sexual function remains normal. Clinically, we encounter many patients with chronic prostatitis whose prostatic fluid and urine contain a large number of white blood cells, yet they experience no discomfort. After antibiotic treatment, all test indicators gradually return to normal.

Currently, there are many methods for treating chronic prostatitis, but for most patients, the efficacy is unsatisfactory. This is due to several reasons: Firstly, because the prostate is located deep in the perineal tissue, after oral antibiotics are absorbed in the gastrointestinal tract and reach the prostate via the bloodstream, the drug concentration is already very low, failing to achieve a good therapeutic effect. Various physical therapies have poor penetration into deep tissues and cannot exert a significant effect. Furthermore, patients vary in their sensitivity to stimulation caused by local inflammatory changes, leading to differences in clinical efficacy and symptom improvement. In addition, the patient's psychological state is also a factor contributing to treatment failure.

2. Nonbacterial Prostatitis

Nonbacterial prostatitis is a type of chronic prostatitis, reportedly eight times more common than bacterial prostatitis. Aside from normal routine prostate fluid examination and bacterial culture, and no history of urinary tract infection, the symptoms of nonbacterial prostatitis are essentially the same as those of bacterial prostatitis. Treatment primarily involves physical therapy, such as local massage, shortwave diathermy, and hot sitz baths. Avoiding prolonged sitting and reducing or eliminating smoking, alcohol, and spicy foods are also effective measures to alleviate local symptoms.

3. Prostatodynia

Prostatodynia refers to persistent urinary tract irritation symptoms and perineal discomfort in some patients with nonbacterial prostatitis. The prostate fluid examination was normal, and there was no obvious history of urinary tract infection. Cultures of the prostate and urine showed no significant growth of pathogenic bacteria. These patients do not have true prostatitis, but rather pain and discomfort caused by urethral smooth muscle spasm. Some patients primarily experience perineal and pelvic floor muscle distending pain. Most patients complain of perineal pain and discomfort, especially after prolonged sitting or cycling, often accompanied by testicular and suprapubic discomfort. Digital rectal examination often reveals tenderness upon pressing the levator ani muscles on both sides.

Treatment for this condition primarily involves physical therapy and antispasmodic drugs; antibiotic treatment is ineffective.