Chronic bacterial prostatitis

Introduction

Introduction to chronic bacterial prostatitis

Chronic bacterial prostatitis (CBP) is a non-acute prostate infection caused by one or several pathogens and is less common in prostate-related diseases. Like acute bacterial prostatitis, pathogenic bacteria are Gram-negative aerobic bacteria, such as Escherichia coli and Pseudomonas aeruginosa, and some clinicians consider Gram-positive bacteria (such as staphylococcus, streptococcus, diphtheria-like) Bacteria can also cause prostatitis, but unlike the prostate infection caused by Gram-negative bacteria, prostate infection caused by Gram-positive bacteria rarely delays or causes repeated attacks, except for prostatitis caused by Enterococcus. However, many authors are skeptical about the chronic prostatitis caused by Gram-positive bacteria. There is evidence that chlamydia and mycoplasma can also cause prostate infection, but it is rare.

basic knowledge

The proportion of illness: 0.012%

Susceptible people: male

Mode of infection: non-infectious

Complications: urinary tract infection epididymitis prostate stones bladder neck contracture

Pathogen

Causes of chronic bacterial prostatitis

Like acute bacterial prostatitis, pathogenic bacteria are Gram-negative aerobic bacteria, such as Escherichia coli and Pseudomonas aeruginosa, and some clinicians consider Gram-positive bacteria (such as staphylococcus, streptococcus, diphtheria-like) Bacteria can also cause prostatitis, but unlike the prostate infection caused by Gram-negative bacteria, prostate infection caused by Gram-positive bacteria rarely delays or causes repeated attacks, except for prostatitis caused by Enterococcus. However, many authors are skeptical about the chronic prostatitis caused by Gram-positive bacteria. There is evidence that chlamydia and mycoplasma can also cause prostate infection, but it is rare.

Prevention

Chronic bacterial prostatitis prevention

Because the predisposing factor has not been determined, the prevention of this disease is difficult. The normal prostatic fluid contains zinc, which is a powerful antibacterial factor in the zinc solution in the prostatic fluid of patients with chronic bacterial prostatitis. Zinc content is significantly reduced. Some authors believe that this antibacterial factor in male prostatic fluid is a natural defense mechanism against genital infections in the genitourinary system. However, oral administration of zinc to male patients does not stimulate the increase of zinc in prostatic fluid. Active bacteria must be actively treated. Prostatitis and prevention of chronic bacterial prostatitis should be treated with strict aseptic technique to prevent iatrogenic anterior fissure gland infection during transurethral device examination and catheterization.

Complication

Chronic bacterial prostatitis complications Complications, urinary tract infection, epididymitis, prostate stones, bladder neck contracture

Recurrent urinary tract infections are characteristic of chronic bacterial prostatitis, although the symptoms and signs of urinary tract infections can be quickly eliminated after bactericidal bacteria are killed during appropriate antibacterial treatment, but at intervals after treatment, the same type The infection caused by the bacteria is easy to re-emerge, because the bacteria in the urine are completely killed, but the pathogenic bacteria in the prostate remain unchanged, because most antibiotics are difficult to penetrate into the prostatic fluid, so after the treatment is completed, the bacteria remain in the prostate. This will eventually cause the urinary tract to re-infect.

Ascending upper urinary tract infection and bacterial epididymitis may also be complications of chronic bacterial prostatitis, it can also form infectious prostatic stones, and lead to drug refractory chronic infection, sometimes chronic bacterial prostatitis can be complicated by bladder Bladder urethral obstruction caused by neck contracture, but whether there is a causal relationship between them is not clear.

Symptom

Chronic bacterial prostatitis symptoms Common symptoms Urinary frequency desire to reduce bladder irritation, pain, dizziness, prostate secretions... Weak radioactive pain, prostate calcification, blood

Chronic prostatitis has various symptoms, and its weight is very different. Some are all asymptomatic, while others are discomfort. The common symptoms are as follows.

1, urination discomfort: bladder irritation may occur, such as frequent urination, urinary tract burning when urinating, pain and radiation to the head of the penis, early morning urethral orifice may have mucus and other secretions, but also the feeling of dysuria.

2, local symptoms: the posterior urethra, perineal and anal bulge discomfort, squat, stool and long time sitting on the chair stool increased pain.

3, radiation pain: chronic prostatitis pain is not limited to the urethra and perineum, but also to the vicinity of the radiation, the following most common low back pain, in addition, the penis, spermatic cord, testicular scrotum, lower abdomen, groin area (thigh root), The thigh, rectum, etc. can be affected. It should be pointed out that the low back pain caused by chronic prostatitis is in the lower back, and it is easy to be confused with orthopedic causes of low back pain such as myofascial inflammation and lumbar muscle strain, but the latter is mostly at the belt. Nearby, the position of low back pain caused by prostatitis is high and can be identified.

4, sexual dysfunction: chronic prostatitis can cause loss of libido and ejaculation pain, ejaculation premature, and affect the quality of semen, urinary tract vaginal discharge after urination or stool, combined with seminal vesiculitis can appear blood.

5, other symptoms: chronic prostatitis can be associated with neurasthenia, showing fatigue, dizziness, insomnia, etc.; long-lasting prostatic inflammation can even cause the body's allergic reactions, conjunctivitis, arthritis and other diseases.

Examine

Examination of chronic bacterial prostatitis

Laboratory examination: in the absence of secondary epididymitis or acute exacerbation of chronic infection, the blood is generally normal, white blood cells are not elevated, and a large number of inflammatory cells are often found in prostate massage fluids. Many researchers and clinicians believe that prostatic fluid More than 10 leukocytes in each high power field are abnormal, more than 15 are leukocytosis, and a large number of lipid-rich macrophages in prostatic fluid are significantly associated with the presence of prostatic inflammation. When there is a secondary bladder, the middle urine can be Pyuria and bacterial urine, the pathogens are consistent with the pathogens that infect the prostate.

When the urine itself is infected, collecting segmented urine and prostate massage fluid for bacterial culture can determine the source of the pathogen. When using this technique, the doctor must carefully collect the urine from the patient and the uncontaminated Prostate secretion specimens, the above specimens are injected into the culture medium for 24 to 48 hours, and the growth of various bacteria is identified using standard microbiological examination methods. When the bladder specimens (middle urine) are sterile or substantially aseptically grown, compare other specimens. The colony count determines the site of infection. If the colony count of the urethral specimen (primary urine) greatly exceeds (at least 10 times) the prostate specimen, the infection is located in the urethra, and conversely, the infection originates from the prostate.

X-ray examination: Except for various complications (such as prostatic stones, prostatic hypertrophy, urethral stricture, kidney infection, etc.), otherwise excretory urography is normal.

Device examination: cystoscopy or urethroscopic surgery may not appear abnormal, or found in the prostate segment of the urethra congestion and edema, with or without inflammatory polyps, these performances are not unique to chronic bacterial prostatitis, may also be present in other prostatitis.

Diagnosis

Diagnosis and diagnosis of chronic bacterial prostatitis

Male patients with acute or chronic symptoms of urethritis may be prompted for prostatitis, and a segmented specimen of the urethra, bladder or prostate secretions may be cultured or stained for smears, generally identifying areas of inflammation and infection.

Cystitis can sometimes be confused with chronic bacterial prostatitis. It is also easy to be complicated with cystitis when the prostate is infected. The above-mentioned segmental urine specimen and prostate secretion specimens can be identified and cultured to identify the infected part. Prostatitis, the presence of prostate infection can be determined by repeated antibiotic treatment after appropriate antibiotic treatment (using antibiotics that are difficult to diffuse in the prostate, such as furantanidine, penicillin G) to kill bacteria in the bladder.

Anal diseases (such as anal fissure, thrombotic acne) can cause perineal pain or even frequent urination, but physical examination should be able to distinguish them.