Chronic prostatitis includes chronic bacterial prostatitis and non-bacterial prostatitis. Among them, chronic bacterial prostatitis is mainly pathogen infection, mainly retrograde infection, the pathogen is mainly Staphylococcus, often repeated urinary tract infection attack history or prostate massage fluid in the persistent presence of pathogenic bacteria. Non-bacterial prostatitis is a complicated pathological change caused by many complicated causes and inducements, including inflammation, immunity and neuroendocrine. The main clinical manifestation is urethral irritation and chronic pelvic pain. And often associated with psychological symptoms of the disease, clinical manifestations are diverse. And the name of chronic prostatitis belongs to the old classfication system in which prostatitis is divided into acute bacterial prostatitis, chronic nonbacterial prostatiti and prostatodynia.
How much do you know chronic bacterial prostatitis?
The pathogenic factor of chronic bacterial prostatitis is mainly due to pathogen infection. When the body resistance is stronger or the pathogen virulence is weak, retrograde infection is the main form of infection. The main pathogens were Staphylococcus, followed by Escherichia coli, Corynebacterium and Enterococcus. Prostatic calculi and urinary reflux may be important causes of persistent pathogens and recurrence of infection.
How much do you know chronic non-bacterial prostatitis?
The nosogenesis of chronic non-bacterial prostatitis is still unkown. The nosogenesis of chronic non-bacterial prostatitis is very complicated with widespread controversy. Many hold a view that the reason that it may be caused by an initiator or may be multifactorial in the first place or more of which play a key role and interact with each other. Also, it may be many different diseases that are difficult to distinguish but with identical or similar clinical manifestations. What’s more, these diseases have been cured and the damage it causes continues to work independently with pathological changes. Most scholars believe that the main cause of the disease may be pathogen infection, inflammation and abnormal pelvic floor neuromuscular activity and immune abnormalities.
How manyoncogenesis do you know？pathogen infection
Although the pathogen can not be isolated by routine bacterial examination, it may still be related to some special pathogens, such as anaerobes, L-Proteus, nanobacteria, chlamydia trachomatis, mycoplasma and so on. Some studies have shown that the detection rate of local prokaryote DNA in this type of patients can be as high as 77%, and some clinical cases of "aseptic" prostatitis, which are mainly chronic inflammation and repeated attacks or aggravation, may be related to these pathogens. Other pathogens, such as parasites, fungi, viruses, trichomonas and Mycobacterium tuberculosis, may also be important pathogenic factors, but there is no reliable evidence, so far there is no unified opinion.
Some factors cause excessive contraction of the urethral sphincter, resulting in bladder outlet obstruction and residual urine formation, resulting in urine reverse flow into the prostate. Not only can the pathogen go into the prostate, but also directly stimulate the prostate to induce aseptic "chemical prostatitis", causing abnormal urination and pelvic pain.
Many prostatitis patients have a variety of urodynamic changes, such as decreased urinary flow rate, functional urinary tract obstruction, detrusor-urethral sphincter synergy, and so on. These abnormalities may only be a clinical phenomenon, and their nature may be related to underlying pathogenic factors.
More than half of the patients with chronic prostatitis have obvious psycho-psychological factors and personality changes, for example, anxiety, depression, hypochondria, hysteria, even suicidal tendency. The changes of these mental and psychological factors can cause autonomic nerve dysfunction to cause posterior urethral neuromuscular dysfunction, and lead to pelvic area pain and urination dysfunction or hypothalamus-pituitary-gonadal axis changes and affect sexual function. The further aggravate symptoms eliminate mental tension can make symptoms relief or recovery. However, it is not clear whether psycho-psychological change is its direct cause or secondary manifestation.
Patients with prostate pain are prone to fluctuations in heart rate and blood pressure, suggesting that autonomic nervous responses may be involved. The pain is characterized by visceral organ pain, local pathological stimulation of the prostate and urethra, triggering of spinal cord reflex through the afferent nerve of the prostate, activation of astrocytes in the lumbar and sacral spinal cord. Nerve impulses pass through the reproductive femoral nerve and ilioinguinal nerve efferent impulses. The sympathetic nerve endings release norepinephrine, prostaglandin, calcitonin gene-related peptide, substance P and so on, which cause bladder urethral dysfunction and lead to perineum. Abnormal pelvic floor muscle activity, persistent pain and traction in the corresponding area outside the prostate A wrench.
Immune response abnormality
Recent studies have shown that immune factors play a very important role in the development and progression of III prostatitis. Some cytokines may change in prostatic fluid, seminal plasma, tissue fluid or blood of the patient, such as IL- 12 Family，IL- 7 Family, IL-8 Family, IL-10 Family, TNF- α and MCP-1. The level of IL-10 was positively correlated with the pain symptoms of patients with III prostatitis, and immunosuppressive therapy was effective.
Oxidative stress theory
Under normal conditions, the production, utilization and removal of oxygen free radicals are in dynamic equilibrium. The excessive production of oxygen free radicals and the decrease of scavenging effect of free radicals in patients with prostatitis may be one of the pathogenetic mechanisms, which can decrease the response ability of the body to antioxidant stress and increase the production and by-products of oxidative stress.
Pelvic disease factors
Some patients with prostatitis are often associated with prostatic peripheral venous plexus dilatation, hemorrhoids, varicocele and so on, suggesting that the symptoms of some patients with chronic prostatitis may be associated with pelvic venous congestion and blood stagnation. This may also be one of the reasons for the persistence of governance.