Related to Men's Health
Prostatitis
is often described as an infection of the prostate. It can also be an
with no sign of infection. Just 5% to 10% of cases are caused by . It does not raise the risk of getting .
Prostatitis can affect men of all ages. According to the National Institutes of Health, prostatitis may account for up to 25% of all office visits for complaints involving the genital and urinary systems from young and middle-aged men. In fact, chronic prostatitis (which means it doesn't go away) is the number-one reason men under age 50 visit a urologist. In some cases, chronic prostatitis follows an attack of acute prostatitis. Chronic prostatitis may also be related to other .
The primary symptom of chronic infectious prostatitis is usually repeated . Prostatitis is considered chronic if it lasts more than three months.
Types of prostatitis include:
. A sudden bacterial infection marked by
of the prostate. This is the least common form of prostatitis, but the symptoms are usually severe. Patients with this condition have an acute urinary tract infection with increased urinary frequency and urgency, a need to urinate a lot at night, and have pain in the pelvis and genital area. They often have fever, chills, , , and burning when urinating.
requires prompt treatment, as the condition can lead to bladder infections, abscesses in the prostate or, in extreme cases, completely blocked urine flow. Left untreated, the condition can cause confusion and , and may be fatal. The condition is usually treated in the hospital with intravenous , pain relievers, and fluids.
. This condition is the result of recurrent
that have entered the . It is thought to exist for several years in some men before producing symptoms. The symptoms are similar to acute bacterial prostatitis, but are less severe and can fluctuate in intensity. The diagnosis of this condition is often challenging. It's often difficult to find the bacteria in the urine. Treatment includes
for four to 12 weeks and other treatment for pain. Sometimes men are given suppressive low-dose, long-duration antibiotic therapy.
Chronic nonbacterial prostatitis/ syndrome. This is the most common form of the disease, accounting for 90% of the cases. The condition is marked by urinary and genital pain for at least three of the past six months. Patients have no bacteria in their urine, but may have other signs of inflammation. The condition can be confused with
(a chronic inflammation of the ).
What Causes Prostatitis?
How the prostate becomes infected is not clear. The bacteria that cause prostatitis may get into the prostate from the urethra by backward flow of infected urine or stool from the rectum.
At one time, prostatitis was believed to be a , but more recent research suggests that only a small number of cases are passed on through .
Certain conditions and medical procedures increase the risk of developing prostatitis. You are at higher risk for getting prostatitis if you:
Recently have had a medical instrument, such as a urinary catheter (a soft, lubricated tube used to drain urine from the ) inserted during a medical procedure
Engage in rectal intercourse
Have an abnormal urinary tract
Have had a recent bladder infection
Other causes may include
(an abnormal reaction of the body to the prostate tissue).
What Are the Symptoms of Prostatitis?
You may have no symptoms of prostatitis or symptoms so sudden and severe that you seek emergency medical care.
When present, symptoms include:
Frequent urge to urinate
Difficulty urinating
Pain or burning during urination
Chills and fever
Other symptoms may include pain that comes and goes low in the , around the , in the groin, or in the back. In some cases, bacteria can get into the vas deferens (the tube that carries
from the testicles to the urethra), causing groin pain or an infection of the epididymis (area near the testicles where sperm mature and are stored).
The prostate may swell, causing a less forceful urine stream. Sometimes
and painful ejaculation are other symptoms of prostatitis.
Men may also complain of , pain during ejaculation, and pain with sexual intercourse.
How Is Prostatitis Diagnosed?
If your doctor suspects that you have prostatitis or another prostate problem, he or she may refer you to a urologist (a doctor who specializes in diseases of the urinary tract and the ) to confirm the diagnosis.
Patients typically undergo a comprehensive exam, including a
The doctor will be able to evaluate whether the prostate gland is enlarged or tender. Then, if the doctor is still not sure what you have, more tests may be done, such as a prostate fluid analysis for signs of infection, , , or voiding studies. Voiding studies involve the collection and analysis of urine to determine which part of the urinary system is infected.
What Is the Treatment for Prostatitis?
Treatments vary among urologists and are tailored to the type of prostatitis you have. Correct diagnosis is crucial and treatments vary. It's important to make sure your symptoms are not caused by
(inflammation of the urethra) or some other condition that may lead to permanent bladder or
Treatments for prostatitis can include:
Anti-inflammatory drugs along with warm sitz baths (sitting in two to three inches of warm water); this is the most conservative treatment for chronic prostatitis.
Antibiotics for in these drugs are not effective treatments for noninfectious prostatitis. For acute infectious prostatitis, patients usually need to take antibiotics for 14-21 days. Almost all acute infections can be cured with this treatment.
For chronic infectious prostatitis, antibiotics are taken for a longer period of time, usually four to 12 weeks. About 75% of all cases of chronic infectious prostatitis clear up with this treatment. For cases that don't, taking antibiotics at a low dose for a long time may be recommended to relieve the symptoms.
Muscle relaxants
Surgical removal of the infected port a doctor may advise this treatment for severe cases of chronic prostatitis or for men whose swollen prostate is blocking the flow of urine.
Supportive therapies for chronic prostatitis, including stool softeners and prostate
Other treatments for chronic noninfectious prostatitis include the use of the alpha blocker drugs such as , ,
(), Rapiflo, or . These drugs relax the muscles of the prostate and bladder to improve urine flow and decrease symptoms. Other drugs that lower hormone levels, such as , may help to shrink the prostate gland in some men.
Some people may benefit from avoiding spicy foods and caffeinated or acidic drinks. Activities that aggravate the condition, such as bicycling, may need to be eliminated, as well.
Many cases of abacterial (nonbacterial) prostatitis (also considered chronic pelvic pain syndrome) respond to a mix of treatments that include , myofascial trigger point release, progressive relaxation, and counseling.
Prostatitis is a treatable disease. Even if the problem cannot be cured, you can usually get relief from your symptoms by following the recommended treatment. Be sure to follow the full course any prescription you are given, even if you no longer have any symptoms. With infectious prostatitis, for example, the symptoms may disappear before the infection has completely cleared.
What Are the Long-Term Effects of Chronic Prostatitis?
Chronic prostatitis affects men differently, with varying degrees of discomfort or pain.
Prostatitis is not a . You can live your life normally and continue sexual relations without passing it on.
Having prostatitis does not increase your risk of developing
or any other prostate or . But even if your prostatitis is cured, you should continue to have regular exams to detect prostate cancer.
American Urological Association. National Kidney and Urologic Diseases Information Clearinghouse. American Family Physician.
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三氧水溶液经尿道前列腺恒压定位灌注治疗慢性前列腺炎的临床...
摘要 目的& 研究三氧水经尿道前列腺恒压定位灌注治疗慢性（CP）的临床价值。方法& 将符合诊断标准的238例CP患者随机分为三氧组和对照组，各119例。三氧组使用前列腺恒压定位灌注装置（专利号）进行前列腺灌注治疗，灌注液为自配三氧水溶液40mL，每周2次，3~6次为一疗程；对照组进行常规治疗。通过对比病人治疗前后NIH-CPSI评分、症状评分及EPS常规镜检结果来观察临床价值。结果 三氧组总有效率100％，对照组总有效率73％，三氧组治愈、显效、总有效率均高于对照组( P&0.05 )。结论 在前列腺恒压定位灌注治疗的基础上，应用自制三氧水溶液作为灌注液治疗CP，其临床疗效优于对照组，能迅速改善症状，适用于各类CP，且长期应用无耐药之虞，无毒副作用。&
&慢性；三氧水；定位灌注
Clinical research on ozonated water transurethral prostate constant pressure positioning perfusion in treatment of chronic prostatitis
Wang Junyou ,Xiang Jianfeng
Department Urology, Jining traditional Chinese Medicine Hospital,Jining 272000，China
Abstract& Objective& To evaluate the clinical value of transurethral prostate constant pressure positioning perfusion of ozonated water in treatment of chronic prostatitis. Methods& 238 patients met the diagnostic criteria of chronic prostatitis were randomly divided into two groups, treatment group and control group, &with 119 cases in each. Ozonated water,42.5mg/L 40ml,was perfused to prostate with constant positioning of prostate perfusion device (Patent No. ). In the treatment group,usage was 2 times per week, 3-6 the patients in control group were offered routine drug treatment.By comparing patients ,before and after treatment NIH-CPSI score, symptom score and the results of EPS results of conventional microscopic observation,to observe the chronic value. Results The total effective rate were 100% in the treatment group, and 73% in the control group, the curative rate，obvious effective rate and total efficiency rate of the treatment group were higher than those of the control group (P&0.05).Conclusion The application of the appropriate concentration of ozoned water as perfusion solution, can rapidly improve the symptoms, and can be applied to all types of chronic prostatitis, without the risk of resistance in the long-term use,also notoxic side.
Key words& C& Positioning Perfusion
&&& 慢性（chronic prostatitis ，CP）发病率高达10％~50％[1]。目前的治疗方法多种多样，有药物治疗、前列腺按摩、生物反馈、热疗及中医治疗等，但常常疗效不佳，而且复发率高。2009年12月我院设计了医用三氧水前列腺恒压定位灌注疗法治疗CP的新思路、新方法，并对238例CP病例进行了临床对比观察，经检索，国内外尚未有类似报道，现报告如下。
资料与方法
一、 临床资料&
&&& 随机选择2009年12月至2011年2月在我科就诊、符合以下标准的CP患者患者238例，年龄23~48岁，平均37岁，其中细菌（多为埃希氏杆菌、金黄色葡萄球菌、表皮葡萄球菌、溶血性链球菌等）感染者153例，解脲支原体、沙眼衣原体感染者58例，混合感染者27例，病史7d~10年，平均9.8个月，已婚201例，未婚37例。诊断标准：①腰骶、下腹、会阴、阴茎及睾丸有一处以上不同程度的疼痛。②尿频、尿急、尿等待、排尿费力、尿不尽感等症状。③直肠指诊：前列腺局部触压痛、质稍韧、不光滑、腺体大小及硬度不等。④前列腺液（ESP）涂片镜检，WBC&1 0个／HP或脓细胞，卵磷脂小体数量减少。⑤B超报告：包膜增厚不光滑，腺体质地不均匀等。⑥细菌培养(二杯法)及药敏试验、PCR检查解脲支原体及沙眼衣原体等呈阳性。⑦美国国立卫生研究院慢性症状评分表（NIH-CPSI)总评分为l8~36（26.71±4.37) 分，其中症状评分（19.10±1.89)分。排除标准：①有神经原性膀胱、尿道狭窄、前列腺增生或前列腺癌等影响排尿的其他疾病的患者；②有消化道溃疡，炎症，肿瘤及等疾病的患者；③有特异性环氧化酶Ⅱ抑制剂过敏史的患者[2]。&
二、 治疗方法&
1. 三氧水配制:（方法省略）即刻使用。
2.灌注方法：首先，对患者行前列腺按摩，以疏通前列腺导管，排出腺液。嘱病人排空膀胱，取仰卧位，常规消毒后，铺无菌洞巾，于阴茎根部用纱布缠绕。取2％利多卡因3~5ml作尿道内灌注行局部粘膜麻醉。操作者左手提起阴茎，右手用血管钳夹住四腔双囊导管轻轻插入尿道至膀胱内，见有尿液流出后，连接一次性引流袋。根据导管端标记，将前囊注入 8~10ml生理盐水后，向外适当紧拉导管，堵住膀胱颈口，随后注入3ml生理盐水至后囊，以堵住后尿道，并在尿道外口用纱布条系紧导管，以做进一步固定。两气囊间的前列腺尿道部则形成一闭合腔，然后将现配制的三氧水溶液40ml使用恒压注射器经导管注药管腔缓慢注入，一般定时在40~60min，使药液均匀的进入前列腺体内，以发挥其治疗作用。用法：每周2次，4~6次为一疗程。 2.对照组进行常规治疗：选择敏感抗生素2种（多为喹诺酮类、头孢类和大环内酯类等药物）联合应用，静脉滴注；同时应用前列腺恒压定位灌注系统，将其中一种适合于前列腺灌注治疗的药物灌注前列腺，用法同上。
三、 疗效判断标准
治愈：临床症状消失，前列腺触诊正常，CPSI评分较治疗前减少≥90％，EPS镜检WBC&10／H P、细菌培养阴性；显效：临床症状好转， 前列腺触诊改善，CPSI评较治疗前减少&60％~89％或总分较前减少&15分，EPS镜检WBC较前减少80%、细菌培养阴性；有效：临床症状有所好转，前列腺触诊改善，CPSI评分较治疗前减少30％~59％或总分较前减少15分，EPS镜检WBC较治疗前减少30%、细菌培养阴性；无效：症状改善或稍有改善，前列腺触诊无改善，CPSI评分较治疗前无减少或总分较前减少&5分，EPS镜检WBC较治疗前少&30％、细菌培养阳性。以治愈、显效、有效病例计算总有效率。
四、 统计学处理
计量资料用均数±标准差表示( ±s)，比较采用t检，计数资料采用x2检验。数据分析均通过SPSS16.0进行，P&0.05为差异有显著性,有统计学意义。
238例病人治疗依从性较好，均按要求按时治疗。除8例因前列腺增生等原因不易插入导管，需用金属内芯支撑插入外，其余患者均能顺利插入导管。采用本法治疗后，根据疗效评定标准，三氧组治愈者101例(84.9％)，显效者12例(10％)，有效者6例(5％)，无效者0例(0％)。对照组治愈者75例(63％)，显效者8例(6.7％)，有效者4例(3.3％)，无效者32例(27％)，总有效率为73%。 患者前1~2次，治疗后尿道口有轻度灼痛症状，持续1d左右，之后治疗不再出现。
表1& 238例CP患者治疗前后NIH-CPSI总评分、
症状评分比较( ±s，分)&
时间 &&&&&&&&&&&&n&&&&&&& NIH-CPSI总评分 &&&&症状评分&
治疗前&&&&&&&&&& 238&&&&& 26.71±4.37&&&&&&&& 19.10±1.89&&
&治疗后 三氧组& &&119&&&&& 6.15±1.32&&&&&&&&& 5.23±0.55
&&&&&& &&&&
&对照组&&& 119&&&&& 12.34±2.21&&&&&&&& 10.05±1.08
表2& 两组患者治疗后总有效率比较
&& 组别&&&&& 例数&&& 治愈&&& 显效&&& 有效&&& 无效&&& 总有效率（%）&& &&
三氧组&&& 119&&&& 101&&&&& 12&&&&& 6&&&&&& 0&&&&&&& 100
对照组&&& 119&&&& 75&&&&&& 8&&&&&& 4&&&&&& 32&&&&&& 73&&
&&& 从以上两表可看出，三氧组CP患者治疗前后NIH-CPSI 总评分、症状评分均较对照组明显下降，差异有统计学意义( P& O.05)，见表l。三氧组总有效率为100％，对照组总有效率73％(三氧组治愈、显效、有效及总有效率均高于对照组),见表2。双检验P&O.05，按仅α=0.05水准，可认为三氧治疗组与对照组治疗效果差异有统计学意义。&
讨&&&&&&&&& 论
CP是之一 ，约占泌尿外科门诊患者的5％~25％左右，近50%的成年男性有罹患症状的可能，从而一定程度地降低其生活质量。
目前，CP的病因病机并不完全清楚，而是一种可能由多种因素参与、发病机制复杂、临床表现多样的临床综合征。目前公认的病因及发病机制有病原微生物感染理论，包括细菌、支原体、衣原体、病毒及寄生虫等感染，前列腺内尿液反流理论，交感神经理论及免疫机制理论等。
CP主要病机仍是炎症反应，可分为细菌性和非细菌性两类。目前认为非细菌性炎症占多数[3]，非细菌性虽然细菌学检查不能证实有细菌存在，但在很大程度上它确起源于细菌感染[3]，因此抗感染治疗对于两类都是非常必要的。
三氧分子式为03，分子量48.0;是氧的同素异形体，由三个氧原子构成，三氧是人类已知的仅次于氟的第二位强氧化剂，三氧在一定浓度下能与细菌、病毒等微生物产生生物化学氧化反应[4]。三氧有很高的能量，所以很不稳定，在常温、常压下分子结构易变，很快自行分解为氧(02)和单个氧原子(O)。单个氧(O)具有很强的活性，对细菌、病毒等微生物有较强的氧化作用。三氧能氧化分解细菌内部氧化葡萄糖所必须的葡萄糖氧化酶，并直接与细菌、病毒发生作用，破坏其细胞器和核糖核酸，分解DNA、RNA、蛋白质、脂质类和多糖等大分子聚合物，使细菌的物质代谢生长和繁殖过程遭到破坏。还可以渗透细胞膜组织、侵入细胞膜内作用于外膜脂蛋白和内部的脂多糖，使细胞发生通透性畸变，导致细胞的溶解死亡。并且将死亡菌体内的遗传基因、寄生菌种、寄生病毒粒子、噬菌体、支原体及热原(内毒素)等溶解变性死亡。按照无菌技术对微生物作用的原理可分为抑菌、杀菌和溶菌三种。三氧应属于溶菌剂，即可以达到“彻底、永久地消灭人体内部所有微生物” [4]。其抗炎效果对于前列腺局部的炎症反应，三氧则通过刺激抗氧化物的过度表达以中和炎症反应中过量的活性氧(ROS)，刺激炎症反应的细胞因子或免疫抑制细胞因子的释放，刺激血管内皮细胞释放一氧化氮(NO)及血小板源性生长因子(PDGF)等引起血管扩张，从而达到了促进炎症吸收作用[5]。
CP难以治愈的原因是多方面的，前列腺生物膜屏障使抗菌药物难以达到前列腺内形成有效浓度[6]，而三氧灌注疗法则不受前列腺生物膜屏障的影响直接进入前列腺，杀灭病原菌；前列腺导管细长、弯曲、开口口径小，炎症反应使导管充血、水肿等因素，不利于炎性分泌物的排出和引流，一方面应用前列腺恒压定位灌注装置经尿道注入三氧水溶液时具有一定压力，可起到扩张作用而进入前列腺导管内，另一方面三氧水溶液能通过上述抗炎作用消除水肿，使导管内压力减小，引流通畅。有人提出前列腺的疼痛可能是神经炎所致[7]，三氧可以通过抗炎作用减少炎症因子释放前列腺素、缓激肽和组胺等致痛物质，从而降低其对前列腺周围的神经末梢刺激，使疼痛症状减轻或消失。&
目前我国已有多个厂家生产医用三氧治疗机，三氧制备浓度控制精确，所用三氧水溶液配制方法简便，在前列腺恒压定位灌注治疗已取得国家专利的基础上，本疗法的设计形成了对治疗的新思路、新方法，有疗效好、痛苦小、无毒副作用等优势，且三氧分解后变成氧气，对环境无污染，对人体无危害。但由于我们开展此项治疗时间较短，缺乏更大样本和更长时间的疗效观察，在其治疗浓度、疗程及联合治疗等方面还需进一步研究。&
参 考 文 献
1 &Nickel JC，Hunter D． Prevalence of prostatitis like symptom population based study using the national institutes of health chronic prostatitis symptom index.J Urol ):843-845&
2曾定冬.美洛昔康在慢性治疗中的应用.药物与临床):54-55
3 王 平,王 侠,刘屹立.慢性诊治及疗效评价.中华泌尿外科杂志 ):528-529
4 Velio Bocci.Ozone as Janus-this controversial &gas can be either toxic or medically useful.Mediators of inflammation，）：3-11
5 林谦.慢性病因学研究进展.现代泌尿外科杂志 ):139
6 张少林.经会阴前列腺药物注射治疗慢性147 例疗效分析.中国男科学杂志,):108
7 Wesselmann U.Neurogenie inflammation and chonic pelvic pain.World J Urol -185
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泌尿男科疾病，如前列腺炎、前列腺增生、阳痿、早泄、结石、血精、血尿、遗尿、尿失禁、睾丸附睾炎、阴囊湿疹、精索静脉曲张、急慢性尿路感染、膀胱肿瘤、肾虚腰痛、肾脏肿瘤等；
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男科好评科室推荐→ 男性前列腺炎这个病要怎么样治疗比较好？
男性前列腺炎这个病要怎么样治疗比较好？
健康咨询描述：
最近我发现我小便的时候感觉尿急的很，而且小便的时候还尿痛，之后我发现还有尿道口滴白的症状，郁闷的是我这几天出血了阳痿早泄的情况了，我去医院检查了，医生说是得了前列腺炎了。
想得到怎样的帮助：请问怎么治疗前列腺炎比较好？
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&&&&&&你好，超声波能改善局部愈液和淋巴循环，加强局部新陈代谢，使组织酸碱度发生变化，pH向碱性改变，使局部酸中毒减轻，缓解或消除疼痛。超声波治疗适用于慢性前列腺炎出尿路刺激症状明显和前列腺液镜检白细胞较多的患者。
疾病百科| 前列腺炎
挂号科室：泌尿科、男科
温馨提示：多饮水，不憋尿，节制性生活。
前列腺炎是由于前列腺受到致病菌感染和(或)某些非感染因素刺激而出现的骨盆区域疼痛或不适、排尿异常等临床表现。前列腺炎是成年男性的常见疾病，且50岁以下成年男性患病率较高，有资料显示前列腺炎患者占泌尿外...
好发人群：成年男性
是否医保：医保疾病
常见症状：会阴部疼痛、尿急、尿频、排尿疼痛、尿液终
治疗方法：药物治疗（抗生素治疗）、前列腺按摩、物理治疗（红光理疗）
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