Guidelines for the Prevention and Treatment of Chronic Prostatitis and Prostatic Hyperplasia: Essential Reading for Men's Health

Chronic Prostatitis

The prostate gland is an accessory gland of the male reproductive system, located at the bladder neck, surrounding the posterior urethra. It is about the size of a chestnut, with a smooth surface and a groove in the middle, and is highly elastic. Its main function is to secrete prostatic fluid. Prostatic fluid, along with secretions from the seminal vesicles and bulbourethral glands, constitutes the liquid portion of semen and is closely related to sperm survival, activation, and fertilization. Furthermore, prostatic fluid facilitates the rapid metabolism of testosterone into androgens, thus playing a close role in male sexual development.

The most common cause of prostatitis is the direct spread of bacteria from the urinary tract to the prostate, leading to inflammation. When the body's resistance is lowered, latent bacteria in the urethra can enter the prostate through the openings of the prostatic ducts located in the posterior urethra. Skin boils, tonsillitis, gum inflammation, or respiratory tract inflammation can also allow bacteria to invade the prostate via the blood and lymphatic system, causing prostatitis. Besides bacteria, viruses, trichomonas, fungi, and mycoplasma can all cause prostatitis.

Prostatitis is divided into acute and chronic types. Acute prostatitis often results from the spread of inflammation from other organs. Due to the widespread use of antibiotics, acute prostatitis is now rare. However, chronic prostatitis is quite common, and some scholars believe that the disease is related to the patient's own immune factors.

Chronic prostatitis has the following symptoms: Firstly, changes in urination, initially including discomfort or burning sensation during urination, urinary frequency, urgency, and painful urination. A few patients experience symptoms such as: 1) sticky discharge from the urethra in the morning, and dribbling after urination that wets their clothes;

2) abnormal urine color, often darker, cloudy, white, or even hematuria;

3) pain, which can cause pain in the lumbosacral region, hip, perineum, suprapubic region, and abdomen, sometimes radiating to the testicles and groin;
4) sexual dysfunction, manifested as decreased libido, impotence, premature ejaculation, nocturnal emission, and infertility;
5) neurasthenia, manifested as frequent dreams, anxiety, and restlessness, even affecting study and work. Young and middle-aged men experiencing these symptoms should seek medical attention.

【Treatment Methods】 Patients with chronic prostatitis should maintain a regular lifestyle, practice moderation in sexual activity, and prioritize exercise to improve physical fitness. Drinking plenty of water to increase urine output can also alleviate symptoms. Avoid alcohol and spicy foods. Avoid exposure to cold, dampness, and overexertion. Prolonged horseback riding, cycling, or long-distance driving can cause prostate congestion, hindering the resolution of inflammation.

Drug treatment may include compound sulfamethoxazole, senna extract, doxycycline, cephalexin, and norfloxacin. If caused by trichomoniasis, metronidazole (Flagyl) is used. If infected with gonorrhea, high-dose penicillin or cefixime is used. Intraprostatic antibiotics can also be injected through the perineum or rectum; posterior urethral drug irrigation can be performed using a double-balloon four-lumen silicone catheter; drugs can also be injected into the vas deferens or the area around the prostate can be sealed.

Persistent hot sitz baths, iontophoresis, and regular prostate massage can alleviate symptoms.

Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia, also known as enlarged prostate, mostly occurs in men over 50 years of age. According to statistics from Europe and the United States, the incidence rate of benign prostatic hyperplasia (BPH) in elderly men can reach over 80%, while domestic reports show a lower rate, but still over 50%. Because the prostate gland is located at the bladder outlet and surrounds the urethra, once enlargement occurs, the prostate gland compresses the urethra from all sides, obstructing urine flow and leading to a series of urinary system diseases. Generally, the prostate gland grows slowly after birth, accelerates during puberty, and remains relatively constant in size until middle age, approximately 4 cm × 3 cm × 2 cm. Afterward, in some men, the prostate tends to atrophy, gradually shrinking, while in others it tends to enlarge. When the enlarged prostate reaches a certain size, it can compress the urethra, causing difficulty urinating, a condition medically termed benign prostatic hyperplasia (BPH).

Besides being closely related to testicular dysfunction and sex hormone metabolism disorders in middle-aged and elderly men, benign prostatic hyperplasia (BPH) is also related to the following factors: excessive sexual activity and unrestrained sexual desire; inflammation such as posterior urethritis, cystitis, and seminal colliculitis; urinary tract obstruction; frequent or prolonged alcohol consumption; a preference for spicy, hot, and sour foods; and lack of physical exercise.

Secondly, urinary obstruction occurs: when feeling the urge to urinate and starting to urinate, the urine cannot be expelled smoothly, requiring a long wait in the toilet before urine can be expelled.

Thirdly, weak urination occurs: normal urine has a force when expelled, so the urine flow has a certain speed and range. After benign prostatic hyperplasia (BPH) occurs, the urine stream becomes thinner and weaker, failing to flow in a straight line and with a shorter range.

Fourthly, nocturnal urinary incontinence occurs: after falling asleep, a large amount of urine accumulates in the bladder, and the pressure gradually increases, exceeding the resistance of the urethra and overflowing spontaneously. In severe cases, this phenomenon can also occur during the day when the patient is awake.

Fifthly, painful urination and urgency occur: after benign prostatic hyperplasia, urine in the bladder cannot be completely emptied, easily leading to bacterial infection. After a urinary tract infection occurs, urinary frequency symptoms are particularly pronounced, with pain during urination and an urgent need to urinate at the first sign, but urination is not smooth.

Early manifestations are varied. One is increased urination frequency: regardless of day or night, the frequency of urination increases abnormally, far exceeding daytime levels.

In later stages, urinary frequency worsens, with increased urination frequency, most notably at night. If complicated by infection or stones, dysuria and urinary urgency will occur. The difficulty in urination progressively worsens, requiring increased abdominal pressure to expel urine with each attempt. The volume of urine per urination is significantly reduced, or severe dribbling occurs, resembling urinary incontinence; some patients frequently experience bedwetting. Urination time is significantly prolonged, the urine stream is weak and short, sometimes wetting clothing.

Medical scientists have conducted extensive research on a series of hormonal changes that occur in men entering middle age, especially old age. However, why older men are prone to benign prostatic hyperplasia (BPH) remains a mystery. Some scholars believe it is related to factors such as frequent sexual activity, incomplete treatment of bacterial posterior urethritis, testicular dysfunction, and urethral obstruction. These factors persist throughout a person's life, thus inducing BPH, which is more common in older men. Others believe it is related to factors such as race, social factors, inflammatory stimulation, endocrine disorders, and nutritional metabolism. It is particularly believed that the high incidence of arteriosclerosis in the elderly can affect the prostate, leading to benign prostatic hyperplasia (BPH).

Some people worry that BPH can develop into prostate cancer. Theoretically, BPH cannot completely rule out the possibility of it becoming cancerous. In fact, the development of prostate cancer from BPH only occurs after the hyperplastic nodules have grown significantly. Patients often seek medical attention for BPH before the prostate becomes noticeably enlarged. Some receive estrogen therapy, which inhibits further development or worsening of the hyperplastic nodules. Others undergo surgical removal of the prostate, eliminating the chance of malignant transformation. Therefore, with proper diagnosis and treatment, BPH will not develop into cancer.

There are many treatment methods for BPH, such as medication, surgery, and physical therapy. Patients should consult a specialist.

[Medication] Drug treatment for BPH may include alpha-adrenergic receptor blockers and hormone therapy.

[Surgical Treatment] Surgical approaches for prostatectomy include suprapubic transvesical, retropubic, transperineal, and transurethral approaches. Each approach has its advantages and disadvantages, and surgeons can choose the appropriate method based on the patient's condition and available equipment. Indications for prostatectomy include: long-term urinary tract obstruction with significant symptoms that do not improve with integrated traditional Chinese and Western medicine treatment; acute urinary retention preventing catheter drainage or bladder obstruction by large blood clots; increased residual urine leading to impaired renal function; and concurrent bladder stones or bladder diverticula.

Among middle-aged and elderly men with benign prostatic hyperplasia (BPH), some require surgery due to severe urinary tract obstruction. Due to the effects of surgery, some may experience changes in sexual function, the most common being retrograde ejaculation and erectile dysfunction. However, most patients recover their sexual function after a period of rehabilitation, especially those who had normal sexual function before surgery and did not undergo perineal radical surgery. Even if retrograde ejaculation occurs, there is little to worry about, as their sexual function generally recovers to pre-operative levels.

Benign prostatic hyperplasia (BPH) is a common disease among middle-aged and elderly men, especially the elderly. According to domestic statistics, although cases have been found before age 50, the number is extremely small. The highest age of onset is 60-69 years old, accounting for 55%. In recent years, the incidence of this disease in my country has shown a gradual upward trend. With the increase in the elderly population, it is foreseeable that the number of patients with BPH will gradually increase.

[Physical Therapy] The main methods of physical therapy for BPH are as follows:

① Thermotherapy.

② Laser therapy.

③ Dilation therapy.

Currently, methods such as balloon dilation catheters and high-intensity focused ultrasound are commonly used to treat BPH.