Guidelines for the Prevention and Treatment of Acute and Chronic Prostatitis and Prostatitis: Identification of Typical Symptoms, Etiological Factors, and Principles of Lifelong Care

28. What are the causes of acute and chronic prostatitis? (1) Acute prostatitis: It is caused by hematogenous infection or direct spread. The prostate is invaded by pathogenic microorganisms such as bacteria, resulting in rapid congestion, edema, and exudation, forming small abscesses or even larger localized abscesses. If it is not treated thoroughly, it may turn into chronic prostatitis. (2) Chronic prostatitis: It is a common disease in middle-aged men. Its causes are roughly as follows: ① Abnormal sexual life, such as excessive sexual activity, forced interruption of intercourse, or excessive masturbation, can cause abnormal congestion of the prostate. However, excessive abstinence from sexual activity can also cause prolonged automatic arousal, resulting in passive congestion. ② Direct pressure on the perineum, such as riding a bicycle, horseback riding, or sitting for a long time, can cause congestion of the prostate. ③ Excessive drinking alcohol can cause congestion of the reproductive organs and sexual arousal. ④ During prostate massage, excessive force or frequency can cause congestion of the prostate, which is iatrogenic congestion. ⑤ Infections in other parts of the body, such as tonsils, dental caries, skin, respiratory tract, and digestive tract infections, can cause bacterial infection of the prostate. ⑥ Residual chronic prostatitis following acute urinary tract infection; inflammation of the lower urinary tract organs, colon, and rectum can infect the prostate via the lymphatic system; bacteria in the urethra can directly cause prostate infection.

29. What are the symptoms of acute and chronic prostatitis? (1) After the onset of acute prostatitis, patients will experience systemic symptoms such as loss of appetite, vomiting, fatigue, chills, and fever; perineal and lower abdominal distension and pain, which radiates to the back, waist, lower abdomen and thighs; urination will be accompanied by urgency, pain, frequency, dribbling, difficulty in urination, or even interruption; rectal distension and pain, with a feeling of heaviness; urethral discharge during defecation; painful intercourse, and even hematospermia. (2) The clinical manifestations of chronic prostatitis are more complex, mainly due to the complex nerve innervation of the prostate. Common clinical symptoms: ① Burning pain in the urethra during urination, which can radiate to the head of the penis. Unclean discharge from the urethral opening in the morning. ② Moist and uncomfortable posterior urethra, perineum and anus, with a feeling of fullness when pressed, which is aggravated by prolonged sitting, squatting or defecation. ③ Pain in the lumbosacral region, hip, perineum, suprapubic region and abdomen. ④ Sexual dysfunction. ⑤ During acute attacks or when abscesses form, symptoms include fever, fatigue, weakness, loss of appetite, nausea, chills, and collapse. ⑥ A series of neurological symptoms may occur, such as dizziness, tinnitus, blurred vision, insomnia, vivid dreams, and depression. ⑦ In some patients who have not received treatment for a long time, it can cause allergic reactions or rheumatic changes in the whole body and joints, such as neuritis and arthritis.

30. Why are middle-aged men over 50 prone to benign prostatic hyperplasia (BPH)? The prostate gland's key function lies in its ability to produce and secrete a fluid called prostatic fluid. Prostatic fluid is the energy source for sperm motility, helps neutralize the acidic environment of the vagina, and improves sperm survival and motility. Therefore, without a prostate gland, or with severe prostate disease, normal sperm motility is impossible, and fertility is out of the question. Throughout a man's life, the structure of the prostate gland changes with age. In terms of volume, the prostate is very small in childhood; it can more than double in size during puberty; its volume is relatively stable between 20 and 50 years of age; after 50, its volume begins to increase again, potentially developing into benign prostatic hyperplasia (BPH). Because the male prostate is anatomically very close to the urogenital organs, during BPH, the enlarged prostate can compress the prostatic urethra, causing it to become tortuous and narrow, leading to difficulty urinating. Inflammation of the prostate often co-occurs with inflammation of the prostatic urethra. Similarly, diseases of the prostatic urethra can also affect the prostate. Therefore, the prostate and urethra are closely related anatomically, physiologically, and pathologically. The prostate is also closely related to the seminal vesicles and ejaculatory ducts; the three can influence each other physiologically and pathologically. When suffering from prostatitis, the seminal vesicles are often affected, leading to seminal vesiculitis.

31. What are the causes of benign prostatic hyperplasia (BPH)? (1) Excessive sexual activity and masturbation cause congestion of the sexual organs, leading to enlargement of the prostate tissue due to prolonged congestion. (2) Incomplete treatment of chronic prostatitis, or urethritis, cystitis, etc., causes congestion and hyperplasia of the prostate tissue. (3) Frequent or prolonged alcohol consumption, and a preference for spicy and other irritating foods, can stimulate prostate hyperplasia. (4) Lack of physical exercise can lead to arteriosclerosis and poor local blood circulation in the prostate, resulting in BPH.