Description of the problem:
●Patient's gender: male
●Patient's age: 23 unmarried
At the end of June when the physical examination of the prostate cysts 7 * 8mm, at that time, no obvious symptoms
From July, after a long period of prolonged sitting in the abdomen, abdominal distension and pain, and groin intermittent pain, the doctor visited a few times, and did the *** diagnosis. *** Diagnosis, said the prostatitis prescribed oral western medicine, Chinese medicine also eat eat after the effect is not obvious
October 4 and went to the reproductive health hospital, did the prostate ultrasound, prostate fluid routine + bacterial culture: B ultrasound report has 1.1 * 1.2cm cysts, leukocytes 2 + pus cells 1 + lecithin bodies less chlamydia mycoplasma chlamydia for the negative at that time, began to infuse anti-inflammatory (Azithromycin, left), and the other is the same, the other is the same as the one in the other. The doctor said that the treatment is not as effective as the last time, but the doctor said that the treatment is not as effective as the last time. Last time, the attending doctor said no longer use western medicine to use Chinese medicine, said that the cyst has a problem, I do not know whether the prostate inflammation caused by cysts or cysts caused by prostatitis, not very good treatment.
Now it has been 11 consecutive days of infusion plus treatment, from the 6th day of liquid also added tinidazole, but azithromycin and levofloxacin every day, I do not know whether it is not a drug resistance, so the results of this review is not very obvious, but the symptoms are much better than before.
After seeing the results, I have been very depressed, please help me, what should be the next step in the treatment, thank you!
Ans:
1. The causes of prostate cyst formation are largely due to the formation of cystic changes in the prostate gland due to congenital or acquired causes.
(1) true prostate cysts: the prostate gland is impaired during embryonic development, causing narrowing of the prostate ducts, resulting in obstruction, the contents of the gradual retention and formation, so it is a retention prostate cyst.
(2) congenital cysts: for the middle renal duct and the middle renal paracellular duct developmental anomalies, the lumen partially dilated and the formation of cysts. Cysts originating from the mesonephric ducts are often located in the center of the prostate, while those originating from the mesonephric ducts are located on both sides. These cysts do not actually originate from the prostate and are often attached to the posterior wall of the bladder. The size of the cyst can be so large that it presses on the bladder neck, causing difficulty in urination, and on the rectum, causing *** swelling and difficulty in defecation. Congenital prostate cysts are often associated with congenital disorders such as hypospadias, cryptorchidism and renal hypoplasia.
(3) Acquired cysts: the tough prostate stroma leads to incomplete or intermittent obstruction of the follicles, gradually thickening the follicular epithelium, and ultimately retention cysts, which can be located anywhere in the prostate or protrude into the neck of the bladder, and have a diameter of 1-2 cm.
(4) Inflammatory cysts: chronic inflammation of the prostate causes connective tissue hyperplasia, resulting in narrowing of the prostate ducts and retention of secretions to form cysts.
(5) parasitic cysts: caused by parasites, such as worms can make the prostate tube and the surrounding chronic inflammation, or by the granulation hyperplasia, the gradual formation of cysts.
The above cysts are most common in retention prostate cysts, which can occur in any part of the gland.
2. Pathologic changes in prostate cysts Cysts can be seen on pathologic section as consisting of normal vesicles, or polycomb, vesicles lined with columnar epithelium, or low cubic epithelium, and filled with plasma or plasma-blood fluid.
3. Symptoms and diagnosis of prostate cysts Prostate cysts can be complicated by infections and stones, and larger cysts can obstruct the flow of urine when their growth presses against the urethra or bladder neck. Common symptoms include urinary urgency, frequent urination, straining to urinate, thin urine line, difficulty in urination, and urinary retention; pressure to the rectum can cause difficulty in defecation. When the cyst is large, rectal fingerprinting in the prostate department touched the cyst, urethrography can be seen in the posterior urethra has a curved pressure trace, ultrasound and CT can be clear its location.
4. Treatment of prostate cysts Smaller and asymptomatic cysts, as long as there is no secondary infection, there is no need for treatment, but just pay attention to the dynamic observation of its changes. The larger cysts or small symptomatic cysts can be treated with surgery. There are reports of perineal or transrectal cyst aspiration under ultrasound localization, followed by injection of coagulant, but due to incomplete or intermittent obstruction of the follicles, even after the above aspiration, the cysts are still prone to recurrence due to local glandular secretion.
Surgery for prostate cysts is mainly through drainage, such as perineal incision and drainage or transurethral prostatic incision and drainage.
Treatment of acute prostatitis consists of both peripheral improvement and localized treatment. The most important is the radical treatment of the cause of the disease. The prognosis is usually favorable.
Medication
The first step is to give antipyretics, pain medications, either orally or intramuscularly, and fluid supplementation, if necessary, to relieve their symptoms.
Sensitive antimicrobials are selected based on bacterial cultures to destroy or inhibit the pathogenic bacteria. Broad-spectrum antimicrobials are preferred when it is too late or not available to perform bacterial culture. The so-called broad-spectrum antimicrobials that most bacteria have a certain efficacy of drugs, such as cephalosporins, quinolones. Specifically, such as vancomycin, Keflex, Cilicin, Coloplast, ciprofloxacin, and so on, these are the role of the better drugs.
For patients with obvious urinary pain, we can use antispasmodic agents such as belladonna, probenecid, urolithiasis and other drugs, but also some sedatives such as Valium, orally or by injection, to relieve the symptoms.
Puncture treatment for prostate abscess:
When the patient continues to have a high fever, no significant improvement in urinary symptoms, urethral pus overflow, bowel movement, should consider the possibility of prostate cysts, with the help of ultrasound and other tests to confirm the diagnosis of abscess incision and drainage or puncture and drainage treatment. Only when the abscess is completely eliminated, the above symptoms will be relieved.
Puncture treatment is relatively simple: a long needle is inserted into the abscess cavity under *** diagnosis, and a syringe is used to aspirate until the pus is completely sucked out. Sometimes it is not completely eliminated at one time, and two or several times are needed to achieve satisfactory results.
Drainage treatment:
When the pus cavity is large and pus is abundant, incision and drainage of the pus cavity is preferred. The prostate is exposed with a *** proctoscope, and the abscess cavity is cut through the rectal wall with a sharp knife to drain the pus out and place a drain tube, depending on the drainage situation, combined with an examination to determine the time to remove the drain tube. Currently the treatment still needs to use antimicrobials with the treatment.
Physiotherapy:
Physiotherapy is helpful for acute prostatitis and abscesses. According to the conditions and needs of each hospital equipment, the rational application can promote the absorption of inflammation. If you don't have the conditions for physiotherapy, use a hot water bag on the pubic bone or will ***, each time for about half an hour, adhere to a few days of treatment is also good.
Traditional Chinese medicine:
Traditional Chinese medicine also has a good effect on acute prostatitis, according to the identification of the treatment given to the prescription.
In the above treatment at the same time, the patient should drink more water, should take the initiative to avoid eating *** sexual food, such as chili peppers, drinking alcohol and so on. The diet should be rich in nutrients and light.