Problem description:
● Patient gender: male
● Patient age: 23 unmarried.
At the end of June, there was a 7*8mm prostate cyst in physical examination, and there were no obvious symptoms at that time.
Since July, I have been sitting for a long time with abdominal distension and intermittent pain in my groin, and I have seen a doctor several times. I made a finger diagnosis and prescribed oral western medicine for prostatitis, but the effect of taking traditional Chinese medicine was not obvious.
654381October 4th, I went to the reproductive health hospital again, and did B-ultrasound of prostate and routine prostatic fluid plus bacterial culture: B-ultrasound reported 1. 1* 1.2cm cyst, and white blood cells 2+ pus cells 1+ lecithin corpuscles were negative. At that time, infusion of anti-inflammatory (azithromycin levofloxacin) plus field effect was started. Re-examination after 7 days of urethral intervention \ Rectal microwave therapy: B-ultrasound reported that there were 0.8*0.8cm cysts, and white blood cells+pus cells 7-9 lecithin bodies+were significantly improved.
After four days of infusion treatment, today's reexamination: B-ultrasound reported a cyst of 0.8*0.7cm, and the treatment effect of white blood cells+pus cells+lecithin corpuscles was not as good as last time. The attending doctor said that western medicine was no longer used and Chinese medicine was used instead, saying that there was something wrong with the cyst. I don't know if it is caused by prostatitis or prostatitis, so it is not easy to treat.
Continuous infusion therapy has been 1 1 day. Tinidazole was added to the liquid from the sixth day, but azithromycin and levofloxacin were used every day. I don't know if it is drug-resistant, so the result of this reexamination is not obvious, but the symptoms are much better than before.
After seeing the results, my mood has been very low. Please help me. What should we do next? Thank you!
Analysis:
1. Prostate cysts are generally caused by congenital or acquired cystic changes of the prostate.
(1) True prostate cyst: Prostate obstruction occurs during embryonic development, which leads to narrowing and blockage of prostate duct and gradual retention of contents, so it belongs to retention prostate cyst.
(2) Congenital cyst: The ducts of the mesonephros and the pararenal ducts developed abnormally, and the lumen partially expanded to form cysts. Cysts originating from accessory renal duct are usually located in the middle of prostate, while cysts originating from accessory renal duct are located on both sides. This cyst does not actually originate from the prostate, but is often attached to the posterior wall of the bladder. Its volume can often grow to a large size, which oppresses the bladder neck and leads to dysuria; Rectal compression can cause swelling pain and difficulty in defecation. Congenital prostatic cyst is often accompanied by congenital diseases, such as hypospadias, cryptorchidism and renal hypoplasia.
(3) Acquired cyst: It is an incomplete or intermittent obstruction of acinus caused by tough prostatic stroma, which gradually thickens acinus epithelium and eventually leads to retention cyst, which can be located in any part of prostate or protrude to bladder neck, with a diameter of 1-2 cm.
(4) Inflammatory cyst: Chronic inflammation of prostate causes connective tissue hyperplasia, which leads to prostatic canal stenosis and secretion retention to form cyst.
(5) Parasitic cyst: It is caused by parasites, such as echinococcosis, which can cause chronic inflammation around the prostate tube, or granulation hyperplasia, and gradually form cysts.
The most common of these cysts is the retained prostate cyst, which can occur in any part of the gland.
2. Pathological changes of prostate cyst After pathological section, it can be seen that the cyst is composed of normal acinus or multilocular. The acinus is lined with columnar epithelium, some of which are low cubic epithelium, and the sac is filled with serous fluid or serous fluid.
3. Symptoms and diagnosis of prostate cyst Prostate cyst can be complicated with infection and stones. When a larger cyst grows and compresses the urethra or bladder neck, it will block the flow of urine. The common symptoms are urgency, frequent urination, urgency, thin urine line, dysuria and urinary retention. Pressing the rectum can lead to difficulty in defecation. When the cyst is large, digital rectal examination touches the cyst in the prostate, and urethrography shows that the posterior urethra has an arc impression, which can be determined by ultrasound and CT.
4. Treatment of prostate cysts Small and asymptomatic cysts, generally as long as there is no secondary infection. No treatment is needed, just pay attention to the dynamic observation of its changes. Larger cysts or symptomatic small cysts can be treated by surgery. It has been reported that the cyst was aspirated through perineal or rectal puncture under the guidance of B-ultrasound, and then the coagulant was injected. However, due to incomplete or intermittent acinar obstruction, even after the above puncture and aspiration, the cyst is still easy to recur due to the secretion of local glands.
Prostate cyst surgery mainly through drainage, such as perineal incision and drainage or transurethral incision and drainage of prostate.
The treatment of acute prostatitis includes systemic improvement and local treatment. The most important thing is to cure the cause. Overall, the prognosis is good.
medicine
First, antipyretics and analgesics should be given, including oral or intramuscular injection, and fluids should be added if necessary to relieve its symptoms.
Select sensitive antibiotics according to the results of bacterial culture to eliminate or inhibit pathogenic bacteria. In the absence of time or bacterial culture, broad-spectrum antibiotics can be the first choice. The so-called broad-spectrum antibiotics are drugs that have certain curative effects on most bacteria, such as cephalosporins and quinolones. Specifically, drugs such as cephalosporin, Kefulong, Celine, Cobituo and ciprofloxacin are all effective.
For patients with obvious dysuria, belladonna, propofol, Niaoling and other antispasmodics can be used, and sedatives such as diazepam can also be used to relieve symptoms.
Puncture treatment of prostate abscess;
When patients with persistent high fever, urinary tract symptoms have not improved significantly, urethral abscess and poor stool, the possibility of prostate cyst should be considered, and abscess incision and drainage or puncture and drainage should be performed after B-ultrasound diagnosis. Only when the abscess is completely eliminated will the above symptoms be alleviated.
Puncture treatment is relatively simple. * * * After the finger is diagnosed, insert a long needle into the abscess cavity and suck it with a syringe until the pus is completely absorbed. Sometimes it will not be completely eliminated once, and it takes two or more times to achieve satisfactory results.
Drainage treatment:
When the pus cavity is large and there is more pus, it is best to cut the pus cavity. Expose the prostate with a rectoscope, cut the rectal wall into the abscess cavity with a sharp knife, discharge the pus, and place a drainage tube. Depending on the drainage situation, combined with examination, the time to pull out the drainage tube is decided. At present, antibiotics are still needed for treatment.
Physical therapy:
Physical therapy is helpful for acute prostatitis and abscess. According to the conditions and needs of hospital equipment, reasonable application can promote the absorption of inflammation. If there is no physical therapy condition, it may be that a hot water bag is applied to the pubic bone for about half an hour at a time, and the curative effect is also several days.
Chinese medicine:
Traditional Chinese medicine also has a good therapeutic effect on acute prostatitis.
While carrying out the above treatment, patients should drink plenty of water and actively avoid eating * * * food, such as pepper and alcohol. The diet should be nutritious and light.