The Study Of Seminal Fluid Quality And The Treatment Of Nanometer Silver In Category Ⅳ Prostatitis

[Object]:The chronic prostatitis is one kind of common diseases in the masculine urogenital system. However, the relations between chronic prostatitis and the sterile have been already argued for many years. Relationship between the seminal quality, dysfunction and the chronic prostatitis had been reported. But the others suggested no distinction to be presence in sperm density, power, the morphology changes between the chronic prostatitis patient's and control group. Furthermore, it had been reported that the white blood cell level of seminal fluid and the prostate gland fluid, which is a symbol as the inflammation, had no relation with the total sperm, the density, power, the shape and the sperm survival rate. Some Chinese date showed that approximate 39.1% male sterility patients had been diagnosed as the chronic prostatitis at the same time.In 1995 the National Institutes of Health convened a consensus conference to re-evaluate the utility of the existing classification system. The result was a refinement of the traditional classification of prostatitis syndromes that allowed for standard inclusion criteria for participants in clinical trials for chronic nonbacterial prostatitis and prostadynia. The new system also has four categories. CategoryⅠ, acute bacterial prostatitis, refers to a combination of lower urinary tract and systemic infectious symptoms such as fever and chills. CategoryⅡ, chronic bacterial prostatitis, is characterized by culture-documented recurrent urinary tract infection combined with symptoms of acute or chronic pelvic pain without the systemic component demonstrated in categoryⅠ. CategoryⅢ, known as chronic prostatitis (CP) or chronic pelvic pain syndrome (CPPS), lacks an infectious component and is subcategorized as inflammatory or non-inflammatory based on the findings of leukocytes in a urine sample and expressed prostatitic secretions. Symptoms, however, can be similar to those found in categoriesⅠandⅡand include perineal or low back pain, lower urinary tract symptoms and painful ejaculation. The existence of pelvic pain is a requirement for diagnosis of categoryⅢprostatitis regardless of the level of urinary symptoms. Due to the differences in presenting symptoms among patients, the National Institutes of Health-Chronic Prostatitis Symptoms Index (NIH-CPSI) was created to quantify and determine the effects of the presenting symptoms for categoryⅢpatients. The NIH-CPSI asks questions that are tabulated into three domain scores:(1) pain, (2) urinary symptoms and (3) quality of life. The index can be helpful in differentiating the levels of CP-CPPS while also quantifying an individual's quality of life. A limitation of the index is that it was validated by a population of mostly white, educated men and may not be as useful in other patient populations. Category IV refers to asymptomatic inflammatory prostatitis. It is usually found incidentally through biopsies of patients being evaluated for benign prostatic hypertrophy (BPH) or an elevated prostate-specific antigen (PSA). It has been estimated that categoryⅣprostatitis may affect one-third of all patients who present with prostatitis.Ⅳ(symptomless prostatitis) as a result of non-prostatitis's related symptom affaired the patient himself, to be neglected frequently by clinician, But often to be discovered in outpatient service sterile screening by chance. Recently, the sterile patient disease incidence rate is raising up and the chronic prostatitis has been thinked as one of the major factors of the masculine potentia generandi. Symptomless prostatitis incidence rate is quite high in the sterile patient, but the research reports concern on situation and mechanism, therapeutics of seminal fluid quality influence, which induced by symptomless prostatitis (Ⅳ), are rare. In our study, the main parameter's influence of seminal fluid quality in symptomless prostatitis patients, the relation between white blood cell level and main parameter of seminal fluid quality in prostate gland fluid, the cytokines of prostate gland fluid and seminal fluid, seminal plasma neutrality grain of elastic proteinase, anti-sperm immune body level of seminal plasma and its mechanism involve in seminal fluid quality, had been investigated. Furthermore, we explored the effect and the function mechanism of nanometer silver gelatin combine with the prostate gland massage in symptomless prostatitis's patients.Significance:Developing with the scientific research method's increasingly progress, relation between prostatitis and the sterile is confirmed unceasingly and clearly. It had been reported that about 60-70% male sterility patients were caused by chronic prostatitis and chronic prostatitis could affect the male reproductive system function. Different chronic prostatitis has the different situation and the consequence. It is very important to make clear the different type chronic prostatitis and deciding the treatment to cure the reproduction function influence. In our study, seminal fluid quality parameter, patient's age, response time will be explored. The relation between the white blood cell level in the prostate gland fluid and the main parameter of seminal fluid quality, various cytokine of prostate gland fluid and seminal fluid, Seminal plasma neutrality grain of elastic proteinase, anti-sperm immune body level of Seminal plasma will be discussed to reveal its possible morbidity mechanism involve in seminal fluid quality and its reasonable method of treatment. About 40% of dysgenesis and infertility suffered from male sterility in recent papers. Making Material and method:60 categoryⅣprostatitis patients, age 21～46 years old, mean age 34.31±8.30 years old and 50 control group volunteers, age 21～43 years old, mean age 32.28±5.3 years old. In the distinction examination of patients' prostatic fluid, the seminal fluid and the cytokine, TNF-α, IL-1β, IL-6, and Seminal plasma neutrality grain of elastic proteinase, anti-sperm immune body of seminal plasma examines. The data indicated by x±s, and the chi-square test, the t-test were be used with the SPSS 13.0 software. Result:1. The levels of TNF-α, IL-1βand IL-6 in prostatic fluid and the seminal fluid in categoryⅣprostatitis patients were higher than that of control group. And they had negative correlation with the seminal fluid liquefied time, class A sperm motility and the normal sperm shape, P<0.01.2. The concentration of seminal plasma neutrality grain of elastic proteinase in categoryⅣprostatitis patients was higher than that of control group, P<0.01.3. The positive rate of anti-sperm immune body of seminal plasma in categoryⅣprostatitis patients was higher than that of control group, P<0.01.Conclusion:Seminal fluid quality of the categoryⅣprostatitis patients may be concern with the changed of cytokine in the prostatic fluid and seminal plasma. It maybe caused by the infection and the immunity. The levels of the cytokine, neutrality grain of elastic proteinase in the categoryⅣprostatitis patients have positive correlation with the levels of white blood cell level in prostatic fluid and seminal plasma. The high level of white blood cell in the prostatic fluid and seminal plasma maybe the result of the infection and immunity.Chapter 2:The effect of nanometer silver treatment in chronic prostatitis with animal model and clinical experience. Prat1. The study of pathomorphology and ultrastructural changes with the treatment of nanometer silver in rat chronic prostatitis model.Objective:To study the nanometer silver effect of pathomorphology and ultrastructural changes in rat prostatitis model.Material and method:24 rats were random divided into 4 groups. Group A (control group, n=6), Group B(escherichia coli, n=6), Group C(chlamydia and mycoplasma, n=6), Group D(chlamydia and mycoplasma and nanometer silver, n=6). The pathological sections and the ultrastructural changes of rat prostates had been observed by optics microscope and transmission electron microscope after 6 weeks treatment.Result:1. In the optics microscope, in Group A, prostate gland epithelium like cubic or columnar, glandular secretions were pink dyed by feosin. No inflammatory cells and fibrous tissue proliferation.In Group B, acinar atrophy, glandular tube occlusion, fold reduced or disappeared significantly, no acinar secretion, inflammatory cell infiltration accompanied by tissue necrosis.In Group C, pathological changes include glandular secretions reduced and disappeared, acinar atrophy, gland lumen shrink and occlusion, interstitial edema, a few of lymphocytic infiltration, showing a small amount of plasma cells, blood vessels dilatation and congestion, prostate gland secretions were also surrounded by lymphocytic infiltration which pink dyed by feosin, fibroblasts observed also, occasional inflammatory granulomatous lesions.In Group D, the pathological changes had significant improvement, although the prostate gland secretions reduced, lymphocytes infiltration was observed occasionally, no fibroblasts and inflammatory granulomatous lesions. 2. The changes of ultrastructural changes.In Group A, microvillus on epithelial cell surface, the cytoplasm contained abundant mitochondria, endoplasmic reticulum expanded slightly, secretory vesicles contained granular, nuclei shape liked oval.In Group B, prostate gland epithelial cell disintegrated with swelling, a large number of light-colored secretory vesicles in the cytoplasm can be seen, showing high electron density E. coli.In Group C, sparse microvillus on epithelial cell surface, connections between cells can be observed, cytoplasm rich in mitochondria, endoplasmic reticulum, cells containing a small amount of secretory vesicles with scattered particles.In Group D, prostate gland epithelial ultrastructure was almost normal.Conclusion:The treatment of nanometer silver is a effective management in chlamydia mycoplasma prostatitis rat model.Prat 2. The feasibility and the effect of nanometer silver treatment in chronic prostatitis patients.Objective:To study the feasibility and the effect of nanometer silver treatment in chronic prostatitis patients.Material and method:1.230 categoryⅣprostatitis patients had accepted transrectal ultrasound examination. The data had been collected to analynize the inflammation distributed character in these patients.2.8 categoryⅣprostatitis patients, age above 50 years old and with high blood serum PSA level, had accepted prostate gland puncture.6 needles puncture in the flank boundary area and the prostate tissue were observed by pathological specialist. 3.60 categoryⅣprostatitis patients were divided into two groups. Control group,30 cases, only accepted prostate gland massage twice each week. Nanometer silver treated group,30 cases, treated with nanometer silver 3ml through rectum every night, and accepted prostate massage twice per week for 12weeks. The main parameter of seminal fluid quality and the cytokine, TNF-α, IL-1βand IL-6, anti-sperm immune body of seminal plasma, seminal plasma neutrality grain of elastic proteinase of seminal fluid were detected. The data indicated by x±s, and the chi-square test, the t-test were be used with the SPSS 13.0 software.Result:1. The inflammation distributed character by ultrasonic iconography in categoryⅣprostatitis patients' indicated as follow. Type A (echoes well-distributed),13 cases in this group(5.6%). Type B(echo un-well-distributed in periphery area),113 cases in this group (49.1%). Type C(increasing echo),96 cases in this group (41.7%). Type D(tubercle calcification),20 cases in this group (3.6%).2. The infiltration of inflammatory cell in the prostatic tissue had been observed in all cases. the inflammatory cell primarily distributed in periphery region and the circum-urethra area.3. Except anti-sperm immune body of seminal plasma, the sperm liquefied time, power, shape, the cytokine, TNF-α, IL-1βand IL-6, seminal plasma neutrality grain of elastic proteinase of seminal fluid had been significant improved in nanometer silver treated group, P<0.05. The effect of nanometer silver treated group was better than that of the control group, P<0.05. The categoryⅣprostatitis patients could not get the significant benefit by prostatic massage, P>0.05.Conclusion:The pathological change of categoryⅣprostatitis patients is mainly around prostate gland periphery area and circum-urethra. The nanometer silver gelatin combined massage treatment may improve the seminal quality in categoryⅣprostatitis patient.