Ke Fan: Today, we invited Dr. Li Hongjun, an andrologist, to talk about the topic of chronic prostatitis. In the previous program, you said that the examination of prostatic fluid is not completed at one time, and it needs to be carried out several times to ensure the correct diagnosis. Examination of prostatic fluid requires bacterial culture and pharmacological experiments. So, how should we look at this problem? Dr. Li: Prostate fluid examination is the most important means to diagnose prostatitis. Of course, many people now diagnose prostatitis by other methods, such as semen examination, urine examination, B-ultrasound and so on, but I think these methods are auxiliary, and only prostatic fluid is the most intuitive. However, because the examination of prostatic fluid is influenced by many factors, it cannot be based on a single result. The production of prostatic fluid is neither uniform nor static. It is very likely that the prostatic fluid is normal in the first examination, and it may be abnormal in the next examination. So is there a standardized standard? Is it true that I am normal this time, but I will be abnormal next time, or is this examination abnormal and I will be normal next time? That's not necessarily true. We have many test standards. Generally, it is more appropriate to detect prostatic fluid twice, with an interval of three to five days, so as to find out the close and unanimously recognized results. However, when detecting prostatic fluid, if white blood cells in prostatic fluid exceed 10, such as 12, is it diagnosed as prostatitis? The laboratory results of prostatitis fluctuate greatly and are influenced by many factors. From the patient's point of view, if he has sex on the first day, or masturbates and ejaculates, then the white blood cells may be higher the next day; If you get drunk on the first day, the prostate will be obviously congested and white blood cells will increase; Some patients are particularly nervous, and trying some irritating drugs or drinking irritating drinks and food may also lead to an increase in this result; If the weather is particularly cold, or the patient rides a bicycle for a long time, you may have abnormal results by checking his prostatic fluid. Doctors may also have problems. For example, massage is very important. If the manipulation is too heavy, it will cause the increase of white blood cells in prostatic fluid. One more chemist is crucial. The choice of vision is also very important for chemists to look at prostatic fluid under a microscope with a magnification of several hundred times. White blood cells have many fields of vision, and some have few fields of vision. In most cases, the visual field is small, and the average value is taken. I think this is problematic and inappropriate. We know that prostatic fluid comes from the posterior urethra, and it has to go through a long way, which is likely to be affected by many factors, such as dilution. When taking prostatic fluid, let the patient urinate, and the remaining drops of urine just comes out of the urethral orifice, so it may dilute a part. If you take a prostatic fluid to 10 chemists for analysis, there must be 10 results. Therefore, from the doctor's point of view, massage should be gentle. From the inspector's point of view, try to use one inspector or try to let different inspectors train in different laboratories, so as to avoid the error of test results. Furthermore, when detecting prostatic fluid, we often like to do bacterial culture and drug experiments. But what about this bacterial culture and drug experiment? Bacteria cultured from prostatic fluid should belong to prostate, but when prostatic fluid passes through urethra, bacteria in urethra will inevitably pollute prostatic fluid, which may cause illusion. It has been reported abroad that only 5% of patients with chronic prostatitis are caused by bacteria, but in our clinical practice, the cultured prostatic fluid may reach 50% to 70%. What does this mean? It means that most people have urinary tract pollution. What are the results of choosing drugs according to the experimental results of bacteria contaminated by urethra? There must be something wrong. Of course, how many people have prostatitis caused by bacterial infection? This is still controversial. Someone abroad did an experiment. They directly take out the prostate of donors or accidental casualties to see if there is inflammation in the prostate, and then do bacterial culture. It was found that the inflammation of prostate reached as much as 20%, and most of these people had no inflammation. Due to the continuous development of diagnostic technology, molecular biology technology has also been applied to the analysis of pathogenic bacteria in prostatic fluid. The PCL I mentioned earlier may produce more pathogens. Is this pathogen a microorganism that causes prostatitis? We say it may be caused by some bacteria, but it is hard to say, so we must have a scientific mind and make an accurate judgment on the experiment of bacterial culture samples. It can't be said that there are bacteria in the prostate, and positive people will think that they must be sick. One of us in China did a study. He found that in the prostate fluid culture of healthy, normal and disease-free men, 30% of men had bacteria. What does this mean? It means that it is polluted, and it is of no practical significance to check the normal flora. Therefore, it is necessary to make a scientific judgment on bacterial culture and sample experiments, and be cautious about the diagnosis basis and results of prostatic fluid, and it is best to make a follow-up visit. Ke Fan: This may be more about our medical staff. Therefore, for patients, if they want to go to the hospital for diagnosis the next day, it is best not to drink alcohol, eat spicy food or ride a bike the day before, so as to ensure the accuracy of the test results. Dr. Li: And don't have sex on the first day. At the same time, I also want to remind patients not to be nervous once bacteria are found, because many people may be normal flora or bacteria contaminated by urethra. I want to say a few words to the doctor. When choosing drugs for chronic prostatitis, don't give antibiotics just because some bacteria have been cultivated, but use drugs according to experience. For example, you can choose those drugs that are most easily absorbed by prostatic fluid. Ke Fan: We said that the probability of bacterial prostatitis is very low, so the audience should not be too nervous.