Ⅲ型前列腺炎的临床诊断与治疗

前列腺炎是一种多发于成年男性的泌尿系统疾病,是具有多种独特形式的临床症候群,表现为排尿异常,如尿频、尿急、尿痛、排尿困难,淋漓不尽等;骨盆区域疼痛或不适;性功能障碍及神经衰弱、烦躁焦虑等精神抑郁症状等。由于病因及发病机制复杂,且病程迁延,治疗效果不满意,易反复发作,已成为一个倍受临床关注的难题。本文就前列腺炎中最常见类型—Ⅲ型前列腺炎（慢性前列腺炎/慢性骨盆疼痛综合症,CP/CPPS）的定义、分类、病因、诊断和治疗作一综述。     

前列舒通胶囊联合美满霉素治疗慢性前列腺炎/慢性骨盆疼痛综合症临床研究

<正>前列腺炎(CP)是泌尿外科和男科临床常见病,多发生于青壮年男性,发病率6.0%～32.9%~([1-2])。慢性前列腺炎/慢性骨盆疼痛综合症(CP/CPPS)又称Ⅲ型前列腺炎,是CP最常见的类型之一~([3])。CP/CPPS病程迁延,病情易反复发作,影响患者身心健康。近年来,笔者应用前列舒通胶囊联合美满霉素治疗CP/CPPS,临床疗效满意,报道如下。1临床资料1.1一般资料选择2017年1月—2018年6月诸暨市人民医院泌尿外科门诊收治的CP/CPPS68例患者采用随机数字表将CP/CPPS患者分为观察组35     

慢性前列腺炎与性功能障碍的相关性研究进展

慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS),即NIH分类Ⅲ型前列腺炎,是一种以生殖器/盆腔疼痛和不伴尿路感染的下尿路症状为特点的常见临床综合征,是泌尿外科常见的疾病。除了下泌尿生殖道、会阴部的不适或者疼痛,性功能障碍也是慢性前列腺炎患者的威胁之一。慢性前列腺炎的症状与患者的性功能指标和性生活质量显著相关。本文就CP/CPPS的潜在发病机制,CP/CPPS与性功能障碍的关系进行综述。     

慢性非细菌性前列腺炎与细胞因子关系的研究进展

前列腺炎是一种好发于男性青壮年的常见病,约有50%的男性在一生中的某个时期会受到前列腺炎的影响。慢性非细菌性前列腺炎/慢性骨盆疼痛综合症(chronic abacterial prostati-tis/chronic pelvic pain syndromes,CAP/CPPS)约占慢性前列腺炎的90%以上,其临床症状主要表现为尿频、尿急、尿痛及夜尿增多,并伴有会阴、阴茎、肛门、尿道、耻骨部或腰骶部的隐痛不     

慢性前列腺炎的病因与治疗进展

慢性前列腺炎(chronic prostatitis,CP)多发生于青壮年,是泌尿外科常见疾病,发病率为4%～25%。目前对其发病机制仍未完全明了,治疗也不尽如人意。1995年,美国国立卫生研究院(nationalinstitute of health,NI H)对前列腺炎进行了重新分类,即NI H分类法。Ⅰ型:急性细菌性前列腺炎(a-cute bacterial prostatitis,ABP);Ⅱ型:慢性细菌性前列腺炎(chronic bacterial prostatitis,CBP);Ⅲ型:ⅢA,慢性非细菌性前列腺炎(chronic non-bacteri-al prostatitis,CNP)和ⅢB,慢性骨盆疼痛综合征(chronic pelvic pain syndrome,CPPS);Ⅳ型:无症状…     

慢性骨盆疼痛综合征前列腺液16s rDNA的检测意义

慢性骨盆疼痛综合征（CPPS，Ⅲ型前列腺炎）临床疗效并不满意，是长期以来困扰着医生和患者的难题，为探讨16s rDNA检测是否有助于CPPS的个体化治疗，我们进行了相关的研究，现报道如下。     

翁沥通胶囊治疗慢性骨盆疼痛综合征

慢性前列腺炎是成年男性的常见病,发病率估计为9％～14％。其中,慢性骨盆疼痛综合征(CPPS)占绝大多数,包括慢性非细菌性前列腺炎及前列腺痛。由于病因不清,目前临床上仍无满意的治疗方法。为了探讨翁沥通胶囊治疗慢性骨盆疼痛综合征的疗效和安全性,笔者于2001～2002年对CPPS门诊患者进行了临床随机对照研究,报告如下。1 资料与方法1.1 一般资料 采用NIH-CPPS诊断标准选取门诊CPPS患者100例,年龄21～48岁,平均年龄36岁,未婚30例,已婚70例,病程9个月～5年,平均18个月。所有患者都曾使用过抗生素治疗,但疗效不佳。临床症状:会阴部疼痛56例,睾丸疼痛25例,阴茎疼痛15例,腰骶部疼痛30例,耻骨上区疼痛50例,小便疼痛或烧灼感28例,射精疼痛25例,性功能障碍12例,尿频71例,尿不尽感76例,伴焦虑37例。前列腺指诊:前列腺压痛57例,质地较硬25例,有硬结26例。前     

慢性前列腺炎联合用药的治疗体会

慢性前列腺炎是50岁以下男性最常见的泌尿生殖系统疾病之一,在我国医院中约占泌尿外科就诊男性患者的25%～30%.本病症状持续多变,病程长,易反复,难以治愈,严重影响患者的生活质量.前列腺炎最常见的类型是Ⅲ型(NIH分类法),亦称为慢性前列腺炎(chronic prostatitis, CP)/慢性盆腔疼痛综合征(chronic pelvic pain syndrome, CPPS).疼痛是CP/CPPS最主要的症状,也是影响患者生活质量的主要原因之一.目前对CP/CPPS患者疼痛产生的原因尚不明确.2006年6月至2008年12月,我们随机选择泌尿外科门诊126例中重度慢性前列腺炎患者给予药物联合治疗,其中对部分产生明显精神症状的患者加用抗抑郁药物取得较好疗效,现报告如下.     

细胞因子与慢性非细菌性前列腺炎

慢性非细菌性前列腺炎(chronic abacterial prostatitis, CAP)是最常见的一种前列腺疾病, 约占临床前列腺炎病例的90 %～95 %,本病又称慢性骨盆疼痛综合征(chronic pelvic pain syndrome,CPPS),易反复发作﹑缠绵难愈,给患者带来很大的生理痛苦及精神负担.     

大柴胡汤合桂枝茯苓丸治疗湿热瘀阻Ⅲ型慢性前列腺炎52例

慢性前列腺炎(chronic prostatitis,CP)以Ⅲ型慢性非细菌性前列腺炎(CNP)/慢性骨盆疼痛综合征(CP/CPPS)为主,发病人群多为青壮年男性,是以盆腔区域疼痛或不适排尿异常等症状为特征的疾病,可伴有性功能障碍,如早泄、阳痿等[1].其特点为缠绵难愈、易复发,严重困扰患者,甚或影响性生殖健康.笔者应...     

慢性前列腺炎症状指数的临床应用

目的采用美国国立卫生研究所(NIH)制定的慢性前列腺炎症状指数(CPSI)评估特拉唑嗪治疗慢性前列腺炎/慢性盆腔疼痛综合症(CPPS)的临床疗效.方法应用特拉唑嗪2～4 mg治疗CPPS 68例,疗程6周.采用NIH-CPSI对治疗结果进行评估.结果用药6周后,CPSI分值平均下降了16.6分(P＜0.01).结论特拉唑嗪是治疗CPPS的有效药物,与炎症性CPPS比较,特拉唑嗪治疗非炎症性CPPS效果更好.     

综合治疗慢性骨盆疼痛综合征的疗效观察

目的：探讨慢性骨盆疼痛综合征（CPPS）的诊疗方法。方法：采用两杯法（PPMT）和综合疗法对我院2000年2月至2001年8月门诊随访的CPPS患者72例进行诊治分析，并按照美国国立卫生研究所（NIH）制定的前列腺炎症状评分（CPSI）标准进行疗效判定。应用喹诺酮类抗生素2－6周及α1受体阻滞剂，并据病情辅以热疗、前列腺按摩等治疗。结果 ：临床治愈30例（41．7％），显效35例（48．6％），有效3例（4．2％），无效4例（5．6％），总有效率为94．4％（68／72）。结论：PPMT法进行前列腺炎诊断简单易行，综合疗法对慢性骨盆疼痛综合征具有较好的疗效。     

生物反馈电刺激盆底肌肉训练治疗ⅢB型慢性前列腺炎疗效观察

目的:探讨生物反馈电刺激盆底肌肉训练治疗ⅢB型慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)的疗效。方法:对确诊ⅢB型CPPS患者50例,采用生物反馈治疗仪进行盆底肌肉电刺激,每次25～30min,2次/d,5d/周,总疗程12周。评价治疗前及治疗6、12周、治疗结束后30d慢性前列腺炎相关的性功能障碍评分(PSFI)、最大尿流率(Qmax)及慢性前列腺炎症状评分(NIH-CPSI)[包括疼痛症状评分(PS)、排尿症状评分(USS)]和生活质量评分(QLS)等观察指标的变化。结果:治疗前患者PS、USS、QLS、PSFI、Qmax分别为(12.62±2.07)、(7.28±2.21)、(8.36±1.57)、(14.37±4.14)分和(16.85±4.48)mL/s;治疗6周分别为(8.13±1.10)、(6.14±1.38)、(7.02±1.34)、(15.86±3.82)分和(18.01±4.21)mL/s;治疗12周分别为(7.51±1.26)、(3.24±1.03)、(4.25±1.26)、(18.28±4.23)分和(22.56±5.02)mL/s;治疗结束后30d分别为(7.82±1.21)、(4.01±1.20)、(4.86±1.33)、(17.20±3.93)分和(22.10±4.83)mL/s;治疗6周仅PS与治疗前有统计学差异(P<0.05);治疗12周、治疗结束后30d各指标与治疗前均有统计学差异(P<0.05);治疗12周与治疗6周比较,除PS外余指标均有统计学差异(P<0.05);治疗结束后30d与治疗6周比较,除PSFI外余指标均有统计学差异(P<0.05)。结论:生物反馈电刺激治疗能改善ⅢB型CPPS患者的下尿路症状(LUTS)、盆底疼痛和性功能障碍等症状,近期疗效满意。     

慢性前列腺炎患者血清中B7-H3分子的表达及其临床意义

目的检测慢性前列腺炎（CP）患者血清中是否存在可溶性B7-H3（sB7-H3）,并探讨其临床意义。方法采用酶联免疫吸附法（ELISA）测定79例CP患者血清中sB7-H3水平,并以11名健康男性作为对照。按美国国立卫生研究院（NIH）分类法将79例CP患者分为3型：Ⅱ型9例,ⅢA型21例,ⅢB型49例。患者症状轻重程度均通过慢性前列腺炎症状评分表（CPSI）判定。分析各组间血清中sB7-H3水平差异,以及与前列腺液（EPS）中白细胞（WBC）、卵磷脂小体（SPL）计数间的关系,并进一步分析其与CPSI评分之间的关系。结果对照组与CP组血清中sB7-H3水平分别为（3.685±1.881）ng/ml和（3.619±1.514）ng/ml,两者差异无统计学意义（P〉0.05）。但Ⅱ型组（2.305±0.732 ng/ml）明显低于ⅢA型（3.670±0.771 ng/ml）及ⅢB型（3.839±1.736 ng/ml）组（均P〈0.01）。从CP患者中诊断Ⅱ型及Ⅲ型患者的ROC曲线下面积为0.814,取最佳诊断点为2.943 ng/ml时,灵敏度为71.4%,特异度为88.9%。血清sB7-H3与CPSI评分、WBC、SPL间无相关关系（P〉0.05）。结论血清sB7-H3检测可能有助于区分Ⅱ型及Ⅲ型前列腺炎。     

Fluoxetine ameliorates symptoms of refractory chronic prostatitis/chronic pelvic pain syndrome

Background  Category III chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common syndrome of unclear etiology with significant impact on quality of life. Because the outcomes of multiple therapies for CP/CPPS have been far from approving, the possible psychological factors have been considered to play an important role in CP/CPPS. Based on this, we investigated the role of antidepressant drug (fluoxetine) in men with refractory CP/CPPS.

Methods  In this study, 42 men diagnosed with refractory CP/CPPS without response to standard therapy (include multiple antibiotic courses and α-blockers) were referred for fluoxetine therapy. All patients received fluoxetine (20 mg/d) for three months and were clinically evaluated before (baseline), and after 4, 8 and 12 weeks of therapy. The evaluation included a National Institutes of Health-chronic prostatitis symptom index (NIH-CPSI) and a Beck depression inventory (BDI) questionnaire. Moreover, the subjective global assessment (SGA) was assessed at the 4th, 8th and 12th week of therapy.

Results  Significant decreases were observed for total NIH-CPSI (28.55 to 9.29), NIH-CPSI pain (14.69 to 5.19), NIH-CPSI urinary (4.95 to 1.88 ), NIH-CPSI quality of life (8.83 to 2.20), and BDI (34.67 to 13.95) scores compared with baseline, all P values <0.05. Twenty-nine (69.05%) reported marked improvement on the subjective global assessment and 33 (78.57%) had a greater than 50% decrease in NIH-CPSI at the end of therapy (12th week). At the same time, the Pearson correlation coefficient analysis demonstrated a positive correlation between BDI score and each CPSI score. No adverse events were reported in this study.

Conclusions  Fluoxetine appears to be a safe and effective treatment in improving symptoms in, and the quality of life of, men with difficult CP/CPPS. Moreover, amelioration of difficult CP/CPPS-related symptoms could be related to a decrease in depressive symptoms.

     

骶管注射治疗型前列腺炎并发早泄60例分析

目的:观察骶管注射治疗型前列腺炎并发早泄(PE)的临床效果。方法:对60例诊断为CAP/CPPS并发PE患者给予骶管注射治疗,分别对治疗前及治疗6周后NIH-CPSI症状评分;射精潜伏期时间比较;观察疗效及不良反应情况。结果:60例患者治疗前后NIH-CPSI症状评分、射精潜伏期时间有显著性差异(P<0.01);前列腺炎总有效率为86.7%;早泄有效率为76.7%;未发现不良反应。结论:骶管注射药物是治疗性前列腺炎并发早泄的有效方法。     

前列腺内注射结合前列腺按摩对慢性前列腺炎/慢性骨盆疼痛综合征的疗效观察

目的探讨前列腺内药物注射结合前列腺按摩治疗慢性前列腺炎/慢性骨盆疼痛综合征的疗效。方法选用多种相关药物经会阴部注入前列腺内结合前列腺按摩治疗,每周2次,连续治疗4次。结果131例中临床治愈28例,好转92例,无效11例,总有效率91.6%。结论前列腺内注射结合前列腺按摩对慢性前列腺炎/慢性骨盆疼痛综合征具有较显著的疗效。     

A preliminary evaluation of the psychometric profiles in Chinese men with chronic prostatitis/chronic pelvic pain syndrome

Background  As one of the most commonly diagnosed diseases, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is characterized by a variety of complex symptoms. Anxiety and depression are two of the most prevalent clinical manifestations of patients with CP/CPPS, and have adverse effects on the health of the subjects and prognosis of comorbidities. Such psychological disorders, however, have not been deeply and thoroughly studied in China. The aim of this study was to investigate the prevalence and severity of psychological disorders in Chinese adults with CP/CPPS.

Methods  From April 2008 to June 2009, 80 patients and 40 age-matched healthy men participating in a voluntary health examination were recruited. The majority of the subjects completed the questionnaires on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) as well as the hospital anxiety and depression scale (HADS).

Results  Of all the participants, 77 (96.3%) patients and 37 (92.5%) healthy controls completed the questionnaires. The average NIH-CPSI total score was 21.0±9.5 for the patients and 2.2±1.5 for the controls (P=0.03). Of the 77 patients with CP/CPPS, 48 (62.3%), 5 (6.5%), and 1 (1.2%) had anxiety symptoms, depression symptoms, or both anxiety and depression symptoms, respectively. For the controls, the average HADS anxiety and depression scores in patients were 14.5±6.8 and 5.2±4.5, which were both significantly higher than in controls. Moreover, the prevalence and the symptom scores of both the HADS anxiety and depression were higher for the younger age group (<35 years) than for the older age group (<35 years).

Conclusions  This preliminary study revealed that male patients with CP/CPPS had a higher prevalence of psychological disorders than in the control subjects. Moreover, the differences of the prevalence and severity of the psychological symptoms between the two different age groups may imply that psychological disorders related to CP/CPPS may be relieved with increasing age. The present study indicated that psychological evaluation is important in men with CP/CPPS, especially in younger men.

     

经会阴前列腺穿刺组织的细菌16S rRNA基因检测

目的 探讨Ⅲ型前列腺炎(CPPS)的细菌学病因及16s rRNA基因检测对抗生素疗效的预测价值.方法 对112例CPPS患者(年龄20～48岁),经会阴前列腺穿刺取得皮下组织及前列腺组织,用聚合酶链反应法(PCR)检测细菌16S rRNA基因.加替沙星片治疗4周后随访,根据治疗前后慢性前列腺炎症状评分(NIH-cPsI)评定疗效.结果 18例病人因皮下组织中检测到细菌信号疑为污染而排除,94例完成研究.16S rRNA基因总阳性率63.8%(60/94),Ⅲ a型信号阳性率为68.3%(28/41),Ⅲb型60.3%(32/53).抗生素治疗后16S rRNA基因阳性组总有效率优于阴性组(55.0%比14.7%,P<0.001),在分组研究中,Ⅲa型和Ⅲb型阳性组有效率均优于阴性组(75%比23.1%,P<0.001;37.5%比9.5%,P<0.05).结论 部分CPPS与细菌感染有关,前列腺组织16SrRNA基因检测对抗生索治疗有指导意义.