慢性前列腺炎诊疗进展

慢性前列腺炎 (CP)尤其非细菌性前列腺炎 (NBP)———慢性骨盆疼痛综合征 (CPPS)发病机理至今不甚明了 ,人群发病率为 2 .5 %～ 16 % ,几乎各个年龄组和种族均可发病。 2 0世纪 90年代以来 ,在国际前列腺炎协作网(IPCN)、美国国立卫生院慢性前列腺炎协作研究网 (NIH CPCRN)等国际研究机构的协调下 ,各国研究者对CP的病因、诊断、治疗等诸方面进行了较以往更大规模的广泛、深入的研究。近年来的主要成果有 :CP多因素、多步骤的发病机制、新的临床分类系统、症状评分体系 (NIH CPSI)的建立、新的诊断标准及规范化临床评估、治疗新技术的尝试等等。今后的研究重点包括分类系统的进一步完善 ,治疗方法、药物验证及筛选等方面。     

慢性前列腺炎中西医结合诊疗指南

<正>一、背景、目的与意义慢性前列腺炎（Chronic prostatitis, CP）是指前列腺在病原体和/或某些非感染因素作用下，患者出现以盆腔区域疼痛或不适、排尿异常等症状为特征的疾病[1]。慢性前列腺炎临床表现复杂、病情缠绵难愈。本病患者常表现为疼痛和下尿路症状，部分患者还伴有焦虑、抑郁、恐惧等精神心理障碍以及勃起功能障碍、早泄等性功能障碍，严重影响患者的身心健康和生活质量，并加重社会经济负担。如何充分运用中医、西医现有的研究成果，进一步规范诊疗，提高临床疗效，改善预后，减轻社会负担，是亟待解决的难题。     

慢性前列腺炎/慢性骨盆疼痛综合征治疗新进展

慢性前列腺炎(CP)尤其是慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)(Ⅲ型)的发病机制至今尚不完全清楚,人群发病率可达2.5%~16.0%,为50岁以下男性最常见的泌尿外科疾病。20世纪90年代以来,在美国国立卫生研究院慢性前列腺炎协作研究网(NIH-CPCRN)、国际前列腺炎协作网(IPCN)等国际研究机构的协调下,各国研究者对CP的病因、诊断、治疗等诸方面进行了较以往更大规模的深入研究。CPPS是CP中最常见的也是疗效最差的一种类型,本文综述了近几年来CP/CPPS治疗新进展,探讨了其目前治疗所面临的主要问题及可能的原因,并对CP/CPPS治疗的前景予以展望。     

慢性前列腺炎/慢性骨盆疼痛综合征的治疗进展

<正>前列腺炎(prostatitis)是一个复杂的临床综合征,美国国立卫生研究院(NIH)目前将前列腺炎分为4型:Ⅰ型为急性细菌性前列腺炎,Ⅱ型为慢性细菌性前列腺炎,Ⅲ型为慢性前列腺炎/慢性骨盆疼痛综合症,Ⅳ型为无症状的前列腺炎。其中Ⅲ型慢性前列腺炎/慢性骨盆疼痛综合症(chronic prostatitis,CP/chronicpelvic pain syndrome,CPPS)是50岁以下男性最常见的疾病之一,治疗费用昂贵,治疗效果不佳~([1-4])。它的定义是在排除尿路感染的情况下,持续发生慢性盆腔疼痛或出现前列腺炎症的症状体征3～6个月。CP/CPPS的终生患病率约为2. 2%～8. 2%~([5]),其主要临     

Ⅲ型慢性前列腺炎/慢性骨盆疼痛综合征中西医结合治疗疗效分析

慢性前列腺炎（CP）是困扰50岁以下中青年男性最常见的泌尿系统疾病。据估计约50％的男性在一生中曾经有过前列腺炎的症状。由于其病因复杂，发病机制不明确，目前尚缺乏有效的治疗办法。2005年12月～2006年11月采用单双日随机、对照、单盲的研究方法，应用中医辨证论治、联合α受体阻滞剂、抗生素治疗CP／CPPS疗效满意，报告如下。     

慢性骨盆疼痛综合征的综合性治疗

目的 :探讨慢性骨盆疼痛综合征 (CPPS)的诊疗方法。　方法 :分析 16 5例CPPS患者的病史和实验室检查结果 ,依据美国国立卫生研究院 (NIH)前列腺炎的诊断标准 ,对患者进行分类。综合性治疗 6～ 8周。ⅢA型患者以广谱抗生素及α1受体阻滞剂治疗为主 ,ⅢB型则分别给予α1受体阻滞剂、镇静剂、镇痛肌松剂治疗 ;全部患者均配合精神心理及物理疗法 ,部分患者加服中成药。根据慢性前列腺炎症状指数 (CPSI)评分判断疗效。　结果 :治疗 6周后显效 12 1例 (73.3% ) ,有效 2 6例 (15 .8% ) ,无效 18例 (10 .9% )。　结论 :综合性治疗是CPPS有效的治疗方法。     

复方玄驹胶囊治疗Ⅲ型前列腺炎疗效观察

目的:观察复方玄驹胶囊治疗Ⅲ型前列腺炎的临床疗效。方法:选择符合美国国家卫生研究院(NIH)分类标准,诊断为Ⅲ型前列腺炎的患者242例,随机分为2组对照研究。治疗组121例,应用复方玄驹胶囊治疗,每天3次,每次3粒;辅以盐酸坦索罗辛缓释片,0.2 mg,每天1次。对照组121例,按常规方法治疗,以喹诺酮类抗生素为主,辅以盐酸坦索罗辛缓释片,以及解痉镇痛和镇静催眠剂。分别治疗6周。疗效观察采用NIH-CPSI评分,及相关合并症治疗改善程度情况。结果:242例全部进入评估。6周后治疗组总有效人数为94例,占77.69%(94/121),合并症治疗总有效人数78例,占71.56%(78/109)。对照组总有效人数57例,占47.10%(57/121)。合并症治疗总有效人数34例,占31.78%(34/107),NIH-CPSI评分及相关合并症治疗对比,前者疗效明显优于后者,(P<0.05)。结论:复方玄驹胶囊对Ⅲ型前列腺炎有较好疗效。     

特拉唑嗪治疗慢性前列腺炎/慢性骨盆疼痛综合征疗效观察

目的 探讨治疗慢性前列腺炎/慢性骨盆疼痛综合征的有效治疗方法.方法 采用特拉唑嗪,辅助用药为活血化瘀中药组方治疗慢性前列腺炎/慢性骨盆疼痛综合征126例.结果 126例中治愈82例(65%),好转30例(23.8%),无效14例(11.2%),总有效率为88.8%.结论 特拉唑嗪配合中药治疗慢性前列腺炎/慢性骨盆疼痛综合征临床效果显著.     

慢性骨盆疼痛综合征的诊治

目的　探讨慢性骨盆疼痛综合征 (CPPS)的诊断和治疗。方法　按照NIH分类标准 ,采用PPMT法 ,结合EPS涂片检测和培养结果 ,共筛选出 6 9例患者 ,其中炎症性CPPS(Ⅲa) 15例 ,非炎症性CPPS(Ⅲb) 5 4例。Ⅲa类患者口服广谱抗生素 8周 ,Ⅲb类患者先后或同时应用抗抑郁药、肌肉松弛剂、a受体阻滞剂和镇痛剂 ,同时配合前列腺按摩、中药调理和热水坐浴等综合治疗 12周。结果　前列腺液培养 4 8次 ,支原体感染 5例 ,衣原体感染 3例。治疗 6周前后CPSI症状评分 ,显效 17例 ,有效 4 6例 ,6例无效。31例患者停止治疗 2周 ,16例复发 ;停止治疗 4周 ,2 7例复发 ;停止治疗 6周 ,31例全部复发。结论　综合治疗和治疗个体化对慢性骨盆疼痛综合征有较好疗效 ;坚持用药治疗以降低复发     

前列腺炎诊断治疗指南（试行版）

前列腺炎是成年男性的常见病之一。虽然它不是一种直接威胁生命的疾病，但严重影响患者的生活质量。同时，其庞大的患者人群和高昂的医疗费用给公共卫生事业造成了巨大的经济负担。由于目前对前列腺炎的发病机制、病理生理学改变还不十分清楚，许多医师在临床诊治前列腺炎过程中感到棘手。至今，对前列腺炎的认识、病情轻重的判断、治疗方法的选择以及疗效评价等诸多方面，在我国尚无明确的标准可依。     

Questionnaire survey of Japanese urologists concerning the diagnosis and treatment of chronic prostatitis and chronic pelvic pain syndrome

OBJECTIVES: We performed a questionnaire survey to investigate various issues in the diagnosis and treatment of chronic prostatitis/chronic pelvic pain syndrome by Japanese urologists and to clarify the circumstances surrounding prostatitis in Japan. METHODS: Japanese urologists (n = 1869) were surveyed by mail using a 17-item questionnaire to determine current diagnostic and treatment practices for prostatitis/chronic pelvic pain syndrome. RESULTS: Only 1.5% (11/739) of urologists diagnosed chronic prostatitis/chronic pelvic pain syndrome using the 4-glass test, while most did so using the 2-glass test (voided bladder [VB]2 and VB3, or VB2 and expressed prostatic secretion [EPS]). Approximately half (55.2%; 412/746) did not perform urine cultures to differentiate chronic bacterial prostatitis from chronic abacterial prostatitis/chronic pelvic pain syndrome. Approximately half (46%; 343/746) did not count the number of leukocytes in VB2 or VB3/EPS to differentiate chronic abacterial prostatitis from chronic pelvic pain syndrome. Although many urologists (63.8%; 459/720) thought that chronic abacterial prostatitis/chronic pelvic pain syndrome was not an infectious disease, many chose antimicrobial agents as the primary treatment. More than half (52.2%; 384/735) of all urologists felt pessimistic about dealing with chronic prostatitis/chronic pelvic pain syndrome compared to treating benign prostatic hypertrophy or prostate cancer, because of the high number of complaints by patients and their own lack of confidence in diagnosing and treating the condition. CONCLUSION: There is much confusion and frustration among Japanese urologists about chronic prostatitis/chronic pelvic pain syndrome. Further studies are needed to elucidate its etiology and pathogenesis, and to establish guidelines for its diagnosis and treatment.     

Seminal plasma cytokine levels in the diagnosis of chronic pelvic pain syndrome

BACKGROUND: Chronic non-bacterial prostatitis/chronic pelvic pain syndrome (CPPS) are frequently encountered clinical entities characterized by painful and irritative voiding symptoms often referable to the prostate. Diagnosis usually depends on the symptoms and treatment mainly consists of reassurance, anti-inflammatory medications and antibiotics in the absence of a documented infection. To have objective diagnostic criteria, we determined the possible roles and diagnostic efficacies of soluble cytokines interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha), IL-2R, IL-6 and IL-8 in the seminal plasma of patients with different forms of CPPS. METHODS: Seminal plasma was obtained from a total of 30 subjects who were evaluated in three groups. Each group comprised 10 patients having inflammatory CPPS, non-inflammatory CPPS and control subjects, respectively. The levels of IL-1beta, IL-2R, TNF-alpha, IL-6 and IL-8 were measured in seminal plasma using chemiluminescence. RESULTS: The level of IL-2R in all three groups was below measurable values. Interleukin-1beta, TNF-alpha, IL-6 and IL-8 levels were elevated significantly in the two groups with CPPS compared with the control group (P < 0.05). Soluble cytokines showed a slight difference between patients with inflammatory CPPS and non-inflammatory CPPS, but this was not statistically significant (P > 0.05). CONCLUSION: Although there are individual variables between the discrimination of inflammatory and non-inflammatory CPPS, cytokines are frequently present and elevated in the expressed prostatic secretions from men with CPPS. Our results indicate that several soluble cytokines can be used to identify this chronic and long-term disease.     

慢性盆腔疼痛综合征的诊断及综合治疗：附103例报告

目的 探讨慢性盆腔疼痛综合征（ＣＰＰＳ）的有效诊治方法。方法 对１９９６年５月～１９９８年６月仍随访的ＣＰＰＳ患者１０３例进行诊治分析,７６例接受“四杯试验”（ＶＢ１、ＶＢ２、ＶＢ３及ＥＰＳ）,２７例接受按摩前尿液及按摩后尿液培养,均阴性,其中６９例ＥＰＳ、ＶＢ３或按摩后尿液显微镜下检查白细胞１～１７个／ＨＰ;治疗上选用５－氟喹诺酮、α－受体阻滞剂、非甾体抗炎药、别嘌呤醇等。结果 全部患者获得６个     

Neuroinflammatory gene expression in chronic prostatitis/chronic pelvic pain syndrome patients: insights into etiology and phenotype biology

BackgroundChronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has diverse clinical phenotypes and its etiology is multifactorial. Studies to date of gene expression in humans have been limited to small numbers of target genes. NanoString can simultaneously measure hundreds of genes. We wished to study gene expression in blood and urine of CP/CPPS patients compared to controls for neuroinflammatory genes and characterize the results by patient phenotype.MethodsBlood and urine were collected from 10 men with CP/CPPS and 7 asymptomatic controls. RNA was isolated from urine pellets using Qiagen RNeasy kits. Whole blood was collected and RNA isolated. 100 ng of RNA was used for gene expression analysis with the 770-gene NanoString Human Neuroinflammation gene panel. Data was imported into Rosalind (OnRamp Bioinformatics) for normalization, calculation of fold-changes and P values, and identification of enriched pathways. Gene expression was considered significantly different if there was a greater than 1.5× change compared to controls and corrected P was <0.05.ResultsMean patient age was 42.2 years, median symptom duration was 15.5 months, median UPOINT domains was 3 and mean total National Institute of Health-Chronic Prostatitis Symptom Index Score was 28.8. In blood, there were 5 genes with significantly different expression to controls, the largest differences found in FOS1 (neuropathic pain control), PROS1 (blood clotting) and DDX58 (antiviral innate immunity). Gene set analysis showed differences in inflammation, angiogenesis and cytokine signaling. In urine there were 48 genes with significantly different expression including SLAMF8 (lymphocyte activation) and LAIR1 (inhibits B and T cell function). Gene set analysis showed differences in carbohydrate metabolism, neurons and neurotransmission, adaptive immunity and inflammatory signaling. Subgroup analysis by UPOINT domain showed unique gene expression in the Organ Specific and Neurologic/Systemic domains in both blood and urine for neurogenic pain and cytokine signaling associated genesConclusionsMen with CP/CPPS have a diverse set of neuroinflammatory genes with differential expression compared to controls. Clinical phenotypes have distinct patterns of gene expression. These findings could lead to novel biomarker development, emphasize the importance of multimodal therapy targeting diverse pathways and further validate the biologic basic of clinical phenotyping.     

Quercetin for chronic prostatitis/chronic pelvic pain syndrome

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition with a heterogeneous origin that responds best to multimodal therapy. The bioflavonoid quercetin has antioxidant and antiinflammatory effects that have proven useful for treating this condition. Using the clinical phenotype system UPOINT, quercetin can be helpful for those with organ-specific complaints (bladder or prostate) and pelvic floor spasm. This article discusses the current understanding of CP/CPPS and how treatment with quercetin can be used alone or as part of multimodal therapy.     

Factors influencing practices for chronic prostatitis: A nationwide survey of urologists in South Korea

BACKGROUND: We investigated the influence of physicians' attitudes on the treatment of chronic prostatitis, and attempted to correlate demographic and professional characteristics with patterns of therapy regarding chronic prostatitis. METHODS: Probability samples were drawn from the Korean Urological Association Registry of Physicians, and a random sample of 850 Korean urologists were asked to complete a questionnaire which explored practice characteristics, attitudes, and diagnostic and treatment strategies for the management of chronic prostatitis. The returned questionnaires were statistically analysed. RESULTS: Of the 850 questionnaires sent, 302 were returned, and 275 of those were included in the final analysis (response rate 32.4%). Multivariate logistic regression analysis indicated that the type of hospital (P < 0.001) and belief that culture tests helped diagnose chronic prostatitis (P = 0.001) were the most determinant factors with respect to the routine performance or non-performance of culture tests. Most Korean urologists (96.4%) prescribed antibiotics for the primary treatment of chronic prostatitis. Even when primary antibiotic treatment was unsuccessful, urologists frequently prescribed a second course of antibiotics (57.8%). In the multivariate model used, the likelihood of prescribing antibiotics as a secondary treatment varied by the type of hospital, with 0.4-fold odds (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.21-0.87; P = 0.019) of the practice occurring in university hospitals, as opposed to primary clinics. According to the same model, the belief that culture tests help to diagnose chronic prostatitis was also an independent influencing factor (OR, 2.29; 95% CI, 1.39-3.77; P = 0.001), whereas the actual performance of culture tests had no statistical significance. CONCLUSION: Our findings suggest that the personal beliefs and professional characteristics of physicians may influence the diagnosis and treatment of chronic prostatitis in Korea.     

Phenotypic approach to the management of the chronic prostatitis/chronic pelvic pain syndrome

? Our traditional approach to managing the chronic prostatitis (CP) syndromes has not been very successful for many of our patients. ? Our developing understanding of CP/chronic pelvic pain syndrome (CP/CPPS) as a heterogeneous syndrome rather than a homogenous disease has allowed us to develop treatment strategies based on individual patient characteristics. ? By considering each patient as a unique individual and tailoring treatments to a specific patient's clinical 'phenotype' we improve our therapeutic outcomes.     

Predictors of quality of life and pain in chronic prostatitis/chronic pelvic pain syndrome: findings from the National Institutes of Health Chronic Prostatitis Cohort Study

OBJECTIVES: To examine the cross-sectional relationship of age, urinary and depressive symptoms and partner status on pain intensity and quality of life (QoL) in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). PATIENTS AND METHODS: In all, 463 men enrolled in the National Institutes of Health (NIH) Chronic Prostatitis Cohort Study from seven clinical centres (six in the USA and one in Canada) reported baseline screening symptoms using the NIH Chronic Prostatitis Symptom Index (CPSI). The CPSI provides scores for pain, urinary symptoms and QoL. In addition, a demographic profile, including age and partner (living with another) status, and a depressive symptom score were obtained. Regression modelling of QoL, adjusting for between-centre variability, examined the unique effects of age, partner status, urological symptoms, depressive symptoms and pain. RESULTS: Urinary scores, depressive symptoms and pain intensity scores significantly predicted QoL for patients with CP/CPPS (higher CPSI QoL scores indicated more impairment; median 8.0, range 0-12). On average, for every 1-point increase in urinary scores, there was a corresponding increase in QoL score of 0.118 points (P = 0.001); for every 1-point increase in pain intensity score, there was a corresponding increase in QoL score of 0.722 points (P < 0.001); and for every 1-point decrease in depressive symptoms (lower scores equal poorer mood), the QoL score increased (poorer quality of life) by 0.381 points (P < 0.001). Age and partner status did not significantly contribute to poorer QoL. Urinary scores and depressive symptoms were significant predictors (P < 0.001) of pain in patients with CP/CPPS. CONCLUSIONS: These data show that depressive symptoms and pain intensity significantly predict a poorer QoL in patients with CP/CPPS, and that these effects are independent of partner status, age and urinary status. In particular, pain intensity was the most robust predictor of a poorer QoL. Further data relating pain and psychological factors to CP/CPPS are highly recommended, to aid in determining specific factors for pain and its impact on QoL. These data are essential if empirically guided efforts to manage pain are to progress.     

A case-control study of chronic prostatitis/chronic pelvic pain syndrome and colorectal cancer

Study Type – Symptom prevalence (case control) Level of Evidence 2b What's known on the subject? and What does the study add? Associations are well established between intestinal infection/inflammation or inflammatory bowel diseases and colorectal cancer (CRC). Our study found an association between CRC and previously diagnosed chronic prostatitis/chronic pelvic pain syndrome. Patients with CRC had a 1.45‐fold higher risk of having a previous diagnosis of chronic prostatitis/chronic pelvic pain syndrome than controls. This phenomenon was found to be more prominent in subjects younger than 60 years.

OBJECTIVE

• ? To estimate the association between chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and colorectal cancer (CRC) using a nationwide population‐based data set.

PATIENTS AND METHODS

• ? This case–control study used data sourced from the Taiwan Longitudinal Health Insurance Database.
• ? The cases comprised 2899 patients with CRC and 14 995 randomly selected subjects as controls.
• ? We used conditional logistic regression to examine the association between CRC and previous diagnosis of CP/CPPS.

RESULTS

• ? Of the sampled patients, 531(3.05%) had been diagnosed with CP/CPPS before the index date, with 123 (4.24% of the patients with CRC) coming from the cases and 408 individuals (2.81% of patients without CRC) coming from the controls.
• ? Conditional logistic regression analysis revealed that cases were more likely to have CP/CPPS than controls (odds ratio 1.45, 95% CI 1.17–1.79, P < 0.001) after adjusting for the monthly income, geographic location, urbanization level, hypertension, diabetes, renal disease, obesity and cystic kidney disease.
• ? In subgroup analysis, we found the magnitude of the association to be higher in subjects younger than 60 years (age 40–49, odds ratio 2.01; 95% CI 2.04–3.58 and aged 50–59, 2.40, 95% CI 1.48–3.87, both P < 0.001) than among other age groups.

CONCLUSION

• ? We conclude that CP/CPPS patients are at higher risk for CRC, especially in males under 60 years of age.