抗生素治疗慢性前列腺炎/慢性骨盆疼痛综合征的疗效观察

目的 观察抗生素在慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)治疗中的作用.方法 将CP/CPPS患者分为A、B 2组,每组100例,对A组患者给予对症治疗,对B组患者在A组治疗方案基础上同时给予抗生素,观察治疗后2组患者美国国立卫生研究院慢性前列腺炎症状积分(NIH-CPSI)的变化情况,并进行统计学处理分析.结果 A、B 2组患者接受治疗后症状均有明显改善,且加用抗生素的B组患者的NIH-CPSI积分明显低于未用抗生素A组患者的NIH-CPSI积分(10.6±3.3 vs 4.2±3.0,P＜0.05).结论抗生素在CP/CPPS治疗中具有重要的作用,加用抗生素联合治疗更有利于CP/CPPS症状的改善.     

慢性前列腺炎/慢性骨盆疼痛综合征的治疗进展

正1995年美国国立卫生研究院(National Institutes of Health,NIH)根据当时对前列腺炎的基础和临床研究情况将前列腺炎分为四型,其中Ⅲ型(chronic prostatitis/chronic pelvic pain syn-drome,CP/CPPS)是最常见的类型,约占慢性前列腺炎的90﹪以上[1],主要临床表现为长期、反复的骨盆区域疼痛或不适,症     

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。     

前列腺注射辅以中医中药治疗慢性前列腺炎综合征

目的观察前列腺注射辅以中医中药治疗慢性前列腺炎综合征的效果。方法采用前列腺内腺体周围注射用药及配合中医中药治疗慢性前列腺炎综合症213例。结果总有效率96%,治愈率82%,注药最多8次,最少2次,平均4次,中药制成丸剂,用药12d~60d,平均26d。结论治愈率高,用药方便,二者配合取长补短,疗效满意,患者容易接受,值得临床应用。     

行为疗法治疗慢性骨盆疼痛综合征的临床观察

目的探讨行为疗法治疗慢性骨盆疼痛综合征（CPPS）的疗效。方法采用消除紧张的行为治疗,让患者保持乐观的精神状态,适当体育锻炼,规律排精,局部热疗,每周一次病友会（心理健康科普教育）包括对前列腺疾病的认识、心理疏导、生活方式等健康教育。8周为一疗程,并进行对比分析。结果70例患者治疗前慢性前列腺炎评分（CPSI）,治疗1、2月降低均有统计学意义。B超、EPS检查治疗前后无变化。显效24例,有效37例,总有效率87．10（79.3％～100．0%）。结论CPPS的治疗以消除紧张、缓解压力、控制情绪、调整心理的行为疗法,可获得满意疗效。     

前列腺内药物注射治疗慢性前列腺炎的疗效观察和护理要点

目的观察前列腺内药物注射治疗慢性前列腺炎的疗效。方法将92例慢性前列腺炎患者随机分为两组,观察组48例前列腺内注射抗生素和中药,并相应给与针对性的健康教育和心理护理;对照组44例口服抗前列腺炎药物,临床治疗4周,观察两组的疗效。结果观察组治疗有效率为87.5%,与对照组相比,合用中药注射治疗慢性前列腺炎比口服抗前列腺炎药物更为有效（P〈0.05）。结论前列腺内注射抗生素和中药是治疗慢性前列腺炎的有效方法,治疗同时给予相应针对性的健康教育和心理护理措施是有效的辅助手段。     

中西医结合治疗慢性骨盆疼痛综合征疗效观察

目的：观察中西医结合治疗慢性骨盆疼痛综合征的临床疗效。方法：将60例患者随机分为2组。治疗组30例,用祛风除湿活血通络中药汤剂（独活10g,防风10g,白芷10g,秦艽10g,皂角刺12g,桃仁10g,红花6g,地鳖虫10g,延胡索10g,甘草6g）同时联合多沙唑嗪控释片治疗。对照组30例多沙唑嗪控释片治疗。30天为1疗程。用慢性前列腺炎症状积分指数（NIH-CPSI）评分进行疗效比较。结果：治疗组总有效率为90%。对照组总有效率为70%。两组的总有效率比较差异有显著性（P〈0.05）。结论：中西医结合治疗慢性骨盆疼痛综合征疗效明显。     

前列腺内药物注射治疗慢性前列腺炎的疗效观察和炉理要点

目的 观察前列腺内药物注射治疗慢性前列腺炎的疗效方法将92例慢性前列腺炎患者随机分为两组,观察组48例前列腺内注射抗生素和中药,并相应给与针对性的健康教育和心理护理;对照组44例口服抗前列腺炎药物,临床治疗4周,观察两组的疗效.结果 观察组治疗有效率为87.5%,与对照组相比,合用中药注射治疗慢性前列腺炎比口服抗前列腺炎药物更为有效(P＜0.05).结论 前列腺内注射抗生素和中药是治疗慢性前列腺炎的有效方法,治疗同时给予相应针对性的健康教育和心理护理措施是有效的辅助手段.     

冲击波治疗慢性骨盆疼痛综合征的研究进展

慢性骨盆疼痛综合征（CPPS）是男性常见疾病。体外冲击波疗法（ESWT）是治疗泌尿系结石的常用方法,也应用于临床痛症治疗。近年来ESWT开始用于治疗CPPS。现就ESWT治疗CPPS的相关机制和治疗现状做一全面的回顾。     

前列腺结石与慢性前列腺炎-慢性盆腔疼痛综合征相关性

目的探讨前列腺结石的形态、临床表现及其与慢性前列腺炎-慢性盆腔疼痛综合征(CP-CPPS)的相关性。方法采用经腹超声对1 650例青年男性进行前列腺检查,按结石的类型将病人分为Ⅰ型、Ⅱ型两组。进行相应病史的询问和体格检查,记录下尿路症状,以及Meares-Stamey四杯法测试结果。结果 126例结石病人中,Ⅰ型86例(68.3%),Ⅱ型40例(31.7%),≥35岁病人Ⅰ型结石比例明显高于<35岁病人(χ2=18.2,P<0.05);Ⅱ型结石病人常伴有临床症状(χ2=42.5,P<0.01);并且与CP-CPPS密切相关(χ2=38.8,P<0.01)。结论散发、细小的前列腺结石可能与病人年龄的增长有关而非与炎症相关。粗大的前列腺结石病人常伴有临床症状,可能与潜在的前列腺炎症有关,因此,对Ⅱ型结石的病人需要进一步评估,并可能需要进行相应的治疗。     

特拉唑嗪治疗慢性前列腺炎/慢性盆腔疼痛综合征的系统评价

目的 评价特拉唑嗪治疗慢性前列腺炎／慢性盆腔疼痛综合征（CP／CPPS）的疗效与安全性。方法 采用Cochrane系统评价方法，电子检索Embase、Pubmed等国内、外数据库。纳入特拉唑嗪与安慰剂或其他疗法比较治疗CP／CPPS男性患者的随机对照试验（RCT）。由两名评价员独立评价文献质量和提取资料，用Stata9．2软件进行Meta分析。结果 检索结果获得9个随机对照实验，其中只有4个RCTs（369例）被纳入。本系统评价的meta分析结果显示特拉唑嗪治疗CP／CPPS的疗效优于安慰剂，能有效地改善CP／CPPS患者的NIH症状指数总评分、生活质量、疼痛及排尿症状，但其不良反应也高于安慰剂。结论 根据现有的证据，可以认为特拉唑嗪有改善CP／CPPS症状的作用。但鉴于目前评价其疗效和安全性的随机对照试验及病例数较少，研究质量普遍不高，有必要进一步开展高质量、大样本随机对照试验评价其疗效和安全性。     

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.

     

Ⅲ型慢性前列腺炎合并勃起功能障碍的中西结合治疗临床观察

目的 探讨花粉芪奴汤结合伐地那非治疗Ⅲ型慢性前列腺炎(CP/CPPS)合并勃起功能障碍(ED)的疗效.方法 CP/CPPS合并ED患者138例,随机分为两组:治疗组70例,使用花粉芪奴汤4周后加用伐地那非治疗;对照组68例持续使用花粉芪奴汤8周.分别于第4和第8周末进行NIH-CPSI评分和IIEF-5评分观察疗效.结果 4周末治疗组和对照组NIH-CPSI分别为13.1±4.7和13.3±4.5,较治疗前均显著下降(P＜0.01),两组间比较差异无统计学意义(P＞0.05),两组IIEF-5评分分别为14.1±3.3和14.3±5.0,较治疗前有所上升(P＜0.01),但两组间比较差异无统计学意义(P＞0.05).8周后治疗组NIH-CPSI评分7.8±2.8、IIEF-5评分20.1±4.4与4周末比较差异均有统计学意义(P＜0.01);对照组NIH-CPSI评分12.7±2.3、IIEF-5评分14.3±4.5、与4周末比较差异均无统计学意义(P＞0.05);两组间NIH-CPSI与IIEF-5评分比较差异均有统计学意义(P＜0.01),治疗组IIEF-5评分值与NIH-CPSI值呈负相关关系.结论 对CP/CPPS合并ED患者在使用花粉芪奴汤加用伐地那非能有效治疗ED,同时使NIH-CPSI评分降低,促进CP/CPPS恢复.     

瑜伽锻炼对慢性非细菌性前列腺炎/慢性骨盆疼痛综合征的辅助康复治疗效果

目的:探讨瑜伽锻炼对慢性非细菌性前列腺炎/慢性骨盆疼痛综合征(CAP/CPPS)的辅助康复治疗效果.方法:将2008年4月～2010年4月期间符合CAP/CPPS诊断标准的200名患者,随机分为对照组和实验组.对照组采用常规治疗方法,实验组采用在常规治疗的基础上辅以瑜伽锻炼,每周5次,每次40 min左右,以患者不感疲...     

针刺治疗慢性前列腺炎/慢性盆底疼痛综合征临床观察

目的 观察针刺治疗慢性前列腺炎/慢性盆底疼痛综合征的近期疗效及远期疗效。方法 选取117例慢性前列腺炎/慢性盆底疼痛综合征患者,将其随机分为治疗组（60例）和对照组（57例）。治疗组选取肾俞、中髎、会阳、三阴交针刺,而对照组选取肾俞、中髎、会阳、三阴交旁非经非穴点微针刺。每周治疗3次,治疗8周。采用美国国立卫生研究院慢性前列腺炎症状指数（National Institutes of Health-Chronic Prostatitis Symptom Index,NIH-CPSI）和挤压前列腺分泌物（expressed prostatic secretion,EPS）积分评价临床疗效。结果 治疗组临床疗效明显优于对照组（P<0.05）。治疗后,两组NIH-CPSI和EPS积分均较治疗前明显降低（P<0.05）,治疗组EPS积分降低程度明显大于对照组（P<0.05）。治疗后12周随访时,治疗组NIH-CPSI较治疗后无明显变化（P>0.05）,而明显低于对照组（P<0.05）。结论 针刺肾俞、中髎、会阳、三阴交治疗慢性盆底疼痛综合征的近期疗效和远期疗效良好。     

Management of chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）： an evidence-based approach

Objective：To evaluate the efficacy and safety of the treatment of chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）. Methods- The randomized controlled trials （RCTs） about the treatment for CP/CPPS all over the world were searched. MEDLINE （January 1966 to June 2007）, EMBASE （January 1988 to June 2007）, and 4 Chinese databases were electronically searched. The studies included in the refer- ences of eligible studies were additionally searched. Two reviewers independently screened the studies for eli- gibility, evaluated the quality and extracted the data from the eligible studies, with confirmation by cross- checking. Divergences of opinion were settled by discussion or consulted by the experts. Meta-analysis was performed by using RevMan 4.2 software. Results： Twelve original studies involving 1 003 participants met inclusion criteria. Compared with placebo, alpha-blockers could improve the symptoms of CP/CPPS obvious- ly with WMD of NIH-CPSI, total score and pain score were -4.10 （95%CI： -6. 92 to -1.28） and -1.68 （95 %CI： -2.54 to -0. 82）. Antibiotics could not improve the symptoms obviously with WMD of NIH-CP- SI; total score and pain score were -2.71 （95%CI： -4. 78 to -0. 64） and -0.86 （95%CI： -2.07 to 0.36）. Flavoxate could not improve the NIH-CPSI total score obviously, but could relieve the pain, with WMD of NIH-CPSI total score and pain score being -2.96 （95%CI： -5.17 to -0. 74） and --2.31 （95%CI.. -4.05 to 0.03）. Prostat could improve the NIH-CPSI total score obviously, but could not relieve the pain, with WMD of NIH-CPSI total score and pain score being --7. 60 （95%CI.. -9. 97 to -5.23） and -2. 02 （95%CI： -4.07 to 0. 04）. Conclusion： Drug intervention could improve total symptoms of CP/CPPS in some degree, but no universally effective treatment is available that can prove significant lasting benefit for all the symptoms of CP/CPPS. Future RCT must use an appropriate sample size and optimal duration and fol- low-up of participants. It is important to improve the quality of internal original studies.     

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.

     

穿刺治疗慢性盆腔疼痛综合征的研究

目的 探讨穿刺治疗慢性盆腔疼痛综合征的临床疗效.方法 临床上对42例慢性盆腔疼痛综合征患者的前列腺液,常规进行细菌培养,以排除其它类型的前列腺炎.根据经验选择一种敏感抗生素,加上地塞米松和利多卡因的混合液行经会阴前列腺注射,隔7天注射一次,4次为一疗程.治疗后1月评价其治疗效果并追踪观察6月.结果 42例慢性盆腔疼痛综合征的患者中,治愈22例(52.38%),有效16例(38.10%),无效4例(9.52%),总有效率达90.48%.其中31例获6月追踪观察,无1例复发.结论 经会阴穿刺注射药物治疗慢性盆腔疼痛综合征是一种有效的、治愈率较高的治疗方法.     

慢性盆腔疼痛综合征对精液质量的影响

目的探讨慢性盆腔疼痛综合症对精液质量的影响。方法分析25例慢性盆腔疼痛综合症患者及25例年龄匹配的正常男性的精液常规及分析资料,将这些资料进行对比,观察他们之间的区别。同时,分析慢性盆腔疼痛综合症患者精液参数与症状持续时间的关系。结果慢性盆腔疼痛综合症组和正常对照组之间在射精量、精子活力及果糖浓度之间差别显著;其他参数差别不显著。慢性盆腔疼痛综合症组有2例无精子,对照组没有发现无精子患者。前列腺痛持续时间与精液参数无关。结论慢性盆腔疼痛综合症患者精子活力及果糖浓度较对照组显著下降,此结论支持慢性盆腔综合症是器质性病变,而不是心理性病因所致。