应用中成药治疗慢性前列腺炎的体会

<正>慢性前列腺炎(chronic prostatitis,CP)是中青年男性的常见病、多发病,据报道,我国20~79岁的男性前列腺炎患病率为2.6%~8.7%。在其治疗效果上,无论是泌尿外科医生还是患者均不满意,成为临床上棘手的问题。     

综合疗法治疗慢性前列腺炎临床应用研究

慢性前列腺炎(CP)是泌尿外科在临床上的常见病、难治病,发病率不断增高,发病年龄有年轻化趋势(发病率为男性人群的33%;未婚男性青年的前列腺炎发病率已达5%)[1].CP迁延难愈,治疗效果不佳,任何单一疗法的疗效均不甚理想,因而有关CP的综合治疗显得尤为重要,也将成为治疗本病的关键所在.     

加强我国慢性前列腺炎的流行病学研究

慢性前列腺炎（CP）是泌尿外科最常见而又充满困惑的疾病之一，患病率高、治愈率低、复发率高，对患者的生活质量影响较大，在美国患病率仅次于良性前列腺增生（BPH）和前列腺癌。近年来，尽管临床医师及有关研究者特别是CP协作网络研究组织（CPCRN）进行了大量流行病学调查和临床研究，并制定了新的分类标准，仍不能就其发病原因、诊断标准和治疗方案给予明确答案，当前临床治疗效果令泌尿外科医生和患者均不满意，过度治疗现象十分严重。因此，应加强对CP的研究，特别是流行病学研究。     

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。     

一种前列腺液新染色方法及应用

慢性前列腺炎(chronic prostatitis,CP)是泌尿外科常见病.临床表现复杂多变,治疗效果不佳,复发率高,成为长期困扰患者和临床医生的难题.大量研究发现,准确识别前列腺液有形成分,对于诊治CP至关重要,为此我院采取碱性品蓝法试染前列腺有形成分,同时与龙胆紫、沙黄的Sternheimer-Malbin法(S-M法)进行了对比观察.     

慢性前列腺炎常见致病因素的回顾性分析(附4062例报道)

目的探讨慢性前列腺炎(CP)可能的常见致病因素。方法回顾性分析2005年7月至2012年7月间云南省第一人民医院(昆明理工大学附属医院)泌尿外科和中山大学附属第一医院泌尿外科门诊就诊的CP患者的临床资料。患者经结合临床表现、国际前列腺炎症状评分指数表(NIH-CPSI)、前列腺液常规、尿液常规、B超等检查诊断为CP。门诊问询并记录患者可能的CP致病因素。结果共4062例经诊断为Ⅱ、Ⅲ型CP的患者纳入研究,年龄17~64岁,平均(31.56±9.06)岁,而CP患者常见的致病因素中,饮酒及食用辛辣等刺激性食物者2889例(71.12%),无规律性生活者2170例(53.42%),长期久坐者2351例(57.87%),从事易发病职业者1557例(38.33%),有不洁性交、冶游史者163例(4.01%),还有81例(1.99%)患者主诉性交后症状明显加重。此外,同时具备至少2项上述因素者2664例(65.58%)。结论目前,饮酒及食用辛辣等刺激性食物、无规律性生活、长期久坐及从事易发病职业仍是国人患CP的常见致病因素。所以对具体患者须行个体化的方案治疗。     

难治性慢性前列腺炎(CP)/慢性盆腔疼痛综合症(CPSS)单一治疗策略失败分析

为了评估以循证医学为基础的单一治疗方法对诊断为慢性前列腺炎 /慢性盆腔疼痛综合征 ((CP/CPSS)患者的作用 ,本文由泌尿外科专家在皇家大学前列腺炎研究所选取建议治疗失败的CP/CPPS患者进行广泛的评估和积极治疗 ,并运用NIH -CPSI随访 1年。所有患者经过CP/CPPS的标准化诊疗方案 ,包括病史、体格检查、标准四杯试验 ,另加尿液拭子和精液的显微镜检查和培养、尿流率测定以及残余尿测定。在逐步解析的基础上采用循证医学的标准化单一治疗方法进行治疗。结果共有 10 0例CP/CPPS患者 (年龄 2 0～ 70岁 ,平均4 2 .2岁 ;症状持续时…     

氟西汀协同治疗伴情绪障碍的慢性前列腺炎

慢性前列腺炎(CP)是成年男性的常见疾病,也是泌尿外科门诊治疗的主要疾病之一.临床表现除躯体症状外,还有相当数量的患者伴明显的情绪障碍,主要为不同程度的焦虑、抑郁症.     

α肾上腺素受体阻滞剂治疗慢性前列腺炎的研究现状

慢性前列腺炎(chronic prostatitis,CP)是一种发病率较高的男性疾病,严重影响男性生活质量.由于其病因、病理、临床症状复杂多样,治疗效果不理想,一直是泌尿外科医生临床工作中的一个难题.治疗方法遍及抗生素、α肾上腺素受体阻滞剂、前列腺按摩、物理治疗、免疫抑制剂、氧自由基清除剂和微量元素、非甾体类抗炎药、肌肉松弛剂及中医治疗[1]等,其中α受体阻滞剂应用广泛.本文就α受体阻滞剂用于治疗CP的研究现状作一综述.     

前列腺增生症与慢性前列腺炎临床关系的研究

目的探讨慢性前列腺炎（CP）与症状性良性前列腺增生（BPH）的临床关系。方法对2005年10月。2007年10月,在我院泌尿外科门诊就诊的,既往已明确诊断为“良性前列腺增生”而常规使用非那雄胺与α-受体阻滞剂联合治疗半年以上,但国际前列腺症状评分（IPSS）及生活质量评分（QOL）仍为中-重度的123例患者,行前列腺液常规（EPS）涂片和细菌培养。参照慢性前列腺炎症状评分标准（NIH—CPSI）,作为慢性前列腺炎的诊断和分类标准。在原有治疗基础上,使用敏感抗生素治疗4周。结果123例患者中伴有CP者105例（85．4％）。其中Ⅰ度前列腺增生38例,合并CP30例（78．9％）;Ⅱ度52例,合并CP45例（86．5％）;Ⅲ度33例,合并CP30例（90．1％）。使用敏感抗生素治疗4周后,三组患者IPSS改善率分别为：30．0％,31．1％,13．3％。结论BPH患者多合并慢性前列腺炎,腺体增生体积与CP发生呈正相关,炎症与诱发膀胱出口梗阻有关联度。抗炎治疗对轻-中度BPH患者效果比对重度BPH患者好。     

Economic impact of chronic prostatitis

There are four types of prostatitis, including type I (acute bacterial prostatitis), type II (chronic bacterial prostatitis), type III (chronic prostatitis/chronic pelvic pain syndrome, or CP/CPPS), and type IV (asymptomatic inflammatory prostatitis). These prostatitis conditions account for approximately 2 million office visits each year to primary care physicians and urologists. The annual cost to treat prostatitis is approximately $84 million. Compared with control subjects, men with prostatitis incur significantly greater costs, predominantly due to increased outpatient visits and pharmacy expenses. CP/CPPS is the most common type of prostatitis. The condition is characterized by chronic, idiopathic pelviperineal pain. Due to the lack of effective treatments for CP/CPPS, the per-person costs associated with the condition are substantial and are similar to those reported for peripheral neuropathy, low back pain, fibromyalgia, and rheumatoid arthritis. Costs appear to be higher in men with more severe symptoms. Indirect costs (eg, work and productivity loss) are incurred by many patients with CP/CPPS. Identification of effective treatments for CP/CPPS would be expected to substantially reduce the costs associated with the condition.     

泌尿外科医师对慢性前列腺炎诊治行为的调查

目的 了解泌尿外科医师对慢性前列腺炎(CP)诊治现状。方法 对83名温州地区泌尿外科医师进行问卷调查。结果 在诊断CP时,不到半数的医师(39.8％)表示常规行细菌培养检查。假如行细菌培养,42.9％的三级医院医师和17.1％的二级医院医师用两杯法或四杯法(P<0.05)。在治疗CP时,50.0％的三级医院医师和73.2％的二级医院医师常规使用抗生素(P<0.05)。关于抗生素的选用,三级医院医师多使用喹诺酮类,而二级医院医师多使用大环内酯类。细菌培养与否并不影响医师使用抗生素(P>0.05),但常规行细菌培养的医师更常使用除抗生素外的药物(P<0.01)。结论 泌尿外科医师对CP的临床处理不一,因此,制定一个合理的CP处理指南是必要的。     

Use of Acupuncture as a Treatment Method for Chronic Prostatitis/Chronic Pelvic Pain Syndromes

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most common category of clinical prostatitis. The etiologic factors of CP/CPPS still remain unknown, and standard therapies often fail to achieve sustainable amelioration of symptoms; therefore, various treatment therapies have been approached. Recently, there is increasing evidence that acupuncture could be a safe and effective treatment in managing CP/CPPS. However, acupuncture therapy still is ranked as low-priority treatment, which results from the fact that the studies, mostly reported in nontraditional medical journals, had not employed standard definitions of the condition or validated-outcome parameters, and that the mechanism of acupuncture effects on CP/CPPS remains to be elucidated. In this article, we review the recent clinical research using acupuncture to reveal its clinical utility for CP/CPPS and the possible mechanisms of action. This article could encourage health care providers and urologists to apply acupuncture for managing pains of CP/CPPS with standard treatment.     

UPOINT:一种新的慢性前列腺炎/慢性盆腔疼痛综合征表型分类系统

慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)是一种严重困扰广大泌尿外科医师及患者的常见疾病。现已认识到CP/CPPS是一种异质性疾病,即它是一种具有不同病因、不同疾病进程且对治疗反应不一的临床综合征。基于对CP/CPPS病因的深入认识以及对CP/CPPS临床研究的重新评估,国外研究者目前制定了能够对CP/CPPS进行分类并指导临床个性化治疗的表型分类系统——UPOINT。UPOINT由6个独立的因子组成,分别为排尿症状(U)、社会心理的(P)、器官特异性的(O)、感染(I)、神经/系统性的(N)及盆底肌疼痛(T)。本文系统综述了UPOINT提出的理论基础、各因子的临床特征以及基于该系统的治疗策略。     

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.     

Failure of a monotherapy strategy for difficult chronic prostatitis/chronic pelvic pain syndrome

PURPOSE: We determined the effect of a best evidence based monotherapeutic strategy for patients diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) referred to a specialized prostatitis clinic. MATERIALS AND METHODS: Patients with CP/CPPS referred by urologists after failure of prescribed therapy for evaluation and treatment at Queen's University prostatitis research clinic were extensively evaluated, aggressively treated following a standardized treatment algorithm and followed for 1 year using a validated prostatitis specific symptom and quality of life instrument, the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). All patients underwent a standardized protocol for CP/CPPS including a history, physical examination, standard 4-glass test, plus urethral swab and semen for microscopy and culture, uroflowmetry and residual urine determination. Treatment followed a best evidence based strategy with a standardized monotherapy based algorithm. RESULTS: A total of 100 consecutive patients with CP/CPPS (average age 42.2 years, range 20 to 70 and average symptom duration 6.5 years, range 0.5 to 39) had 1-year followup after initial evaluation. Patients were prescribed treatment based on documentation of "failed," "successful" and "never tried" therapies based on a standardized treatment algorithm. Patients treated successfully were continued on the prescribed therapy, while therapy was discontinued and new therapy instituted (based on algorithm) in those in whom the initially prescribed therapy failed. At 1 year there was a statistically significant decrease in total NIH-CPSI (23.3 to 19.5, p = 0.0004), pain (11.0 to 9.4, p = 0.03) and quality of life (7.7 to 6.1, p <0.001), but not voiding (4.6 to 4.0, p = 0.12). A perceptible 25% decrease in total NIH-CPSI symptom score was noted in 37% and the greatest improvement was in the quality of life domain (43% of patients had greater than 25% improvement in quality of life). Of the patients 35% had a significant decrease of greater than 6 points in total NIH-CPSI. A clear, clinically significant improvement in total NIH-CPSI (greater than 50% decrease) was noted in 19%. CONCLUSIONS: Approximately a third of patients with treatment refractory CP/CPPS undergoing extensive evaluation and therapy based on a sequential monotherapy treatment strategy in a specialized prostatitis clinic had at least modest improvement in symptoms during 1 year. This study confirms that a treatment strategy based on the sequential application of monotherapies for patients with a long history of severe CP/CPPS remains relatively poor.     

Prostatitis and aspiration biopsy cytology of prostate

Aspiration biopsy of the prostate is contraindicated when active prostatitis is present. However, we have found prostatitis in 45.2 percent of 250 consecutive aspiration biopsy specimens, confirming that urologists have difficulty in distinguishing prostatitis from carcinoma on a clinical basis. The epithelial changes accompanying prostatitis also may be confused with carcinoma. We review the microscopic features which distinguish prostatitis from carcinoma. Because 14.1 percent of the patients with prostatitis in this study also had carcinoma, repeat follow-up biopsy is necessary if suspicion of carcinoma persists after adequate therapy for prostatitis.     

Recommendations for the evaluation of patients with prostatitis

Prostatitis is a prevalent, confusing and frustrating clinical presentation for urologists. Three recent international and North American consensus meetings have drafted suggestions for the evaluation of a man presenting with prostatitis. Published consensus statements from the 2000 Washington meeting of the International Prostatitis Collaborative Network, the 2002 Virginia meeting of the National Institutes of Health Chronic Prostatitis Collaborative Research Network and the 2002 Giessen meeting of the International Consensus Conference on Advances in the Diagnosis and Treatment of Prostatitis were examined to develop suggestions for evaluation of the prostatitis patient by urologists. Clinical, laboratory and imaging evaluations for the patient presenting with prostatitis and chronic prostatitis/chronic pelvic pain syndrome can be categorized as basic or mandatory evaluations (which would include a complete history, focused physical examination, and urinalysis/urine culture), further or recommended evaluations (those that are recommended but not mandatory) and optional evaluations in selected patients. As more evidence and data are accumulated and published, these recommendations may eventually evolve into practice guidelines for the evaluation of men presenting with prostatitis symptoms.     

Results of a questionnaire among Dutch urologists and general practitioners concerning diagnostics and treatment of patients with prostatitis syndromes.

By means of a questionnaire, all Dutch urologists (n = 250, 136 responded) and regional general practitioners (GPs; n = 400, 176 responded) were contacted concerning current diagnostics and treatment modalities applied in patients with prostatitis syndromes. The patients seen by urologists seem to be younger (30-40 years) and they mostly complain of pain in the perineum, penis or scrotum, while GPs see older patients (> 40 years) mainly presenting with micturition complaints. Urologists think nonbacterial causes (40%) most important, while GPs mention bacterial infections (63%) as the most important cause. The first choice of therapy is antibiotics, mostly co-trimoxazole Sulfatrim for 3 weeks, but patients seen by urologists are more resistant to this therapy. If not successful, urologists frequently prescribe a second course with antibiotics. However, many urologists think psychosomatic causes are an important factor in the etiology of prostatitis.