前列腺液白细胞计数在慢性前列腺炎诊断中的意义

目的　探讨慢性前列腺炎患者前列腺液白细胞计数在诊断中的意义。　方法　门诊慢性前列腺炎患者 75例 ,测定前列腺按摩液 pH(EPS pH)并送常规检查 ,膀胱充盈后经腹行前列腺B超检查。　结果　EPS pH 6 .4～ 7.7,平均 6 .9± 0 .4;EPS白细胞数量 (EPS WBC) 3～ 38个 /HP ,平均(18.2± 8.8)个 /HP。前列腺B超阳性率 6 0 % (4 5 / 75 )。EPS pH值和B超诊断慢性前列腺炎的阳性率与前列腺EPS WBC呈正相关 (P <0 .0 1) ,与患者年龄、病程无相关性 (P >0 .0 5 )。分组比较显示EPD pH随EPS WBC增多而增高 (P <0 .0 1) ,并逐渐接近或稍超过血浆pH。随EPS WBC增多 ,B超诊断慢性前列腺炎的阳性率先增加 ,后维持不变。EPS WBC与患者年龄、病程无相关性 (P >0 .0 5 )。　结论　慢性前列腺炎患者EPS WBC计数与前列腺超声异常和EPS pH升高呈正相关 ,对慢性前列腺炎的诊断和治疗有指导意义     

经直肠B超在慢性前列腺炎诊断中的价值

用经直肠B超对73例前列腺进行了探测,其中43例为慢性前列腺炎患者,30例为正常人.检查发现慢性前列腺炎组前列腺声像图具有一定的特征,其中36例(84%)内部回声不均,周边区有低回声晕,5例(12%)发现有结节样强回声团,6例(14%)前列腺部尿道呈串珠样改变,3例发现有前列腺囊肿.在测得前列腺各径中,前列腺炎组的长径、横径明显大于正常组,差异显著(P<0.01),前后径无显著性差异(P>0.05).我们认为经直肠B超对前列腺内部结构显示清晰,对了解前列腺炎的发展程度和发现并发疾病、指导治疗有着重要的意义.     

经直肠超声引导下前列腺穿刺活检540例临床分析

目的评价经直肠超声引导下前列腺穿刺活检诊断前列腺癌（PCa）的临床应用价值,提高PCa的诊治水平。方法回顾性分析血PSA升高和（或）直肠指检前列腺结节及超声检查有异常的540例患者经直肠超声引导下前列腺穿刺活检的临床资料和声像图表现。其中直肠指诊异常者248例;超声显示有异常回声结节者178例,145例为低回声,占81.4％,42例在声像图上未发现异常;380例PSA〉10μg／L。结果540例活检中PCa220例,阳性率为40．7％,前列腺肉瘤4例,前列腺增生症269例,前列腺增生症并上皮内瘤（PIN）35例,前列腺炎9例,前列腺结核2例,非典型增生1例。结论经直肠超声引导下前列腺穿刺活检是诊断PCa的一种安全有效的检查方法。     

排尿后即刻前列腺按压液检查在慢性前列腺炎诊治中的应用

目的:探讨排尿后即刻前列腺按压液(EPS)检查在慢性前列腺炎诊治中的应用价值。方法:2013年1月~2015年3月,共接诊慢性前列腺炎患者56例,连续进行排尿后即刻EPS常规检查和细菌、支原体培养、衣原体DNA检测100次。年龄22~65岁,平均35.8岁,病史1~36个月,平均3个月。诊断方法:检查前停用抗生素3天以上。禁止性生活1天以上。充盈的膀胱于检查前排空后,立即进行前列腺按摩,取得前列腺液。第1滴送做常规检查,然后用无菌棉签于尿道内沾得前列腺液,密封后立即送做细菌培养、支原体培养和衣原体DNA检测。结果:细菌培养阳性39例,解尿支原体培养阳性3例,衣原体DNA阳性1例。常规检查发现滴虫1例,结核菌1例。将其归结为感染性前列腺炎,共44例(其中1例为细菌和支原体混合感染)。无感染性前列腺炎12例。前者EPS常规检查中WBC10个/HP 21例,WBC10个/HP 23例,后者WBC10个/HP 6例,WBC10个/HP 6例。感染性前列腺炎口服敏感抗生素治疗后复查1次病原体转阴的37例,临床症状均明显减轻或基本消失。2次转阴的2例,3次转阴的1例。无EPS复查4例。40例病原体转阴的患者,44次EPS常规检查WBC10个/HP 22次,WBC10个/HP 22次。结论:排尿后即刻EPS检查在慢性前列腺炎的诊断、治疗和随访中,有着非常重要的临床意义。EPS常规检查中WBC的数量不能反映前列腺是否存在感染。     

骶管注射联合抗感染药治疗慢性前列腺炎

<正> 2001年7月～2002年10月我们应用骶管注射联合抗感染药治疗92例慢性前列腺炎患者,取得较好疗效,现报告如下。 1 资料与方法 1.1 一般资料:随机选择门诊慢性前列腺炎患者92例,年龄17～65岁,平均29.5岁,病程3个月～1年8个月,平均7个月。诊断标准:症状主要表现为不同程度的耻骨上、会阴部、腰骶部及腹股沟区隐痛,阴囊、睾丸坠胀,尿频、尿急,尿痛,尿道不适等;按美国慢性前列腺炎症状调查评分表(SFQ),初步评价患者的症状积分;直肠指检前列腺有触痛;尿常规检查WBC<10/HP;前列腺液检查(EPS)WBC>10/HP;采用Meares     

前列腺异常声像特征及位置对经直肠超声穿刺活检诊断前列腺癌的影响

目的 探讨经直肠超声检查中异常声像特征及位置对经直肠超声(TRUS)穿刺活检诊断前列腺癌的影响.方法 前列腺特异性抗原(PSA)4~20 ng/ml、发现异常声像和/或合并直肠指检异常的可疑前列腺癌患者410 例,根据声像特征分为低回声、等回声、高回声组,所有患者均行8+X 针的穿刺方法,详细记录患者临床资料及病理结果,比较两组的穿刺结果.结果 总的前列腺癌检出率为27.07%,低回声组前列腺癌穿刺阳性率(34.27%)明显高于等回声(22.77%)和高回声(13.33%)组(P<0.05),Gleason 评分在低、等回声组前列腺癌中无明显统计学差异(P>0.05).左右侧外周带单独存在低回声病例前列腺癌穿刺阳性率无明显统计差异(P>0.05),双侧外周低回声病例前列腺癌穿刺阳性率(46.97%)明显高于左侧(27.27%)与右侧(28.85%)外周带存在低回声病例(P<0.05).结论 PSA4~20 ng/ml,TRUS 存在低回声声像前列腺穿刺率阳性率明显高于TRUS 中等回声、高回声病例病例,双侧外周带存在低回声病例前列腺穿刺阳性率明显高于单侧外周带存在低回声病例.     

慢性前列腺炎患者前列腺液IL-1β和TNF-α的检测及意义

目的 :了解IL 1β和TNF α在慢性前列腺炎患者前列腺按摩液 (EPS)中的变化及临床意义。 　方法 :应用ELISA法对 34例慢性前列腺炎 [EPS中白细胞 (WBC)计数≥ 10 /HP为A组 16例 ,WBC <10 /HP为B组 18例 ]、10例无症状性前列腺炎、12例良性前列腺增生 (BPH)及 8例健康对照EPS中的IL 1β和TNF α进行检测。 　结果 :IL 1β和TNF α在EPS中WBC≥ 10 /HP的慢性前列腺炎和无症状性前列腺炎两组检测值明显高于WBC <10 /HP的慢性前列腺炎、BPH和健康对照 3组 (P <0 .0 5 ,P <0 .0 2 )。IL 1β与TNF α有显著的数列等级相关性 (P <0 .0 0 3) ,而WBC计数和IL 1β、TNF α之间的数列等级相关性无显著性意义。 　结论 :IL 1β与TNF α在伴有WBC计数增高的慢性前列腺炎患者EPS中明显增高 ,IL 1β与TNF α对传统以WBC计数为慢性前列腺炎进行分类的方法可以提供一个更准确的新分类方法。     

前列安栓治疗慢性前列腺炎78例疗效观察

1 临床资料 2001-10/2001-12我院对78例慢性前列腺炎病人用前列安栓(珠海丽珠制药集团)经直肠用药治疗,年龄18～50岁。按美国NIH标准:CP症状评分>4分,前列腺液(EPS)中WBC 1～满视野/HP。除外合并其它疾病,如膀胱炎、腹泻、精索静脉曲张等。停用一切针对慢性前列腺     

中年男性急性前列腺炎:一项前瞻性研究

作者通过经直肠超声 (TRUS)检查、实验室检查等确定中年男性急性前列腺炎患者的疗效 ,确定复查前列腺特异抗原 (PSA)的最佳时机 ,检查由急性前列腺炎所导致的回声区和血管改变。选取 2 8例中年男性急性前列腺炎患者 ,分别于第 3,6 ,12个月随访时应用TRUS彩色多普勒成像法检查前列腺脓肿 ,并与实验室检查、临床诊断等比较。结果检测到 2例前列腺脓肿 ;第 3个月随访时 19例 (6 8% )患者已无感染 ,11例(39% )患者炎症的血清PSA水平升高 ;同时确诊 3例前列腺癌。 6 8%的患者前列腺内彩色血流信号丰富 ,同时 4 6 %的患者出现低回声区。结论…     

良性前列腺增生合并慢性前列腺炎的临床分析

目的:对良性前列腺增生(BPH)合并慢性前列腺炎的发病情况进行分析和探讨。方法:对213例已确诊为BPH患者进行前列腺按摩液(EPS)常规检查及EPS细菌培养,支原体、衣原体检测和血清PSA检测。对合并慢性前列腺炎的患者,进行抗炎治疗前后的BPH症状评分(IPSS)比较。结果:213例BPH患者中,合并慢性前列腺炎69例(32.4%),EPS细菌培养阳性27例(12.7%),EPS支原体、衣原体检测,15例阳性(7.0%)。合并慢性前列腺炎的患者中有7例PSA异常(>4μg/L)。69例合并慢性前列腺炎的患者经抗炎治疗后,IPSS由治疗前(12.2±2.6)分,降为治疗后(10.5±2.3)分,差异有显著性(P<0.01)。结论:BPH患者进行EPS检查,以明确是否合并有慢性前列腺炎,对临床上明确诊断、选择治疗药物或手术方式,提高疗效及减少并发症都有着重要意义。     

Value of semen culture in the diagnosis of chronic bacterial prostatitis: a simplified method

OBJECTIVE: To investigate the role of semen cultures versus segmented urine cultures for the diagnosis of bacterial chronic prostatitis. MATERIAL AND METHODS: We retrospectively examined 895 patients (age range 17-67 years) who met the consensus criteria for clinical chronic prostatitis/chronic pelvic pain syndrome, 50.1% of whom had dysuria and/or perineal discomfort, 37.4% infertility of unknown etiology and 12.5% erectile dysfunction. Segmented urine cultures, including expressed prostatic secretions (EPSs) and semen culture, were performed in all patients. RESULTS: Of the 895 patients, 182 had significant positive cultures for Gram-negative microorganisms (Escherichia coli was the commonest specimen isolated: 70.4% of cases) and 283 had significant positive cultures for Gram-positive microorganisms. We compared the culture yield in EPS and/or the urine voided after prostatic massage (VB3) sample (four-glass method) with that of the semen sample. In the Gram-negative group, 32 patients were diagnosed by means of semen culture (negative EPS and/or VB3 sample) and in only five cases was a positive diagnosis made despite a negative semen culture (positive EPS and/or VB3 sample). In the remaining subjects, diagnosis was performed with the aid of both EPS/VB3 sample and semen (both of which were positive). In the Gram-positive group, there was significant growth of such microorganisms in semen in every case considered positive, but in only 46 cases was diagnosis achieved via EPS and/or VB3 sample. A diagnosis of chronic prostatitis by Gram-positive microorganisms in these patients was only considered when the same microorganism was retrieved in repeated cultures without previous treatment. Only three cases met such criteria (all of whom had negative EPSs). To evaluate the diagnostic efficiency of the semen and EPS samples, we analyzed their sensitivity and specificity, obtaining higher sensitivity in semen than EPS samples for significant Gram-negative cultures: 97% vs 82.4%. In significant Gram-positive cultures, the sensitivity of semen samples was 100%, compared to only 16.1% for EPS. CONCLUSIONS: A semen sample has higher sensitivity than an EPS for the diagnosis of bacterial chronic prostatitis. In our clinical work-up, first-void urine and a semen culture are considered the only tests necessary to diagnose chronic prostatitis.     

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.     

巨噬细胞炎性蛋白-1α在前列腺按摩液中的表达及意义

目的:检测前列腺按摩液(EPS)中巨噬细胞炎性蛋白-1α(MIP-1α)的mRNA和蛋白表达水平,探讨其在慢性前列腺炎分型中的意义。方法:50例临床诊断的慢性前列腺炎患者,其中慢性细菌性前列腺炎(CBP)16例,慢性非细菌性前列腺炎/慢性骨盆疼痛综合征(CPPS)23例,分为ⅢA型11例,ⅢB型12例。无症状性炎症性前列腺炎Ⅳ型11例。收集EPS。同时选取15例健康自愿者做正常对照。RT-PCR法扩增MIP-1αmRNA,统计分析各组mRNA表达差异。ELISA法检测MIP-1α的蛋白表达水平,统计分析各组EPS的MIP-1α浓度差异。结果:RT-PCR半定量分析显示,MIP-1αmRNA在CPPSⅢA组和CPPSⅢB组的表达显著高于其他各组(P<0.05)。ELISA分析显示,MIP-1α蛋白浓度在CPPSⅢA组[(1 174.3±89.2)pg/ml]和CPPSⅢB组[(842.3±76.2)pg/ml]也显著高于正常组[(198.0±37.8)pg/ml]、CBP组[(347.0±61.6)pg/ml]及Ⅳ型组[(292.0±56.4)pg/ml](P<0.05)。结论:从mRNA和蛋白水平检测EPS中MIP-1α可能有助于慢性前列腺炎的分型诊断。     

慢性前列腺炎对血清PSA水平的影响

目的 :研究慢性前列腺炎 (chronicprostatitis ,CP)中前列腺特异性抗原 (PSA)水平。　方法 :选择诊断为ⅢA型前列腺炎患者 4 5例 ,30例健康男性为正常对照 ,分别检测血清PSA水平 ,并进行分析。　结果 :在 4 5例ⅢA型前列腺炎患者中 ,血清PSA水平为 2 .4 1± 0 .6 4 μg/L ,而正常对照组为0 .93± 0 .5 2 μg/L ,2组PSA水平差异具有显著性(P <0 .0 5 )。其中 ,ⅢA型前列腺炎患者中血清PSA超过 4 .0 μg/L的共有 6例 (1 3.3%) ,而正常对照组中仅有 1例(3.3%)。ⅢA型前列腺炎患者中 ,随着前列腺按摩液内白细胞数增加 ,PSA水平有一定程度的增高 ,但没有显著性差异。　结论 :ⅢA型前列腺炎可以使血清PSA水平有一定程度的增高 ,在诊断过程中应予以考虑。     

慢性前列腺炎患者前列腺液16S rDNA检测的临床意义

目的:探讨慢性前列腺炎患者前列腺液16S rDNA检测的临床意义。方法:对116例慢性前列腺炎患者前列腺液采用PCR方法检测其16S rDNA,比较不同亚型前列腺炎的16S rDNA阳性率并分析其相关性。结果:29例Ⅱ型前列腺炎前列腺液16S rDNA PCR均阳性,阳性率100%;87例Ⅲ型前列腺炎前列腺液16S rDNA PCR阳性71例,阳性率82%,其中ⅢA型前列腺炎前列腺液PCR阳性率94%(45/48),ⅢB型前列腺炎前列腺液PCR阳性率67%(26/39)。结论:16S rDNA的检测可能成为慢性前列腺炎分型的一个指标。     

Clinical evaluation of IL-1beta and TNF-alpha in prostatic secretions for chronic prostatitis]

OBJECTIVE: To determine the clinical significance of interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha( TNF-alpha) in expressed prostatic secretions(EPS) for chronic prostatitis. METHODS: Prostatic secretions IL-1beta and TNF-alpha were evaluated for 34 patients with chronic prostatitis, 10 with asymptomatic inflammatory prostatitis, 12 with benign prostatic hyperplasia (BPH) and 8 health controls by enzyme-linked immunosorbent assay (ELISA). RESULTS: IL-1beta and TNF-alpha levels in EPS in the patients of chronic prostatitis with WBC > or = 10/HP and asymptomatic inflammatory prostatitis were obviously higher than those of chronic prostatitis with WBC < 10/HP, BPH and health controls, (P < 0.05 and P < 0.02). There was a correlation between IL-1beta and TNF-alpha (P < 0.003) but none between WBC and IL-1beta or TNF-alpha. CONCLUSION: Cytokines are frequently elevated in EPS in men of chronic prostatitis with high WBC and asymptomatic inflammatory prostatitis, which provides a novel means different from traditional methods based on WBC for the identification of men with chronic prostatitis.     

The value of endotoxin concentrations in expressed prostatic secretions for the diagnosis and classification of chronic prostatitis.

OBJECTIVE: To clarify the value of endotoxin concentrations in expressed prostatic secretions (EPS) in the diagnosis and classification of chronic prostatitis. PATIENTS, SUBJECTS AND METHODS: The study included 88 consecutive patients with chronic prostatitis and 15 controls with no urological disease. The diagnosis and classification were based on a history, symptoms, a digital rectal examination of the prostate, and a white blood cell count in the EPS. Endotoxin concentrations in the EPS or urine were measured using a colorimetric assay and standard microbiological methods used to identify bacterial growth. RESULTS: In men with chronic prostatitis caused by Gram-negative or combined Gram-negative and -positive bacteria, the endotoxin levels in urine collected immediately after prostatic massage were significantly greater (P < 0.01) than in a midstream urine sample, and the concentration in the EPS was significantly higher (P < 0.05) than that in the control group. The same was true of patients with chronic prostatitis and Gram-positive bacteria isolated from the EPS or urine after massage. In patients with chronic pelvic pain syndrome (grade IIIA) the endotoxin level in the urine after massage was also significantly higher (P < 0.05) than that of the midstream sample, but there was no significant difference between the concentration in these samples in patients with grade IIIB, and no significant difference between the endotoxin concentration of the EPS in patients with grade IIIB and that in controls. CONCLUSION: Endotoxin concentrations are increased in the EPS or urine (after prostatic massage) of men with bacterial chronic prostatitis or chronic pelvic pain syndrome grade IIIA. The current routine examinations (including bacterial culture and routine examination of EPS or urine) before diagnosis and classification of chronic prostatitis are insufficient to describe the cause and pathogenesis of this condition. The endotoxin concentration of the EPS or urine after massage may provide a supplementary tool to identify the cause of chronic prostatitis.     

龙金通淋胶囊治疗慢性前列腺炎/慢性骨盆疼痛综合征的初步研究

目的:探讨龙金通淋胶囊治疗慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS,III型前列腺炎)的疗效。方法:选择符合美国国立卫生研究院(NIH)诊断标准的III型前列腺炎患者136例,其中IIIA型84例,IIIB型52例。口服龙金通淋胶囊,3粒/次,3次/d,疗程3个月。以NIH-慢性前列腺炎症状指数(NIH-CPSI)和前列腺按摩液(EPS)白细胞计数为疗效指标,进行治疗前后疗效比较。结果:完成治疗的131例患者(IIIA型81例,IIIB型50例)中,NIH-CPSI总评分治疗前后分别为(24.8±5.6)分和(13.3±6.8)分(P<0.01),平均降低11.5分;症状评分治疗前后分别为(15.4±4.3)分和(8.7±3.9)分(P<0.01),平均降低6.7分;生活质量评分治疗前后分别为(9.4±3.7)分和(4.6±2.7)分(P<0.01),平均降低4.8分。IIIA型患者EPS中白细胞计数治疗前后分别为(21.7±14.5)个/HP和(8.8±12.6)个/HP。治愈者24例(18.3%),显效者41例(31.3%),有效者40例(30.5%),无效26例(19.8%)。总显效率49.6%,总有效率80.1%。未见肝肾功能异常及不良事件发生。结论:龙金通淋胶囊治疗慢性非细菌性前列腺炎安全、有效,无明显不良反应。