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。     

Classification and diagnosis of prostatitis: a gold standard?

The National Institutes of Health Classification System for prostatitis has now been accepted by the North American and International urology community. This categorization system consists of category I (acute bacterial prostatitis), category II (chronic bacterial prostatitis), category III (chronic prostatitis/chronic pelvic pain syndrome - CP/CPPS) and category IV asymptomatic inflammatory prostatitis. The evaluation of a patient with category I and category II bacterial prostatitis consists of history and physical examination and urine culture for lower urinary tract localization cultures, respectively. The clinical tests for the evaluation of CP/CPPS can be classified as mandatory, recommended and optional. Mandatory evaluations include history and physical examination, urinalysis and urine culture. Recommended evaluations include lower urinary tract localization tests, symptom index, flow rate, residual urine determination and urine cytology. Optional evaluations include semen analysis and culture, urethral swab, urodynamics, cystoscopy, imaging, and prostate specific antigen determination. The physician must individualize a rational diagnostic strategy for each patient. There is no 'gold standard' for the diagnosis and evaluation of patients presenting with prostatitis.     

Morphological reseach on expression of inflammatory mediators in murine models of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) induced by T2 antigen

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common clinical syndrome with unknown aetiology. In this study, we used the T2 peptide in C57BL/6 (B6) mice and Sprague Dawley (SD) rats model during different stages. We sought to understand the role of CD4⁺ T cells and macrophages in CP/CPPS. A total of 16 B6 mice and 18 SD rats were divided into five groups: B6‐naïve (n = 6), B6 model (n = 10), SD‐naïve (n = 6), SD‐45‐day model (n = 6) and SD‐56‐day model (n = 6). The B6 model group was subcutaneously injected with 0.2 ml of (225μg/ml) T2 peptide on 0 and 14th day and was finally sacrificed on 28th day. The SD‐45‐ and SD‐56‐day model groups were subcutaneously injected with 1ml of (50 μg/ml) T2 peptide on 0 and 14th day and were finally sacrificed on 45th and 56th day respectively. An equivalent volume of normal saline (NS) solution was injected to the naïve groups and analysed the pain and voiding behaviour. We have calculated the prostate index, H&E staining and immunofluorescence of CD4⁺ T cells and macrophages (CD68) in each group. T2 peptide immunization in B6 mice and SD rats caused severe prostatitis and cell infiltration, mainly composed of CD4⁺ T cells and macrophages. The SD‐56‐day model group showed more severe inflammatory cells infiltration than SD‐45‐day model group. Moreover, inflammatory cells infiltration and red secretions in B6 model were less than SD model. Expression of CD4⁺ T cells and macrophages was also consistent with H&E results. These results indicated that different stages of CP/CPPS, inflammatory response, and the inflammation of the rat were stronger than the mouse. Our study suggests that CD4⁺ T cells and macrophages are key factors in the development of CP/CPPS.     

Morphological sperm alternations in different types of prostatitis

The possible negative effect of the chronic pelvic pain syndrome (CPPS) on semen parameters and especially sperm morphology is still a controversial matter. The aim of this study was therefore to investigate if different types of prostatitis can have a negative effect on sperm morphology and to compare our results with that of a literature survey. Semen analyses were performed on 34 males with confirmed CPPS (NIH III A), 18 males with CPPS (NIH III B) and 17 males as controls. When sperm morphology was evaluated according to WHO criteria, no differences were found between the mean percentages of morphologically normal spermatozoa for the three groups. An extended sperm morphology evaluation according to strict criteria showed that the NIH III A group had a tendency for a lower percentage of morphologically normal spermatozoa (5.3 +/- 3.1%) and acrosome index (8.7 +/- 4.8%) compared with the control group with values of 7.3 +/- 5.6% and 12.7 +/- 7.3%, respectively. There was a statistically significant higher (P = 0.0186) mean percentage (17.5 +/- 15.7%) of elongated spermatozoa in the NIH III A group compared with the control group (7.2 +/- 9.5%) while the NIH III B group had values between those of the control and NIH III A group. Our results indicate that CPPS NIH III A can have a significant negative effect on sperm morphology parameters, as evaluated by strict criteria, and to a lesser extent in cases of CPPS NIH III B compared with a control group.     

曾庆琪教授辨证治疗慢性盆腔疼痛综合征

对慢性盆腔疼痛综合征的论治,曾庆琪教授从"气,血,寒,热,湿(痰),虚,风"7个方面入手,辨证分型,简化理论研究,注重临床实践,以提高临床诊治水平为主要目的,将多年临床经验加以凝炼,总结出一套行之有效的处方用药经验模式(临床思维方法),以肝为落脚点,疏肝通络散结方一以贯之,并以公式化的形式罗列,方便学用对临床处理此病大有裨益。     

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     

前列安通片治疗慢性盆腔疼痛综合征临床研究

目的:探讨前列安通片治疗慢性盆腔疼痛综合征的疗效。方法:试验采用随机、双盲、安慰剂对照的临床研究方法。选取CPPS患者200例,随机分为治疗组(前列安通片组)和对照组。治疗4周后进行NIH-CPSI评分和前列腺液白细胞计数。结果:前列安通片组治愈率20.2%,显效率33.3%,有效率31.3%,总有效率84.8%;安慰剂组治愈率0%,显效率5.1%,有效率21.4%,总有效率26.5%。两组间有极显著性差异(P<0.01)。结论:采用前列安通片治疗慢性盆腔疼痛综合征疗效可靠,且在改善患者疼痛症状方面疗效独特。     

Medical and surgical management of chronic pelvic pain

Chronic pelvic pain (CPP) affects over 1 million women in the UK, with subsequent impact on ability to work and the economy. It is often debilitating and can be difficult to treat. Gynaecologists have traditionally focussed on the organ-specific approach to the diagnosis of pain. Endometriosis is common as is chronic pelvic inflammatory disease and adenomyosis. Some causes are non-gynaecological such as irritable bowel syndrome and interstitial cystitis. However, as many as 55% of women presenting with CPP will have no obvious underlying pathology following completion of all investigations.This review focuses on the appropriate investigations, diagnosis and management of women with identified pathological causes of pelvic pain. It also considers the holistic approach to the management of the woman with chronic pelvic pain syndrome. Careful prescribing, assessment, interaction and support from a multidisciplinary team are required.     

Autoimmune T cell responses to seminal plasma in chronic pelvic pain syndrome (CPPS)

The aetiology of chronic prostatitis is not understood. The aim of this study is to investigate an autoimmune hypothesis by looking for T cell proliferation in response to proteins of the seminal plasma. We studied peripheral blood mononuclear cell proliferation from 20 patients with chronic prostatitis and 20 aged-matched controls in response to serial dilutions of seminal plasma (SP) from themselves (autologous SP) and from a healthy individual without the disease (allo-SP). We found that the patients have a statistically greater lymphocyte proliferation to autologous SP at the 1/50 dilution on day 6 compared to controls (P = 0 x 01). They also have a greater proliferation to allo-SP on both day 5 (P = 0 x 001) and day 6 (P = 0 x 01) at the same dilution. Using a stimulation index (SI) of 9 to either autologous SP or allo-SP on day 6 at the 1/50 dilution as a definition of a proliferative response to SP, then 13/20 patients as compared to 3/20 controls showed a proliferative response to SP (P = 0 x 003, Fishers exact test). These data support an autoimmune hypothesis for chronic prostatitis.     

What interpersonal problems are related to different therapeutic techniques early in treatment?

The current study seeks to explore the relationship between patient‐reported interpersonal problems and therapist interventions in early psychodynamic psychotherapy for 71 outpatients. Pretreatment ratings on the Inventory of Interpersonal Problems Circumplex Scales (IIP‐C) total and subscale scores were examined in relation to early treatment process. Independent clinicians reliably rated therapist use of psychodynamic–interpersonal (PI) and cognitive–behavioural (CB) interventions using the Comparative Psychotherapy Process Scale (CPPS) over two early treatment sessions (third and ninth). Intraclass correlation (ICC) values were in the excellent range for CPPS‐PI and CPPS‐CB scale scores (CPPS‐PI = 0.86; CPPS‐CB = 0.78). A significant positive correlation was found between interpersonal problems and global PI therapist technique. A significant positive correlation was also found between interpersonal problems and specific PI interventions, most significantly experience and expression of feelings in session. In specific interpersonal problem subscales, most significant was that Cold/Distant and Socially Inhibited octants positively related to global PI and to specific PI techniques, including exploration of uncomfortable feelings. Multiple regression analyses revealed most significantly that CPPS Intervention 7 (discussion of patient‐therapist relationship; positive) and CPPS Intervention 11 (therapist explanation of rationale behind treatment; negative) explained 15.6% of variance in interpersonal problem score. These findings demonstrate that the use of psychodynamic techniques tend to occur alongside patient‐reported interpersonal problems early in psychotherapy treatment. Clinical implications are discussed for this area of research, and future directions are explored.