伐地那非降阶梯对慢性前列腺炎合并勃起功能障碍的疗效分析

目的 分析伐地那非降阶梯对慢性前列腺炎（CP）合并勃起功能障碍（ED）的疗效及安全性,探讨该方案的临床应用价值。方法 以该院2013 年1 月-2016 年1 月收治的240 例CP 合并ED 患者为研究对象。按照随机数字表法将其分为观察组和对照组,每组120 例,均在CP常规治疗的基础上加用伐地那非治疗,对照组治疗方案为伐地那非口服,10 mg/ 次,隔日1 次,持续3 个月;观察组治疗方案为伐地那非降阶梯口服,初始剂量20 mg,隔日1 次,持续1 个月,而后降至10 mg/ 次,隔日1 次,持续1 个月,最终阶段降至5 mg/ 次,隔日1 次,持续1 个月。记录两组患者治疗1~3 个月后国际勃起功能指数（IIEF）、日记插入成功率、完成性交成功率及国前列腺炎症状指数评分（NIH-CPSI）变化,并记录其副反应发生情况,比较2 种治疗方案的临床疗效、安全性。结果 两组患者治疗前IIEF-5 评分、NIH-CPSI 评分、日记插入成功率、完成性交成功率比较,均差异无统计学意义（P >0.05）,两组患者治疗后IIEF-5 评分、日记插入成功率、完成性交成功率均较治疗前升高,NIH-CPSI 评分均较治疗前降低,差异有统计学意义（P <0.05）,同时期组间IIEF-5 评分、NIH-CPSI 评分、日记插入成功率、完成性交成功率比较,均差异无统计学意义（P >0.05）。两组患者治疗 后SDS 评分、SAS 评分均较治疗前降低,观察组降低更为明显,差异有统计学意义（P <0.05）。两组患者治疗1 个月后副反应比较,差异无统计学意义（P >0.05）,观察组治疗2、3 个月后副反应发生率较治疗1 个月后降低,差异有统计学意义（P <0.05）。治疗1 ～ 3 个月后对照组副反应发生率无明显变化,差异无统计学意义（P >0.05）。观察组总有效率为90.83%,对照组总有效率为94.17%,两组患者临床总有效率比较,差异无统计学意义（P >0.05）。结论 伐地那非降阶梯治疗CP 合并ED 能够在保证临床疗效的前提下进一步降低治疗期间副反应,改善患者心理状态,较大剂量持续治疗方案具有更佳的安全性,值得推广。     

慢性前列腺炎合并勃起功能障碍心理治疗体会

目的 探讨慢性前列腺炎(CP)合并勃起功能障碍(ED)患者心理治疗效果.方法 采用NIH-CPSI和IIEF-5,对96例CP合并ED患者随机分为心理治疗组48例和对照组48例.对两组患者均采用有效、足量的药物治疗和物理治疗的同时,对心理治疗组患者增加心理治疗.结果 经过治疗,心理治疗组和对照组两组的NIH-CPSI结果无显著性差异(P＞0.05),而在IIEF-5方面,心理治疗组比对照组具有显著性差异(P＜0.01).结论 对CP合并ED患者,采取药物治疗和物理治疗的同时结合心理治疗,是能够更加有效地改善ED症状的治疗方法之一.     

慢性前列腺炎伴勃起功能障碍的治疗

目的探讨慢性前列腺炎伴勃起功能障碍患者的治疗。方法对38例慢性前列腺炎伴发勃起功能障碍患者的治疗资料进行整理分析。结果所有患者在接受药物及认知行为疗法相结合的治疗后,27例有不同程度的改善,8例疗效明显,3例无效。结论对于慢性前列腺炎伴发的勃起功能障碍综合使用药物及认知行为疗     

复方玄驹胶囊治疗Ⅲ型慢性前列腺炎合并勃起功能障碍的疗效观察

目的 观察复方玄驹胶囊治疗慢性非细菌性前列腺炎(CNP)并发勃起功能障碍(ED)的临床疗效与安全性.方法 符合试验入选标准的患者52例口服复方玄驹胶囊,每次3粒,每天3次,治疗4周,采用自身对照的方法,根据服药前后各项指标的变化情况评价疗效.结果 治疗前后各项指标比较,差异均有统计学意义(P<0.05),治疗4周后NIH-CPSI总评分较治疗前下降了9.12(42.44%)分,轻、中、重度勃起功能障碍国际勃起功能指数(IIEF-5)评分分别增加5.01(34.86%),5.86(59.31%),6.31(104.99%)分,与治疗前比较均差异有统计学意义(P<0.05).治疗4周后CNP的治愈率为15.4%(8/52),总有效率为86.5%(45/52);ED的治愈率为17.3%,总有效率为82.7%.全组患者在观察过程中有出现轻度头晕1例,恶心2例,大便干结2例,心慌2例,其他无不良反应.结论 复方玄驹胶囊是治疗慢性非细菌性前列腺炎并发勃起功能障碍的有效药物,安全性好.     

慢性前列腺炎与勃起功能障碍

慢性前列腺炎(CP)是男性青壮年常见病,大约 50％的男性在不同时期曾有过前列腺炎的症状。随着生活水平的提高,人们对性生活的要求也逐渐提高,因此勃起功能障碍(Erectile dysfunction,ED)也倍受重视,而CP与ED有着密切的关系。     

清热逐瘀汤治疗Ⅲ型前列腺炎伴勃起功能障碍

目的:探讨清热逐瘀汤治疗Ⅲ型前列腺炎伴勃起功能障碍的临床疗效。方法:选取Ⅲ型前列腺炎伴勃起功能障碍患者150例,按照随机抽样法分成两组,其中观察组80例,对照组70例。观察组口服中药清热逐瘀汤,每次200 mL,每天2次。对照组口服前列欣胶囊,每次6粒,每天3次,,疏肝益阳胶囊每次4粒,每天3次,治疗时间均为4周。比较治疗前后慢性前列腺炎症状指数(chronic prostatic inflammatory index,CP NIH-CPS)积分及国际勃起功能指数(international erectile function index,ED IIEF-5)评分,观察两组临床疗效。结果:观察组CP NIH-CPS评分较治疗前显著降低(P<0.05);治疗后ED IIEF-5评分较治疗前显著提高(P<0.05)。与对照组比较,观察组患者疼痛、排尿、生存质量、IIEF-5评分改善程度明显高于对照组,观察组治疗有效率明显高于对照组,差异均具有统计学意义(P<0.05)。结论:清热逐瘀汤治疗Ⅲ型前列腺炎伴勃起功能障碍有较好的临床效果,可有效改善患者疼痛或不适症状、排尿症状以及勃起功能。     

慢性前列腺炎与勃起功能障碍相关性研究进展

慢性前列腺炎(CP)是中青年男性泌尿生殖系统的常见病、多发病。有报道CP在25岁以上成年人中的患病率达到35%~40%,在城市医院男性泌尿外科门诊就诊人数约占就诊患者的25%[1];亦有学者认为约50%的男性一生中曾有过前列腺炎的症状[2]。CP患者常常被伴发的性功能障碍所困扰,勃起功能障碍(ED)是CP患者伴发的性功能障碍中最主要表现[3]。临床上有为数不少的患者以排尿不适、疼痛等CP的其他主要症状来就诊,发现有不同程度的ED;或以ED为主诉来求医,经检查存在有CP。1 CP患者的临床表现CP患者的临床表现多样化,主要表现在以下几方面:①排尿…     

伐地那非治疗男性勃起功能障碍的临床研究

目的：探讨伐地那非在ED患者诊治中的有效性和安全性。方法：对我院90例ED患者服用伐地那非1周,观察治疗后性功能指标变化、疗效及不良反应。结果：伐地那非治疗后性生活持续时间、性生活满意度和IIEF评分各项指标均显著高于治疗前（P〈0.01）,总有效率为94.44%,且无明显不良反应。结论：伐地那非治疗ED安全有效且耐受性良好,为ED的药物治疗提供了更多的选择。     

复方仙灵脾汤合用伐地那非治疗勃起功能障碍临床研究

目的 观察复方仙灵脾汤合用伐地那非治疗勃起功能障碍(ED)与单用伐地那非的疗效区别.方法 120例肾阳虚兼气滞血瘀勃起功能障碍患者随机平均分为试验组和对照组.试验组服用复方仙灵脾汤颗粒24g/次,2次/d,性生活前30min服用伐地那非10 mg,疗程6周.对照组性生活前30 min服用伐地那非10 mg,疗程6周.以国际勃起功能问卷表(IIEF-5)评分、性欲评分、性交满足感评分、中医证候评分为评价指标.结果 治疗6周后,2组的IIEF-5评分、性欲评分、性交满足感评分较治疗前有显著提高(P＜0.05),中医证候评分较治疗前有显著降低(P＜0.05).试验组性欲评分、性交满足感评分评分较对照组有显著提高(P＜0.05),中医证候评分较对照组有显著降低(P＜0.05).结论 复方仙灵脾汤合用伐地那非治疗勃起功能障碍在提高性欲、增加性交满足感、减轻全身症状方面优于单用伐地那非.PDE5-抑制剂联合中药治疗ED值得推广.     

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.

     

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。     

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.

     

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...     

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.     

前列腺炎综合症伴发的勃起功能障碍的治疗

目的 探讨慢性前列腺炎综合征（CPS）伴发的勃起功能障碍（ED）患者的处理。方法 对47例伴有CPS的继发性ED患者的治疗资料进行分析。结果 所有患者在接受药物与认知行为疗法相结合的治疗后，33例有不同程度的改善，其中10例疗效明显。使用海绵体注射血管活性药物的患者改善比例更高，达15／17。多因素分析显示，海绵体内注射及病程是影响疗效的重要因素。结论 对于CPS伴发的ED，综合使用药物及认知行为疗法，疗效比较满意。     

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。     

前列腺内注射结合前列腺按摩对慢性前列腺炎/慢性骨盆疼痛综合征的疗效观察

目的探讨前列腺内药物注射结合前列腺按摩治疗慢性前列腺炎/慢性骨盆疼痛综合征的疗效。方法选用多种相关药物经会阴部注入前列腺内结合前列腺按摩治疗,每周2次,连续治疗4次。结果131例中临床治愈28例,好转92例,无效11例,总有效率91.6%。结论前列腺内注射结合前列腺按摩对慢性前列腺炎/慢性骨盆疼痛综合征具有较显著的疗效。