慢性前列腺炎诊断标准的再认识

慢性前列腺炎是泌尿外科最常见而又充满困惑的疾病之一,其患病率高、治愈率低、复发率高。慢性前列腺炎患者的生活质量较低。本文根据《前列腺炎诊断治疗指南》中对前列腺炎分类及诊断结合临床研究进行分析,发现目前对前列腺炎的分类、诊断中存在不足之处,并进行了多中心的研究,从而提出建立以症状为核心的诊断标准的建议,对于探索前列腺炎的诊断标准及疗效评价有重要意义。     

前列腺炎综合征

前列腺炎是泌尿外科的常见疾病。由于前列腺炎病程较长，治疗效果又不甚满意，因而对病人的生活质量产生严重影响。二十世纪，良性前列腺增生症和前列腺癌的诊断和治疗己取得明显进展，但对前列腺炎，特别是慢性前列腺炎的病因、发病机制、诊断、治疗仍相当困惑。     

慢性前列腺炎与前列腺液关系研究现状

慢性前列腺炎是泌尿外科常见病,目前临床尚无特异性诊断方法.除前列腺液常规检查外,研究慢性前列腺炎前列腺液细胞学、细胞因子、微生物学等改变有助于慢性前列腺炎诊断、治疗.     

前列腺炎的临床诊断程序

前列腺炎虽是目前临床上一种常见病、多发病，但除少数专科医师能按正规程序诊断外，其他医师多是问症定病，问病开药，或是他们自己也不清楚前列腺炎该怎么诊断。许多病人按“前列腺炎”治疗数月或者几年，但最基本的前列腺肛门指诊、前列腺液镜检都没作过。这里面既有医师嫌脏怕麻烦的因素，也存在病人和医师双方认识不足的问题。从流行病学的角度来看，对前列腺炎的一定规模的临床研究在我国还是近十几年的事，病因、病理有许多不清楚的地方，诊断治疗也不规范；但前列腺炎已经成为一种常见病，其发病率逐年增加，并将成为下个世纪的主要…     

中西医结合治疗慢性前列腺炎的思路

慢性前列腺炎是青壮年男性的常见病、多发病。目前慢性前列腺炎,特别是慢性盆腔疼痛综合征的病因与发病机制尚未完全明了,在治疗上有许多问题没有统一的认识。本文系统地探讨了中西医结合诊断和治疗慢性前列腺炎的思路。     

国家级继续医学教育项目:前列腺炎中西医结合诊疗高级研修班通知

<正>由江苏省中医院男科主办的全国继续教育培训项目:前列腺炎中西医结合诊疗高级研修班(项目编号:100203041)于2011年12月16~18日在江苏南京举办。届时将系统总结前列腺炎的诊断和中西医治疗方法,详细介绍前列腺炎的最新研究进展,普及和推广前列腺炎治疗的新理念、新技术、新方法,以提高男科临     

前列腺炎诊治中几个问题的探讨

目的提高前列腺炎的诊治水平。方法对近5年来临床工作中遇到的前列腺炎漏诊、误诊及认识有误的病例进行分析、探讨。结果有12例急性前列腺炎被误诊、漏诊，其中5例误诊为上呼吸道感染，7例诊断为尿路感染。15例前列腺增生（BPH）伴慢性前列腺炎者，漏诊了前列腺炎。17例慢性前列腺炎伴有其它泌尿生殖系疾病者，漏诊了其中之一。15例前列腺液常规中白细胞数与前列腺炎严重程度及治疗效果不一致。4例B超检查提示前列腺炎，患者无不适，按前列腺炎治疗后反而出现症状。结论前列腺炎诊治中尚存在一些问题。临床工作中需开阔思路，多做肛指检查。对症状、体征、前列腺液检查、B超检查结果等进行综合考虑，才能作出正确的诊断和治疗。     

桂林地区BPH并前列腺炎的发病及治疗情况调查

目的：调查前列腺增生（BPH）患者并发前列腺炎的发病及治疗情况。方法：对桂林地区2152例BPH患者询问病史,并作前列腺液常规、前列腺B超、血清前列腺特异抗原（PSA）及尿常规等检查。结果：2152例患者中只有385例患者存在前列腺炎,占17．9％,其中87例患者有较明显的前列腺炎症状,35例患者曾诊断为前列腺炎并进行过间断治疗。结论：目前对BPH患者并发前列腺炎的诊断及治疗均不理想,应引起临床医师的高度重视。     

前列腺液16s rDNA检测在慢性前列腺炎诊治中的临床意义

目的探讨前列腺液16s rDNA检测对慢性前列腺炎的临床诊断和治疗意义。方法选择符合美国国立卫生研究院（NIH）诊断标准的Ⅱ型前列腺炎和Ⅲ型前列腺炎患者67例。常规前列腺液镜检和细菌、支原体、衣原体检查，并对前列腺液中的16s rDNA进行PCR检测，治疗全部采用以抗生素为主的综合治疗。以慢性前列腺炎症状指数（NIH-CPSI）为疗效指标，治疗4周后进行疗效比较。结果Ⅱ、ⅢA和ⅢB型前列腺炎16s rDNA阳性率分别为100％（11／11）、62．5％（20／32）、66．7％（16／24）。Ⅱ型前列腺炎治疗显效率100％；在Ⅲ型前列腺炎中，ⅢA、ⅢB组无差异，而16s rDNA阳性组治疗总显效率（80．0％）明显高于16s rDNA阴性组（52．4％）（P〈0．05）。结论前列腺液16s rDNA表达与前列腺炎的疗效有良好的相关性，可作为Ⅲ型前列腺炎选用抗生素治疗的依据，并对前列腺炎分型有一定参考价值。     

慢性前列腺炎合并性功能障碍的研究进展

慢性前列腺炎患者性功能障碍的发生率较高,对患者的生活质量产生重要影响.本文就近年来对慢性前列腺炎患者性功能障碍的流行病学、两者之间的相关性、慢性前列腺炎导致性功能障碍的原因及治疗进展进行,为临床诊断治疗提供参考.     

中国慢性前列腺炎的流行病学特征

慢性前列腺炎(CP)一直都是困扰泌尿外科的常见疾病,对患者的身心健康造成严重影响。由于其病因尚不明确、临床症状复杂多样化、诊断方法存在争议、治疗时间长久等问题存在,临床治疗效果令泌尿外科医师和患者均不满意。本文针对CP的发病率、年龄分布、各种类型前列腺炎的发病情况、气候、职业、相关疾病、生活方式、教育水平等因素与其的关系做一全面的综述,总结目前中国CP流行病学特征。     

Transurethral microwave thermotherapy for the treatment of prostatitis

The lethal action of microwaves on various microorganisms is well established and has been exploited in various clinical settings. Transurethral microwave thermotherapy (TUMT) has become a recognized modality for the treatment of prostatic diseases. Recently, it has been applied for the treatment of patients with nonbacterial prostatitis unresponsive to traditional therapeutic schemes. We review the current literature and present our recent encouraging experience with the in vitro bactericidal effect of microwaves on bacteria considered possible etiologic agents of prostatitis. Thus, we may consider the application of TUMT in patients with chronic bacterial prostatitis.     

Eosinophilic prostatitis and prostatic specific antigen.

Eosinophilic prostatitis is a rare form of abacterial prostatitis with uncertain aetiology. Its clinical presentation, like other types of abacterial prostatitis, commonly mimics carcinoma of the prostate. Transrectal ultrasound may be helpful in the diagnosis of prostatitis but histological confirmation is necessary. Prostatic specific antigen has been widely used in the diagnosis and follow-up of patients with prostatic carcinoma. High levels of this antigen (greater than 30 micrograms/l) have been claimed to be highly specific for prostate cancer, although lesser elevations may also occur in patients with large benign prostate glands and in bacterial prostatitis. We report 3 patients with histologically proven eosinophilic prostatitis and high levels of prostatic specific antigen. This diagnosis may closely mimic carcinoma of the prostate and must be excluded by histological examination of biopsy material before treatment for presumed prostate carcinoma is initiated.     

Research trends of prostatitis over past 20 years: A bibliometric analysis

In the past two decades, thousands of documents in the field of prostatitis have been published. This bibliometric analysis aimed to assess the characteristics, hotspots and frontiers trend of global scientific output on prostatitis. With the trend of moderate growth, altogether 2,423 papers were reviewed. The leading role of the United States in global prostatitis research was obvious, while China had developed rapidly in recent years. Queen's University and JOURNAL OF UROLOGY were the most prolific affiliation and journal respectively. Nickel, J. C made the greatest contribution to the field of prostatitis. Five hotspots have been confirmed: (a) male infertility associated with prostatitis and the molecular mechanisms; (b) diagnosis and treatment of prostatitis; (c) inflammation, pain and bladder irritation symptoms; (d) relationship between chronic prostatitis/chronic pelvic pain syndrome, benign prostatic hyperplasia and prostate cancer; (e) epidemiology, complications of prostatitis and improvement of acupuncture. This bibliometric analysis reveals that the international cooperation was becoming more and more close. Hotspot analysis shows that the molecular mechanism of prostatitis will be a hotspot in the future, mainly focussing on inflammatory immunity and oxidative stress.     

Combined treatment of chronic prostatitis with sulfamethoxazole-trimethoprim and hachimi-ji-oh-gan

Treatment of chronic prostatitis is difficult and many antimicrobial drugs have been tried. Although these drugs showed good permeability into prostatic fluid in experimental studies, they have limited value in clinical use and development of more effective drugs has been anticipated. A study was performed on the effect of Hachimi-ji-ji-oh-gan, a traditional Chinese medicine, for the treatment of chronic prostatitis. Symptoms were improved in 53% of the patients treated with sulfamethoxazole-trimethoprim alone for two weeks and in 84% of those treated with Hachimi-ji-oh-gan in addition to sulfamethoxazole-trimethoprim for two weeks. Since Hachimi-ji-oh-gan has no antimicrobial effect, the drug may change the characteristics of the prostatic tissue or prostatic fluid providing a favorable condition for antimicrobial agents to penetrate into the prostatic fluid. Further examination is necessary to disclose the machanism of Hachimi-ji-oh-gan on the effect of prostatitis.     

Bacterial prostatitis

Objectives

The prostatitis syndrome is classified into bacterial prostatitis (acute and chronic), chronic pelvic pain syndrome and asymptomatic prostatitis. The aim of this report is to review current management standards for bacterial prostatitis.

Methods

A research was performed on literature dealing with acute and chronic bacterial prostatitis.

Results

There is a consensus on diagnostic management of bacterial prostatitis comprising microbiological sampling of midstream urine in acute bacterial prostatitis and performance of a bacterial localisation test in chronic bacterial prostatitis. Approximately 10 % of acute bacterial prostatitis cases eventually develop into chronic bacterial prostatitis and further 10 % into chronic pelvic pain syndrome. Bacterial isolates causing acute bacterial prostatitis are highly virulent strains comprising an array of different virulence factors. Presumably, the additional ability of isolates to form biofilms might be one factor amongst others to facilitate development of chronic bacterial prostatitis. Therapy for infectious prostatitis is standardised with antibiotics as the primary agents, empirically administered in acute prostatitis and after susceptibility testing in chronic bacterial prostatitis. Fluoroquinolones exhibit more favourable pharmacological properties; therefore, fluoroquinolones have been recommended as first-line agents in the treatment for chronic bacterial prostatitis. Antibiotic resistance to fluoroquinolones, however, is increasing and is posing significant clinical problems. Further studies on alternative antibiotics active within the prostate are therefore needed both for prophylaxis in transrectal prostate biopsy, for example, and for therapy of chronic bacterial prostatitis.

Conclusions

Bacterial prostatitis has developed into well-managed entities with increasing antimicrobial resistance being the most severe drawback of yielding therapeutic success.     

A protocol for evaluation of prostatitis

The traditional office diagnosis of prostatitis has been based on clinical history, rectal palpation of the gland, and a microscopic examination of the expressed prostatic fluid. In light of present day information this approach appears to be incomplete. We have examined 41 consecutive patients with complaints of prostatitis along with 17 controls. In each case expressed prostatic fluid was collected under sterile conditions. On each specimen, we performed a bacterial culture, microscopic examination for white blood cells, and assay for zinc. The intent of this protocol was to classify clearly those with bacterial prostatitis from those with nonbacterial prostatitis and prostatodynia. We believe this approach is simple to perform even in the setting of a busy office practice.     

Sexual dysfunction and prostatitis

Despite a large number of reports exploring the links between diseases of the prostate and effects on sexuality, the relationship between prostatitis and sexual dysfunction has not been as thoroughly investigated. A number of reports have focused on the adverse effects of prostatitis on quality of life, with resultant indirect effects on sexuality. More detailed studies are available on the links between ejaculation and the chronic prostatitis/chronic pelvic pain syndrome subgroup of prostatitis. Improvement of sexual dysfunction following treatment of prostatitis has been reported in a few studies, most notably in association with α-blocker therapy. This review addresses some of the more relevant reported links between prostatitis and sexual function.     

The role of nanobacteria in urologic disease

Recent data proposing an extremely small, self-replicating agent termed “nanobacteria” has raised a great deal of controversy within the scientific community. Since these agents have been isolated within the genitourinary tract, much research has focused attention on the potential role these particles may play in the development of urologic pathology, including polycystic kidney disease, renal calculi, and chronic prostatitis. Recent clinical research targeting these agents has proven effective in treating some patients with refractory category III prostatitis (chronic pelvic pain syndrome). This article reviews the current state of nanobacteria research and explore where these particles may impact urologic disease.     

The use of prostatilen in treating patients with prostatic diseases]

A clinical trial of polypeptide prostatic preparation prostatilen has been performed in 37 and 15 patients with chronic prostatitis and prostatic adenoma, respectively. The treatment resulted in attenuation of algetic and dysuria symptoms. Copulative function and spermatogenesis improved. The uroflowmetric index rose, while residual urine and leukocyte count in prostatic secretion reduced. The drug demonstrated antibacterial and immunomodulation effects in the absence of adverse reactions. Prostatilen is indicated in: chronic prostatitis, prostatic adenoma stage I, normospermatogenic and toxic sterility, interoceptive copulative dysfunction, dysuria. The drug in recommended for clinical application.