中国泌尿外科医师慢性前列腺炎认知与诊治行为问卷调查

Questionnaire survey of Chinese urologists concerning the diagnosis and treatment of chronic prostatitis

目的了解中国泌尿外科医师对慢性前列腺炎（CP）认知与诊治行为的现状。方法以问卷形式调查来自全国29个省、自治区及直辖市的656名泌尿外科专科医师。调查内容包括对CP病因的认识、诊断策略、治疗行为等。结果收回有效问卷627份。64．6％（394／610）医师认为非细菌感染为CP的病因。前列腺液（EPS）检查（86．3％，535／620）为最常用的检查手段。57．4％（356／620）医师常规行细菌培养，而单纯EPS培养（43．4％，260／599）为最常用的培养方法。仍有37．7％（225／597）医师采用传统分类法。66．6％（412／619）医师认为CP需要治疗。药物治疗（86．2％，538／624）、心理治疗（60．7％，379／624）、前列腺按摩（54．2％，338／624）及物理治疗（44．7％，279／624）为最常用治疗方法。抗生素（74．0％，455／615）及α受体阻滞剂（60．3％，371／615）为最常用的治疗药物。最常用的抗生素为喹诺酮类（79．0％，480／608），其次为大环内酯类（45．7％，278／608）及头孢菌素类（35．2％，214／608）。多数医师认为细菌培养阳性（64．4％，351／545）或EPS中WBC和（或）脓细胞较多（65．9％，359／545）时应使用抗生素。70．3％（395／562）医师使用α受体阻滞剂是基于解除CP患者的尿路梗阻症状。医师对病因的认识是医师诊断及治疗方法选择的影响因素；而诊断方法的选择又影响治疗方法及治疗药物的选择。结论中国泌尿外科医师对CP病因的认识、分类、诊断与治疗等方面仍充满困惑，诊断及治疗行为仍需进一步规范，需要深入对CP的研究并不断提高中国泌尿外科医师对CP的认知水平。

Objective To evaluate the philosophies and practices of Chinese urologists regarding the diagnosis and treatment of chronic prostatitis （CP）. Methods A sample of 656 urologists from 29 provinces （including autonomous regions and municipalities） of China were asked to complete a questionnaire that explored their practice characteristics and attitudes towards prostatitis, and diagno sis and treatment patterns of CP. Results Of the 656 questionnaires sent, 627 were included in the final analysis. Many urologists （64.6%, 394/610） considered CP to be non-bacterial in nature. For routine diagnosis assessment, the most commonly used tests were reported to be microscopic analysis of expressed prostate secretions（EPS） （86.3%, 535/620） and bacterial culture （57.4%, 356/620）. Most urologists 225/597） of the （43.4%, 260/599） performed simple culture of EPS. More than one-third （37.7%, urologists still employed the traditional classification system of chronic tatitis, chronic nonbacterial prostatitis and prostatodynia. About two thirds （66.6 %, 4 bacterial pros 12/619） of the urologists believed that CP needed to be treated. The most common choices for therapy included phar maceutical therapy （86. 2%, 538/624）, psychotherapy （60. 7%, 379/624）, prostatic massage （54.2%,338/624）, and physical therapy （44.7%, 279/624）. Seventy-four percent （455/615） of the urologists chose antimierobial agents as the first choice of therapy and these physicians tended to use fluoroquinolones （79.0%, 480/608）, macrolides （45.7%, 278/608）, and cephalosporins （35.2%, 214/608） for CP. Most urologists would prescribe antibiotics when bacterial culture was positive （64.4%, 351/545）or too many white blood cells or pyocytes （65.9%, 359/545）were present in EPS. The second most commonly used pharmaceutical therapy was alpha-blocker （60. 3%, 371/615）, which was prescribed to relieve the obstructive voiding symptoms by most urologists （70.3 %, 395/ 562）. The beliefs regarding the etiology affected the diagnostic and treatment strategies; meanwhile, the diagnostic practice had an influence on the selection of treatment methods. Conclusions There is much confusion and frustration about the etiology, diagnosis and treatment of CP among Chinese urol ogists. Meanwhile, their practice patterns should be standardized. Moreover, it is necessary to conduct further study on CP and constantly improve the cognitive level about CP among Chinese urologists.