经直肠低强度脉冲超声治疗Ⅲ型前列腺炎的临床效果及其影响因素

Efficacy and influence factors of transrectal low-intensity pulsed ultrasound therapy on men with chronic prostatitis/chronic pelvic pain syndrome

目的慢性前列腺炎/慢性盆腔疼痛综合征(chronic prostatitis/chronic pelvic pain syndrome,CP/CPPS)发病机制不明,部分患者3-As治疗(抗生素、α-受体阻滞剂及消炎药物)效果欠佳,本研究探讨了采用经直肠低强度脉冲超声(LIPUS)治疗难治性CP/CPPS的临床效果及其相关影响因素。方法选取沧州市人民医院泌尿外科门诊诊治的76例难治性CP/CPPS患者为研究对象,年龄(46.55±13.15)岁,CP/CPPS平均病程43.14个月。采用经直肠超声电导前列腺治疗仪治疗,每日治疗1次,每次治疗30min,连续治疗5d为1个疗程,共治疗2个疗程。治疗结束后1周、1个月和3个月采用详细的问卷调查评估临床效果,包括慢性前列腺炎症状指数(NIH-CPSI)评分、视觉模拟量表(VAS)评分、国际前列腺症状评分(IPSS)、勃起功能国际问卷5(IIEF-5)、勃起硬度评分(EHS)和自我报告的射精潜伏期时间(IELT)。结果 76例患者随访3个月后,62例(81.6%)患者治疗有效,NIH-CPSI总分平均值从(28.03±6.18)分下降至(15.06±4.67)分(P<0.001),VAS评分和IPSS总评分下降了3.29分和5.97分,IIEF-5平均值从(17.52±4.71)分增至(19.42±4.12)分(P=0.021);进一步发现,经直肠LIPUS治疗有效患者基线BMI及腰围显著小于无效患者(P=0.027及<0.001)。结论经直肠LIPUS是临床上治疗CP/CPPS的有效措施,BMI与腰围可能是CP/CPPS患者超声治疗效果的阴性预测因子。

Objective The pathophysiology of CP/CPPS is usually multifactorial. Some patients with CP/CPPS do not respond sufficiently to the traditional 3-As therapy. This study evaluates the Efficacy and influence factors of transrectal low-intensity pulsed ultrasound(LIPUS) therapy on men With CP/CPPS. Methods 76 patients with refractory CP/CPPS were selected from outpatient clinic of Urology, Cangzhou people’s Hospital. The mean age of was(46.55 ±13.15) years. The mean course of was 43.14 months. Patients were underwent transrectal ultrasound guided prostatic therapy. One times a day, 30 min was treated each time, and 5 D was treated continuously for 1 courses in a continuous 2 course of treatment. Clinical symptoms of the participants were reassessed using NIH-CPSI score, VAS score, IIEF-5, and IPSS at 1 week, 1 and 3 months after a complete course of transrectal LIPUS. Results A total of 76 patients followed up for 3 months. 62(81.6%) had a successful response. The mean value of the NIH-CPSI total score decreased from(28.03±6.18) to(15.06±4.67). A decrease of 3.29 and 5.97 in VAS score and total IPSS. The mean value of the IIEF-5 also increased from(17.52±4.71) to(19.42±4.12) points. Patients with higher BMI and waist circumference at baseline had a significantly low response rate to transrectal LIPUS. Conclusions Transrectal LIPUS can serve as a salvage therapy for patients with CPPS refractory to traditional 3-As therapy. BMI and waist circumference might be a negative predictive factor for transrectal LIPUS in patients with CP/CPPS.