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 1003 participants met inclusion criteria.Compared with placebo,alpha blockers could improve the symptoms of CP/CPPSobvious- ly with WMD of NIH CPSI,total score and pain score were -4.10 (95%CI:-6.92 to -1.98) and -1.68 (95%CI:-2.64 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 WMDof 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 improvc the quality of internal original studies.

Characterisation of the bacterial community in expressed prostatic secretions from patients with chronic prostatitis/chronic pelvic pain syndrome and infertile men： a preliminary investigation

The expressed prostatic secretions （EPSs） of men with chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）, infertile men and normal men were subjected to microbiological study. EPSs were collected from the subjects, which included 26 normal men, 11 infertile patients and 51 CP/CPPS patients. DNA was extracted from each specimen, and the V3 regions of the 16S rRNA genes were amplified using universal bacterial primers. The results showed that the EPS 16S rRNA gene-positive rate in the CP/CPPS and infertile patients was much higher than in the normal men, but without any difference among the three patient groups. The denaturing gradient gel electrophoresis （DGGE） method was used to characterize the EPS bacterial community structure of the prostate fluid from patients with CP/CPPS or infertility issues. Principal component analysis （PCA） and partial least squares （PLS） analyses of PCR-DGGE profiles revealed that the EPS bacterial community structure differed among the three groups. Three bands were identified as the key factors responsible for the discrepancy between CP/CPPS patients and infertile patients （P〈O.05）. Two bands were identified as priority factors in the discrepancy of category IliA and category IIIB prostatitis patients （P〈O.05）. According to this research, the ecological balance of the prostate and low urethra tract, when considered as a microenvironment, might play an important role in the maintenance of a healthy male reproductive tract.

Chronic proctalgia and chronic pelvic pain syndromes:New etiologic insights and treatment options

This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs:chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence available to guide their diagnosis and treatment. This situation appears to be changing:A recently published large randomized,controlled trial by our group comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of chronic proctalgia has shown success rates of 85% for biofeedback when patients are selected based on physical examination evidence of tenderness in response to traction on the levator ani muscle-a physical sign suggestive of striated muscle tension. Excessive tension (spasm) in the striated muscles of the pelvic floor appears to be common to most of the pelvic pain syndromes. This suggests the possibility that similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic pain disorders.

Boswellia resin extract and propolis derived polyphenols in patients with type III chronic prostatitis/chronic pelvic pain syndrome:An Italian prospective multicenter study

Objective:To assess the efficacy and safety of a treatment regimen based on rectal administration of Boswellia resin extract and propolis derived polyphenols in patients with type IIIa and type IIIb chronic prostatitis and chronic pelvic pain syndrome(CP/CPPS).Methods:Patients with type IIIa and type IIIb CP/CPPS received one rectal suppository a day for 15 days per month for 3 consecutive months.Participants were evaluated with National Institutes of Health-Chronic Prostatitis Symptom Index(NIH-CPSI),the International Prostate Symptom Scores(IPSS),International Index of Erectile Function(IIEF),four-glass test,uroflowmetry,and prostate-specific antigen assessments at baseline and at Week 4,and Week 12.Primary endpoints were improvement in pain domain of NIH-CPSI and improvement of NIH-CPSI total score.Secondary outcomes included improvement of micturition and quality of life(QoL)domains of NIH-CPSI questionnaire.Results:A total of 61 males were enrolled.No adverse events were reported.Significant improvements from baseline to Day 30 were reported for NIH-CPSI total score(mean difference:-9.2;p<0.01),NIH-CPSI pain domain(mean difference:-5.5;p<0.01),NIH-CPSI micturition domain,NIH-CPSI QoL domain,and IPSS total score(mean difference:-5.6;p<0.01).No significant changes from baseline in terms of IIEF score or maximum flow rate were observed.At final follow-up(Day 90),further significant improvements in terms of NIH-CPSI total score(mean difference:-12.2;p<0.01),NIH-CPSI pain domain(mean difference:-6.6;p<0.01),NIH-CPSI micturition domain,NIH-CPSI QoL domain,and IPSS total score were reported.Conclusion:Rectal administration of Boswellia resin extract and propolis derived polyphenols is well tolerated and delivers a significant symptomatic improvement in most patients with type IIIa and type IIIb CP/CPPS.

Treatment of intractable chronic pelvic pain syndrome by injecting a compound of Bupivacaine and Fentanyl into sacral spinal space

Objective:To investigate the effect of injecting a compound of Bupivacaine and Fentanyl into sacral spinal space to treat chronic pelvic pain syndrome (CPPS). Methods: A total of 36 men with recalcitrant CPPS refractory to multiple prior therapies were treated with the injection of a compound of Bupivacaine and Fentanyl (10 ml of 0. 125% Bupivacaine, 0. 05 mg Fentanyl, 5 mg Dexamethasone, 100 mg Vitamin B1 and 1 mg Vitamin B12) into sacral space once a week for 4 weeks. The National Institute of Health Chronic Proslatitis Symptom Index (NIH-CPSI), maximum and average flow rate were performed at the start and the end of 4 weeks' therapy. Results :Mean NIH-CPSI total score was decreased from 26. 5±1. 6 to 13. 4±2. 0 (P<0. 001). Significant improvement was seen in each subscore domain. A total of 32 patients (89%) had at least 25% improvement on NIH-CPSI and 22 (61 %) had at least 50% improvement. Maximal and average flow rate were increased from 19. 5±3. 8 to 23. 6±4. 2 and 10. 9±2. 6 to 14. 3±2. 4 respectively. Conclusion: Injection of this compound of Bupivacaine, Fentanyl and Dexamethasone into sacral spinal space is an effective and safe approach for recalcitrant CPPS. Further study of the mechanisms and prospective placebo controlled trials are warranted.

Updates on therapies for chronic prostatitis/chronic pelvic pain syndrome

Prostatitis comprises of a group of syndromes that affect almost 50% of men at least once in their lifetime and makeup the majority of visits to the Urology Clinics.After much debate, it has been divided into four distinct categories by National Institutes of Health namely(1) acute bacterial prostatitis;(2) chronic bacterial prostatitis;(3) chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS) which is further divided into inflammatory and non-inflammatory CP/CPPS; and(4)asymptomatic inflammatory prostatitis. CP/CPPS has been a cause of great concern for both patients and physicians because of the lack of presence of thoroughinformation about the etiological factors along with the difficult-to-treat nature of the syndrome. For the presented manuscript an extensive search on PubM ed was conducted for CP/CPPS aimed to present an updated review on the evaluation and treatment options available for patients with CP/CPPS. Several diagnostic criteria's have been established to diagnose CP/CPPS, with prostatic/pelvic pain for at least 3 mo being the major classifying symptom along with the presence of lower urinary tract symptoms and/or ejaculatory pain. Diagnostic tests can help differentiate CP/CPPS from other syndromes that come under the heading of prostatitis by ruling out active urinary tract infection and/or prostatic infection with uropathogen by performing urine cultures, Meares-Stamey Four Glass Test, Preand Post-Massage Two Glass Test. Asymptomatic inflammatory prostatitis is confirmed through prostate biopsy done for elevated serum prostate-specific antigen levels or abnormal digital rectal examination. Researchers have been unable to link a single etiological factor to the pathogenesis of CP/CPPS, instead a cluster of potential etiologies including atypical bacterial or nanobacterial infection, autoimmunity, neurological dysfunction and pelvic floor muscle dysfunction are most commonly implicated. Initially monotherapy with anti-biotics and alpha adrenergic-blockers can be tried, but its success has only been observed in treatment nave population. Other pharmacotherapies including phytotherapy, neuromodulatory drugs and anti-inflammatories achieved limited success in trials. Complementary and interventional therapies including acupuncture, myofascial trigger point release and pelvic floor biofeedback have been employed. This review points towards the fact that treatment should be tailored individually for patients based on their symptoms. Patients can be stratified phenotypically based on the UPOINT system constituting of Urinary, Psychosocial, Organ-specific, Infectious, Neurologic/Systemic and symptoms of muscular Tenderness and the treatment algorithm should be proposed accordingly. Treatment of CP/CPPS should be aimed towards treating local aswell as central factors causing the symptoms. Surgical intervention can cause significant morbidity and should only be reserved for treatment-refractory patients that have previously failed to respond to multiple drug therapies.

Addressing quality of life in the patient with interstitial cystitis/bladder pain syndrome

Interstitial cystitis/bladder pain syndrome(IC/BPS)is a debilitating,chronic condition characterized by chronic pelvic pain,urinary urgency,and frequency and is well-known to be associated with a decrease in work productivity,emotional changes,sleep,sexual dysfunction,and mobility.Many metrics of quality of life(QoL)in this patient population have been developed;however,a unified,standardized approach to QoL in these patients has not been determined.The effects of IC/BPS and co-morbid conditions on QoL are described using current validated metrics.Next,data regarding successful treatment of IC/BPS in terms of QoL improvement are reviewed.While QoL is the single most important clinical measure of success in the treatment of patients suffering from IC/BPS,addressing QoL in this patient population remains a significant challenge,as its effects on QoL are highly variable and unable to be differentiated from the effects of comorbid conditions on QoL,including depression,poor sleep,and inability to work.Future studies will need to address treatment efficacy on the basis of IC/BPS specific QoL metrics,and multi-modal assessment and therapy to address comorbid disease will also play an important role in the future to ensure comprehensive management of these patients.

Molecular mechanism and promising treatments of chronic prostatitis/chronic pelvic pain syndrome:An exploratory bibliometric analysis and literature review of preclinical studies

Background:As one of the most common diseases in urology,a large number of preclinical studies have been accumulated to explore the etiological mechanism and potential intervention of chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS).Methods:In this study,we systematically evaluated the current status of preclinical research on CP/CPPS through bibliometrics analysis using VOSviewer and Citespace.Characteristics of publication such as year,country/region,institution,author,journal,citation,and keywords were analyzed.Based on the bibliometrics analysis results of keywords,we summarized the possible mechanisms and promising treatments for CP/CPPS narratively.Results:According to the results of this study,the most common mechanisms involved in CP/CPPS were as follows:Disturbed immune and inflammation mediators,immune cell dysfunction,oxidative stress,dysregulated signaling pathways,apoptosis,gut microbiota,and testosterone metabolism.Traditional Chinese Medicine and extracorporeal shock wave therapy have important potential in the treatment of CP/CPPS.Conclusion:Further translational studies targeting the above mechanisms and validating the objective efficacy of potential treatments indicated by preclinical studies in clinical patients are needed in the future.

Effect of thermophilic bacterium HB27 manganese superoxide dismutase in a rat model of chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS)

We investigated the therapeutic effects of superoxide dismutase(SOD)from thermophilic bacterium HB27 on chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS)and its underlying mechanisms.A Sprague–Dawley rat model of CP/CPPS was prepared and then administered saline or Thermus thermophilic(Tt)-SOD intragastrically for 4 weeks.Prostate inflammation and fibrosis were analyzed by hematoxylin and eosin staining,and Masson staining.Alanine transaminase(ALT),aspartate transaminase(AST),serum creatinine(CR),and blood urea nitrogen(BUN)levels were assayed for all animals.Enzyme-linked immunosorbent assays(ELISA)were performed to analyze serum cytokine concentrations and tissue levels of malondialdehyde,nitric oxide,SOD,catalase,and glutathione peroxidase.Reactive oxygen species levels were detected using dichlorofluorescein diacetate.The messenger ribonucleic acid(mRNA)expression of tissue cytokines was analyzed by reverse transcription polymerase chain reaction(RT-PCR),and infiltrating inflammatory cells were examined using immunohistochemistry.Nuclear factor-κB(NF-κB)P65,P38,and inhibitor of nuclear factor-κBα(I-κBα)protein levels were determined using western blot.Tt-SOD significantly improved histopathological changes in CP/CPPS,reduced inflammatory cell infiltration and fibrosis,increased pain threshold,and reduced the prostate index.Tt-SOD treatment showed no significant effect on ALT,AST,CR,or BUN levels.Furthermore,Tt-SOD reduced inflammatory cytokine expression in prostate tissue and increased antioxidant capacity.This anti-inflammatory activity correlated with decreases in the abundance of cluster of differentiation 3(CD3),cluster of differentiation 45(CD45),and macrophage inflammatory protein 1α(MIP1α)cells.Tt-SOD alleviated inflammation and oxidative stress by reducing NF-κB P65 and P38 protein levels and increasing I-κBαprotein levels.These findings support Tt-SOD as a potential drug for CP/CPPS.

泌尿男科医师应用《CUA前列腺炎诊断治疗指南》诊疗CPPS的调查

目的:了解中华医学会泌尿外科学分会(CUA)《前列腺炎诊断治疗指南》(以下简称《指南》)的推广和应用效果,及其对我国泌尿男科医师诊断、治疗CPPS的观念和实践的影响。方法:在全国21个城市173家医院泌尿男科发放问卷,回收问卷后,对有效问卷进行统计分析。结果:发放问卷1 056份,回收有效问卷851份(80.6%)。答卷者中,71.6%来自三级医院,高级和中级职称的医师占80.7%,97.5%的医师学习过《指南》。绝大多数医师认同Ⅲ型前列腺炎是一种临床综合征,诊断需要排除其他引起类似症状的疾病,治疗目标是缓解疼痛、改善排尿症状、提高生活质量。在学过或没学过指南的医师中,对部分观点的认同也有差异。在临床实际工作中,泌尿男科医师给CPPS患者最常选用的治疗方法(多选)是心理治疗(80.7%)、药物治疗(80.4%)、调整生活方式(79.6%);最常用的前3类药物是植物药(80.0%)、α受体阻滞剂(68.9%)和抗生素(61.0%)。结论:CUA《前列腺炎诊断治疗指南》得到了广泛的推广,其主要内容得到了深入的领会和应用,推动了我国泌尿男科医师规范化诊治CPPS的进程。

体外冲击波调控免疫反应对ⅢB型CP/CPPS患者的疗效及其机制研究

目的探讨体外冲击波治疗(extracorporeal shock wave therapy,ESWT)对ⅢB型慢性前列腺炎(CP)/慢性盆腔疼痛综合征(CPPS)患者免疫反应的影响,并观察其疗效。方法收集2014年1月至2016年9月于我院就诊的120例CP/CPPS患者,采用随机数字表法分为试验组与对照组,各60例。对照组给予坦索罗辛治疗,试验组予ESWT+坦索罗辛治疗,两组均治疗4周。治疗后收集两组患者慢性前列腺炎症状评分(NIH-CPSI),国际前列腺症状评分(IPSS),前列腺液中TNF-α、IL-6、卵磷脂小体及外周血中CD3^+、CD4^+、CD8^+、CD4^+CD25^+、TGF-β1、CD4^+CD25^+Foxp3^+的表达变化。结果治疗4周后,与对照组相比,试验组总体有效率明显提高(63.3%vs 93.3%,P<0.05);NIH-CPSI评分(13.12±1.71 vs 23.16±1.33)和IPSS评分(8.23±2.28 vs 13.14±2.69)明显降低。在炎症和免疫影响方面,与对照组相比,试验组前列腺液中卵磷脂小体明显升高,炎性因子TNF-α、IL-1β水平明显降低;外周血中CD3^+、CD4^+、CD8^+、CD4^+CD25^+、TGF-β1、CD4^+CD25^+Foxp3^+表达均明显提高。结论 ESWT治疗ⅢB型CP/CPPS安全有效,其可能的作用机制与提高患者的免疫功能、降低前列腺局部炎症应答有关。

中药直肠滴注对CAP/CPPS患者炎症因子MCP-1及PDGF-BB表达的影响

目的观察中药直肠滴注对慢性非细菌性前列腺炎/慢性盆腔疼痛综合征(CAP/CPPS)患者炎症因子单核细胞趋化因子-1(MCP-1)及血小板衍生生长因子-BB(PDGF-BB)的影响,探讨其作用机制。方法将CAP/CPPS患者(湿热夹瘀证)40例随机分为2组。治疗组20例予灌肠I号方直肠滴入,对照组20例予邦列安纳米银抗菌水凝胶肛门给药。4周后对2组的疗效进行评价,观察治疗前后中医证候积分、美国国立卫生研究院慢性前列腺炎症状指数(NIH-CPSI)、前列腺液白细胞(EPS-WBC)计数及前列腺液中MCP-1、PDGF-BB水平的变化。结果灌肠Ⅰ号方可显著降低中医证候评分,减少EPS-WBC计数,并降低MCP-1、PDGF-BB水平,但2组在总有效率、改善NIH-CPSI症状评分方面,差异无统计学意义。结论调控炎症因子MCP-1及PDGF-BB可能是灌肠Ⅰ号方直肠滴注治疗CAP/CPPS的重要免疫机制之一。

癃清胶囊联合会阴三联针刺治疗湿热型慢性盆腔疼痛综合征的疗效分析

目的探讨癃清胶囊联合会阴三联针刺治疗湿热型慢性盆腔疼痛综合征的疗效。方法回顾性分析120例湿热型慢性盆腔疼痛综合征患者的临床资料,根据治疗方案的差异分为药物组(A组)、针刺组(B组)和药物+针刺治疗组(C组),每组40例。A组给予口服癃清胶囊治疗,B组采用会阴三联针刺治疗,C组予以癃清胶囊联合会阴三联针刺治疗。比较三组美国国立卫生研究院慢性前列腺炎症状评分表(NIH-CPSI)积分、中医证候积分、临床疗效、不良反应发生情况。结果A组、B组、C组临床总有效率分别为87.5%、85.0%、90.0%,组间比较无差异(P>0.05)。治疗前,三组NIH-CPSI症状影响、疼痛症状、尿路症状、生活质量积分与总积分及中医证候积分比较无差异(P>0.05)。治疗2周后,C组NIH-CPSI症状影响、疼痛症状、尿路症状、生活质量积分与总积分及中医证候积分分别为(1.76±0.21)、(9.27±2.09)、(5.15±0.05)、(4.44±0.72)、(20.62±4.25)、(18.35±4.23)分,B组分别为(2.07±0.62)、(13.29±2.25)、(5.29±0.02)、(4.75±0.65)、(25.40±3.20)、(26.35±5.10)分,A组分别为(1.96±0.56)、(13.27±2.24)、(5.27±0.03)、(4.85±0.25)、(25.35±3.22)、(26.37±5.09)分。治疗4周后,C组NIH-CPSI症状影响、疼痛症状、尿路症状、生活质量积分与总积分及中医证候积分分别为(1.02±0.20)、(5.13±1.10)、(3.30±0.24)、(3.28±0.06)、(12.73±2.22)、(12.20±2.08)分,B组分别为(1.48±0.42)、(6.25±0.25)、(4.31±0.27)、(3.60±0.06)、(15.64±2.12)、(13.23±2.00)分,A组分别为(1.52±0.25)、(6.23±0.15)、(4.55±0.95)、(3.56±0.04)、(15.86±2.09)、(13.22±2.13)分。治疗2、4周后,三组NIH-CPSI症状影响、疼痛症状、尿路症状、生活质量积分与总积分及中医证候积分均低于治疗前,且C组低于A组与B组,差异有统计学意义(P<0.05)。A组有2例出现腹痛、腹泻,B组未见不良反应,C组出现1例腹痛、腹泻;A、B、C组不良反应发生率分别为5.0%、0、2.5%,比较无差异(P>0.05)。结论湿热型慢性盆腔疼痛综合征采用癃清胶囊联合会阴三联针刺治疗是一种安全有效、起效快的治疗方法,可对其进行更加深入、全面的研究。

3M物理疗法在女性高张力盆底肌功能障碍中的应用现状

女性高张力盆底肌功能障碍是盆底肌损伤的常见类型,对女性身心健康和生活质量产生极大影响。3M物理疗法是包含物理因子治疗、手法治疗和运动治疗的一种综合性治疗方法。其中,物理因子治疗可以减轻疼痛,手法治疗能够松解高张力盆底肌,运动治疗能够恢复盆底肌平衡。3M物理疗法能使筋膜柔顺,力量均衡,且疗效显著,不易复发。明确3M物理疗法在高张力盆底肌功能障碍中的治疗思路及其代表性治疗方式的运动处方,可促进3M物理疗法更全面系统地应用于临床并深入验证其长期疗效。

艾灸治疗慢性前列腺炎/慢性盆腔疼痛综合征的疗效和安全性评价:系统综述和Meta分析

背景:随着现代生活方式的改变及社会老龄化的加剧,慢性前列腺炎/慢性盆腔疼痛综合征(Chronic Prostatitis/Chronic Pelvic Pain Syndrome,CP/CPPS)的发病率逐年增高,目前多以西医治疗为主,存在一定的不良反应及并发症。艾灸治疗CP/CPPS有良好的疗效,但缺乏循证证据。目的:系统评价艾灸治疗CP/CPPS的疗效和安全性。方法:按照检索策略检索Cochrane临床对照试验中心注册库、Pubmed、Embase、中国生物医学文献系统数据库、中国知网、维普中文科技期刊数据库、万方数据库等相关数据库,检索时间均从建库到2022年4月1日。筛选出艾灸治疗CP/CPPS的随机对照试验(Randomized Controlled Trial,RCT)文献,主要结局指标:临床有效率、美国国立卫生研究院慢性前列腺炎症状指数(National Institutes of Health Chronic Prostatitis Index,NIH-CPSI)评分、疼痛数字评分法(Numerical Rating Scales,NRS)评分、生活质量评价量表(Quality of Life,QOL)评分、尿道分泌物(Urethral Discharge,UD)评分、白细胞计数(White Blood Cell Count,WBC)。根据Cochrane手册对纳入文献进行质量评价。运用Review Manager 5.4和Stata 16.0软件对数据进行分析。结果:纳入15篇文献,包括1 301例患者。试验组临床有效率[相对危险度(RR)=1.22,95%置信区间(CI)(1.16,1.30),P <0.000 01]高于对照组。试验组NIH-CPSI评分[均数差(MD)=1.55,95%CI(–2.15,5.25),P <0.000 1]、NRS评分[MD=–0.01,95%CI(–2.37,2.34),P <0.000 1]、QOL评分[MD=0.12,95%CI(–3.58,3.83),P=0.95]、UD评分[MD=–1.07,95%CI(–1.42,0.71),P <0.000 1], WBC[MD=2.79,95%CI(1.28,4.30),P <0.000 1]低于对照组。对临床有效率、NIH-CPSI评分进行亚组分析,临床有效率均高于对照组[RR=1.20,95%CI(1.13,1.28),P <0.000 01;RR=1.33,95%CI(1.56,1.53),P <0.000 1],NIH-CPSI评分均低于对照组[MD=0.47,95%CI(–1.46,2.39),P <0.000 1;MD=7.69,95%CI(–1.22,16.50),P <0.000 1]。结论:艾灸治疗CP/CPPS的疗效和安全性良好,但仍需更多高质量的临床研究加以验证。

揿针在治疗慢性盆腔痛综合征中作用的临床回顾研究

目的探讨揿针联合西药治疗慢性盆腔痛(CPP)的临床疗效。方法选择2017年3月—2022年5月在滨州医学院附属医院妇科收治的CPP患者120例,随机分为对照组和观察组,各60例。对照组口服布洛芬缓释胶囊治疗,观察组在对照组基础上联用揿针治疗,取三阴交、子宫、足三里等穴位,连续治疗4周。盆底肌力牛津分级构成比较两组治疗前后的盆底肌力;视觉模拟疼痛评分(VAS)、Mc Cormack量表评分分别进行主观、客观疼痛评价,比较两组治疗前后疼痛症状;比较两组治疗后的临床总有效率、生活质量量表(EHP-30)得分和盆底功能情况。结果(1)盆底肌力:观察组CPP患者治疗后盆底肌力牛津分级构成显著优于对照组,差异有统计学意义(P<0.05),观察组中Ⅳ级和Ⅴ级患者比例(76.67%,46/60)高于对照组(46.67%,28/60)。(2)VAS评分与Mc Cormack量表评分:两组CPP患者治疗后VAS评分与Mc Cormack量表评分较治疗前降低;与对照组比较,观察组患者治疗后VAS评分与Mc Cormack量表评分降低,差异均有统计学意义(均P<0.05)。(3)临床总有效率:观察组为85.00%(51/60),高于对照组(63.33%,38/60),差异有统计学意义(P<0.05)。(4)EHP-30问卷评分:观察组CPP患者治疗后EHP-30问卷中的疼痛、控制无力感、情感健康评分以及总分较对照组降低,差异均有统计学意义(均P<0.05)。(5)盆底功能:两组患者治疗后盆底功能障碍类型包括膀胱垂落、阴道垂落、盆底陷窝疝、性功能障碍、尿失禁,对照组盆底功能障碍总发生率为40.00%(24/60),观察组为36.67%(22/60),差异无统计学意义(P>0.05)。结论揿针联合西药治疗CPP能够改善患者盆底肌力,改善疼痛症状,提高临床疗效和生活质量,且安全性较好,研究可为临床治疗CPP提供一定参考。

盆底肌筋膜手法联合磁电治疗女性慢性盆腔疼痛综合征的疗效观察

目的探讨盆底肌筋膜手法联合磁电治疗对女性慢性盆腔疼痛综合征患者疼痛、基本生活活动能力及盆底电生理的影响。方法选取2021年1月至2022年2月遂宁市中心医院盆底康复中心收治的60例女性慢性盆腔疼痛综合征患者作为研究对象。按照随机数字表法分为对照组和试验组,各30例。对照组采用磁电治疗,试验组在磁电治疗的基础上采用盆底肌筋膜手法治疗。收集两组治疗前及治疗后即刻的视觉模拟评分法(VAS)评分、疼痛障碍指数(PDI)及盆底电生理指标,随访两组治疗后3个月及6个月的VAS评分及PDI。结果试验组在治疗后即刻、治疗后3个月及6个月的VAS评分和PDI均低于对照组,差异具有统计学意义(P<0.05);治疗后即刻,试验组的前静息及后静息平均肌电值(EMG)均低于对照组,试验组的快肌最大肌电值、慢肌平均肌电值及耐力平均肌电值均高于对照组,差异具有统计学意义(P<0.05)。结论盆底肌筋膜手法联合磁电治疗女性慢性盆腔疼痛综合征患者有利于改善盆底电生理功能、减轻疼痛程度及提高基本生活活动能力。

特拉唑嗪及与双氯芬酸钠联合治疗CP/CPPS的研究

目的:比较单用特拉唑嗪与特拉唑嗪联合双氯芬酸钠治疗慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)的效果。方法:将106例CP/CPPS患者随机分为2组,A组予特拉唑嗪治疗(2 mg/d),B组予特拉唑嗪(2 mg/d)加双氯芬酸钠(25 mg/d)治疗。采用美国国立卫生研究所慢性前列腺炎症状评分(NIH-CPSI)、亚评分(疼痛及生活指数)及国际前列腺症状评分(IPSS)标准评价患者治疗8周后的效果。结果:2组治疗后的NIH-CPSI、亚评分及IPSS均明显减少,且2组之间评分无显著性差异。结论:特拉唑嗪单独治疗与联合双氯芬酸钠治疗CP/CPPS的效果相当。

加味千金地肤子汤治疗肾虚湿热型慢性前列腺炎/慢性盆腔疼痛综合征合并弱精症的临床观察

目的探讨采用加味千金地肤子汤治疗慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)合并弱精症的临床疗效。方法选取2020年7月至2021年12月于珠海市中西医结合医院就诊的86例肾虚湿热型CP/CPPS合并弱精症患者作为研究对象,随机分为治疗组(n=44)和对照组(n=42)。对照组给予西药常规治疗,治疗组在对照组的基础上给予加味千金地肤子汤治疗。比较两组临床疗效、治疗前后的中医证候评分及精液质量。结果经12周治疗后,治疗组总体有效率(88.6%)高于对照组(66.7%),美国国立卫生研究院慢性前列腺炎症状指数(NIH-CPSI)评分、中医证候评分、精子DNA碎片率(DFI)显著低于对照组,平均尿流率(AFR)、最大尿流率(MRF)、精子总活力(PR+NP)、精子顶体酶活性显著高于对照组(P<0.05)。结论加味千金地肤子汤联合西药治疗可改善肾虚湿热型CP/CPPS合并弱精症患者的排尿困难、骨盆疼痛、性功能及精子活力下降等症状。

雷火灸联合常规西药治疗慢性盆腔炎气滞血瘀证患者的效果

目的:观察雷火灸联合常规西药治疗慢性盆腔炎气滞血瘀证患者的效果。方法:选取2021年1月至2023年1月该院收治的60例慢性盆腔炎患者进行前瞻性研究,按随机数字表法将其分为观察组和对照组各30例。对照组给予常规西药治疗,观察组在对照组基础上联合雷火灸治疗。比较两组临床疗效,治疗前后中医证候积分、疼痛程度[视觉模拟评分法(VAS)]评分、病灶指标水平、炎性因子[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]水平和不良反应发生率。结果:观察组治疗总有效率为96.67%(29/30),高于对照组的73.33%(22/30),差异有统计学意义(P<0.05);治疗后,两组畏寒肢冷、神疲乏力、月经不调、低热起伏等中医证候积分均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);两组VAS评分均低于治疗前,且观察组低于对照组,两组炎性包块直径、盆腔积液深度均小于治疗前,且观察组小于对照组,差异有统计学意义(P<0.05);两组CRP、TNF-α水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);治疗期间,两组均未见明显不良反应。结论:雷火灸联合常规西药治疗慢性盆腔炎气滞血瘀证患者可提高治疗总有效率,降低中医证候积分、VAS评分、炎性因子水平,缩小炎性包块直径、盆腔积液深度,其效果优于单纯常规西药治疗。