Prostatitis: A Review.

IF 55 Q1 Medicine
Benjamin J Borgert, Eric M Wallen, Minh N Pham
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引用次数: 0

Abstract

Importance: Prostatitis is defined as infection, inflammation, or pain of the prostate gland and affects approximately 9.3% of men in their lifetime.

Observations: Acute bacterial prostatitis consists of a urinary tract infection (UTI) that includes infection of the prostate, typically associated with fever or chills and caused by gram-negative bacteria, such as Escherichia coli, Klebsiella, or Pseudomonas, in 80% to 97% of cases. First-line therapy for acute prostatitis is broad-spectrum intravenous or oral antibiotics, such as intravenous piperacillin-tazobactam, ceftriaxone, or oral ciprofloxacin, which has a 92% to 97% success rate when prescribed for 2 to 4 weeks for people with febrile UTI and acute prostatitis. Chronic bacterial prostatitis is defined as a persistent bacterial infection of the prostate, typically presenting as recurrent UTIs from the same strain. Up to 74% of chronic bacterial prostatitis diagnoses are due to gram-negative organisms, such as E coli. First-line therapy for chronic bacterial prostatitis is a minimum 4-week course of levofloxacin or ciprofloxacin. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) presents as pelvic pain or discomfort for at least 3 months and is associated with urinary symptoms, such as urinary frequency. CP/CPPS is diagnosed when evaluation, including history and physical examination, urine culture, and postvoid residual measurement, does not identify other causes for the symptoms, such as infection, cancer, urinary obstruction, or urinary retention. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) measures symptom severity (scale of 0-43), with a 6-point change considered clinically meaningful. First-line oral therapy for CP/CPPS with urinary symptoms is α-blockers (eg, tamsulosin, alfuzosin; ΔNIH-CPSI score difference vs placebo = -10.8 to -4.8). Other oral therapies are associated with modest changes in NIH-CPSI score compared with placebo, including anti-inflammatory drugs (eg, ibuprofen; ΔNIH-CPSI score difference = -2.5 to -1.7), pregabalin (ΔNIH-CPSI score difference = -2.4), and pollen extract (ΔNIH-CPSI score difference = -2.49).

Conclusions and relevance: Prostatitis includes acute bacterial prostatitis, chronic bacterial prostatitis, and CP/CPPS, each of which is diagnosed and treated differently. First-line treatments are broad-spectrum antibiotics for acute bacterial prostatitis (such as piperacillin-tazobactam, ceftriaxone, or ciprofloxacin), at least 4 weeks of fluoroquinolones for chronic bacterial prostatitis, and α-blockers for CP/CPPS with urinary symptoms.

前列腺炎:综述。
重要性:前列腺炎被定义为前列腺的感染、炎症或疼痛,影响约9.3%的男性。观察:急性细菌性前列腺炎由尿路感染(UTI)组成,包括前列腺感染,通常伴有发烧或寒战,由革兰氏阴性菌引起,如大肠杆菌、克雷伯氏菌或假单胞菌,80%至97%的病例。急性前列腺炎的一线治疗是广谱静脉注射或口服抗生素,如静脉注射哌拉西林-他唑巴坦、头孢曲松或口服环丙沙星,对发热性尿路感染和急性前列腺炎患者开2至4周的处方,成功率为92%至97%。慢性细菌性前列腺炎是一种持续的前列腺细菌感染,通常表现为来自同一菌株的复发性尿路感染。高达74%的慢性细菌性前列腺炎诊断是由于革兰氏阴性菌,如大肠杆菌。慢性细菌性前列腺炎的一线治疗是至少4周的左氧氟沙星或环丙沙星疗程。慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)表现为盆腔疼痛或不适至少持续3个月,并与尿频等泌尿系统症状相关。当评估(包括病史和体格检查、尿液培养和尿后残留测量)未发现症状的其他原因(如感染、癌症、尿路梗阻或尿潴留)时,可诊断为CP/CPPS。美国国立卫生研究院慢性前列腺炎症状指数(NIH-CPSI)衡量症状严重程度(0-43分),6分的变化被认为具有临床意义。有泌尿系统症状的CP/CPPS的一线口服治疗是α-受体阻滞剂(如坦索罗辛、阿夫唑嗪;ΔNIH-CPSI与安慰剂评分差异= -10.8至-4.8)。与安慰剂相比,其他口服治疗与NIH-CPSI评分的适度变化相关,包括抗炎药(如布洛芬;ΔNIH-CPSI评分差值= -2.5 ~ -1.7)、普瑞巴林(ΔNIH-CPSI评分差值= -2.4)、花粉提取物(ΔNIH-CPSI评分差值= -2.49)。结论及意义:前列腺炎包括急性细菌性前列腺炎、慢性细菌性前列腺炎和CP/CPPS,诊断和治疗各不相同。对于急性细菌性前列腺炎,一线治疗是广谱抗生素(如哌拉西林-他唑巴坦、头孢曲松或环丙沙星),对于慢性细菌性前列腺炎,至少4周的氟喹诺酮类药物,对于有泌尿系统症状的CP/CPPS, α-阻滞剂。
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来源期刊
CiteScore
45.40
自引率
0.00%
发文量
0
期刊介绍: JAMA, published continuously since 1883, is an international peer-reviewed general medical journal. JAMA is a member of the JAMA Network, a consortium of peer-reviewed, general medical and specialty publications.
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