Ateya Ahmad, Fayez Ashraf, Hani Ragab, Zohdy Wael, Gabbar Mohammad A, Shamloul Rany
Department of Andrology, Sexology, and Sexually Transmitted Diseases, Cairo University Hospital, Cairo, Egypt.
Urology. 2006 Apr;67(4):674-8. doi: 10.1016/j.urology.2005.10.021. Epub 2006 Mar 29.
To evaluate the efficacy of regular prostatic massage in combination with culture-specific antibiotic therapy for men with chronic prostatitis.
This study included 81 consecutive patients who attended our outpatient clinic with a history or symptoms suggestive of chronic prostatitis (National Institutes of Health category II and IIIA). In addition to prostatic culture and sensitivity, all patients were asked to complete the National Institutes of Health Chronic Prostatitis Symptom Index. According to their chronic prostatitis category, all patients were divided into four groups: group 1, chronic bacterial prostatitis treated with antibiotics and prostatic massage, n = 17; group 2, chronic bacterial prostatitis treated with antibiotics alone, n = 20; group 3, chronic nonbacterial prostatitis treated with antibiotics and prostatic massage, n = 25; and group 4, chronic nonbacterial prostatitis treated with antibiotics alone, n = 19.
Of the 37 patients with initially positive cultures, 30 (81.1%) had sterile final cultures. Overall, 30 patients (37%) of 81 had complete resolution of symptoms, 18 (22.2%) had initial resolution but had recurrence after therapy, 22 (27.1%) had partial improvement, and 11 (13.5%) had no improvement. No significant difference was found in the response between patients treated with antibiotics alone and those treated with antibiotics and prostatic massage in all four groups. Only 29% of class IIIa patients had complete improvement in contrast to 52% complete improvement in the class II patients.
Prostatic massage did not significantly improve the response of patients with chronic pelvic pain syndrome to antibiotics. Patients with National Institutes of Health class II prostatitis should be primarily treated with culture-sensitive antibiotics. Treatment of nonbacterial prostatitis is challenging and requires additional extensive research.
评估定期前列腺按摩联合针对特定培养结果的抗生素治疗对慢性前列腺炎男性患者的疗效。
本研究纳入了81例连续到我院门诊就诊的患者，他们有慢性前列腺炎病史或症状（美国国立卫生研究院分类II型和IIIA型）。除了进行前列腺培养及药敏试验外，所有患者均被要求完成美国国立卫生研究院慢性前列腺炎症状指数问卷。根据慢性前列腺炎的类型，所有患者被分为四组：第1组，慢性细菌性前列腺炎，采用抗生素及前列腺按摩治疗，n = 17；第2组，慢性细菌性前列腺炎，仅采用抗生素治疗，n = 20；第3组，慢性非细菌性前列腺炎，采用抗生素及前列腺按摩治疗，n = 25；第4组，慢性非细菌性前列腺炎，仅采用抗生素治疗，n = 19。
在最初培养结果为阳性的37例患者中，30例（81.1%）最终培养结果为无菌生长。总体而言，81例患者中有30例（37%）症状完全缓解，18例（22.2%）最初症状缓解但治疗后复发，22例（27.1%）部分改善，11例（13.5%）无改善。在所有四组中，仅接受抗生素治疗的患者与接受抗生素及前列腺按摩治疗的患者之间的反应无显著差异。与II型患者52%的完全改善相比，IIIA型患者只有29%完全改善。
前列腺按摩并未显著提高慢性盆腔疼痛综合征患者对抗生素治疗的反应。美国国立卫生研究院II型前列腺炎患者应首先使用对培养结果敏感的抗生素进行治疗。非细菌性前列腺炎的治疗具有挑战性，需要进一步深入研究。
