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首页> 外文期刊>Experimental and therapeutic medicine >Multimodal therapy for category III chronic prostatitis/chronic pelvic pain syndrome in UPOINTS phenotyped patients
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Multimodal therapy for category III chronic prostatitis/chronic pelvic pain syndrome in UPOINTS phenotyped patients

机译：UPOINTS表型患者的III型慢性前列腺炎/慢性盆腔疼痛综合征的多式联运疗法

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摘要

The complex network of etiological factors, signals and tissue responses involved in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) cannot be successfully targeted by a single therapeutic agent. Multimodal approaches to the therapy of CP/CPPS have been and are currently being tested, as in the frame of complex diagnostic-therapeutic phenotypic approaches such as. the urinary, psychosocial, organ-specific, infection, neurological and muscle tenderness (UPOINTS) system. In this study, the effect of combination therapy on 914 patients diagnosed, phenotyped and treated in a single specialized prostatitis clinic was analyzed. Patients received alpha-blockers, Serenoa repens (S. repens) extracts combined or not with supplements (lycopene and selenium) and, in the presence of documented or highly suspected infection, antibacterial agents. Combination treatment induced marked and significant improvements of National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) prostatitis symptom scores, International Index of Erectile Function (IIEF) sexual dysfunction scores, urinary peak flow rates and bladder voiding efficiency. These improvements, assessed after a 6-month course of therapy, were sustained throughout a follow-up period of 18 months. A clinically appreciable reduction of points of the total NIH-CPSI score was achieved in 77.5% of patients subjected to combination therapy for a period of >= 6 months. When the patients were divided in two cohorts, depending on the diagnosis of CP/CPPS [inflammatory (IIIa) vs. non-inflammatory (IIIb) subtypes], significant improvements of all signs and symptoms of the syndrome were observed in both cohorts at the end of therapy. Intergroup comparison showed that patients affected by the IIIa sub-category of CP/CPPS showed more severe signs and symptoms (NIH-CPSI total, pain and quality of life impact scores, and Qmax) at baseline when compared with IIIb patients. However, the improvement of symptoms after therapy was significantly more pronounced in IIIa patients when compared with IIIb patients. In contrast to current opinion, the evidence emerging from the present investigation suggests that the inflammatory and non-inflammatory sub-categories of CP/CPPS may represent two distinct pathological conditions or, alternatively., two different stages of the same condition. In conclusion, a simple protocol based on alpha-blockers, S. repens extracts and supplements and antibacterial agents, targeting the urinary, organ specific and infection domains of UPOINTS, may induce a clinically appreciable improvement of the signs and symptoms of CP/CPPS in a considerable percentage of patients. In patients not responding sufficiently to such therapy, second-line agents (antidepressants, anxiolytics, muscle relaxants, 5-phosphodiesterase inhibitors and others) may be administered in order to achieve a satisfactory therapeutic response.
机译：单一治疗剂无法成功靶向慢性前列腺炎/慢性盆腔疼痛综合征（CP / CPPS）所涉及的病因，信号和组织反应的复杂网络。 CP / CPPS的多峰治疗方法已经并且正在测试中，例如在复杂的诊断-治疗表型治疗方法中。泌尿系统，社会心理系统，特定器官，感染，神经系统和肌肉压痛（UPOINTS）系统。在这项研究中，分析了联合治疗对在一家专门的前列腺炎诊所中诊断，表型和治疗的914例患者的影响。患者接受α受体阻滞剂，塞雷诺亚猪笼草（S. repens）提取物或不与补充剂（番茄红素和硒）结合使用，并且在有文件证明或高度怀疑感染的情况下接受抗菌剂。联合治疗可显着改善美国国立卫生研究院慢性前列腺炎症状指数（NIH-CPSI）前列腺炎症状评分，国际勃起功能指数（IIEF）性功能障碍评分，尿峰值流速和膀胱排尿效率。经过6个月的疗程评估，这些改善在整个18个月的随访期内一直持续。在接受联合治疗≥6个月的患者中，有77.5％的患者的NIH-CPSI总评分得分在临床上明显降低。将患者分为两个队列时，根据对CP / CPPS的诊断[炎症（IIIa）对非炎症（IIIb）亚型]，在两个队列中均观察到该综合征的所有体征和症状均有明显改善。治疗结束。组间比较显示，与IIIb患者相比，受CP / CPPS IIIa子类别影响的患者在基线表现出更严重的体征和症状（NIH-CPSI总，疼痛和生活质量影响得分以及Qmax）。但是，与IIIb患者相比，IIIa患者治疗后症状的改善明显更为明显。与当前观点相反，从本研究中得出的证据表明，CP / CPPS的炎性和非炎性亚类可能代表着两种截然不同的病理状况，或者是同一状况的两个不同阶段。总之，针对UPOINTS的泌尿，器官特异性和感染域的基于α受体阻滞剂，白葡萄球菌提取物和补品以及抗菌剂的简单方案，可能会导致CP / CPPS的体征和症状在临床上得到明显改善。相当一部分患者。在对这种疗法没有足够反应的患者中，可以给予二线药物（抗抑郁药，抗焦虑药，肌肉松弛药，5-磷酸二酯酶抑制剂等）以达到满意的治疗效果。

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