F Y E P

CBGEF QDBF \RGPS\ / \KRGZM SKJKJJSGZV
NIH - II
Chronic Bacterial Prostatitis
YK'XCZY KKDZS Z"E ,QGZJKX NBGP[ Z"E
FKDGNGZGBN FYNIPF
OGFKHF \PXGT .\KRGPZTF \JGNC N[ ZHGI KNBKZJZYC OGFKH GRF
.\KREZGJG Z\GK \M[GPP LB ,Z\GK FRG\P
NIH - III
Chronic Non-bacterial Prostatitis / Chronic Pelvic Pain
Syndrome (CP/CPPS)
F[YF CXPF FH .K\YNE LKNF\ NM IMGP GB ODEGP BN ,FH CXPC
:FR[P \GXGCY K\[N DGGSP BGFG NGVKJG QGICBN Z\GKC
NIH - III A
.
Inflammatory Chronic Pelvic Pain Syndrome
Q\[C (EPS) KJJSGZVF NHGRF \G[ZVFC OKJKXGYKGN BXPR FH CXPC
KVM GB (voided bladder urine) FJJSGZVF KGSKT ZIBN YVGPF
.Stamey KVN \GSGM 4 =C \GKCZ\C ,VB-3 ,FRGMP[
NIH - III B
.
Non-Inflammatory Chronic Pelvic Pain Syndrome
NM GB OKJKXGYKGN BGXPN QKBG K\YNE LKNF\N \GET NM QKB QBM
.TZHF NHGRC GB VB-3 =C ,EPS =C \YNEN \ZIB \GET
BN III FKZGDJYP OKNGIN ,II =G I \GKZGDJYP OKNGIC GPM BN[
KVM \KRGPZTF N[ OGFKH GB \KRGPZTC \GKPGFKH \GC[GP GBXPR
-CB OKKGRK[ .\GKNRGKXRCRGY \GKDGNGKCGZYKP \GYKRMJC TCYR[
-GBF OKRKKVBPF ORF (EPS) \KRGPZTF \G[ZVFC OKKNPZGR
.SKJKJJSGZV N[ III FKZGDJY N[ OKKRG[BZF OKKCKJYKKC
.KCKJYKKCGB OGJVPKS GZYKTC GRF ,(chronic
pain)
QGNY[B ,KNKHZC KBGVZ HMZP
FPE YF
KVM ,GB (Chronic Prostatitis - CP) \KRGPZTC \KRGZM \YNE
Chronic Pelvic) CBGEF QDBF \RGPS\ ,OGKM CXPN SIKK\FN OKJGR[
.EGBP FIKM[ FTVG\ FRF ,(Pain Syndrome - CPPS
.FN OKSIKKP OKDGNGZGBF CGZ[ UYKFFP Z\GK NGED FVYKF
OKDGNGZGBN OKZGYKC 13,000,000 LG\P ,C"FZBC FTXGC[ FZKYSC
FZKYSC .\KRGPZTF \GYNE TYZ NT OKZGYKCM GIGGE 5.3% ,FBVZPC
KM BXPR ,C"FZB ,FJGSRKPC 1996=1992 OKR[F QKC FTXGC[ \VSGR
\K\YNE FNIP N[ FRICB TYZ NT QRF OKBVGZN \GKRVF NNMP 11%
.\KRGPZTC
(incidence) \GTZBKF KZGTK[ NT GIGGKE FVGZKBC \GVSGR \GEGCT
\GCK[IN ZCTP FCZF ,Z\GK OKFGCD (prevalence) \GBXPKFG
.FNIPN OKSIKKP OKDGNGZGBF[
FZGXC B[GRF \B HMZN \GRGZIBF OKR[C JNIGF \BH ZGBN
FNIPN \G[KDF ,OKPGJVPKSF N[ NGEDF QGGDPF N[C \BHG \ZYGCP
OKD[GPF OKMGPRF FINXFF KHGIB ZGBN EIGKPCG ,OKNGVKJFG
OKDGNGZGBF N[ GH \GRDZB\F .F\T ET OKIGGEPF OKRG[F OKNGVKJC
\GBXG\ \D[FC QFG GRGICBC QF ,FH WGVR B[GR OEYN KEM FBC
Chronic :BZYR 1997 \R[C ESGR[ UGDF .Z\GK \GCGJ \GKNGVKJ
.Prostatitis Collaborative Research Network (CPCRN)
:ORF FH ZYIP UGD DKFRF[ OK[GEKIF KR[
KRGZM CBM
OKMKK[ SKJKJJSGZV OT OKNGIF N[ NGEDF CGZF ,ZTXF FCZPN
.III FKZGDJYN
.SKJKJJSGZVF N[ (Classification) [KEI DGGKS .1
= FRGMPF,OKRGGDPFG OKCZF OKPGJVPKSN EKIB SYERKB \DFRF .2
N.I.H - CPSI: The USA National Institutes of Health -
.Chronic
Prostatitis Symptom Index
NIH - IV
[EIF DGGKSF
Asymptomatic Inflammatory Prostatitis (AIP)
OKBXGP LB ,FNGIF NCGS OFP OKPGJVPKS NM QKB FH FZYPC
\ZDSPC \KRGPZTF \PYZC GB \GKJJSGZVF \G[ZVFC OKJKXGYKGN
CGZN OKNGI N[ GH FXGCY .SKJKJJSGZVP \GZIB \GTZVFC ZGZKC
.OFC NVJN LZGX [K EKP\ BNG FKTC FGGFP FRKB
NIH - Chronic Prostatitis Symptom Index (NIH-CPSI)
N[ OKCG[IF OKCKMZPF \[GN[ \B F[TPN EEGP FHF SYERKBF
:OKNGIF OKNCGS OFP \KRGZM SKJKJJSGZV
27
N.I.H
Prostatitis
= FRGMPF F[EIF FKXYKVKSNYF QNFN
:Classification
NIH - I
Acute Bacterial Prostatitis
5% =M \RKKVBP F[TPN Z[B \KRGPZTF N[ FVKZI \YNE
\GSIKK\FFG NGVKJF OFKCDNG ,SKJKJJSGZVP OKNCGSF OKZCDFP
NGVKJN CJKF FCKDP FNIPF ONXBG OKIKNXP CGZN \NCGYPF
.OKB\P KJGKCKJRB
OKRGMETG OK[GEKI FKDGNGZGB
.G\GZKE\G ,G\PXGT ,GPGYKP \B NNGM ,CBM
.OKKCKJYGZJSCGB GB OKKCKJJKZKB = FR\[FC OKPGJVPKS
.FNGIF N[ GKKI \GMKB NT \RGPS\F N[ JYVPKBF :OKKIF \GMKB
:EZVRC LZTGP OKCKMZPFP EIB NM
Score - For Pain
0-21
For Urinary Domain
0-10
For Impact on Quality of Life
0-12tpb 2
TOTAL
0-43
\TV[FG OKNGI \GXGCY QKC \GG[FN BC SYERKBF F[TPN
\GXGCYC ZGVK[F ZIB CGYTNG clinical trials =C OKRG[F OKNGVKJF
.\GRYSP \YVFG QFKRKC FBGG[F LZGXN \GPGE OKNGI
\KJSGRDBKE FMZTF
:GH FZGXC OKKJSGRDBKEF OKRICPF \B DGGSN Q\KR
NMC \G[TKFN FMKZXG FCG[I ,(Basic Evaluation) \KSKSC FMZTF .1
.FNGIG FNGI
FKTCF \ZEDFN \XNPGPF ,(Further Evaluation) \VSGR FMZTF .2
.OKNGIF NMC FCGI FRKB NCB ,NGVKJ NT FXNPFG
QBM .(Evaluation in Selected Patients) OKZICR OKNGI N[ FMZTF .3
,\KSKSCF FMZTFC \GNGTF \GE[I ZGYIN BKF FMZTFF \ZJP
QGICB ,\B[ \NKN[N ZGZKC \CKKIPF FEG[I FKDGNGJKX N[PN GPM
GB FBKZGRGDN OKKCGKI FMVG[FP OKIJ[P GB ,\K\PKSI FTZVF
.YVYGVP KRKP TDP N[ KJSRPRB ZGVKS OT OKZCDC FKEKPNY
Chronic Pelvic Pain OT OKNGIF N[ FMZTFF \B OMSN Q\KR
.1 FNCJC Syndrome
NIA - Category I \KRGZMG FVKZI SKJKJJSGZV
\GMKZX \GSGM 4 =C \GKCZ\ .\GTGC[ 6=4 \GIVN N[ L[GPP QPHN
.OGFKHF ZGDKP \B IKMGFN \RP NT ,NGVKJF OG\C CG[ \G[TKFN
CP/CPPS =N K\YNE=KJRB NGVKJ
KNGIC KJJSGZVF NHGRC OKRCN OE KB\ \BKXP ZGTK[
.50% CGZKYC BGF CPPS
\KRGPZTF \G[ZVFC OKJKXGYKGN \BKXP[ [IPGF BN QKKET
\BKXP=KB \PGTN ,NIH Category III/A =C OKNGI \XGCYC
,TZHC GB \KRGPZTF KGSKT ZIBN \KRGPZTF \G[ZVFC OKJKXGYKGN
\NTC FKXPZGVRKB FGGFP ,NIH Category III/B \XGCYP OKNGIC
B[GR ,ONGB .FHGRDGZVF \B GB NGVKJF \B QGGMN FNGMKF \GTP[P
KJJSGZVF NHGRC \GRCN OE \GKZGEM \BKXP KM BGFG [KDEFN [K EIB
.\YNE OGKYN QKPB KMF (marker) QPSF GRF (EPS)
TZHC OKZCDGP OKK\YNE OKRKYGJKX KM OKIKMGP OK[EI OKZYIP
CP/
OKRGMETG OK[GEKI FKDGNGZGB
NGVKJC [P\[FN [KG NCGYPM \NVGJP \GKFN FMKZX FNIPF
OKZK[M\F .\KPGV LZEC GB EKZGGF LZE FYKJGKCKJRB N[ KZKVPB
OKRGNGRKGGYGZGBGNV :ORF [GPK[N OKNCGYPF OKKGXZF OKKJGKCKJRBF
.Beta Lactam =F \XGCYP \GYKJGKCKJRB GB/G
OB\FC Q\RKFN OKMKZX OKKJGKCJRBF OKZK[M\F L[PFC
KVN QMG Q\[F GB OEF \GKCZ\P OKEEGCPF OKRDG\VF N[ \G[KDZN
KPGV NGVKJ .KRKNYF ZGVK[FG GCXP ,FNGIF N[ \KRKNYF FCGD\F
\GTGC[ 4 L[PN NGVKJF \B OKN[FNG Q\RKFN CKKI FYKJGKCKJRBC
.\GIVN
\KNBKZJYC \KRGZM SKJKJJSGZV
NIA - Category II
K"T \RICGBP \GKFN \CKKI \KNBKZJYC \KRGZM \KRGPZT \YNE
\KVGYSGZYKP FRGP\ QMG (Localization Culture) \GSGM 4=C \GKCZ\
\BHF \YNEC NVJN FCGI .(EPS) \KRGPZTF \G[ZVF N[
\G[KDZ KV NT \ZICRF \KPGV LZEC ,FGCD QGRKPC FYKJGKCKJRBC
.\GRG[F \GYKJGKCKJRBN NNGIPF
G\\N [KG Z\GKC NKTKF GRF CGZN OKRGNGRKGGYGZGBGNVC NGVKJF
28
OKNGIN KM \GTKCXP \GPKKGSP \GEGCT .NIH Category III/B DGSP
EDRM OKRGGMPF OKKNBKCGZYKPKJRB OKZK[M\ \\N [K GH FKZGDJYP
\\N NCGYP QMN .(uncommon organisms) OKK\ZD[ K\NC OKRDG\V
K\ZD[ K\NC NNGIP BXPR OBG ,OKPK OKKTGC[N GNB OKZK[M\
FTCZB ET OKKTGC[ EGT \GIVN OKZK[M\F Q\PC LK[PFN ,\GKCZ\C
KEP FMGZB FVGY\N KNBKCGZYKPKJRB ZK[M\ \\N KGXZ BN .\GTGC[
FEKPT FZGNV NGEKDP FBXG\M YHR \PKZDN NBKXRJGVF N[C
.OGKM OKNCGYPF OKZK[M\N
CP/CCPSKPSGIC
[GPK[F
=C NGVKJM BVNB
OKV\\[P KCZ OKPGSZV QKB
\KTP[P=EI OKEKTPF OKZYGCP
BVNB KPSGIC NGVKJF \GNKTK NT
LB
,SKJKJJSGZVF
\NIPC
BN OKIGGKEG OKZYP OKPSZV\P
GH NGVKJ \ZGXC OKMPG\F OKJTP
\KTEP FIMGF QKKET QKB[ \GZPN
.BVNBF KPSGI \GNKTKC \MPG\F
OKC[IR QKKET GNB OKNGVKJ[ LM
OGKMG OKNCGYP LB OKKZKVPBM
OKNGMK BVNB KPSGI[ OMSGP
YNIM NKTGP EKYV\ YI[N
SKJKJJSGZVC
NGVKJFP
.III/B GB NIH III/A FKZGDJYP
B[GRC FNGED \KZYIP FEGCT
BN QKKET LB ,\TM \NFR\P
\GP[Z\F .\GBXG\F GPSZGV
FRF \GRG[F \GEGCTC OKZYGIF
OKNGIFP YNI KCDN \KCGKI
.OKNVGJPF
OKTE \GPKP\ QKB ,QM GPM
NNMN FH NGVKJ \\N [K OBC
OKNCGSF GNBN YZ GB OKNGIF
LB ,FR\[FC \K\PKSI FTZVFP
KPSGIC NGVKJ SZGY KM NCGYP
GRF \GTGC[ 18=12 L[PN BVNB
CGZ NT NCGYP BGFG KRGKDF
.B[GRC OKZYGIF
OKNGVKJ
SKJKJJSGZVN OKKNYKHKV
CP/CPPS
N[ FKDGNGKHKVG\VF
NKCYPC .FKE \RCGP FRKB FZYKTC
-G OKYEKKI OKFHPF OKZYIPN
,OFKRKPN OKK\YNE=KJRB OKNGVKJ
FKTCF [ZG[ \B BGXPN OKSRP
OKRG[ OKKNYKHKV OKNGVKJ K"T
CP/CPPS
29
\GKVX\G FEKPC .CPPS OT OKZCDC (EPS) \KRGPZTF \G[ZVFCG
\GCJF KM GIKMGKG OGKM OKTXGCPF OKZYIPC G[PP\K GNB \GRG[BZ
OKRKYGJKXF \PZ \EKZK OT FKXNZGYC \GBXPR \GKJPGJVPKS
.[KDZ EGBP KJSGRDBKE QPS GGFK OF HB ,OKK\YNEF
OKKZGJPNVRKB-KJRB
OKZK[M\[
FBZP
KRKNY
QGKSKR
KJPGJVPKS ZGVK[N \GIVN OKPZGD (NSAID) OKKEKBGZJS=NB
FTV[FF OBC \TEN QKBG ,CP/CPPS OT OKCZ OKNGIN ,KRPH GNKVBG
.\KJDNRB GB \K\YNE=KJRB FRF
NGMK \NCDGP FVGY\N FHM NGVKJ
\B IGM[N QKB LB ,YEXGP \GKFN
.GNB OKZK[M\ N[ KBGGNF \GTVG\
FVGY\N GNB OKZK[M\ \\N QKB
SSCN KGXZG \GTGC[ 4 NT FNGTF
NT NSAID = F \VGZ\ Q\P \B
\GBXPKF GPM \YNEN \GET
KCBM GB EPS =C OKJKXGYKGN
.QDBF \VXZC \G[KDZG OKZKZ[
\GEGCT N[ QJY ZVSPC
ZVSP KM BXPR \GKGG[MT
=F
DGSP
OKZK[M\
FCJF OKBZP Phytotherapies
NT QM\K ,CP/CPPS OT OKNGIC
\GK\YNE=KJRBF OFK\GRGM\ TYZ
KCMTPM GB \GKJREKSYGB=KJRB GB
.Nitric Oxide
ZK[M\C
FNGTVF
QGRDRP
QM\K LB TGEK GRRKB Cernilton
Cyclooxygenase =M NTGV BGF[
.YNI ZKZ[ FVZPM GB Inhibitor
NGVKJ
=F KNGIC KNBKCGZYKPKJRB
CP/CPPS
KBVGZG OKDGNGZGB FCZF
\KRKJGZ FZGXC OKP[GZ FIV[P
OKKNBKCGZYKPKJRB
OKZK[M\
CP/CPPS OT OKTKVGPF OKNGIN
OCXP N[ \K\GTP[P FMZTF BNN
OKPKKY OBF ZGZKCN FYKEC BNNG
.\YNE KRPS
KM FBZPF \GZVS [K
OKKNBKCGZYKPKJRB
OKZK[M\
NIH Category =C OKNKTK ORF
Prostatitis
FEGCT
.III/A
FH B[GRC \ZYGCP \KHMZP=CZ
QKKET QKB LB ,FHF QPHC \TXC\P
.FK\GBXG\ NT OKRG\R NM
OBF \GTE KYGNKI OKPKKY
OKKNBKCGZYKPKJRBF OKZK[M\N
Prostatitis NT KF[NM FTV[F [K
OKRGMETG OK[GEKI FKDGNGZGB
ORKB OKZHGI OKNGVKJG EGBP OKM[GPP OKNGVKJ .Q\[F OZH
\GTVG\N [[IF OG[P \BHG ,OKEIGKP OKZYPC JTPN ,OKXNPGP
NGVKJN OKEKPT OKPHKRDZGBGZYKP \ZKXKN QMG \GVGZ\F N[ KBGGN
.ZYGCP BN KJGKCKJRB
,OKNGVKJ QGGDPN WGZV FKF F[TPN FHF LCGSPFG WGVRF F[GRF
BN[ YZ BN OTV BN[ OKKRJNZ[ OKNGVKJN ET OKNKTKG OKKRGKDFP
GTKRF B[GRN \GTEGPFG F[EIF \GBKXPF QMN .GYKHF UB BNB GNKTGF
:FBCF FZGXC \BHG CXPF ZGVK[N QDZB\FN \KBGVZF FZCIF \B
GPM OKKNYKHKV OKNGVKJ N[ OKZYGCPG CJKF OKRRMG\P OKZYIP *
.YCEKVGKC GB Trigger Point Therapy ,FZGJYRGVGYB
(Microwave) GZYKPF KNDC NGVKJ NT OKKHMZP=CZ OKZYIP *
.KJZERJS NGYGJGZV KVN OKTXGCPF
NGNMK[ OKZYGCP OKKZGJPNVRKB=KJRB OKZK[M\C KNGVKJ ZYIP *
GB cytokines GPM OKK\YNE=KJRB OKRPS K"T NGVKJF \MZTF
.OKJKXGYKGN
G J K VF K Z K [ M \ C N G VK J N T O K Z Y G C P O K KH M Z P = C Z O K Z Y I P *
.Quercetin GB Saw Palmetto Cernilton GPM OKKZNGVGVF
ZGZKC ZGCTN OKCKKI OKZYGCP OKZYIPC GNNMKK Z[B OKNGIF NM
OKCZ OKXPBP .NIH Criteria =F KVN DGGKS ZGCTNG OCXP N[ YEYGEP
pilot) [G[KD KZYIP \GTXPBC serum markers \BKXPN OK[TR
QGICB LZGXN ,Z[VBF NMM OKNKTK OKRPS Z\BN \RP NT (studies
OKKIF \GMKBC ZGVK[N SIKK\FN CKKI NMF[ QCGPMG FNIPF ZGJKRG
.FNIPFP EGBP \TDVRF
QCGPMG FNI[ KBGVZ LVFP \PZC \KR[EIF \GI\V\FF ZGBN
BNF EK\TC FBZR GRB = FH B[GRC OKZMKR OKCB[P \BXYF \GTXPBC
\B OXPXNG FKTCFP YNI \GIVN ZDPN GIKNXK Z[B OK[GEKI YGIZ
.FVYKF
\GZGYP
1.
Schaeffer A. J. Chicago, USA. Weidner Gressen Wolfgang
Germany. EAU Supplement Vol 2 No 2, March 2003, pp 142.
2.
Stamey T. Urinary tract infections in males. In Stamey T,
eds: Pathogenesis and Treatment of Urinary Tract Infections.
Williams and Wildins, eds, Baltimore USA, 1980, pp 342429.
3.
Krieger JN, Nyberg Jr. NIH Consensus Definition and
Classification of Prostatitis. JAMA 1999;282;236-7.
OKRGMETG OK[GEKI FKDGNGZGB
YCEKVGKC ,OEF \PKZH ZGVK[ ,GZYKP KND ,OGPKI QGDM OKKR[EIG
\GKZGBK\ QGGDP NT OKSSC\P FNBF OKNGVKJF .'GMG \KCXT FNIPN
\NYFN OKRG[ OKTXPB OKGGFPG FNIPF N[ FKDGNGKHKVG\VF N[
.CXPF
NT \GZYGCP \GEGCT OGKM OKRRM\P ,GNB OKNGVKJ LKZTFN KEM
\GSIKK\P GNB \GEGCT .GCRKB \GXGCYN GG[GK[ NGVKJ \GXGCY
FKVZF ,stress =C FJKN[N NGVKJ ,Bio-feedback DGSP OKNGVKJN
OK[INBP OKZPGI \YZHFG FZGJYRGVGYB ,\KCKSZDGZV \KZKZ[
FNBM OKNGVKJC OKEEXP OKJTP BN OKIGGKE .Pain Clinic \ZDSPC
GMKZTK[ OKZYGCPF OKZYIPF ZPDC Q\RK\ FCG[\F LB ,OKZIB GB
NVJN [K \GRG[F \GKZGDJYF LG\P OKZYP GNKBCG FINXFF ZGTK[ \B
QRKBG \GIGJC GNB \GNGTV OBC LKZTFN [K ,QM GPM .\ZIB GB LM
.\GZIB \GPYZC YHRN \GPZGD
No Treatment - NGVKJ BNN
=F \XGCYP OKNGI O\GBC NVJN QKB[ NCGYP
,OKK\ECTPF OKBXPPN \GSIKK\F BNN ,OKKJPGJVPKSB ORF[
.\YNE OKIKMGPF OKK\ECTPF GB OKKDGNGJKXF
Z[BM YZ KVKXVS NGVKJC LZGX [K FNBM OKKJPGJVPKSB OK[RBC
GB Neisseria Gonorrheal GPM ,OKNNGIP N[ KVKXVS QGGDP OKKY
ZSGI \GZPN FNB OKNNGIPP ONT\FN QKB .Chlamidia Trachomatis
.OKPGJVPKSF
OT OKZCDC KJGKCKJRB K\YNE=KJRB NGVKJ \\N YEXGP QM GPM
OB .PSA NT ZGHIN ,NGVKJF OGKSCG \YNEN E[IG \ZCDGP PSA \PZ
\GKSVGKC TXCN LKZX BN NGVKJF ZIBN OKEZGK PSA=F KMZT
.ECNC CYTPC LK[PFN [KG \KRGPZTFP
NIH Category IV
EK\TC OKYVGBF
\GJNIFC LGP\N OKNGMKF OKJTP OKRG\R YZ [K GK[MTN QGMR
[GVKI LG\P .CP/CPPS SKJKJJSGZVF \NIPC \GKRGKDF \GKNGVKJ
,OTVP Z\GK OKBVGZ OKVKNIP CGZN OKNGIF ,OFKCGBMPN ZGHP ZIB
OKNGI JTP BN .KVGS QKB JTPM OKNGVKJ QGGDP OFN OKTKXP GNNFG
NT ZGZC BNG FCJF [K OK\TNG ,GFR[PN EIB KNGVKJ ZJ[PP OKZCGT
.FCJFF FPZDR FP TYZ
GPM KGG[MT SGSRXRGY OKGGFPF ,ECNC OKNCDGP OKIGGKE OKPKKY
SIKK\P FHG ,\GIV BNG \GTGC[ 6=4 QKC FVGY\N KJGKCKJRB NGVKJ
NM = BVNB KPSGI ,NSAID KZK[M\N ,OKKNBKCGZYKPKJRB OKZK[M\N
KNC GB OT (reasonable options) OKKRGKDF OKNGVKJN OKC[IR FNB
\PXGTC FEKZK GB \GKCGKI \GKCZ\ \[IPF ,\YNE \GBXPKFN FIMGF
30