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Kronisk prostatitt eller bekkensmertesyndrom

Sist revidert:
Sist revidert av:


Definisjon:
Kronisk prostatitt eller bekkensmertesyndrom er et klinisk syndrom definert primært ut fra urologiske symptomer og/eller smerte eller ubehag i bekkenregionen
Forekomst:
Prevalens varierer mellom 2-10%
Symptomer:
Mest typiske symptomer er smerter eller press lokalisert i perineum eller bak symfysen. Smertene stråler ofte ut til skrotum, penis, lyske, rygg eller mage
Funn:
Den fysiske undersøkelsen er som regel normal
Diagnostikk:
Aktuelle undersøkelser er dyrkning av urin, ev. CRP
Behandling:
Ikke alle behøver medikamentell behandling. Mest aktuelt er kombinasjon av alfablokker og antibiotika
  1. Pontari M. Chronic prostatitis/chronic pelvic pain syndrome. UpToDate, last updated Feb 20, 2018. UpToDate  
  2. Sandhu J, VIncent HY. Recent advances in managing chronic prostatitis/chronic pelvic pain syndrome. F1000Res. 2017 Sep 25;6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5615772/
  3. Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA 1999; 282:236. Journal of the American Medical Association  
  4. Suskind AM, Berry SH, Ewing BA, Elliott MN, Suttorp MJ, Clemens JQ. The prevalence and overlap of interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome in men: results of the RAND Interstitial Cystitis Epidemiology male study. J Urol. 2013;189(1):141–145.
  5. Nickel JC, Shoskes D, Wang Y, et al. How does the pre-massage and post-massage 2-glass test compare to the Meares-Stamey 4-glass test in men with chronic prostatitis/chronic pelvic pain syndrome? J Urol. 2006;176(1):119–124.
  6. Propert KJ, McNaughton-Collin M, Leiby BE et al. A prosepctive study of symptoms and quality of life in men with chronic prostatitis/chronic pelvic pain syndrome: The National Institutes of Health Chronic Prostatitis Cohort Study. J Urol 2006; 175: 619-23. PubMed  
  7. Schaeffer AJ. Editorial: Emerging concepts in the management of prostatitis/chronic pelvic pain syndrome. J Urol 2003; 169:597. PubMed  
  8. Nickel JC, Roehrborn CG, O'leary MP, et al. Examination of the relationship between symptoms of prostatitis and histological inflammation: baseline data from the REDUCE chemoprevention trial. J Urol 2007; 178:896. PubMed  
  9. Anderson RU, Orenberg EK, Morey A, et al. Stress induced hypothalamus-pituitary-adrenal axis responses and disturbances in psychological profiles in men with chronic prostatitis/chronic pelvic pain syndrome. J Urol 2009; 182:2319. PubMed  
  10. Nickel JC, Roehrborn CG, O'Leary MP et al. Examination of the relationship between symptoms of prostatitis and histological inflammation. J Urol 2007; 178: 896-901. PubMed  
  11. Sharp VJ, Takacs EB, Powell CR. Prostatitis: diagnosis and treatment. Am Fam Physician. 2010;82(4):397–406.
  12. Cai T, Wagenlehner FME, Mondaini N, et al. Effect of human papillomavirus and Chlamydia trachomatis co-infection on sperm quality in young heterosexual men with chronic prostatitis-related symptoms. BJU Int. 2013 May 23. doi:10.1111/bju.12244 DOI  
  13. Meyrier A, Fekete T. Chronic bacterial prostatitis. UpToDate, last updated Feb 12, 2014. UpToDate  
  14. Højkjær Larsen E, Frimodt-Møller C. Prostatitis - pelvic pain syndrome. Ugeskr Læger 2007; 169: 1921-3. PubMed  
  15. Rodríguez MA, Afari N, Buchwald DS, National Institute of Diabetes and Digestive and Kidney Diseases Working Group on Urological Chronic Pelvic Pain. Evidence for overlap between urological and nonurological unexplained clinical conditions. J Urol 2009; 182:2123. PubMed  
  16. Walz J, Perrotte P, Hutterer G, et al. Impact of chronic prostatitis-like symptoms on the quality of life in a large group of men. BJU Int 2007; 100:1307. PubMed  
  17. Sönmez NC, Kiremit MC, Güney S, et al. Sexual dysfunction in type III chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) observed in Turkish patients. Int Urol Nephrol 2011; 43:309. PubMed  
  18. Müller A, Mulhall JP. Sexual dysfunction in the patient with prostatitis. Curr Urol Rep 2006; 7:307. PubMed  
  19. Schaeffer AJ. Etiology and management of chronic pelvic pain syndrome in men. Urology 2004; 63:75. PubMed  
  20. Holt JD, Garrett WA, McCurry TK, Teichman JMH. Common questions about chronic prostatitis. Am Fam Physician. 2016 Feb 15;93(4):290-296. .
  21. Krieger JN, Ross SO, Limaye AP, Riley DE. Inconsistent localization of gram-positive bacteria to prostate-specific specimens from patients with chronic prostatitis. Urology. 2005;66(4):721–725.
  22. Rees J, Abrahams M, Doble A, Cooper A; Prostatitis Expert Reference Group (PERG). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int. 2015;116(4):509–525.
  23. Nickel JC, Ardern D, Downey J. Cytologic evaluation of urine is important in evaluation of chronic prostatitis. Urology. 2002;60(2):225–227.
  24. Magistro G, Wagenlehner FM, Grabe M, et al Contemporary Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome. Eur Urol. 2016 Feb;69(2):286-97. Epub 2015 Sep 26. pmid: 26411805 PubMed  
  25. Zhang R, et al. Physical activity and chronic prostatitis/chronic pelvic pain syndrome. Med Sci Sports Exerc. 2015;47(4):757–764.
  26. Anothaisintawee T, Attia J, Nickel JC, et al. Management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis. JAMA 2011; 305:78. Journal of the American Medical Association  
  27. Alexander RB, Propert KJ, Schaeffer AJ et al. Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: a randomized, double-blind trial. Ann Intern Med 2004; 141: 581-9. Annals of Internal Medicine  
  28. Nickel JC, Downey J, Clark J et al. Levofloxacin for chronic prostatitis/chronic pelvic pain syndrome in men: a randomized placebo-controlled multicenter trial. Urology 2003; 62: 614-7. PubMed  
  29. Dalhoff A, Shalit I. Immunomodulatory effects of quinolones. Lancet Infect Dis 2003; 3:359. PubMed  
  30. Perletti G, Marras E, Wagenlehner FME, Magri V. Antimicrobial therapy for chronic bacterial prostatitis. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD009071. DOI: 10.1002/14651858.CD009071.pub2. DOI  
  31. Franco JVA, Tirapegui FI, Turk T, Garrote V, Vietto V. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome (Protocol). Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD012551. DOI: 10.1002/14651858.CD012551. The Cochrane Library  
  32. Wenninger K, Heiman JR, Rothman I, Berghuis JP, Berger RE. Sickness impact of chronic nonbacterial prostatitis and its correlates. J Urol 1996; 155: 965-8. PubMed  
  • Terje Johannessen, professor i allmennmedisin, Trondheim

Tidligere fagmedarbeidere

  • Dag Berild, overlege, Medisinsk klinikk, Aker Sykehus
  • Svein Z. Bratland, spesialist i allmennmedisin, Sandviken Legesenter, Bergen, og seniorrådgiver i Statens helsetilsyn, Oslo
  • Per Inge Lundmo, overlege Kirurgisk klinikk, Urinveissykdommer, RiT og førsteamanuensis Norges teknisk-naturvitenskapelige universitet, Trondheim