【作者】 刘龙飞；

【导师】 杨金瑞；

【作者基本信息】 中南大学 ， 外科学， 2010， 博士

【摘要】 在20世纪,前列腺炎(Prostatitis)通常指的是感染所致的前列腺炎症。本世纪,前列腺炎通常指的是慢性盆腔疼痛综合征,而炎症的存在及前列腺的受累与否并不确定。前列腺炎是泌尿外科最常见的疾病,发病率约为3%-16%。尽管前列腺炎不会对患者的生命造成直接威胁,但它严重地影响了患者的生活质量,尤其是患者的身心健康。临床上许多医生在诊治前列腺炎的过程中感到棘手；绝大多数患者对治疗效果不满意；医生及患者都经历过明显的挫折与失望。同时,前列腺炎给患者及社会造成了巨大的经济负担。前列腺炎的病因错综复杂,各种假说众说纷纭,而其确切的病理生理机制仍未被阐明。这严重滞后了前列腺炎治疗学的发展。目前泌尿外科医师根据前列腺炎各种可能的病因及发病机制,尝试将各种各样的药物及方法应用于前列腺炎的临床治疗之中。然而,治疗效果仍不能让人满意。而治疗药物及治疗方法的繁复多样,更加反映了其病因及发病机制的复杂性及泌尿外科医师在诊治过程中所表现出来的困惑及无奈。若能找到前列腺炎发生的根本原因,毫无疑问将给前列腺炎的诊治带来新的希望。疼痛是前列腺炎最常见及最主要的症状,也是影响患者生活质量及患者就诊的主要原因。然而,前列腺炎疼痛的发病机制尚未被阐明。其中一个重要的原因就是缺乏合适、可靠的前列腺炎诱导的疼痛或前列腺痛动物模型用于其发病机制的研究。本课题分为三部分：第一部分通过λ-角叉菜胶前列腺内注射建立SD雄性大鼠非细菌性前列腺炎及前列腺炎性疼痛动物模型,并从行为改变、组织学、COX2表达及血浆蛋白质渗漏等方面综合评估该模型的有效性及可靠性。第二部分通过检测前列腺组织中的氧化损伤及抗氧化标记物,评估氧化应激加剧及氧化损伤在λ-角叉菜胶所致非细菌性前列腺炎及前列腺炎性疼痛发生、发展中的作用。第三部分评估抗氧化剂N-乙酰半胱氨酸对λ-角叉菜胶所致的非细菌性前列腺炎及前列腺炎性疼痛的保护作用。通过这三部分的研究,明确氧化应激加剧及氧化损伤在前列腺炎及前列腺炎性疼痛发生、发展中的作用,并分析氧化应激参与前列腺炎疼痛病理生理过程的可能机制,最终探讨抗氧化治疗在前列腺炎性疼痛的作用。目的：建立大鼠非细菌性前列腺炎及前列腺炎性疼痛模型并对模型的有效性进行评估,为后续对男性慢性盆腔疼痛综合征发病机制的深入研究提供一个可靠的实验载体。方法：实验组(n=20)：分别向成年雄性SD大鼠前列腺左右腹侧叶注射3%λ-角叉菜胶50μl。在λ-角叉菜胶注射24h(n=6)或7天(n=6)后评估大鼠的行为改变,取出前列腺组织检测其组织学改变及COX2蛋白表达的变化。将Evans blue(50mg/kg)静脉注射至大鼠体内,评估λ-角叉菜胶前列腺内注射24h(n=4)或7天(n=4)后血浆蛋白质渗漏情况。对照组(n=20)：分别向雄性SD大鼠前列腺左右腹侧叶注射等量灭菌生理盐水,余同实验组。结果：λ-角叉菜胶前列腺内注射24h后能够诱导SD雄性大鼠发生显著的行为改变：闭眼、活动力下降,和前列腺组织的炎症改变：炎症细胞聚集、COX2表达增加,及血浆蛋白质渗漏增加。λ-角叉菜胶前列腺内注射7天后,大鼠的疼痛行为、前列腺组织的炎症改变及血浆蛋白质渗漏均未消除。实验组与对照组相比,各项指标的差异均有统计学意义(P<0.05)。结论：λ-角叉菜胶前列腺内注射能够诱发神经源性前列腺炎及前列腺炎性疼痛。这个新的模型可望成为研究男性慢性盆腔疼痛神经机制的有用工具。目的：探讨氧化应激加剧及氧化损伤在λ-角叉菜胶致大鼠前列腺炎性疼痛中的作用,并分析氧化应激参与前列腺炎性疼痛病理生理过程的可能机制。方法：实验组(n=12)：分别向雄性SD大鼠前列腺左右腹侧叶注射3%λ-角叉菜胶50μl。λ-角叉菜胶注射24h(n=6)或7天(n=6)后取前列腺检测组织中酶性抗氧化水平(SOD、CAT及GSH-PX)、非酶性抗氧化水平(GSH)及脂质过氧化标记物(8-epi PGF2α)的水平。对照组(n=12)：分别向雄性SD大鼠前列腺左右腹侧叶注射等量灭菌生理盐水,余同实验组。结果：λ-角叉菜胶前列腺内注射能够诱导SD雄性大鼠前列腺发生脂质过氧化损伤(8-epi PGF2α↑).前列腺组织的酶性抗氧化水平及非酶性抗氧化水平均显著下降(SOD↓、CAT↓、GSH-PX↓及GSH↓)。λ-角叉菜胶前列腺内注射7天后,前列腺组织的抗氧化防御保护机制依然受抑制,氧化应激及氧化损伤依然存在。实验组与对照组相比,各项检测指标的差异均有统计学意义(P<0.05)。结论：λ-角叉菜胶所致非细菌性前列腺炎及前列腺炎性疼痛中存在氧化应激加剧及氧化损伤。本研究提示氧化应激可能参与了前列腺炎性疼痛发生、发展的病理生理过程。目的：目前,N-乙酰半胱氨酸(NAC)作为一种抗氧化剂广泛应用于多种疾病的基础研究及临床治疗中,而其对前列腺炎及前列腺痛的作用尚不清楚。本研究旨在探讨NAC对λ-角叉菜胶所致大鼠非细菌性前列腺炎及前列腺炎性疼痛的干预作用。方法：实验组(n=10)：向雄性SD大鼠腹腔注射NAC(300mg/kg), Qd×7。NAC最后一次注射1h后在前列腺内注射3%λ-角叉菜胶建模。建模成功24h后,随机取6只大鼠,对其行为改变、前列腺组织的炎症细胞、COX2蛋白质表达以及氧化应激的相关生化指标(SOD、CAT、GSH-PX、GSH及8-epi PGF2α)进行检测。其余4只大鼠用于评估Evans blue渗漏。对照组(n=10)：建模前腹腔注射1.5ml等量灭菌生理盐水,Qd×7,余同实验组。结果：NAC预处理能够显著降低λ-角叉菜胶诱导的大鼠行为改变、前列腺组织炎症细胞聚集、COX2表达及及血浆蛋白质渗漏。此外,NAC还能抑制λ-角叉菜胶诱发的前列腺组织脂质过氧化损伤(8-epi PGF2α↓),改善酶性抗氧化剂及非酶性抗氧化剂的活性(SOD↑、CAT↑、GSH-PX↑及GSH↑)。实验组与对照组相比,各项检测指标的差异均有统计学意义(P<0.05)。结论：NAC具有抗炎及止痛作用,且能抑制λ-角叉菜胶诱导的前列腺氧化应激加剧及氧化损伤。NAC可能是一种非常有前途的CP／CPPS的治疗药物。慢性前列腺炎(Chronic prostatitis, CP)是泌尿外科最常见的疾病,它反映了一个重要的世界卫生问题。总体来说,2%-10%的成年男性遭受CP症状,且约有15%的男性在其一生的某个时刻会遭受前列腺炎。在美国,前列腺炎每年的花费除了药费支出仍高达8400万美元。一些横断面调查研究发现CP往往伴随有生活质量的下降,其对患者的影响与心绞痛、充血性心衰、Crohn’s病及糖尿病类似。然而,CP通常被认为是医师及患者巨大困惑及挫折的来源。目前,国外有多项研究调查了临床医师,包括泌尿外科医师、全科医师及初级保健医师对CP的认知、态度及诊治行为的现状。这些研究表明,临床医师对CP的认知不足,对CP的诊治存在巨大差异。而中国泌尿外科医师对CP的认知及诊治行为的现状仍不是很清楚。此外,影响中国泌尿外科医师对CP认知及诊治行为的因素尚不明确。为此,我们就对CP的认知、诊断策略、治疗行为等情况调查了部分中国泌尿外科医师。本研究旨在为规范中国泌尿外科医师对CP的诊治行为提供参考。目的：了解中国泌尿外科医师对慢性前列腺炎(CP)认知与诊治行为的现状。方法：以问卷形式调查来自全国29个省、自治区及直辖市的656名泌尿外科专科医师。调查内容包括对CP病因的认识、诊断策略、治疗行为等。结果：收回有效问卷627份。多数医师(64.6%；394/610)认为非细菌感染为CP的病因。EPS检查(86.3%；535/620)为最常用的检查手段。57.4%(356/620)的医师常规行细菌培养,而单纯EPS培养(43.4%；260/599)为最常用的培养方法。仍有37.7%(225/597)的医师采用传统分类法。多数医师(66.6%；412/619)认为CP需要治疗。药物治疗(86.2%；538/624)、心理治疗(60.7%；379/624)、前列腺按摩(54.2%；338/624)及物理治疗(44.7%；279/624)为最常用治疗方法；抗生素(74.0%；455/615)及α-受体阻滞剂(60.3%；371/615)为最常用的治疗药物。最常用的抗生素为喹诺酮类(79.0%；480/608),其次为大环内酯类(45.7%；278/608)及头孢菌素类(35.2%；214/608)。多数医师认为细菌培养阳性(64.4%；351/545)或EPS中WBC/脓细胞较多(65.9%；359/545)时应使用抗生素。多数医师(70.3%；395/562)使用α-受体阻滞剂是基于解除CP患者的尿路梗阻症状。医师对病因的认识是医师诊断及治疗方法选择的影响因素；而诊断方法的选择又影响治疗方法及治疗药物的选择。结论：中国泌尿外科医师对CP病因的认识、分类、诊断与治疗等方面仍充满困惑；诊断及治疗行为仍需要进一步规范。需要深入对CP的研究并不断提高中国泌尿外科医师对CP的认知水平。目的：了解中国泌尿外科医师对慢性前列腺炎(CP)患者心理障碍认知及诊治行为的现状。方法：以问卷形式调查来自全国29个省、自治区及直辖市的656名泌尿外科专科医师。结果：40.8%的医师认为精神心理因素为CP病因；多数医师(71.8%)认为其为病因而非结果。48.5%的医师认为CP患者精神心理障碍的发生率在26%-50%之间；焦虑症(73.6%)、神经衰弱(63.5%)、抑郁症(53.7%)、疑病症(41.3%)为最常见的心身症状。分别有20.7%、60.7%的医师常规行心理学分析及心理治疗。认为精神心理障碍为CP病因的医师更趋向于行心理学分析及心理治疗,而行心理学分析的医师更常行心理治疗。仅23.5%的医师将CP常规治疗、心理治疗及抗精神药物综合应用于伴有心身症状的CP患者的治疗中。结论：中国泌尿外科医师对CP患者精神心理障碍的认知及诊治行为仍充满困惑。对CP患者的精神心理障碍的评估手段、治疗方法等方面仍需要深入研究。目的：分析中国泌尿外科医师在慢性前列腺炎(CP)诊治行为方面的影响因素,为规范临床CP诊治行为提供参考。方法：以问卷形式调查来自全国29个省、自治区及直辖市的656名泌尿外科专科医师。调查内容包括对CP病因的认识、诊断策略、治疗行为等。利用单因素及多因素logistic回归法进行统计学分析。结果：收回问卷656份,410份纳入单因素及多因素分析。多因素分析显示：是否认为细菌感染为CP病因(OR=2.544；95%CI=1.650-3.923；P=0.000)为医师行细菌培养检查与否的主要影响因素；大学医院与否(OR=2.799；95％CI=1.719-4.559；P=0.000)及采用四杯法或两杯法与否(OR=3.194；95％CI=2.069—4.931；P=0.000)是医师采用NIH新分类法与否的重要影响因素；是否认为细菌感染为病因(OR=3.415；95％CI=2.024-5.762；P=0.000).是否常规行细菌培养检查(OR=2.261；95％CI=1.364-3.749；P=0.002)为医师使用抗生素治疗与否的重要影响因素。结论：医师对CP的观念、医师的个人及专业特征可能是影响中国泌尿外科医师对CP诊治行为的重要因素。更多还原

【Abstract】 In the 20th century, the term "prostatitis" traditionally referred to inflammation in the prostate, often attributed to infection. Prostatitis in this century usually refers to a chronic pain syndrome for which the presence of inflammation and involvement of the prostate are not always certain. Prostatitis is one of the most common entities encountered in urologic practice, and its worldwide incidence ranges from 3%to 16%. Although prostatitis is not life-threatening, it is also associated with a significant negative impact on both mental and physical domains of quality of life. In clinic, urologists always experience confusion in managing this disease; the patients are always dissatisfied with the effect of various therapies as well. It is generally acknowledged as a source of great frustration and disappointment in physicians and patients alike. Moreover, prostatitis has resulted in substantial financial costs for the patient and for society.At present, many different theories and the mechanisms of pathogenesis of prostatitis including infectious, immunological, neurological, endocrine and psychological have been proposed but precise pathophysiology remains largely unknown, which seriously blocks the development of therapy for prostatitis. In clinic, although a serious of medicine and treatment options have been developed for prostatitis according to the probable mechanisms of symptom production or propagation, the therapy is always difficult and unrewarding. The wide scope of treatment options available just reflects the lack of knowledge around prostatitis. If the underlying, primary cause of prostatitis has been demonstrated, it will bring fresh hope to the diagnosis and treatment of prostatitis.Pain is the most common and important symptom of prostatitis, and is the principal cause for office visiting and negative impact on quality of life. The mechanism of pain development in prostatitis is poorly understood. This is mainly due to the lack of a suitable and reliable preclinical animal model of prostatitis-induced pain or prostatodynia.This study was divided into three part:Part 1, An animal model for nonbacterial prostatitis and prostate inflammation pain in rats was developed with the use of intraprostatic injection ofλ-carrageenan and the reliability and validity of this model was tested by a behavior approach, histology, C0X2 protein expression and plasma protein extravasation. Part 2, The role of increased oxidative stress and oxidative damage in the occurrence, development ofλ-carrageenan-induced prostatitis and prostatodynia was explored via testing the biomarkers of oxidative damage and antioxidative system. Part 3, The analgesic and anti-inflammatory properties of N-Acetylcysteine was tested in this model. Objectives:To develop an animal model for nonbacterial prostatitis and prostate inflammation pain in rats with the use of intraprostatic injection ofλ-carrageenan, and to test the reliability and validity of this model. The final goal of this research is to provide reliable animal model for identifying the mechanisms of chronic prostatic pain (prostatodynia).Methods:In experimental groups (n=20), a sterile suspension of 3%λ-carrageenan in a volume of 50μl each was injected into both right and left ventral lobes of the prostate gland in SD rats. The nociceptive effects ofλ-carrageenan were evaluated by using a behavior approach at 24 h (n=6) or 1 wk (n=6) after injection; then the prostate was removed for histology and cyclooxygenase2 (C0X2) protein concentration measurement. Evans blue (50 mg/kg) was also injected intravenously to assess for plasma protein extravasation at 24 h (n=4) or 1 wk (n=4) after injection of X-carrageenan injection. In the control groups (n=20) the same surgical procedures were followed and 50μl of sterile normal saline, instead of X-carrageenan, was injected into both the right and left ventral prostate lobes. Results:λ-carrageenan induced modifications in pain behavior: closing of the eyes, hypolocomotion, and inflammatory changes: increase of inflammatory cell accumulation, COX2 expression, and Evans blue extravasation at 24 h after injection, but not recovered at 1 wk.Conclusions:Intraprostaticλ-carrageenan injection induced neurogenic prostatitis and prostate inflammation pain. The current model is expected to be a valuable preclinical tool to study the neurobiological mechanisms of male chronic pelvic pain. Objectives:To investigate the role of increased oxidative stress and oxidative damage in prostate inflammation pain induced by intraprostaticλ-carrageenan injection in rats, and to explore its possible mechanism.Methods:In experimental groups(n=12), a sterile suspension of 3%λ-carrageenan in a volume of 50μl each was injected into both right and left ventral lobes of the prostate gland in SD rats. The enzymatic antioxidant defense levels:the superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-PX) activities, and the nonenzymatic antioxidant defense level:glutathione (GSH) content, as well as the levels of 8-isoprostane (8-epi PGF2α), indicative of lipid peroxidation, were examined at 24 h (n=6) or 1 wk (n=6) after injection. These studies were made in prostate homogenates of rats withλ-carrageenan-induced prostatitis and of control rats treated with sterile normal saline (n=12).Results:This study revealed a significant diminution of the SOD, CAT and GSH-PX activities, and the GSH content, and a significant increase of 8-epi PGF2αlevel in experimental SD rats induced by intraprostaticλ-carrageenan injection at 24 h after injection in relation to control rat samples(P<0.05). These oxidative stress-related parameters in prostate of rats withλ-carrageenan-induced prostatitis did not recovered at 1 wk.Conclusions:The findings suggest that there exist increased oxidative stress and oxidative damage in prostate inflammation pain induced by intraprostaticλ-carrageenan injection in rats. This study implies that oxidative stress may take part in the pathophysiological processes of the occurrence, development ofλ-carrageenan-induced prostatitis and prostatodynia. Objectives:N-acetylcysteine (NAC) has, in recent years, been widely used as an antioxidant in many basic researches and clinical therapies for a range of diseases. However, the role of NAC in prostatitis and prostate inflammation pain is uncertain. The aim of the current study is to examine the possible protective effect of N-acetylcysteine on prostate inflammation pain induced by intraprostatic X-carrageenan injection.Methods:Adult SD rats of experimental groups (n=10) were treated i.p. with NAC at a dose of 300mg/kg once a day for seven days. One hour after the last NAC injection,3%λ-carrageenan was injected into the ventral prostate. Behavioral changes of animals were assessed at 24 h afterλ-carrageenan injection; then the prostate was removed for histology, C0X2 protein concentration and oxidative stress-related parameters levels (SOD, CAT, GSH-PX, GSH and 8-epi PGF2a) measurement in 6 of the 10 rats. The rest 4 rats were used for assessing the Evans blue extravasation. In the control groups (n=10) the animals were pretreated i.p. with 1.5ml sterile normal saline instead of NAC and the same surgical procedures were followed. Results:Pretreatment with both NAC significantly reduced pain behavior, inflammatory cell accumulation, C0X2 expression, and Evans blue extraction. Moreover, N-acetylcysteine pretreatment caused a decrease in 8-epi PGF2αlevels and an increase in SOD, CAT, GSH-PX and GSH levels compared to control groups.Conclusions:Systemic NAC administration produces anti-inflammatory and analgesic effects and suppresses the increased oxidative stress and oxidative damage in prostate induced by intraprostaticλ-carrageenan injection. NAC may be a promising drug for treatment of CP/CPPS. Chronic prostatitis (CP) is one of the most common entities encountered in urologic practice and represents an important international health problem. Overall,2%-10% of adult men suffer from symptoms compatible with CP at any time and approximately 15% of men suffer from symptoms of prostatitis at some point in their lives. In the USA, the cost of prostatitis is approximately USD 84,000,000 annually, exclusive of pharmaceutical spending. In cross-sectional studies, CP is associated with reductions in patients’quality of life, similar to or greater than those associated with angina, congestive heart failure, Crohn’s disease and diabetes mellitus. However, CP is generally acknowledged as a source of great confusion and frustration for physicians and patients alike. Several surveys of physicians have been undertaken in order to examine the characteristics of their practice, attitude, diagnostics and treatment modalities applied in patients with CP. These surveys demonstrate that physicians show large deficits in familiarity with and knowledge of CP along with significant variability in their approaches to diagnosis and treatment. Yet, Chinese circumstances surrounding CP have not been clarified. To define the current spectrum of practice of the Chinese urologists, we initiated a comprehensive cross-sectional study to determine the current situation among the Chinese urologists on the diagnosis and treatment of patients with CP. Objective:To examine the philosophies and practices of Chinese urologists regarding the diagnosis and treatment of chronic prostatitis (CP).Methods:A sample of 656 urologists from 29 provinces (including autonomous regions and municipalities) of China were asked to complete a questionnaire that explored their practice characteristics about and attitudes towards prostatitis, and diagnosis and treatment patterns in the management of CP.Results:Of the 656 questionnaires sent,627 were included in the final analysis. Many urologists (64.6%; 394/610) considered CP to be non-bacterial in nature. For routine diagnosis assessment, the most commonly used tests were reported to be microscopic analysis of expressed prostate secretions (86.3%; 535/620) and bacterial culture (57.4%; 356/620). Most urologists (43.4%; 260/599) performed simple culture of expressed prostate secretions (EPS). More than one-third (37.7%; 225/597) of the urologists still employed the traditional classification system of chronic bacterial prostatitis, chronic nonbacterial prostatitis and prostatodynia. About two-thirds (66.6%; 412/619) of the urologists believed that CP needed to be treated. The first choice for therapy included pharmaceutical therapy (86.2%; 538/624), psychotherapy (60.7%; 379/624), prostatic massage (54.2%; 338/624) and physical therapy (44.7%; 279/624). Seventy-four percent (455/615) of the urologists chose antimicrobial agents as the first choice of therapy and these physicians tended to use fluoroquinolones (79.0%; 480/608), macrolides (45.7%; 278/608) and cephalosporins (35.2%; 214/608) for CP. Most urologists said they would prescribe antibiotics when bacterial culture was positive (64.4%; 351/545) or too many white blood cells or pyocytes (65.9%; 359/545) were present in EPS. The second most commonly used pharmaceutical therapy was alpha-blocker (60.3%; 371/615), which was prescribed to relieve the obstructive voiding symptoms by most urologists (70.3%; 395/562). The beliefs regarding the etiology affect the diagnostic and treatment strategies; meanwhile, the diagnostic practice has an influence on the selection of treatment methods.Conclusions:There is much confusion and frustration about the etiology, diagnosis and treatment of CP among Chinese urologists. Meanwhile, their practice pattern should be standardized. Moreover, it is necessary to conduct some further study on CP and constantly improve the cognitive level about CP among Chinese urologists. Objective:To determine Chinese urologists’current diagnosis and treatment of psychological problems involved in chronic prostatitis (CP).Methods:656 urologists from 29 provinces of china (including autonomous region and municipality) were surveyed by a questionnaire.Results:Forty-one percent of the urologists considered mental and psychological disorders were the causes of CP and more urologists (71.8%) believed that mental and psychological disorders were the causes but not effects of CP. Most urologists (48.5%) considered that the incidence of psychological disorders involved in CP was between 26% and 50%, and anxiety (73.6%), neurasthenia (63.5%), depression (53.7%) and hypochondriasis (41.3%) were the most common psychosomatic symptoms. About one-fifth (20.7%) of the urologists carried out psychological assessment and 60.7%performed psychotherapy routinely. The urologists who considered psychological factors were the causes of CP were more likely to carry out psychological assessment and psychotherapy, and those who carried out psychological assessment routinely were more likely to perform psychotherapy. Only 23.5% urologists applied routine methods of therapy, psychotherapy and antipsychotic to the treatment of psychological disorders in patients with CP comprehensively.Conclusions:Chinese urologists still have much confusion about the cognizance, diagnosis and treatment of psychological problems involved in CP. Moreover, it’s necessary to make some further research on the methods of assessment and treatment for psychological disorders involved in CP. Objective:To identify the factors influencing practices for chronic prostatitis (CP) among Chinese urologists.Methods:A sample of 656 urologists from 29 provinces of China was asked to complete a questionnaire that explored attitudes towards CP as well as diagnosis and treatment patterns in the management of CP. Both univariate and multivariate logistic regression analysis schemes were utilized to determine the factors influencing the diagnosis and treatment of CP.Results:A total of 656 questionnaires sent. All were returned and 410 of those were included in the final univariate and multivariate analysis. Multivariate logistic regression analysis indicated that beliefs in bacterial infection in the etiology of CP (odds ratio [OR],2.544; 95% confidence interval [CI],1.650-3.923; P=0.000) was the significant factor influencing the routine performance of bacterial culture test. In the same model used, the type of hospital (OR,2.799; 95%CI,1.719-4.559; P=0.000) and the routine use of the 4-glass test or the 2-glass test (OR, 3.194; 95%CI,2.069-4.931; P=0.000) were determined to be significant factors influencing the use of the NIH new classification system. According to the same model, beliefs in bacterial infection in the etiology of CP (OR,3.415; 95%CI,2.024-5.762; P=0.000) and the routine use of bacterial culture test (OR,2.261; 95%CI,1.364-3.749; P=0.002) were important factors influencing the routine prescription of antibiotics.Conclusions:Our findings suggest that the personal beliefs, and the demographic and professional characteristics of individual urologists many influence the diagnosis and treatment of CP in China.更多还原