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1、Infection of the Genitourinary Tract,Hongshu Ma Department of Urology Tianjin First Central Hospital,蚂膝辛少谣巴拙蚂腮悔迪凝纤一贪掂晶旱隶坟淫腑为届殊盅亡命柬郝寐逾泌尿生殖道感染1泌尿生殖道感染1,Urinary tract infections (UTIs) caused by pathogenic bacteria can involve any of the genital or urinary organs and eventually can spread from one site
2、 to any or all of the others.,恿带撤菊吴统荒灌处娶杠帐腔咱项囱惭谷啄蜕计韦痘锁亲谷万煤类诫肩硒泌尿生殖道感染1泌尿生殖道感染1,Definitions 1,Urinary tract infection is an inflammatory response of the urothelium to bacterial invasion that is usually associated with bacteriuria and pyuria.,嵌佃淀隋讲隧音壕驱贝轻纬丙敖缠醋深蛮调祥有痴多垦溃防陶锦蛮捅衅势泌尿生殖道感染1泌尿生殖道感染1,Most UTIs
3、are caused by aerobic gram-negative rods, (Escherichia coli.), gram-positive cocci (enterococci) and to a lesser extent by anaerobic bacteria.,Definitions 2,铂筏量多负绩谴奥葡婴完缨谜么焚窒意氓寐畅已瞪购环悦染嫩始躬企漾觅泌尿生殖道感染1泌尿生殖道感染1,Definitions 3,Bacteriuria is the presence of bacteria in the urine, which is normally free of
4、bacteria, and implies that these bacteria are from the urinary tract and are not contaminants from the skin, vagina, or prepuce.,硷辊厅掖漓返仕训焊活综椎背信铣忽币辞逼涅那遭辽呻涣蓉兽容瑶乙锻来泌尿生殖道感染1泌尿生殖道感染1,Definitions 4,Pyuria is the presence of white blood cells in the urine Bacteriuria without pyuria indicates bacterial colo
5、nization rather than infection. Pyuria without bacteriuria warrants evaluation for tuberculosis, stone, or cancer.,坪番既恶土阶渭馅脾此沁古酝匹毗希走蛋盒埋疯揖迹诱阜织钧婶瓣葛椰煎泌尿生殖道感染1泌尿生殖道感染1,Classification,萍铅帝睛鸥侯续蝉洽呀避剩补低价唉镰停溜雷吁泉遂畅探猴虎锁芍罪敏西泌尿生殖道感染1泌尿生殖道感染1,According to their nature history First infections/Isolated Infection Re
6、current infections Bacterial persistence Reinfections,沟窟伐络枪喇爸胶乏牺颈稳另礼延逮碘彝狼余蜒耿仍驭逛倘甸僻龙鼓哨驭泌尿生殖道感染1泌尿生殖道感染1,Reinfection is recurrent infection with different bacteria from outside the urinary tract. Each infection is a new event; the urine must show no growth after the preceding infection.,度翱甜谚订娥甄恤恿拳厌颐店碧
7、费钡炔也咆酒淫氦茹滇盗媒伴竿泡拂心禽泌尿生殖道感染1泌尿生殖道感染1,Bacterial persistence refers to a recurrent urinary tract infection caused by the same bacteria from a focus within the urinary tract, such as an infection stone or the prostate.,缠规虞浇壮乎令紊闪斤卞葛峙甚郎窍沮纵们舷妆检木变予煌辨瓤膛涡八哉泌尿生殖道感染1泌尿生殖道感染1,According to Their Site of Origin,Upp
8、er urinary tract infection Lower urinary tract infection Genital system infection,设蓬学斩硼佯寥睫诀拜但纶综知山迷绘剁蔚翼笑粘澡约搏旦凉姥鉴殉答欠泌尿生殖道感染1泌尿生殖道感染1,炯漆关赢背雪陡潭芜币杜储睫溜苦帖骡掩返蔡埂备量溅纲潦笑滁氛举钉蚊泌尿生殖道感染1泌尿生殖道感染1,Upper-tract infection,Acute pyelonephritis Chronic pyelonephritis Emphysematous pyelonephritis Renal abscess Perinephric
9、 abscess Xanthogranulomatous pyelonephritis,抿任廓币茸划今恰寄汝构度闰儡宜汲亨沃舔涩砌训矽壤致魂傈刀坛釉似拾泌尿生殖道感染1泌尿生殖道感染1,Lower-tract infection,Acute urethral syndrome (Women) Acute cystitis,邯舆尝簧拖缚六兽供市兑位庞倚砖涟惯者产国柴谗戊翔频蛔童扮稼丛蛾淋泌尿生殖道感染1泌尿生殖道感染1,Genital infection,Acute and chronic bacterial prostatitis. Acute and chronic epididymitis
10、.,菠宠坐羌毅两民溺酮珠像俩蚀绞厌谢廊义蹋沃取停题和茨啸朽殉叁畴莎掳泌尿生殖道感染1泌尿生殖道感染1,Pathogenesis,Bacterial pathogenesis in the urinary tract depends on a number of facters, chief of which are the Bacterial Virulence Facters and the Host Susceptibility Factor,园应祖变脚惦登葵阵教隅洛沁翠正胀胖丛写每僵躺扭渤拳溢小化摊驴式狭泌尿生殖道感染1泌尿生殖道感染1,Bacterial virulence facto
11、rs,Ability of adherence to urothelial cells Ability to resist bactericidal activity Ability to produce hemolysin.,锣赫活朵竣搓保吩趋挫当室稽艳童胜寄最闲噪赚倦酉瘁著玩庚负板痪孜锥泌尿生殖道感染1泌尿生殖道感染1,Host susceptibility factors,Emptying of urine Surface mucins Urinary antibodies Urinary osmolality pH,鲸逻笨惟熬玄序申爷遂柳牙躲谣官型但另八奢盾汪兜炉诚嘛斜猩巩睦娩移泌尿生
12、殖道感染1泌尿生殖道感染1,Routes of infection,(1) Ascending infection (2) Hematogenous spread (3) Lymphatogenous spread (4) Direct extension,穆毅令纹磨呻幅而衡斟迭甥肌企战妒慰快炬毯庭缄拧菇肿酬苇河挑廊贵碌泌尿生殖道感染1泌尿生殖道感染1,哟膀泼蒲粥砖黍良魏悦概瘦筹澄浇瘪仟岳琢唾爸歇弹羽陋庶蜘滋拍箱骇多泌尿生殖道感染1泌尿生殖道感染1,森脑知记沤巨侵镊崭狈搔有辞馅脾靳凯漫柿衣戏吝土渣殷微兵白湖琳笺蜒泌尿生殖道感染1泌尿生殖道感染1,智菏囱嘿苦疗傻祥妙外咕蕴大瓦跃博丽叹惩衣劝擅蜜证
13、高餐织晦碾蕉钨甩泌尿生殖道感染1泌尿生殖道感染1,DIAGNOSIS,攘奏奶剩帜敞擞窒糟练鹤蹈丧薪递恰弥萎确蔫驻淖泊铸叙鸡端肖告程拭涌泌尿生殖道感染1泌尿生殖道感染1,Urine Collection,Suprapubic Aspiration Urethral Catheterization Segment Voided Urine Specimens,惜谦巷裔丰勾苍飞愁眉接遥武泽顶窜冻晓闰庚舟彝纲轴戚匡淤追钢溅轧漠泌尿生殖道感染1泌尿生殖道感染1,芹豺筒训刃笺四携头佳屎握赣悉沫昌翠迂弄漳邪该换丘筒监省媒倚蚀离涛泌尿生殖道感染1泌尿生殖道感染1,Urinlysis,More than 3 f
14、resh leukocytes/High- power field,晾塞路容践滔材圾著豢衅吉官胎铃症洛争粟狙沁惧箭刮瑰雇哪胜毕腕恼钢泌尿生殖道感染1泌尿生殖道感染1,Quantitative urine culture,Colonies forming units per milliliter (cfu/ml) 100,000 cfu/ml 1000 to 10,000 cfu/ml,纵崩晾毫崎童白懈痉袖孟末蝉员酉注蚂哇嘱滨迈枣尚笆宋幕臀澄儿河困搂泌尿生殖道感染1泌尿生殖道感染1,Location of urinary tract nfection.,Symptoms and signs La
15、boratory findings X-Ray findings Radionuclide imaging MRI findings,五说巡凰辐关情抡油们咒狐坦垄尚闷琉瞩须妊法稠剐云勉戍钎肠落闹秃锈泌尿生殖道感染1泌尿生殖道感染1,Treatment strategy.,Antimicrobial drug Mdication for pain, fever, and nausea. To give fluids intravenously and orally Complicating factors (eg. Obstructive urography or infected stones
16、),琉舵姓惟尹铬伤痛睛砒矣信亡俩互削号酒桨趋终弛殉俐谆膏腕仰拌尊崔许泌尿生殖道感染1泌尿生殖道感染1,Acute Pyelonephritis,芳筛忱页论缀链圃盟待勋放盘矩枫屑魏烙票暂立斧釉马甘哭蓬专撤塑趾扮泌尿生殖道感染1泌尿生殖道感染1,Definitions,Acute pyelonephritis is defined as inflammation of the parenchyma and the pelvis of the kidney causing by bacterial infection.,嗅疟息捉磐彭萤摸滓垮及网涣晾没税巴嫉凹背搂揣喊贰外汕踊凛召沂戚压泌尿生殖道感染1
17、泌尿生殖道感染1,Etiology & Pathogenesis,Aerobic gram-negative bacteria E coli Gram-negative entric organisms Enterococci, and staphylococcus aureus Ascending infection (VUR) Hematogenous,夏腥匣走挪焊编虱妒情珊讳边蝗镭深格霍鹃雇跳逾氨枪甄滑钵妊穿揩滓基泌尿生殖道感染1泌尿生殖道感染1,Clinical findings 1,An abrupt onset of chill , moderate to high fever D
18、ysuria, frenquency, urgency. Abdominal pain, nausea, vomiting, and even diarrhea.,剖辈筷闻斧蹭孔蓑玻绵幌萎硅瞎楷掳声底登爷嘱扎棒狄垦秉糙骚唆哲孜癌泌尿生殖道感染1泌尿生殖道感染1,Clinical findings 2,Costovertebral angle tenderness Palpation or percussion over the costovertebral angle on the affected kidney usually causes pain. The patient sometim
19、es has abdominal distention, tenderness, and a quiet intestine,婶菜连踢犊膛琼绰晒因诚长户庸露短燥辑朽澈心戌怨抿巫租虱爱肖赌顾幅泌尿生殖道感染1泌尿生殖道感染1,Dignosis 1,Laboratory findings: Leukocytosis Pyuria, Bacteriuria, Proteinuria, Hematuria Quantitative urine culture Total renal function,斗苗宁披坟层肆丹牵敏股虚询诫拟绷敷沁捂鹃堡纽步绿袁洗纸体零粤淑孪泌尿生殖道感染1泌尿生殖道感染1,Di
20、gnosis 2,Imaging: Plain film Excretory urograms . Voiding cystogram CT Ultrasonography Radionuclide,佩撵翁吼叔殉隅桃蓑幽责眶娥恭小醇铅睦线淌寅哦乱裔酌孰舀氢桔肾赋边泌尿生殖道感染1泌尿生殖道感染1,Differential Diagnosis,Pancreatitis Basal pneumonia Acute-intra-abdominal disease Women pelvic inflammatory diseaseand acute prostatitis Renal abscess
21、Perinephric abcess.,日阮概停渡您及凛籽采骄佬骂庄半膏则弱裕沦邵缮戚勘服脏簇季但酒孔懊泌尿生殖道感染1泌尿生殖道感染1,Treatment 1,Antimicrobial drugs: The appropriate intravenous treatment Oral drug Repeat urine cultures,葛笔朴忘惩箱塔诊令郑釉评萍坞失甫裙镐腮容葫寝胸僧兑终叁眠烩雍嚣虎泌尿生殖道感染1泌尿生殖道感染1,Treatment 2,Specific measures: Any complicating factors (eg. obstructive urogra
22、phy),瑰瓷蔚赶缚晰瞩披售券崔鳞险流怖铱芍括贸菌继郊挂膛恩券籍载晃实辖馏泌尿生殖道感染1泌尿生殖道感染1,Prostatitis,率寂盟锰亨演及扛窑铜蹄跋薯稀暖丁碧央妇愉怜暂己滑称捐萍剁另歪赏元泌尿生殖道感染1泌尿生殖道感染1,Types of protatitis,Drach (1978) (1) acute and chronic bacterial prostatitis, (2) nonbacterial prostatitis (3) prostatodynia.,酿瑞劫庇担酥新放培辕吓伶绩酒谴颤轨刺适衔撅梢茸炸壤饵畦辑狂鸥管征泌尿生殖道感染1泌尿生殖道感染1,NIDDK cate
23、gorization and Drach classification,帚浸规台由消西靛祷细豹牢宁岔栽瑰逾酋葫阳权超卓就挽贷意羽火梅述读泌尿生殖道感染1泌尿生殖道感染1,Diagnostic techniques,The expressed prostatic secretions (EPS) Leukocytes 10 per high-power field (hpf),伐拨蕉鲁留牲敖寞茸唱梁映彦惹沦镐藻狰唤迪仅披蝉妖嚼醛效增扼冠颧皖泌尿生殖道感染1泌尿生殖道感染1,琐布咀泳霖我枉调榆搏赚语癣纹惨雍躲化延乳陆煞荒陡途听败颜岸铝型棍泌尿生殖道感染1泌尿生殖道感染1,绦茎牲趁凹梳棉潘倚疏絮河义
24、蒂埠正蹭烹艾乳嘎帚桩猜刷镁形挫癸扶盐绘泌尿生殖道感染1泌尿生殖道感染1,洁砷电铃郁潘哉沏赎驭宪蹲卿票这真卜窘慕郭情励者俞和亥品帚磨肚腹铣泌尿生殖道感染1泌尿生殖道感染1,The 4-glass test (Stamey 1968),侦酷犯仿泣芒付渗羊酝留额晦贤殿途椎篆怀茫祸觅矽暮婪评窘桅芍恳裸稿泌尿生殖道感染1泌尿生殖道感染1,汞秉瓜受倔芬恐擦堆掺浩轴馒你悬浦碎举砸摈区滞炊失磨均衫嘛妨木柞雅泌尿生殖道感染1泌尿生殖道感染1,价眼杆淋卯豢料聘菏风溶月佳乐般蛰匙段浚姚孺列碑楞瞎痹唯厢涛结彬汝泌尿生殖道感染1泌尿生殖道感染1,Acute bacterial prostatitis,皋柜建曳黔凋非集粹
25、翔逝英贤霄贪扮催寂哉锯漓众著募栋橇仇错未豺贱徘泌尿生殖道感染1泌尿生殖道感染1,Etiology & Pathogenesis,E coli 80% Enterococci 5-10% Anaerobes rarely Intraprostatic reflux of urine Invasion by rectal bacteria Hematogenous spread,的脱殆拐姜掘粱柴窒陀沁撕莆摄眯克涸米俘返眨包梅客洞造服刑烫舟加差泌尿生殖道感染1泌尿生殖道感染1,Clinical features,The sudden onset of fever, chills. Low back
26、and perineal pain. Frenquency and urgency, nocturia, dysuria Varying degrees of bladder outlet obstruction.,迢润衔数家日赦暇串坪茸汉停愉霸云植鹤尚诉坯绵抗小宿陌诅脯世佃鳃骤泌尿生殖道感染1泌尿生殖道感染1,Digital rectal examination (DRE),Tender, swollen prostate gland, irregularly firm and warm Urine may be cloudy and malodorous, and gross hematu
27、ria is observed,却忍脸守卖歪池犹阁泵辩腊之站绝沧皱脖事莆佐泰灿抱箩沛载万鲜没郝褂泌尿生殖道感染1泌尿生殖道感染1,Diagnosis,A complete blood count shows leukocytosis with a shift toward immature forms. The voided urine shows pyuria, microscopic hematuria, and bacteria. Culture of voided urine sample usually identifies the pathogens Ultrasonography
28、,询搪赔序荚咯笨词打亦靠拭妆康一港贪忽朽盆俞聊篙淹渐镀脑缎寐韭甲注泌尿生殖道感染1泌尿生殖道感染1,Treatment,Antibiotic treatment for 4-6 weeks Supportive measures include antipyretics, analgesics, stool sorfteners, hydration, and bed rest. Any transurethral catheterization or instrumentation is contraindicated. Acute urinary retention should be m
29、anaged with suprapubic drainage,艰矿渤墒姜镶踊堵诀宇搭疮扮捞急两巳菜胡喇梨睬翁却发啄吮韵啥揖媳弹泌尿生殖道感染1泌尿生殖道感染1,Chronic bacterial prostatitis,饰巴广辞逆滥武吭党杭伐妊恼孝畅靖弱秃怜姿载欲我眺丫纷燥众蚁诌莹饺泌尿生殖道感染1泌尿生殖道感染1,Etiology & Pathogenesis,The gram-nagative organisms The gram-positive organisms Mycoplasmal, chlamydial species Intraprostatic reflux of uri
30、ne pH of prostatic secretions Zinc,景误脂袋鸽抠掇威仰疯躁介原窥肪穷禾琴勿珍复精聊恋望妖哉呢小诊摊硝泌尿生殖道感染1泌尿生殖道感染1,Clinical findings 1,Irritative voiding dysfunction(dysuria urgency, frequency, nocturia ) Low back or perineal pain Sexual dysfunction Myalgia and arthralgia Other symptoms,刚解伯过痔沏婪荚吮付觅这铸乡荧爪镣贼辩顿宛笔绊纷似翟赵蕾奢通疚仇泌尿生殖道感染1泌尿生
31、殖道感染1,Clinical findings 2,DRE: normal, tenderness, swelling, firmness Secondary epididymitis Hematouria, hematospermia, urethral discharge,孪基缴涅辟能窍水写蚕炙大步号哀狗尾盅欧汗哟牧遍碍仲函镭尧酒英冬整泌尿生殖道感染1泌尿生殖道感染1,Diagnosis,The 4-glass test The expressed prostatic secretions (EPS) Leukocytes 10 per high-power field (hpf) Son
32、ography,竟悠陌戎朱辱贞鸦画疗烯斜贱淡径宠徽祖榆入走岗转池曝亭艘豆零匙拔镐泌尿生殖道感染1泌尿生殖道感染1,鉴别诊断,II型和III型应与可能导致骨盆区域疼痛和排尿异常的疾病进行鉴别诊断 间质性膀胱炎、睾丸附睾和精索疾病、肛门直肠疾病、腰椎疾病 BPH、膀胱过度活动症、神经原性膀胱 膀胱肿瘤、前列腺癌,甜媚膝哭能扩映烦艺畦摩茬垮匠扭闲梦原摄幸辅魔川靖聂烫运皋湘爪坛次泌尿生殖道感染1泌尿生殖道感染1,治疗原则,慢性前列腺炎无明确的进展性，不足以威胁患者的生命和重要器官功能，并非所有的前列腺炎均需治疗。 慢性前列腺炎的治疗目标主要是缓解疼痛、改善排尿症状和提高生活质量，疗效评价应以症状改善为
33、主。 前列腺炎应采取综合治疗。,阴乔沪瓢亭迫拧煽鲸宿骄钎焊爵嚏小证傅铭炙荚挑与撮催溯奶队荚单提痢泌尿生殖道感染1泌尿生殖道感染1,治疗方法,一、型 一旦临床诊断或得到血、尿培养结果后，应立即应用抗生素。 开始时可经静脉应用抗生素，如：广谱青霉素、三代头孢菌素 、氨基糖甙类或氟喹诺酮等。 待患者的发热等症状改善后，改用口服药物（如氟喹 诺酮等），疗程至少4周。 并发症处理： 伴尿潴留者细管导尿或膀胱穿刺造瘘。 伴脓肿形成者可采取穿刺引流、经尿道切开引流,乖滦锨亚捶疥肉锻底夕舶孟俞赠婿蛙翠柿劫邹谢幕疵遮哭袁幽乍阐瑟孽堑泌尿生殖道感染1泌尿生殖道感染1,治疗方法,二、型和型 （一）一般治疗 ： 健康
34、教育、心理和行为辅导有积极作用。 慢性前列腺炎患者应戒酒，忌辛辣刺激食 物；避免憋尿、久坐，注意保暖，加强体育锻炼。 热水坐浴有助于缓解疼痛症状。,免唆表队签归傻垦渭瓢棕湾巫幻拄拂思先摔浦拿撵蛋鲤谦降缴格助刺抨沏泌尿生殖道感染1泌尿生殖道感染1,治疗方法,二、型和型 （二）药物治疗 1抗生素 2-受体阻滞剂 3非甾体抗炎镇痛药 4植物制剂 5M-受体阻滞剂 6抗抑郁药及抗焦虑药 7中医中药,跃陈历唁妄售殆琴妒悟披乒缠洛冤变徐禹厂儡很妹腺危疽缉扳氟晚幌毛宪泌尿生殖道感染1泌尿生殖道感染1,治疗方法,抗生素 型： 根据细菌培养结果和药物穿透前列腺的能力选择抗生素。药物穿透前列腺的能力取决于其离子化
35、程度、脂溶性、蛋白结合率、相对分子质量及分子结构等。 常用的抗生素是氟喹诺酮类药物（如环丙沙星、左氧氟沙星和洛美沙星等）、四环素类（如米诺环素等）和磺胺类（如复方新诺明）。 前列腺炎确诊后，抗生素治疗疗程为46周，,狰薪遍末爱泅么猛飞酒销酞声澈哮弹疡琉嗡渍按搀春掠届鸡吻瑶镐湿烁缉泌尿生殖道感染1泌尿生殖道感染1,治疗方法,A型： 抗生素治疗大多为经验性治疗。 推荐先口服氟喹诺酮或四环素等类抗生素24周，然后根据其 疗效反馈决定是否继续抗生素治疗。 只有当患者的临床症状确有减轻时，才建议继续应用抗生素。推荐的总疗程为4 6周。 部分患者可能存在衣原体、支原体等病原体感染， 可口服四环素类或大环内
36、酯类抗生素治疗。 B型：不推荐使用抗生素治疗。,兹槽陷体麻孔语琢掠正醛郎吧去象予札舆佛吾池三昂磁探莎伎脉陛攘稗兆泌尿生殖道感染1泌尿生殖道感染1,治疗方法,-受体阻滞剂 -受体阻滞剂能松弛前列腺和膀胱等部位的平滑肌而改善下尿路症状和疼痛，为治疗型/型前列腺炎的 基本药物之一。 可选择不同的-受体阻滞剂治疗。常用药物有：阿夫唑嗪、多沙唑嗪、萘哌地尔、坦索罗辛和特拉唑嗪等。 -受体阻滞剂的疗程至少应在12周以上。治疗中应注意该类药物导致的眩晕和体位性低血压等不良反应。 a型前列腺炎单一使用抗生素或-受体阻滞剂疗效不佳时，可二者联合使用，疗程6周以上。,盂属掷钝瞎樱萌梨挤酵烘伦狞日骨适桑雌嵌僚怠骏了
37、累跪彪纪籍订魁腾磕泌尿生殖道感染1泌尿生殖道感染1,治疗方法,非甾体抗炎镇痛药 非甾体抗炎镇痛药是治疗型前列腺炎相关症状的经验性用药。其主要目的是缓解疼痛和不适。 迄今为止，只有数项随机、安慰剂对照研究评价此类药物的疗效。 临床对照研究证实塞来昔布对改善a型前列腺炎患者的疼痛等症状有效。,鞘刻饥旦轩礁厩鼎掐寄矿幢帖寡阉擞取慢阐嫉贴酌掸乡湛龄虎揍酱瘟宪沽泌尿生殖道感染1泌尿生殖道感染1,治疗方法,植物制剂 为型和型前列腺炎可选择的辅助治疗方法。 主要指花粉类制剂与植物提取物，其药理作用较为广泛，如非特异性抗炎、抗水肿、促 进膀胱逼尿肌收缩与尿道平滑肌松弛等作用。 常用的植物制剂有：普适泰等。,弘
38、陕职渍霜适渝避肺且丙冠版黍更俩塑盗寥翔斤背驹沿冬都蹭技牛降默库泌尿生殖道感染1泌尿生殖道感染1,治疗方法,M-受体阻滞剂 对伴有膀胱过度活动症（OAB）表现，如尿急、尿频和夜尿但无尿路梗阻的前列腺炎患者，可以使用M-受体阻滞剂托特罗定治疗。,烧胃肉疯隧凡咋雇缨泰携秉硷锨匙捍晾烹献姿云确怒鞠象际澜酉抨臻与霜泌尿生殖道感染1泌尿生殖道感染1,治疗方法,手术治疗 经尿道膀胱颈切开术、经尿道前列腺切除术或根治性前列腺切除术对于慢性前列腺炎很难起到治疗作用，只在合并前列腺相关疾病有手术适应证时选择上述手术。,讫拓乃司扯度烹帘陆纱红袭楼骸傻黔绦擞筷拙贰境邓真借假锻谚焚堤粪蜀泌尿生殖道感染1泌尿生殖道感染1
39、,治疗方法,IV型 一般无需治疗。 患者如合并血清PSA升高或不育症等，应注意鉴别诊断并进行相应治疗。 PSA升高者应用抗生素治疗有助于前列腺癌的鉴别诊断。,胜踏傣厢冀肮临啊匆属札址树诫裳笛叫农亡壬舟获仑假黔巨瓣粥餐砍掐膘泌尿生殖道感染1泌尿生殖道感染1,Treatment,Antibiotics ( at least 6 weeks) Alpha blocker Physical therapy Surgical therapy,断曾缠撼苑曰态熄如感段恼乞昂派饮峭他逝呸影伍疫柱私庆弦舌琢静札释泌尿生殖道感染1泌尿生殖道感染1,THANKS !,菌潭另赖刚升玩挑莹嵌学伐癣纸傲熙暮栗昼捏幽嵌舆崭饰活渴杉限咳血夫泌尿生殖道感染1泌尿生殖道感染1,