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Prostatitis cronicas signos, diagnostico y tratamientos


, : Prostatitis cronicas signos, diagnostico y tratamientos.

Las prostatitis cr nicas son de origen infeccioso en el 5-1% de los casos y las dem s entidades reciben el nombre de s ndrome doloroso p lvico cr nico (SDPC), de etiolog as desconocidas o hipot ticas. Las clasificaciones han cambiado con el tiempo y siguen estando basadas hist ricamente en pruebas bacteriol gicas de las secreciones prost ticas. El estudio incluye pruebas destinadas a descartar otras afecciones con s ntomas similares. Se ha validado y recomendado un cuestionario de evaluaci n, el National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). El concepto de fenotipo cl nico UPOINT propone seis factores (urinario, psicosocial, espec fico de un rgano, infeccioso, neurol gico y sist mico y relativo a la tensi n muscular). Este concepto permitir a orientar mejor el tratamiento en funci n del fenotipo de cada paciente. Un tratamiento de ensayo de 15 d as de antibi ticos asociado o no con un alfabloqueante sigue siendo recomendado, pero es emp rico. En funci n de la respuesta cl nica, se contin a o se sustituye por los tratamientos de apoyo. Se han ensayado y evaluado otros tratamientos, como los inhibidores de la 5-alfa-reductasa, antiinflamatorios, fitoterapia, alopurinol, antidepresivos y anticonvulsivantes, ondas de choque extracorp reas, entre otros. Existen pocos estudios de nivel 1 de evidencia que hayan aportado una prueba de eficacia. Los tratamientos denominados de apoyo y los de mantenimiento ps quico desempe an un importante papel. El SDPC sigue siendo una entidad de etiolog a controvertida cuyos tratamientos son emp ricos.

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