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1 Incont Pelvic Floor Dysfunct 2012; 6(3):69-73 Review!"#$% &'(C!"#$%&'()*+,!"#!!"#$%&'()*+,-./0E1F!"!"#$%E2F!"#$%!&'()*!"E3F!"#C!"#$%&'()*+,!"#$E4F!"!"#$%&'(!"#$%&!"'(Echronic prostatitisf!"#$%&'()!*+,-./ !"#$%&'(%)*+,-./0123*4567!"#$2008!"#$%&'()*+,-./0!"#$%&'()*+,-./5αe5α-reductase inhibitor, 5ARIF!"#$%&'()*+,-+./0 1!"# 8,224!x1z!"#$%&'( 9!"#$%&'()*+,-./015.4%!!"#$% 77.6%!"#$%&' 21.6%!!"#$%&'(!)*+,-./97.9% 1.9%!"#$% 0.2%!"#$%&'()!"#$%&'!()89%!"#10.7%! 0.3%!"#$%&'()*+,-./012345!"#$%&'()*+,"-."#$%/01234!"#$%&%'()*+,#-./ !"#$%&'()*+,-./!"#$%&'()*+,%-./'0123*4!"#$%&'()*+,-./E!"#$%& International Prostate Symptom Score, IPSSF!"#$%&' IPSS! IPSS!"#$%&'"#$()*"#!"#$%&'()*+,-./0)123456!"#$%&'()IPSS!"#$%&'()'*!"E 1F!"#$%&'()*+,-./0123IPSS!"#$%&'()*+*,-./ !"#$IPSS!"#$%&'()*+,-./0!"#$%&'()*+,Ebody mass index, BMIF!"#!$%&'()*+',-./ "!"#$%&'()*+,-./012IPSS!"!"#$%&'()*+,-./ #78!"#$%&'()*!+,-./0123!+,4!"#$%&'()!"#$%&'()*+!"#$,-$./012!"#Kramer!"#$%&'()*+,-./!"#EcytokinesF!"Egrowth factorsf!"#!"#$%&'()*+(,-./0%12x2z!!"#$%&'()*+,-./ /!"#$%&'()*+,-./" !"#$%&'()&*( +,-./0123+,(!"#$%&'()*+,-./ !"#$%&'()*+,-./0!12) K Average acute inflammation Average chronic inflammation N Correlation coefficient N Correlation coefficient Total IPSS score < Grouped IPSS score < Irritative subscore < Obstructive subscore < Nocturia subscore IPSS=International Prostate Symptom Score!"#$%&'()*+,-./0/12321!"#$%&'(!" chungshiudong@gmail.com SV

2 !"#$%&'()*+,-./01234%5678!"#$%&'(x3z Kramer!"#$%&'()*+,-./01!"#$%&'()*+,-./0)123456'!"#$%&&'()*+,E1F!"#$T!"#$%&'()*+,-!"(.$/T! IL-17 IFN-g IL-2 IL-4 IL-13 FGF-2!!"#$%&'( IL-6 IL-8 IL-15!"#$%!"#$%&'()*+,#-./-(01234!"#$%&'()*+,-#./ % x2z!"#$%!&'()*+,-.!"#$%&'()*&'+,-./012echronic pelvic pain syndrome, CPPSF!"#$%&'()*+,!"#$%&'()*+,-./01234IL-8!"#$%Efibroblast growth factor 2, FGF-2F!"#!"#$%&'()*++,-./ IL- 10!"#$%&'()*+,-./ !"#$%&'()*+,-./0123*45#$'!"#$E 2Fx4z!"#$%&'()*+,-./ ,!"#$%&'()*+,-./0123#4567!"#$%&'()*+,-./ !"#$%&'()*+,-./0&1(234567!"#$$%&x5z Primary Injury Genetic predisposition low systemic IL-10 Tissue damage Cytokine PAIN IL8 NOXA WBC FGF2 growth factors Stroma Fibromuscular tissue growth Lumen 2K!"#$%!"&'()*+,-Echronic pelvic pain syndrome, CPPSF!"#$%&'()*+,!"#$%&'()*+,-./012IL-8!"#$%&Efibroblast growth factor 2, FGF-2F!"#$x4z!"#$%&'()*+,-./012+,345!"#$%&'()*%+,-./01'234567!"#$%&'()*+, -./ IFN-γ IL-6 IL-8!"#$%&'()*+ IL-10!"#$"%&'()*+,-./0&'(12)34!"#$%&'()'*+,-./0123"4567!"#$%&'()*+,$-./01234E3Fx6z!"#`!"#$%&'()*+,-./!"#$%&'()*+,-.!"/01234!"#$%&'()*+,-./01234)567!"#$%&'()*+,-./0123'45678 Infection Foreign antigen Cellular injury Exposure to autoantigen Change in hormonal milieu Trauma (Duct rupture due to obstruction) Exaggerated/Misdirected Immune/Autoimmune pesponse Chronic inflammation Degree of prostatic growth Time 0GH(I x2z TM

3 Mechanisms in Prostatitis/Chronic Pelvic Pain Syndrome Low testosterone: Local inflamation Autoimmune response Endocrine Altered androgen receptors Local inflammation: Inhibits testosterone synthesis Testosterone inhibits effects of NGF Immune response Imbalance of cytokines Proinflammatory: IFN-γ, IL-6, IL-8 (IL-10, TNF-α, IL-1β) Anti-inflammatory: IL-10 Autoimmune process Nervous system Neurogenic inflammation with NGF Low local levels of β-endorphin Reduced stress lowers IL-6, IL-10 levels Stress induced mast cell degranulation Psychological factors Stress Anxiety/Depression FGH%IJKLMNBCO!"#$%&'()*+,-./012 IFN-γ IL-6 IL-8!"#$%&'()*+ IL-10 x6z!"#$%&'(nhanes III!"C!ECreactive protein, CRPF!"#$%&'()*+,-./0!"#$%&x7z!"#$%&'()*+,-$.!"#$%&C!"#$%&'()*+,-&.!"#$% 0.32 mg/dl!" 3 4!"#$!"#0.35 mg/dlep=0.06f!"#$%&'()*(!"#$%&' C!"#$ 0.36 mg/dlep=0.06f!"#$%&'()*+,-./0123'4,%+,!"#$%&'()*+,-./0x8z!"#$%!"#$%&'()*+,'-./01"23456!"#$%&'()*+,-'./0"12,34c!"#$%&'(&)*+,-./ !"#$ %&x9z!"#$%&'()*+,-!"#$%&'(c!"#$%&'()*+,-!"#$%&'()*+,-"./ %7!"#$%&'()*+,-./ !"#$%&'()*+,-$./0!"#$ %&'()*+,-./012,-. Interleukin-8!"#$%&'()*+,-./0)!"#$%& '( IL-8!"#$x10z IL-8!"#$%&'()*$%&'(+,-./$%& 8!"#$IL-8!"#$%&'()*+,-./" x11z!"#$%&'()*+ IL-8!"#$%&' IL-8!"#$%&'()*+,-./01+,2345!"#$%&'()*+,-./0" !"#$%&'()*+,-./0123,-./!"#$%&'() Silverio! Refecoxib=ECOX-2!"#$%F 5αFinasteride!"#$%!"#$%&'()"*+x12z!"#$COX-2 Finasteride!"#$ Finasteride!" 4!"#$%&'()*+COX-2!Finasteride!"#$%&'()*+,-./012 Finasteride!"#$%&'()*+,-./01!"#$%&'()COX-2!"#$%&'( EDoxazosinF!"#$%&'(x13z!"#$!"#$%COX-2!"#$%&' ()*+!"#$%&'()*+,-./012345Eoveractive bladder symptom score, OABSSFIPSS!IPSS!" 8 TN

4 !"#$%&'()*+,-.$/0.12)*+34!"#$%x14z!"#$%&'()*+,-./!"#$%&'(ENSAIDF!"#$%&'NSAID!"#$%&'()%*+,-./0123+4!"#$%&=> 30 ml!"#$%&'()=> 1.4 ng/ml!"#$%&'()*+,-./0123!"#$%&'()*"+,-./ !"#$%&'!"#$% &'()*+,-./01!"#$%&'()*+",-./ !"#$%&'()*+,-!"./0123!"#$%&'()*+,-./"012*34"5!"#$%&'()*+,-%./0123"45%6!"#$%&'$%()*+#,-./01&()23!x15z!"#$%&'()*+,-./01&*.8!"#$%&'()*+,-./01#$-2%&'3!"#$%&'()!*+,-./(01234!*!"#$%&'()*'+,"-./(0123'4!"#$%&'()*+,-./0123!"#$!"#$%&'!%()*+,-./ !"#$ 40!"#$%&'()*+,-.-!"#$%&'()*+,-./0!1234 +,-!"#$%!"&'()*+,-./0123*+!"#$%&'()*+,!-.!Epost-void residual, PVRF!"#$%&'()*+,-./0Doxazosin 4 mg Tolterodine 4 mg12!21!"#$%&'102!"#$%&'()*+,!"#$(-./*01!"#$%&"#$'()*+,-./012345!"#$%&'()*+,-./0 123#45/)!"#$%&'()*+,-./012(345678!"#$%&'()*+,-!"#$%&'()*+,21!"#$%&'!"#$%&'()$*+,-."/0123"#$!"#$%&'()*+,-./0!"#1&23,4 E2F!"#$%&'()*!+,-./0(%12()!"#$%&'()*+,-./ !"#$%&'()*+,-./0"#$12345!"#$% &'()*+,-./ !"#$%&'()"#*+,$(-./012345!"#$%&'()*+,-./01234,5678!"#$%&'()*+,#-./ #6!"#$%&'()*+,$-./012345!"#$%&'()*+,-./0123"456!"#$%& '()*+,-./ !"#$%&'()*+,-./0123!/014!"#$%&'()*+,-./ )!"#$%&'()*+,-./0)*+1/2(34!"#$%&'()*+,-./0"1234%567!"#$%!&'()*+,-.'!/0+123$%!"#$%&'()*+,!!"#$%&'()*+,-./ K!"#$%&'(")*+,-./01234&'(5*6708 Non-calculi (N=21) Calculi (N=102) PAIR (N=21) Mean (±SD) Mean (±SD) Before After Before After Before After IPSS 16.8± ± ± ± TPV 32.8± ± ± ± PSA 2.1± ± ± ± Volume 286.2± ± ± ± Qmax 12.4± ± ± ± PVR 41.6± ± ± ± IPSS= International Prostate Symptom Score; TPV= total prostatic volume; PSA= prostatic specific antigen; Qmax= maximum flow rate; PVR= post-void residual TO

5 !"#$%&'()*+,-./0123&45678!"#$%&'()*+,%-./ !"#$%&'()*+,-./012()*+345!"#$%&'()*+,-./01'2345*67 C!"#$%&'()*+,-./&' /!"C!"#$%&'()C!"#$%&! C!"#$%&'()*+!"#$%&'()*+,-#./01%&'(5α!"#$%&'()*+,-./012345!"#C!"#$%&'()*+,-./C!"#$%&'() *+,-./ !C!"#$%&'()*+,-./01234!"#$%&!"#'%()*+,C!"!"#$%&'()*+,-"./ !! 1. Nickel JC, Roehrborn CG, O'Leary MP, Bostwick DG, Somerville MC, Rittmaster RS: The relationship between prostate inflammation and lower urinary tract symptoms: Examination of baseline data from the REDUCE trial. Eur Urol 2008; 54: Kramer G, Mitteregger D, Marberger M: Is benign prostatic hyperplasia (BPH) an immune inflammatory disease? Eur Urol 2007; 51: De Marzo AM, Platz EA, Sutcliffe S, et al: Inflammation in prostate carcinogenesis. Nat Rev Cancer 2007; 7: Dellabella M, Milanese G, Sigala S, et al: The role of the prostatic stroma in chronic prostatitis/chronic pelvic pain syndrome. Inflamm Res 2009; 58: Rudick CN, Berry RE, Johnson JR, et al: Uropathogenic Escherichia coli induces chronic pelvic pain. Infect Immun 2011; 79: Pontari MA, Ruggieri MR: Mechanisms in prostatitis/chronic pelvic pain syndrome. J Urol 2008; 179(5 Suppl):S61-S Rohrmann S, De Marzo AM, Smit E, Giovannucci E, Platz EA: Serum C-reactive protein concentration and lower urinary tract symptoms in older men in the Third National Health and Nutrition Examination Survey (NHANES III). Prostate 2005; 62: St Sauver JL, Sarma AV, Jacobson DJ, et al: Associations between C-reactive protein and benign prostatic hyperplasia/lower urinary tract symptom outcomes in a population-based cohort. Am J Epidemiol 2009; 169: Liao CH, Chung SD, Kuo HC: Serum C-reactive protein levels are associated with residual urgency symptoms in patients with benign prostatic hyperplasia after medical treatment. Urology 2011; 78: Liu L, Li Q, Han P, et al: Evaluation of interleukin-8 in expressed prostatic secretion as a reliable biomarker of inflammation in benign prostatic hyperplasia. Urology 2009; 74: Penna G, Mondaini N, Amuchastegui S, et al: Seminal plasma cytokines and chemokines in prostate inflammation: Interleukin 8 as a predictive biomarker in chronic prostatitis/chronic pelvic pain syndrome and benign prostatic hyperplasia. Eur Urol 2007; 51: Di Silverio F, Bosman C, Salvatori M, et al: Combination therapy with rofecoxib and finasteride in the treatment of men with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Eur Urol 2005; 47: Ozdemir I, Bozkurt O, Demir O, Aslan G, Esen AA: Combination therapy with doxazosin and tenoxicam for the management of lower urinary tract symptoms. Urology 2009; 74: St Sauver JL, Jacobson DJ, McGree ME, Lieber MM, Jacobsen SJ: Protective association between nonsteroidal antiinflammatory drug use and measures of benign prostatic hyperplasia. Am J Epidemiol 2006; 164: Kim WB, Doo SW, Yang WJ, Song YS: Influence of prostatic calculi on lower urinary tract symptoms in middle-aged men. Urology 2011; 78: TP

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