Андрология и генитальная хирургия. 2022; 23: 53-59
Коррекция хронического простатита с помощью экстракорпоральной ударно-волновой терапии
https://doi.org/10.17650/1726-9784-2022-23-1-53-59Аннотация
Введение. В данной статье представлены результаты лечения пациентов с хроническим простатитом (ХП) категории II, IIIA и IIIB с применением экстракорпоральной ударно-волновой терапии (ЭУВТ).
Цель исследования – изучение эффективности применения ЭУВТ при лечении пациентов с ХП.
Материалы и методы. В исследование включено 43 пациента с ХП II, IIIA, IIIB категории, средний возраст которых составил 38,8 лет (27–65 лет), средняя продолжительность заболевания – 13,5 мес (3–24 мес). Пациенты были разделены на 3 группы согласно результатам трансректального ультразвукового исследования (ТРУЗИ) предстательной железы (ПЖ): 1-я группа – очаги фиброза в ПЖ (n = 21); 2-я группа – кальцинаты в ПЖ (n = 5); 3-я группа – зоны фиброза с кальцинатами в ПЖ (n = 17). Всем пациентам выполнялась ЭУВТ дважды в неделю на протяжении 6 нед, сеанс включал от 2000 до 3500 ударов, максимальная частота импульсов – 8–6 Гц, максимальная плотность потока энергии – 0,051–0,062 мДж/мм2. Обследование выполнено в 0-й и 60-й дни исследования: анкеты NIH-CPSI (шкала симптомов хронического простатита и синдрома тазовых болей у мужчин), IPSS (международный индекс симптомов при заболеваниях предстательной железы), ТРУЗИ ПЖ, посев на микрофлору секрета ПЖ/спермы, микроскопия секрета ПЖ/анализ спермы, анализ крови на общий простатический специфический антиген у мужчин старше 50 лет.
Результаты. У мужчин старше 50 лет уровень общего простатического специфического антигена составил менее 4 нг/мл. В посеве спермы/секрета ПЖ у 26 пациентов был обнаружен рост микрофлоры, в связи с чем была дополнительно назначена антибиотикотерапия согласно чувствительности. Пациенты переносили лечение удовлетворительно. При контрольном обследовании оценка по NIH-CPSI снизилась с 13,39 (1–34) до 5,44 (0–24) балла (p <0,05), по IPSS – с 11,39 (0–34) до 4,39 (0–29) балла (p <0,05). По данным ТРУЗИ объем ПЖ уменьшился с 25,18 (12,2–58,8) до 22,78 (12–56,6) см3 (p >0,05). В 1-й группе у 3 пациентов фиброз исчез полностью, у 18 пациентов зона фиброза уменьшилась с 5,3 (0–13) до 3,24 (0–8,1) мм (p <0,05). Во 2-й группе уменьшились количество и размер кальцинатов – с 6,92 (2–21) до 4 (0–20) мм (p >0,05). В 3-й группе кальцинаты исчезли полностью (p <0,05), зона фиброза сократилась с 6,8 (3,2–15) до 4,5 (1–17) мм (p <0,05). В 9 случаях при повторном посеве спермы/секрета ПЖ на микрофлору рост не обнаружен, у 16 пациентов отмечено снижение титра бактерий, в 1 случае титр бактерий не изменился. Отмечена нормализация лейкоцитов у всех мужчин с ХП/синдромом хронической тазовой боли категории IIIA.
Выводы. ЭУВТ является эффективным неинвазивным методом лечения ХП категории II, IIIA и IIIB, эффект достигается посредством купирования болевого синдрома, воспалительного процесса, лизиса зоны фиброза и кальцинатов, улучшения дренажной функции ПЖ, что способствует ускоренному элиминированию микрофлоры.
Список литературы
1. Reynard J., Brewster S., Biers S. Oxford Handbook of Urology. 4th edn. Oxford: Oxford University Press, 2019. 896 p.
2. Урология. Российские клинические рекомендации. Под ред. Ю.Г. Аляева, П.В. Глыбочко, Д.Ю. Пушкаря. М.: ГЭОТАР-Медиа, 2016. 496 с. [Urology. Russian clinical guidelines. Ed. by Yu.G. Alyaev, P.V. Glybochko, D.Yu. Pushkar’. Moscow: GEOTARMedia, 2016. 496 p. (In Russ.)].
3. Urological Infections. EAU Guidelines. Edn. presented at the EAU Annual Congress, Milan, 2021. ISBN 978–94–92671–13–4. Available at: https://uroweb.org/guideline/urological-infections/.
4. Zhang J., Liang C., Shang X., Li H. Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Disease or Symptom? Current Perspectives on Diagnosis, Treatment, and Prognosis. Am J Mens Health 2020;14(1):1557988320903200. DOI: 10.1177/1557988320903200.
5. Shoskes D.A., Nickel J.C., Kattan M.W. Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: A prospective study using UPOINT. Urology 2010;75(6):1249–53. DOI: 10.1016/j.urology.2010.01.021.
6. Hao Z.Y., Li H.J., Wang Z.P. et al. The prevalence of erectile dysfunction and its relation to chronic prostatitis in Chinese men. J Androl 2011;32(5):496– 501. DOI: 10.2164/jandrol.110.012138.
7. Li H.J., Kang D.Y. Prevalence of sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: A meta-analysis. World J Urol 2016;34(7):1009–17. DOI: 10.1007/s00345-015-1720-3.
8. Agarwal M.M., Elsi Sy M. Gabapentenoids in pain management in urological chronic pelvic pain syndrome: Gabapentin or pregabalin? Neurourol Urodyn 2017;36(8):2028–33. DOI: 10.1002/nau.23225.
9. Al Edwan G.M., Muheilan M.M., Atta O.N. Long term efficacy of extracorporeal shock wave therapy [ESWT] for treatment of refractory chronic abacterial prostatitis. Ann Med Surg (Lond) 2017;14:12–7. DOI: 10.1016/j.amsu.2016.12.051.
10. Chang S.C., Hsu C.H., Hsu C.K. et al. The efficacy of acupuncture in managing patients with chronic prostatitis/chronic pelvic pain syndrome: A systemic review and meta-analysis. Neurourol Urodyn 2017;36(2):474–81. DOI: 10.1002/nau.22958.
11. Franco J.V.A., Turk T., Jung J.H. et al. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome: a Cochrane systematic review. BJU Int 2019;124(2):197–208. DOI: 10.1111/bju.14492.
12. Lin G., Reed-Maldonado A.B., Wang B. et al. In Situ Activation of Penile Progenitor Cells With Low-Intensity Extracorporeal Shockwave Therapy. J Sex Med 2017;14(4):493–501. DOI: 10.1016/j.jsxm.2017.02.004.
13. Liu J., Zhou F., Li G.Y. et al. Evaluation of the effect of different doses of low energy shock wave therapy on the erectile function of streptozotocin (STZ)-induced diabetic rats. Int J Mol Sci 2013;14(5):10661–73. DOI: 10.3390/ijms140510661.
14. Liu T., Shindel A.W., Lin G., Lue T.F. Cellular signaling pathways modulated by low-intensity extracorporeal shock wave therapy. Int J Impot Res 2019;31(3):170–6. DOI: 10.1038/s41443-019-0113-3.
15. Mariotto S., Cavalieri E., Amelio E. et al. Extracorporeal shock waves: from lithotripsy to anti-inflammatory action by NO production. Nitric Oxide 2005;12(2):89–96. DOI: 10.1016/j.niox.2004.12.005.
16. Oudega M., Perez M.A. Corticospinal reorganization after spinal cord injury. J Physiol 2012;590(16):3647–63. DOI: 10.1113/jphysiol.2012.233189.
17. Qiu X., Lin G., Xin Z. et al. Effects of low-energy shockwave therapy on the erectile function and tissue of a diabetic rat model. J Sex Med 2013;10(3):738–46. DOI: 10.1111/jsm.12024.
18. Chen Y.T., Yang C.C., Sun C.K. et al. Extracorporeal shock wave therapy ameliorates cyclophosphamide-induced rat acute interstitial cystitis though inhibiting inflammation and oxidative stress – in vitro and in vivo experiment studies. Am J Transl Res 2014;6(6): 631–48. PMID: 25628776.
19. Wang H.J., Cheng J.H., Chuang Y.C. Potential applications of low-energy shock waves in functional urology. Int J Urol 2017;24(8):573–81. DOI: 10.1111/iju.13403.
20. Wang H.J., Lee W.C., Tyagi P. et al. Effects of low energy shock wave therapy on inflammatory moleculars, bladder pain, and bladder function in a rat cystitis model. Neurourol Urodyn 2017;36(6):1440–7. DOI: 10.1002/nau.23141.
21. Rees J., Abrahams M., Doble A., Cooper A. Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int 2015;116(4):509–25. DOI: 10.1111/bju.13101.
22. Guo P., Gao F., Zhao T. et al. Positive Effects of Extracorporeal Shock Wave Therapy on Spasticity in Poststroke Patients: A Meta-Analysis. J Stroke Cerebrovasc Dis 2017;26(11):2470–6. DOI: 10.1016/j.jstrokecerebrovasdis.2017.08.019.
23. Li G., Man L. Low-intensity extracorporeal shock wave therapy for male chronic pelvic pain syndrome: a systematic review and meta-analysis. Transl Androl Urol 2021;10(3):1202–11. DOI: 10.21037/tau-20-1423.
24. Pajovic B., Radojevic N., Dimitrovski A., Vukovich M. Comparison of the efficiency of combined extracorporeal shock-wave therapy and triple therapy versus triple therapy itself in Category III B chronic pelvic pain syndrome (CPPS). Aging Male 2016;19(3):202–7. DOI: 10.1080/13685538.2016.1197899.
25. Vahdatpour B., Alizadeh F., Moayednia A. et al. Efficacy of extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome: a randomized, controlled trial. ISRN Urol 2013;2013:972601. DOI: 10.1155/2013/972601.
26. Zeng X.Y., Liang C., Ye Z.Q. Extracorporeal shock wave treatment for non-inflammatory chronic pelvic pain syndrome: a prospective, randomized and sham-controlled study. Chin Med J 2012;125(1):114–8. PMID: 22340476.
27. Zimmermann R., Cumpanas A., Hoeltl L. et al. Extracorporeal shock-wave therapy for treating chronic pelvic pain syndrome: a feasibility study and the first clinical results. BJU Int 2008;102(8):976–80. DOI: 10.1111/j.1464-410X.2008.07742.x.
28. Moayednia A., Haghdani S., Khosrawi S. et al. Long-term effect of extracorporeal shock wave therapy on the treatment of chronic pelvic pain syndrome due to non bacterial prostatitis. J Res Med Sci 2014;19(4):293–6. PMID: 25097599.
29. Guu S.J., Geng J.H., Chao I.T. et al. Efficacy of Low-Intensity Extracorporeal Shock Wave Therapy on Men With Chronic Pelvic Pain Syndrome Refractory to 3-As Therapy. Am J Mens Health 2018;12(2):441–52. DOI: 10.1177/1557988317736585.
Andrology and Genital Surgery. 2022; 23: 53-59
Correction of chronic prostatitis by extracorporeal shock wave therapy
https://doi.org/10.17650/1726-9784-2022-23-1-53-59Abstract
Introduction. This article presents the results of treatment of patients with chronic prostatitis (CP) type II, IIIA and IIIB by extracorporeal shock wave therapy (ESWT).
The study objective was to evaluate the effectiveness of ESWT in the treatment of CP.
Materials and methods. The research included 43 patients with CP. The patient’s age was 38.8 (27–65). The mean CP duration was 13.5 (3–24) months. 43 patients were assigned into 3 groups based on transrectal ultrasound (TRUS) examination. Group 1 had fibrotic changes in the prostate (n = 21). Group 2 had prostate calcifications (n = 5). Group 3 had fibrotic changes and calcifications in the prostate (n = 17). Treatment included ESWT (Dornier Aries) twice per week during 6 weeks. Each ESWT-session was comprised 2000–3500 pulses (0.05–0.062 mJ/mm2) and 8–6 Hz of frequency. All men were evaluated on 0 and 60 days of the study using NIH-CPSI (National Institutes Health Chronic Prostatitis Symptom Index), IPSS (International Prostate Symptom Score), TRUS of the prostate, the culture of seminal or prostate fluid, spermogram or prostate fluid analysis, serum prostatic specific antigen for men over 50 years of age.
Results. The patients over 50 years-old had total prostatic specific antigen less than 4 ng/ml. Bacterial growth was found in the culture of seminal/prostate fluid of the 26 patients. They were additionally prescribed antibiotics according to antibiogram. All patients got the treatment well. Control study pointed at lower scores of NIH-CPSI – grade decreased from 13.39 (1–34) to 5.54 (0–24) (p <0.05), IPSS decreased from 11.39 (0–34) to 4.39 (0–29) (p <0.05). Prostate volume decreased from 25.18 (12.2–58.8) cm3 to 22.78 (12–56.6) cm3 according to TRUS (p >0.05). In the group 1 in 3 cases local fibrosis were completely resolved, in 18 cases fibrotic changes decreased from 5.3 (0–13) mm to 3.24 (0–8.1) mm (p <0.05). In the second group the number and the size of calcifications decreased from 6.92 (2–21) mm to 4 (0–20) mm (p >0.05). In the group 3 calcifications were completely resolved (p <0.05), the volume of fibrosis decreased from 6.8 (3.2–15) mm to 4.5 (1–17) mm (p <0.05). Bacterial growth wasn’t found in 9 patients’ seminal/ prostate fluid, 16 patients had a decrease of the causative agent concentration on 60 day, WBC count normalized in all subjects with CP/chronic pelvic pain syndrome IIIA.
Conclusion. ESWT is an effective and non-invasive method of treatment of CP type II, IIIA and IIIB. The proposed treatment to relieve pain syndrome, inflammation, to promote lysis of fibrosis zone and calcinates, improves the draining function of prostate, contributing to accelerated elimination of microflora.
References
1. Reynard J., Brewster S., Biers S. Oxford Handbook of Urology. 4th edn. Oxford: Oxford University Press, 2019. 896 p.
2. Urologiya. Rossiiskie klinicheskie rekomendatsii. Pod red. Yu.G. Alyaeva, P.V. Glybochko, D.Yu. Pushkarya. M.: GEOTAR-Media, 2016. 496 s. [Urology. Russian clinical guidelines. Ed. by Yu.G. Alyaev, P.V. Glybochko, D.Yu. Pushkar’. Moscow: GEOTARMedia, 2016. 496 p. (In Russ.)].
3. Urological Infections. EAU Guidelines. Edn. presented at the EAU Annual Congress, Milan, 2021. ISBN 978–94–92671–13–4. Available at: https://uroweb.org/guideline/urological-infections/.
4. Zhang J., Liang C., Shang X., Li H. Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Disease or Symptom? Current Perspectives on Diagnosis, Treatment, and Prognosis. Am J Mens Health 2020;14(1):1557988320903200. DOI: 10.1177/1557988320903200.
5. Shoskes D.A., Nickel J.C., Kattan M.W. Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: A prospective study using UPOINT. Urology 2010;75(6):1249–53. DOI: 10.1016/j.urology.2010.01.021.
6. Hao Z.Y., Li H.J., Wang Z.P. et al. The prevalence of erectile dysfunction and its relation to chronic prostatitis in Chinese men. J Androl 2011;32(5):496– 501. DOI: 10.2164/jandrol.110.012138.
7. Li H.J., Kang D.Y. Prevalence of sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: A meta-analysis. World J Urol 2016;34(7):1009–17. DOI: 10.1007/s00345-015-1720-3.
8. Agarwal M.M., Elsi Sy M. Gabapentenoids in pain management in urological chronic pelvic pain syndrome: Gabapentin or pregabalin? Neurourol Urodyn 2017;36(8):2028–33. DOI: 10.1002/nau.23225.
9. Al Edwan G.M., Muheilan M.M., Atta O.N. Long term efficacy of extracorporeal shock wave therapy [ESWT] for treatment of refractory chronic abacterial prostatitis. Ann Med Surg (Lond) 2017;14:12–7. DOI: 10.1016/j.amsu.2016.12.051.
10. Chang S.C., Hsu C.H., Hsu C.K. et al. The efficacy of acupuncture in managing patients with chronic prostatitis/chronic pelvic pain syndrome: A systemic review and meta-analysis. Neurourol Urodyn 2017;36(2):474–81. DOI: 10.1002/nau.22958.
11. Franco J.V.A., Turk T., Jung J.H. et al. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome: a Cochrane systematic review. BJU Int 2019;124(2):197–208. DOI: 10.1111/bju.14492.
12. Lin G., Reed-Maldonado A.B., Wang B. et al. In Situ Activation of Penile Progenitor Cells With Low-Intensity Extracorporeal Shockwave Therapy. J Sex Med 2017;14(4):493–501. DOI: 10.1016/j.jsxm.2017.02.004.
13. Liu J., Zhou F., Li G.Y. et al. Evaluation of the effect of different doses of low energy shock wave therapy on the erectile function of streptozotocin (STZ)-induced diabetic rats. Int J Mol Sci 2013;14(5):10661–73. DOI: 10.3390/ijms140510661.
14. Liu T., Shindel A.W., Lin G., Lue T.F. Cellular signaling pathways modulated by low-intensity extracorporeal shock wave therapy. Int J Impot Res 2019;31(3):170–6. DOI: 10.1038/s41443-019-0113-3.
15. Mariotto S., Cavalieri E., Amelio E. et al. Extracorporeal shock waves: from lithotripsy to anti-inflammatory action by NO production. Nitric Oxide 2005;12(2):89–96. DOI: 10.1016/j.niox.2004.12.005.
16. Oudega M., Perez M.A. Corticospinal reorganization after spinal cord injury. J Physiol 2012;590(16):3647–63. DOI: 10.1113/jphysiol.2012.233189.
17. Qiu X., Lin G., Xin Z. et al. Effects of low-energy shockwave therapy on the erectile function and tissue of a diabetic rat model. J Sex Med 2013;10(3):738–46. DOI: 10.1111/jsm.12024.
18. Chen Y.T., Yang C.C., Sun C.K. et al. Extracorporeal shock wave therapy ameliorates cyclophosphamide-induced rat acute interstitial cystitis though inhibiting inflammation and oxidative stress – in vitro and in vivo experiment studies. Am J Transl Res 2014;6(6): 631–48. PMID: 25628776.
19. Wang H.J., Cheng J.H., Chuang Y.C. Potential applications of low-energy shock waves in functional urology. Int J Urol 2017;24(8):573–81. DOI: 10.1111/iju.13403.
20. Wang H.J., Lee W.C., Tyagi P. et al. Effects of low energy shock wave therapy on inflammatory moleculars, bladder pain, and bladder function in a rat cystitis model. Neurourol Urodyn 2017;36(6):1440–7. DOI: 10.1002/nau.23141.
21. Rees J., Abrahams M., Doble A., Cooper A. Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int 2015;116(4):509–25. DOI: 10.1111/bju.13101.
22. Guo P., Gao F., Zhao T. et al. Positive Effects of Extracorporeal Shock Wave Therapy on Spasticity in Poststroke Patients: A Meta-Analysis. J Stroke Cerebrovasc Dis 2017;26(11):2470–6. DOI: 10.1016/j.jstrokecerebrovasdis.2017.08.019.
23. Li G., Man L. Low-intensity extracorporeal shock wave therapy for male chronic pelvic pain syndrome: a systematic review and meta-analysis. Transl Androl Urol 2021;10(3):1202–11. DOI: 10.21037/tau-20-1423.
24. Pajovic B., Radojevic N., Dimitrovski A., Vukovich M. Comparison of the efficiency of combined extracorporeal shock-wave therapy and triple therapy versus triple therapy itself in Category III B chronic pelvic pain syndrome (CPPS). Aging Male 2016;19(3):202–7. DOI: 10.1080/13685538.2016.1197899.
25. Vahdatpour B., Alizadeh F., Moayednia A. et al. Efficacy of extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome: a randomized, controlled trial. ISRN Urol 2013;2013:972601. DOI: 10.1155/2013/972601.
26. Zeng X.Y., Liang C., Ye Z.Q. Extracorporeal shock wave treatment for non-inflammatory chronic pelvic pain syndrome: a prospective, randomized and sham-controlled study. Chin Med J 2012;125(1):114–8. PMID: 22340476.
27. Zimmermann R., Cumpanas A., Hoeltl L. et al. Extracorporeal shock-wave therapy for treating chronic pelvic pain syndrome: a feasibility study and the first clinical results. BJU Int 2008;102(8):976–80. DOI: 10.1111/j.1464-410X.2008.07742.x.
28. Moayednia A., Haghdani S., Khosrawi S. et al. Long-term effect of extracorporeal shock wave therapy on the treatment of chronic pelvic pain syndrome due to non bacterial prostatitis. J Res Med Sci 2014;19(4):293–6. PMID: 25097599.
29. Guu S.J., Geng J.H., Chao I.T. et al. Efficacy of Low-Intensity Extracorporeal Shock Wave Therapy on Men With Chronic Pelvic Pain Syndrome Refractory to 3-As Therapy. Am J Mens Health 2018;12(2):441–52. DOI: 10.1177/1557988317736585.
