Segmental Electrical Stimulation and Basic Pharmacotherapy in the Treatment of Chronic Prostatitis/chronic Pelvic Pain Syndrome
The objective: assessment of the efficacy and safety of the segmental effects of sinusoidal electric current alone and in combination with basic pharmacotherapy in treatment of chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS).
Materials and methods. The study involved 64 patients with CP/CPPS who were equally randomized into 2 groups. Patients filled out questionnaires NIH-CPSI, PHQ-9, GAD-7. An enzyme immunoassay revealed changes in the concentration of testosterone, dihydrotestosterone (DHT) and prostate-specific antigen (PSA) in the blood, as well as ejaculate cytokines. All patients received segmental electrical stimulation, which was performed using the «Amplipulse» apparatus, 10 sessions of 15 minutes. Group 2 patients additionally received basic pharmacotherapy. The latter included diclofenac sodium (Dicloberl® retard, 100 mg/day, oral, 2 weeks), modified release tamsulosin (Flosin®, 0.4 mg/day, oral, 1 month), extract from the fruit of the Serenoa repens palm tree (Prostamol® Uno, 320 mg/day, orally, 6 months). Treatment was prescribed regardless of the presence and severity of symptoms of CP / CPS. The reduction in NIH-CPSI by 6 points, PHQ-9 by 6 points, GAD-7 by 5 points were considered clinically significant.
Results. A significant decrease in prostatitis symptoms was observed in both groups after 2 weeks and persisted throughout the observation period (6 months). In group 2 patients, unlike group 1, there was a statistically significant increase in testosterone level, a decrease in DHT and PSA blood, a significant decrease in the pro-inflammatory cytokine in the ejaculate (interleukin-1β), along with an increase in the content of the anti-inflammatory cytokine (interleukin-10), a significant improvement depression and anxiety. The clinical efficacy of electrotherapy was 47 % and 34 % (at 2 weeks and 6 months of treatment, respectively). The combination ofelectrotherapy with basic pharmacotherapy reduced the intensity of the symptoms of prostatitis significantly more (p<0.05). Its clinical efficacy was 85 % and 69 %, respectively. A significant link between the duration of the disease and the effectiveness of treatment was revealed: the greatest effectiveness and the minimum risk of relapse were observed with a disease duration of up to 1 year. Treatment tolerance was good in both groups of patients, especially in the electrotherapy group, in which no side effects were detected.Conclusion. The use of segmental electrotherapy and its combination with basic pharmacotherapy in the treatment of CP/CPPS is quite effective and safe. Using a combination of these techniques is significantly more effective, especially with a disease duration of up to 1 year. The advantage of electrotherapy is the safety of the technique.
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Нуриманов К.Р. Эффективность и безопасность базовой фармакотерапии хронического абактериального простатита // Здоровье мужчины. – 2019. – № 1 (68). – Р. 40–45.
Thakkinstian A., Attia J., Anothaisintawee T., Nickel J.C. α-blockers, antibiotics and anti-inflammatories have a role in the management of chronic prostatitis/chronic pelvic pain syndrome. BJU Int. – 2012; N. 110 (7) – 1014–1022, doi:10.1111/j.1464-410X.2012.11088.x Epub 2012 Apr 3
Ушаков А.А. Практическая физиотерапия. – 2-е изд., испр. и доп. – М.: ООО «Медицинское информационное агентство», 2009. – 608 с.
William Gibson, Benedict M. Wand, Catherine Meads, Mark J. Catley, Neil E. O’Connell Transcutaneous electrical nerve stimulation (TENS) for chronic pain - an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2019 Feb; 2019(2): CD011890. Published online 2019 Feb 19. doi: 10.1002/14651858.CD011890.pub2 Update in: Cochrane Database Syst Rev. 2019 Apr; 2019(4):CD011890 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379178.
Nickel J.C., Roehrborn C.G., O’Leary M.P., et al. The relationship between prostate inflammation and lower urinary tract symptoms: examination of baseline data from the reduce trial. Eur Urol. 2008; 54: 1379-1384.
Kroenke K., Spitzer R.L., Williams J.B.; The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep 16(9):606-613.
Spitzer R.L. et al. A brief measure for assessing generalized anxiety disorder. Arch. Intern. Med. – 2006. – N 166 (10) – P. 1092–1097.
Kessler T.M., Mordasini L., Weisstanner C., Jüni P., da Costa B.R., Wiest R. et al. (2014) Sono-Electro-Magnetic Therapy for Treating Chronic Pelvic Pain Syndrome in Men: A Randomized, Placebo-Controlled, Double-Blind Trial. PLoS ONE 9(12):e113368. https://doi.org/10.1371/journal.pone.0113368.
Kabay S., Kabay S.C., Yucel M., Ozden H. (2009) Efficiency of posterior tibial nerve stimulation in category IIIB chronic prostatitis/chronic pelvic pain: a Sham-Controlled Comparative Study. Urol Int 83: 33–38.
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