Русский
The effectiveness of the integrated approach to the treatment of chronic prostatitis, including in patients with benign prostatic hyperplasia
DOI: https://dx.doi.org/10.18565/urology.2018.4.81-87
A.B. Zhiborev, A.G. Martov
1 I.P. Pavlov Ryazan State Medical University of Minzdrav of Russia, Ryazan, Russia; 2 D.D. Pletnev City Clinical Hospital, Moscow Health Department, Moscow, Russia; 3Department of Urology and Andrology, Institute of Postgraduate Professional Education, A.I. Burnazyan Federal Medical Biophysical Center of FMBA of Russia, Moscow, Russia
Introduction. Concurrent chronic prostatitis (CP) plays an important role in the pathogenesis and progression of benign prostatic hyperplasia (BPH), increasing the severity of lower urinary tract symptoms (LUTS), lowering the quality of life, and increasing the risk of acute urinary retention. However, in the management of patients with BPH, the role of CP is not always taken into account.
Aim. To evaluate the effectiveness of integrated management of patients with CP and patients with co-occurring BPH and CP using a physiotherapeutic device Mavit for the treatment of inflammatory diseases of the prostate.
Materials and methods. Clinical effectiveness of integrated therapy using the Mavit device was studied in 45 patients with CP. The first group (BPH + CP) comprised 25 patients, who were diagnosed with stage I–II BPH co-occurring with CP. The group of CP included 20 patients with an established diagnosis of CP. Clinical outcomes were followed for 12 months after treatment. In 10 CP patients, the tissue effect of the Mavit device on the prostate blood circulation was assessed before and after the physiotherapy session using transrectal ultrasound in the color Doppler mapping mode. We studied the linear peak blood flow velocity, index of peripheral vascular resistance, and vascular density pattern.
Results. Clinical outcomes were followed for 3 to 12 months. All patients reported an improvement in dysuria and voiding, a reduction in pain in the genital area. Voiding function improvements were confirmed by IPSS, uroflowmetry, and postvoid residual urine volume. Transrectal color Doppler ultrasound mapping showed positive changes in the prostate microcirculation. In 7 patients, the treatment results were followed for 4 to 9 years. During the entire period of observation, the level of prostate-specific antigen remained below 1.75 ng/ml, which indicates the safety of this method in patients with BPH.
Conclusion. In patients with symptomatic BPH with concomitant CP in the conservative stage of the disease, integrated treatment of CP using physiotherapeutic modalities has pathogenetic significance. It significantly reduces the LUTS secondary to BPH, improves IPSS, QoL, urinary flow rate, postvoid residual urine volume. The findings allow us to recommend the Mavit device for the treatment of CP, including in patients with I–II stage BPH.
Aim. To evaluate the effectiveness of integrated management of patients with CP and patients with co-occurring BPH and CP using a physiotherapeutic device Mavit for the treatment of inflammatory diseases of the prostate.
Materials and methods. Clinical effectiveness of integrated therapy using the Mavit device was studied in 45 patients with CP. The first group (BPH + CP) comprised 25 patients, who were diagnosed with stage I–II BPH co-occurring with CP. The group of CP included 20 patients with an established diagnosis of CP. Clinical outcomes were followed for 12 months after treatment. In 10 CP patients, the tissue effect of the Mavit device on the prostate blood circulation was assessed before and after the physiotherapy session using transrectal ultrasound in the color Doppler mapping mode. We studied the linear peak blood flow velocity, index of peripheral vascular resistance, and vascular density pattern.
Results. Clinical outcomes were followed for 3 to 12 months. All patients reported an improvement in dysuria and voiding, a reduction in pain in the genital area. Voiding function improvements were confirmed by IPSS, uroflowmetry, and postvoid residual urine volume. Transrectal color Doppler ultrasound mapping showed positive changes in the prostate microcirculation. In 7 patients, the treatment results were followed for 4 to 9 years. During the entire period of observation, the level of prostate-specific antigen remained below 1.75 ng/ml, which indicates the safety of this method in patients with BPH.
Conclusion. In patients with symptomatic BPH with concomitant CP in the conservative stage of the disease, integrated treatment of CP using physiotherapeutic modalities has pathogenetic significance. It significantly reduces the LUTS secondary to BPH, improves IPSS, QoL, urinary flow rate, postvoid residual urine volume. The findings allow us to recommend the Mavit device for the treatment of CP, including in patients with I–II stage BPH.
About the Autors
Corresponding author: A. B. Zhiborev – Ph.D., Teaching Assistant at the Department of Urology and Nephrology, I.P. Pavlov Ryazan State Medical University of Minzdrav of Russia, Ryazan, Russia; e-mail: zhiborev@yandex.ru
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