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The effectiveness of the integrated approach to the treatment of chronic prostatitis, including in patients with benign prostatic hyperplasia
Abstract
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.
... Улучшение мочеиспускания зафиксировано также по данным обследования. Терапевтический эффект локального физического воздействия, оказываемого устройством «МАВИТ» в комплексном лечении ХП, авторы исследования связывают с улучшением микроциркуляции в предстательной железе и в перипростатических тканях, с обезболивающим эффектом вибрационного фактора и импульсного МП, с уменьшением спастического и отечного компонентов, сопровождающих воспалительный процесс в простате [12]. В введении представлена лишь небольшая часть мировых исследований, которая показывает эффективность и безопасность лечения аппаратными методами. ...
Recent studies have shown that chronic prostatitis is one of the most common clinically and socially significant diseases. With chronic prostatitis, mental health suffers no less than with other severe somatic diseases, which sharply reduces the quality of life of men. This was a serious incentive for this study. In outpatient conditions, 50 patients with a confirmed diagnosis of N41 were examined. 1 Chronic prostatitis; R10.2 Pelvic and perineal pain. At the stage of inclusion in the study and treatment, the patient is examined: 1) Study of anamnesis. (NIH-CPS; IPSS; IIEF-5; PHQ-9; GAD-7; EQ–5D–3L) 2) Physical examination (determination of the somatic status of the study subjects) 3) Laboratory examinations were carried out in the laboratories of the clinical bases of the Consultative and Diagnostic Center No2 of the Moscow Health Department, Moscow, 8 Igralnaya Street; Clinical base Central Medical Clinic CMD, Moscow, Perovo metro station, Novogireevskaya st., 3A; Clinical base Clinic «New Medicine», Moscow region, Orekhovo-Zuevo, Lenin st., 44. (urine culture for microflora or urine assessment with a test strip once - before the start of therapy, four-cup test, PSA, CRP, STI screening) 4). Specialized diagnostic tests (ultrasound of the bladder with determination of the volume of residual urine, uroflowmetry, TRUS of the prostate with Doppler mapping). GE LOGIQ V2 ultrasound machine with convex and rectal probe. The obtained research data and interpretation of statistical data allow us to conclude that it is possible to use the MAVIT device according to GIKS.941549.102 TU, manufactured by Yelatma Instrument Plant JSC, according to the selected methods, 7 procedures every 2 months in urological patients with chronic prostatitis and the presence of chronic pelvic pain syndrome in order to relieve pain symptoms, lower urinary tract symptoms. The study also found positive effects on men’s sexual function and a reduction in anxiety disorders. All these positive outcomes in relation to the treatment of the main group of patients allow us to conclude that the MAVIT device may be widely used in the work of a practitioner both on an outpatient basis and in a day hospital.
... The effects of the therapy are caused by the factors heat, pulsed magnetic field and a soft vibration massage. In transrectal ultrasound in the color Doppler mapping mode, a research proves an improvement in blood circulation in the prostate gland (Zhiborev & Martov (2018)). No convincing evidence has been found on the effectiveness of prostate massage, and there is no data on adverse reactions, effect on sexual dysfunction, quality of life and anxiety. ...
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a common condition in men and a serious problem affecting the health of adults men. It is considered that symptoms persisting for more than one year may lead to a decrease in quality of life. It is accepted that older men may be affected at different age by symptoms of CP/CPPS. Men under 50 years old are diagnosed frequently. It is characterized by pain and discomfort in the pelvis, symptoms of the lower urinary tract and a high incidence of depression. CP can evolve without symptoms or with only weakening of sexual function. It never heals spontaneously. The disease poses significant psychological and social problems for men of sexually active age. The diagnosis and treatment create many difficulties. CP/CPPS combines several different prostate diseases and syndromes that differ in their characteristics and methods of treatment. CP/CPPS requires multimodal therapeutic behavior. It is recommended for the individual therapy plans to be developed based on multimodal therapy. The treatment is complex and aims at influencing the infectious agent and inflammatory processes, improving the quality of life, reducing symptoms and complications. Depending on the clinical manifestation, antibiotic therapy, Alpha-blockers, non-steroidal anti-inflammatory drugs, 5-alpha reductase inhibitors, antidepressants, phytopreparations, standardized pollen extract, other drugs that improve local and general immunity and function, Botulinum toxin A (BTA), Injection of local anesthetic, neuropathic pain medications, Phosphodiesterase type 5 (PDE-5) inhibitors and others are recommended. Non-pharmacological treatment includes lifestyle change, psychotherapy and cognitive behavioural therapy, prostate massage, therapeutic exercise, myofascial release, manual therapy, diaphragmatic breathing, biofeedback, postural training, education and training for home exercise program, traditional Chinese medicine (acupuncture), balneotherapy, peloid therapy. Reformed physical factors are affordable and safe to administer and do not have the usual adverse events observed with pharmacological therapy. These include TENS, interferential and sinusoidal modulated currents, high frequency currents, microwave currents, magnetic field, extracorporeal shock-wave therapy, Light therapy-infrared and red radiation LASER therapy. Due to the lack of high quality, randomized clinical studies, the effects of the physical factors applied need further clinical studies to determine their effectiveness.
The Manual presents the possibilities of using the MAVIT device in the combination treatment of patients with benign prostatic hyperplasia. The content of the Manual is consistent with the higher education program for training the highest qualification resident physicians and the professional retraining program for physicians (OD.A.03.2.3 Alternating Currents, Electric, Electromagnetic and Magnetic Fields. High, Ultra-High and Extra-High Frequency) in the specialty 31.08.50 “Physiotherapy” and (B.1.B.1.4.5.1 “Physiotherapy in Urology,” B.1.B.1.6.3.5. “Prostatitis”) in the specialty 08/31/68 “Urology”. The team of authors has, based on the available scientific data and their own clinical observations, summarized the information relative to the use of the MAVIT device in the combination treatment of patients with benign prostatic hyperplasia and outlined its indications and contraindications. The equipments used in performing the procedures are characterized. This Manual was developed and prepared by the workers of the Chair of Urology with Course of Surgical Diseases of the I. P. Pavlov Ryazan State Medical University jointly with the workers of the chairs of urology, surgical andrology, physical therapy, sports medicine and medical rehabilitation, and the workers of the Research Institute of Molecular and Personalized Therapy of the Federal State Budgetary Educational Institution of Further Professional Education Russian Medical Academy of Continuous Professional Education of the Ministry of Health of Russia in accordance with the system of standards for information, library and publishing. ICD-10 code: Chapter XXI. Factors influencing health status and contact with health services.
BACKGROUND: To date, there are few studies in the literature that have examined the efficacy of extracorporeal magnetic stimulation alone for urinary incontinence in patients after radical prostatectomy. AIM: The purpose of the study is to obtain preliminary data on the effectiveness and safety of a low-frequency low-intensity traveling pulsed magnetic field in patients with long-term urinary incontinence after radical prostatectomy. MATERIALS AND METHODS: 22 patients (mean age is 66.3±6.8 years) with stage TI-IIIAN0M0 prostate cancer were observed. To assess the type and degree of urinary incontinence, urination diaries, a cough test, a 24h pad-test, the number of nocturnal mictions, and the OAB-q SF questionnaire were analyzed. Patients were divided into 2 comparable groups: 1 (main group) ― a combination of exercises for the pelvic floor muscles and a local pulsed magnetic field, 2 (control group) ― exercises for the pelvic floor muscles, a rehabilitation course of 10 days. RESULTS: All patients showed a stressful form of urinary incontinence. Mild urinary incontinence was observed in 75% of patients in group 1 and in 70% of patients in group 2; moderate urinary incontinence was observed in 25% and 30% of the group, respectively. 50% of patients suffered from nocturia. According to the OAB-q SF questionnaire, there were no statistically significant differences between patients in both groups: 8.1±1.6 points versus 8.0±1.5 points (p=0.9), respectively. As a result of the rehabilitation course, the cough test remained positive in 66.7% of patients in the main group and in 80% of patients in the control group. According to this indicator, the combined method of rehabilitation was more effective than exercise therapy by 13.3%. Nocturia stopped in half of the patients in the main group and in 10% of the patients in the control group. The overall incidence of urinary incontinence episodes decreased in 75% of patients in the main group and in 40% of patients in the control group. The effectiveness of the combined rehabilitation method was 35%. The OAB-q SF questionnaire showed no statistically significant differences between the groups: 6.2+0.9 and 6.9+1.3 points (p=0.8), respectively. CONCLUSION: Local traveling pulsed magnetic field increases the effectiveness of therapeutic exercises in rehabilitation of patients with long-standing urinary incontinence after radical prostatectomy. The obtained data can serve as a basis for further well-organized studies on a larger number of patients allowing to make unambiguous conclusions.
BACKGROUND: MayerRokitanskyKuesterHauser syndrome occurs in 1 of 40005000 newborn girls. The first-line treatment of aplasia of the vagina is considered a vaginal dilation. The use of physiotherapy capabilities in the practice of obstetricians and gynecologists is quite widespread and has firmly established itself in clinical practice. AIMS: To evaluate the effectiveness and tolerability of dilation in combination and without physical effects in the formation of vagina in adolescent girls. MATERIALS AND METHODS: A prospective cohort study of 64 adolescent girls 15 to 18 y with a first-time diagnosis of vaginal and uterine aplasia was conducted. Their psychophysiological features were analyzed with testing according to the questionnaire well-being, activity, mood (SAN), physical and sexual development, a gynecological examination was performed to determine the depth of the vaginal fossa. Teenage girls were randomized into 2 groups: 1 (n=36) to create an artificial vagina, with the method of dilation. The second group of patients (n=28) underwent preformed physiotherapy with subsequent dilation. All the girls daily made a graph of the increase in the length of the vagina and determined the intensity of pain using a visual-analog scale (VAS). After the treatment was completed, the patients were re-tested according to the SAN method. RESULTS: A significant increase in the length of the neovagal space was noted in the group of complex treatment with physiotherapy already at the 8th procedure, with an increase after the completion of 20 procedures. In group 2, the dynamics of pain intensity significantly decreased in comparison with the 1st group. The psychological status of the patients according to the SAN before the start of treatment was characterized by an unfavorable state. CONCLUSION: Conducting course procedures of complex dilation with the use of heat-magneto-vibration in girls with vaginal aplasia has a significant reduction in pain and allowed to achieve the required anatomical length in a shorter time compared to monomethodics.
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