agxАндрология и генитальная хирургияAndrology and Genital Surgery2070-97812412-890210.17650/1726-9784-2022-23-1-53-59agx-545Research ArticleОРИГИНАЛЬНАЯ СТАТЬЯORIGINAL REPORTКоррекция хронического простатита с помощью экстракорпоральной ударно-волновой терапииCorrection of chronic prostatitis by extracorporeal shock wave therapyhttps://orcid.org/0000-0002-8398-7255ЕпифановаМ. В.EpifanovaM. V.

Майя Владимировна Епифанова  

117819 Москва, ул. Миклухо-Маклая, 6

125284 Москва, 2-й Боткинский пр-д, 3

Maya Vladimirovna Epifanova

Bld. 3, 21 Miklukho-Maklaya St., Moscow 117198

3 2nd Botkinskiy proezd, Moscow 117198

epifanova_maya@mail.ruhttps://orcid.org/0000-0002-0792-6012КостинА. А.KostinА. А.

117819 Москва, ул. Миклухо-Маклая, 6

249031 Калужская область, Обнинск, ул. Маршала Жукова, 10

Bld. 3, 21 Miklukho-Maklaya St., Moscow 117198

10, Marshala Zhukova St., Obninsk 249031

https://orcid.org/0000-0002-8509-4338ГамееваЕ. В.GameevaE. V.

117819 Москва, ул. Миклухо-Маклая, 6

125284 Москва, 2-й Боткинский пр-д, 3

Bld. 3, 21 Miklukho-Maklaya St., Moscow 117198

3 2nd Botkinskiy proezd, Moscow 117198

https://orcid.org/0000-0002-3630-9427АртеменкоС. А.ArtemenkoS. A.

117819 Москва, ул. Миклухо-Маклая, 6

Bld. 3, 21 Miklukho-Maklaya St., Moscow 117198

https://orcid.org/0000-0003-4111-6037ЕпифановА. А.EpifanovА. А.

127473 Москва, ул. Делегатская, 20, стр. 1

Bld. 1, 20 Delegatskaya St., Moscow 127473

ФГАОУ ВО «Российский университет дружбы народов»; Московский научно-исследовательский онкологический институт им. П.А. Герцена – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава РоссииРоссияRUDN University; P.А. Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre, Ministry of Health of RussiaRussian FederationФГАОУ ВО «Российский университет дружбы народов»; ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава РоссииРоссияRUDN University; National Medical Research Radiological Centre, Ministry of Health of RussiaRussian FederationФГАОУ ВО «Российский университет дружбы народов»РоссияRUDN UniversityRussian FederationФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава РоссииРоссияA.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of RussiaRussian Federation2022180320222315359Copyright © Епифанова М.В., Костин А.А., Гамеева Е.В., Артеменко С.А., Епифанов А.А., 20222022Епифанова М.В., Костин А.А., Гамеева Е.В., Артеменко С.А., Епифанов А.А.Epifanova M.V., Kostin А.А., Gameeva E.V., Artemenko S.A., Epifanov А.А.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://agx.elpub.ru/jour/article/view/545

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.

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.

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The authors declare that there are no conflicts of interest present.