agxАндрология и генитальная хирургияAndrology and Genital Surgery2070-97812412-890210.17650/2070-9781-2023-24-4-91-99agx-709Research ArticleОРИГИНАЛЬНАЯ СТАТЬЯORIGINAL REPORTБезопасность и потенциальная эффективность аутоплазмы, обогащенной тромбоцитарными факторами роста, и экстракорпоральной ударно-волновой терапии при лечении эректильной дисфункции у пациентов после нервосберегающей радикальной простатэктомии: пилотное исследованиеSafety and potential effectiveness of platelet-rich plasma and extracorporeal shock wave therapy in the treatment of erectile dysfunction after nerve-sparing radical prostatectomy in patients: pilot studyhttps://orcid.org/0000-0002-8398-7255ЕпифановаМ. В.EpifanovaM. V.

Майя Владимировна Епифанова

117198 Москва, ул. Миклухо-Маклая, д. 6

Maya Vladimirovna Epifanova

6 Miklukho-Maklaya St., Moscow, 117198

epifanova_maya@mail.ruhttps://orcid.org/0000-0002-3630-9427АртеменкоС. А.ArtemenkoS. A.

117198 Москва, ул. Миклухо-Маклая, д. 6

6 Miklukho-Maklaya St., Moscow, 117198

https://orcid.org/0000-0002-0792-6012КостинА. А.KostinA. A.

117198 Москва, ул. Миклухо-Маклая, д. 6

6 Miklukho-Maklaya St., Moscow, 117198

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

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

Bld. 1, 20 Delegatskaya St., Moscow 127473

https://orcid.org/0000-0002-8213-5608КирилловаК. А.KirillovaK. A.

117198 Москва, ул. Миклухо-Маклая, д. 6

6 Miklukho-Maklaya St., Moscow, 117198

Российский университет дружбы народовРоссияRUDN UniversityRussian FederationФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава РоссииРоссияA.I. Yevdokimov Moscow State Medical and Dental University, Ministry of Health of RussiaRussian Federation2023291120232449199Copyright © Епифанова М.В., Артеменко С.А., Костин А.А., Епифанов А.А., Кириллова К.А., 20232023Епифанова М.В., Артеменко С.А., Костин А.А., Епифанов А.А., Кириллова К.А.Epifanova M.V., Artemenko S.A., Kostin A.A., Epifanov A.A., Kirillova K.A.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/709Введение

Введение. Рак предстательной железы является наиболее распространенным видом рака у мужчин. Радикальная простатэктомия (РПЭ), в том числе нервосберегающая, часто приводит к эректильной дисфункции, значительному снижению качества жизни. Существующие методы лечения имеют ограниченную эффективность и/или не подходят пациентам.

Цель исследования – оценка безопасности и эффективности применения аутоплазмы, обогащенной тромбоцитарными факторами роста (АОТ), и экстракорпоральной ударно-волновой терапии (ЭУВТ) при лечении эректильной дисфункции у пациентов после нервосберегающей РПЭ.

Материалы и методы

Материалы и методы. В исследование включены 14 мужчин, перенесших одно- или двустороннюю робот-ассистированную нервосберегающую РПЭ более чем 3 мес назад. Уровень общего простатспецифического антигена у всех пациентов составил <0,2 нг/мл через 3 мес и более после операции. Возраст пациентов – 57,8 ± 6,2 (49–72) года, продолжительность эректильной дисфункции – 7,6 ± 3,9 (3–16) мес. Осуществлялось 2 визита в неделю на протяжении 6 нед: в 1-й визит выполняли ЭУВТ (Dornier Aries) на половой член (ПЧ) и инъекции АОТ в ПЧ и мышцы, участвующие в акте эрекции, в конце сеанса активировали АОТ с помощью ЭУВТ; во 2-й визит – ЭУВТ на ПЧ. Обследование проводили на 0-й и 60-й дни исследования с использованием опросников (международный индекс эректильной функции  (МИЭФ-5), профиль половых отношений, шкала твердости эрекции, Global Assessment Questions (GAQ), International Prostate Symptom Score (IPSS), Quality of Life (QoL)), определением уровня общего тестостерона крови, выполнением фармакодопплерографии (ФДГ) сосудов ПЧ с аналогом простагландина Е1. Критерии включения в исследование: отсутствие метастазов в отдаленные органы, лимфатические узлы; стадия не более T3b; МИЭФ-5 <21 балла после РПЭ; PSV (пиковая систолическая скорость) <30 см/с и/или RI (индекс резистентности) <0,8 по данным ФДГ сосудов ПЧ с аналогом простагландина Е1 после РПЭ; наличие эрекций до РПЭ.

Результаты

Результаты. Все пациенты переносили лечение удовлетворительно. Статистически значимое улучшение эректильной функции отмечено по данным МИЭФ-5 (р <0,05), профиля половых отношений (р = 0,002), шкалы твердости эрекции (р = 0,002). По опроснику GAQ 11 (78,5 %) пациентов отметили положительный эффект от лечения. Согласно результатам ФДГ сосудов ПЧ, показатели PSV и RI по обеим кавернозным артериям значимо возросли (р <0,05). Все пациенты отметили снижение дизурических явлений по опросникам IPSS (р = 0,007) и QoL (р = 0,58). Концентрация общего тестостерона крови – без значимой динамики (р = 0,192).

Заключение

Заключение. Наблюдается положительная динамика в отношении значимого улучшения эректильной функции у всех пациентов по данным валидированных опросников и ФДГ сосудов ПЧ. Предложенное лечение является перспективным методом восстановления для данной категории пациентов. Продолжается исследование на большей выборке пациентов.

Background

Background. Prostate cancer is the most common type of cancer in men. Radical prostatectomy (RPE), including nerve-sparing, often leads to erectile dysfunction and a significant decrease in the quality of life. The available treatments are limited in effectiveness and/or are not suitable for patients.

Aim

Aim. The aim of the study was to evaluate the safety and effectiveness of platelet-rich plasma (PRP) and extracorporeal shock wave therapy (ESWT) in the treatment of erectile dysfunction in patients after nerve-sparing RPE.

Materials and methods

Materials and methods. 14 men were included in the study after unilateral or bilateral nerve-sparing RPE more than 3 months ago. The total prostate-specific antigen in all patients was less than 0.2 ng/ml 3 months or more after surgery. Age – 57.8 ± 6.2 (49–72) years, duration of erectile dysfunction – 7.6 ± 3.9 (3–16) months. Two visits per week were out for 6 weeks: in visit 1, the ESWT (Dornier Aries) was performed on penis and injections of PRP into the penis, the muscles involved in the erection were activated at the end of the session by ESWT, in visit 2, ESWT on penis. The examinations were performed on the 0 and 60 days of the study: International Index of Erectile Function (IIEF-5), Sexual Encounter Profile (SEP), Erection Hardness Score (EHS), Global Assessment Questionnaire (GAQ), International Prostate Symptom Score (IPSS), Quality of Life (QoL), total blood testosterone, to penile duplex Doppler ultrasonography (PDDU) with prostaglandin E1 analog. Inclusion criteria were absence of metastases to distant organs and lymph nodes; stage no more than T3b; IIEF-5 less than 21 points after RPE; PSV less than 30 cm/s and/or RI less than 0.8 according to the PDDU after RPE; the presence of erections before RPE.

Results

Results. Treatment was tolerated satisfactorily for all patients. Significant improvement of erectile function was noted according to IIEF-5 (p <0.05), SEP (p = 0.002), EHS (p = 0.002). According to GAQ, 11 patients (78.5 %) noted a positive effect of treatment. PSV and RI in both cavernous arteries increased significantly (p <0.05) according PDDU. All patients noted a dysuria decrease based on IPSS (p = 0.007) and QoL (p = 0.58). The concentration of total testosterone in the blood without significant dynamics (p = 0.192).

Conclusion

Conclusion. There are positive effects in relation to a significant improvement in erectile function in all patients according to validated questionnaires and PDDU. The proposed treatment is a promising method of restoring patient data. The study continues on a larger sample of patients.

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