agxАндрология и генитальная хирургияAndrology and Genital Surgery2070-97812412-8902MedINK Publishing House LLC10.63769/2070-9781-2025-25-3-15-25agx-828Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL REPORTВосстановление эректильной функции у пациентов после радикальной простатэктомии с использованием аутоплазмы, обогащенной тромбоцитарными факторами роста, и экстракорпоральной ударно-волновой терапии: контролируемое исследованиеRecovery of erectile function in patients after radical prostatectomy using platelet rich plasma and extracorporeal shock wave therapy: a controlled studyhttps://orcid.org/0000-0002-8398-7255ЕпифановаМ. В.EpifanovaM. V.

Мая 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.KostinА. А.

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

6 Miklukho-Maklaya st., Moscow, 117198

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

127006, Москва, ул. Долгоруковская, д. 4

4 Dolgorukovskaya str., Moscow, 127006

https://orcid.org/0000-0003-0916-3984СлавкинаЕ. В.SlavkinaE. V.

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

6 Miklukho-Maklaya st., Moscow, 117198

Российский университет дружбы народовРоссияRUDN UniversityRussian FederationФГБОУ ВО «Российский университет медицины» Минздрава РоссииРоссияFSBEI HE ROSUNIMED Of MOH of RussiaRussian Federation2025250220262531525Copyright © Епифанова М.В., Артеменко С.А., Костин А.А., Епифанов А.А., Славкина Е.В., 20262026Епифанова М.В., Артеменко С.А., Костин А.А., Епифанов А.А., Славкина Е.В.Epifanova M.V., Artemenko S.A., Kostin А.А., Epifanov А.А., Slavkina E.V.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/828

Введение. Рак предстательной железы (РПЖ) остаeтся одной из ведущих онкологических причин заболеваемости у мужчин. Несмотря на развитие современных хирургических подходов, включая нервосберегающую радикальную простатэктомию (РПЭ), эректильная дисфункция (ЭД) остаeтся частым и значимым осложнением, существенно влияющим на качество жизни пациентов. В настоящее время существующие методы реабилитации имеют ограничения по эффективности или доступности.Цель работы. Оценка эффективности и безопасности сочетанного применения аутоплазмы, обогащeнной тромбоцитарными факторами роста (АОТ), и экстракорпоральной ударно-волновой терапии (ЭУВТ) в восстановлении эректильной функции у пациентов с эректильной дисфункцией после нервосберегающей радикальной простатэктомии (РПЭ).Материалы и методы. В проспективное контролируемое исследование включены 46 пациентов, перенесших одноили двустороннюю нервосберегающую робот-ассистированную РПЭ. Группа 1 получала инъекции АОТ в сочетании с процедурами ЭУВТ. Группа 2 (контроль) – терапию тадалафилом. Оценка проводилась в начале лечения и на 60-й день. Использовались валидированные шкалы: МИЭФ-5, ППО, ШТЭ, IPSS, QOL, ICIQ-SF, GAQ, а также фармакодопплерография (ФДГ) сосудов полового члена, урофлоуметрия, уровень общего тестостерона.Результаты исследования. В группе комбинированной терапии (АОТ + ЭУВТ) отмечено достоверное улучшение показателей эректильной функции: МИЭФ-5 (p < 0,001), ППО (p < 0,001), ШТЭ (p < 0,001), улучшение гемодинамики по данным ФДГ (PSV и RI, p < 0,001), купирование симптомов недержания мочи по ICIQ-SF (p < 0,001), улучшение мочеиспускания по данным УФМ (p < 0,001). В контрольной группе значимого улучшения эректильной функции не зафиксировано. Различий по безопасности между группами не отмечено.Заключение. Сочетание АОТ и ЭУВТ показало высокую клиническую эффективность и безопасность у пациентов с постпростатэктомической эректильной дисфункцией. Метод заслуживает дальнейшего изучения и может быть рекомендован в качестве эффективной стратегии пенильной реабилитации после РПЭ.

Background. Prostate cancer (PCa) remains one of the leading oncological causes of morbidity in men. Despite advances in modern surgical techniques, including nerve-sparing radical prostatectomy (RP), erectile dysfunction (ED) remains a frequent and significant complication that substantially affects patients’ quality of life. Currently available rehabilitation methods have limitations in terms of effectiveness or accessibility.Aim. To evaluate the efficacy and safety of the combined use of autologous plasma enriched with platelet-rich plasma (PRP) and extracorporeal shockwave therapy (ESWT) in the restoration of erectile function in patients with erectile dysfunction following nerve-sparing radical prostatectomy.Materials and Methods. A prospective controlled study included 46 patients who had undergone unilateral or bilateral nerve-sparing robot-assisted RP. Group 1 received PRP injections combined with ESWT sessions. Group 2 (control) received tadalafil therapy. Assessments were conducted at baseline and on the 60th day of treatment. Validated scales were used: IIEF-5, SEP, EHS, IPSS, QOL, ICIQ-SF, GAQ, as well as penile vascular pharmacodopplerography (PDG), uroflowmetry (UFM), and total testosterone levels.Results. The combination therapy group (PRP + ESWT) demonstrated a significant improvement in erectile function indicators: IIEF-5 (p < 0.001), SEP (p < 0.001), EHS (p < 0.001), improved hemodynamics according to PDG (PSV and RI, p < 0.001), resolution of urinary incontinence symptoms per ICIQ-SF (p < 0.001), and improved urination according to UFM data (p < 0.001). No significant improvement in erectile function was recorded in the control group. No differences in safety profiles were observed between the groups.Conclusion. The combination of PRP and ESWT showed high clinical efficacy and safety in patients with postprostatectomy erectile dysfunction. This method warrants further investigation and may be recommended as an effective penile rehabilitation strategy following RP.

рак предстательной железыэректильная дисфункцияреабилитациярадикальная простатэктомияаутоплазмаобогащенная тромбоцитарными факторами ростаэкстракорпоральная ударноволновая терапия.prostate cancererectile dysfunctionrehabilitationradical prostatectomyplatelet rich plasmaextracorporeal shock wave therapy.ReferencesSiegel R.L., Miller K.D., Wagle N.S. et al. Cancer statistics, 2023. CA Cancer J Clin. 2023 Jan;73(1):17-48. DOI: 10.3322/caac.21763. PMID: 36633525.Siegel R.L., Miller K.D., Wagle N.S. et al. Cancer statistics, 2023. CA Cancer J Clin. 2023 Jan;73(1):17-48. DOI: 10.3322/caac.21763. PMID: 36633525.EAU Guidelines. Edn. presented at the EAU Annual Congress Madrid 2025. ISBN 978-94-92671-29-5.EAU Guidelines. Edn. presented at the EAU Annual Congress Madrid 2025. ISBN 978-94-92671-29-5.Avulova S., Zhao Z., Lee D. et al. The Effect of Nerve Sparing Status on Sexual and Urinary Function: 3-Year Results from the CEASAR Study. J Urol 2018;199:1202. PMID: 29253578. 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The authors declare that there are no conflicts of interest present.