Management of patients with chronic prostatitis/chronic pelvic pain syndrome: "second-line" therapy possibilities
Introduction. CThe basic symptoms in the non-inflammatory form of chronic prostatitis / chronic pelvic pain syndrome (CP / CPTB III B) are Pain, Symptoms of the Lower Urinary Tract (LUTS) and Erectile Dysfunction (ED). Pain is the main and leading symptom. Treatment of patients with this condition is extremely difficult and often ineffective. For the correction of present symptoms, it is considered reasonable to use alphai-Adrenergic Blockers (α1-AB), Antibacterial Drugs, Nonsteroidal Anti-inflammatory Drugs (NSAIDs) and Phytotherapy, since these drugs are approved and have a high level of evidence. However, their use in most cases does not allow to achieve the proper clinical effect.Objectives. Comparative analysis of the effectiveness of combination therapy of the «first-line» (α1-AB + NSAIDs) and combination therapy of the «first-line» (α1-AB + NSAIDs), supplemented by local physical effects on the prostate.Materials and methods. 73 patients with a previously confirmed diagnosis of CP / CPPS III B were included in the study. Study Design: A prospective randomized simple comparative study. The key evaluation criterion is the arterial intraprostatic blood flow rate. Clinical evaluation of patients was carried out by questioning (I-PSS, NIH-CPPS and ICEF-5 questionnaires) before and after taking medications. Drug therapy was performed for 30 days. Randomization: Group 1- first line therapy (α1-AB + NSAIDs). Group 2 - a massage of the prostate was added to the «first-line» therapy (α1-AB + NSAIDs). Statistical analysis was performed using non-parametric statistics.Results. Pain: decrease in pain intensity - by 7.7 and 26.9% for the Group 1 and 2, respectively. LUTS: decrease in severity / reduction - by 18.2 / 0% and 50 / 15.4% of cases for the Group i and 2, accordingly. Treatment satisfaction -3.8 and 26.9% of patients for the Group 1 and 2, respectively. A statistically significant improvement in erectile function was not observed in patients of both groups.Conclusions. In the case when CP / CPPS III B is accompanied by moderate arterial hemodynamic disorders of the prostate, it is possible to achieve an improvement in the results of standard «first-line» therapy recommended by the European Association of Urology. At the same time, it is possible to reduce the intensity of pain and the severity of LUTS. However, there is no improvement in erectile function in these patients.