urovestВестник урологииUrology Herald2308-6424Rostov State Medical University10.21886/2308-6424-2019-7-2-14-23urovest-250Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESСравнительный анализ терапии 1-й и 2-й линий в ведении пациентов с невоспалительной формой хронического простатита/ синдрома хронической тазовой болиManagement of patients with chronic prostatitis/chronic pelvic pain syndrome: «second-line» therapy possibilitieshttps://orcid.org/0000-0003-0674-9429БелоусовИ. И.BelousovI. I.

Белоусов Игорь Иванович - доктор медицинских наук, доцент; профессор кафедры урологии и репродуктивного здоровья человека с курсом детской урологии-андрологии.

Ростов-на-Дону, тел.: +7 (928) 904-30-90

Igor I. Belousov - M.D., Ph.D. (M), D.M.S., Associate Professor (Docent); Professor, Department of Urology and Human Reproductive Health with the course of Pediatric Urology and Andrology, Advanced Training and Specialist Professional Retraining Faculty.

Rostov-on-Don

beirost_dept@maii.ruhttps://orcid.org/0000-0002-1710-0169КоганМ. И.KoganM. I.

Коган Михаил Иосифович - Заслуженный деятель науки РФ, доктор медицинских наук, профессор; заведующий кафедрой урологии и репродуктивного здоровья человека с курсом детской урологии-андрологии.

Ростов-на-Дону

Mikhail I. Kogan - Honored Scientist of Russian Federation, M.D., Ph.D. (M), D.M.S., Full Professor; Head, Department of Urology and Human Reproductive Health with the course of Pediatric Urology and Andrology, Advanced Training and Specialist Professional Retraining Faculty.

Rostov-on-Don

dept_kogan@mail.ruФГБОУ ВО «Ростовский государственный медицинский университет» МЗ РФРоссияRostov State Medical UniversityRussian Federation201916072019721423Copyright © Белоусов И.И., Коган М.И., 20192019Белоусов И.И., Коган М.И.Belousov I.I., Kogan M.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.urovest.ru/jour/article/view/250Актуальность

Актуальность. В Основными симптомами при невоспалительной форме хронического простатита / синдрома хронической тазовой боли (ХП/СХТБ III Б) являются боль, симптомы со стороны нижних мочевых путей (СНМП) и нарушения эректильной функции. Боль является ведущим симптомом. Лечение пациентов с данным состоянием является крайне сложным и нередко малоэффективным. Для коррекции симптомов считается обоснованным применение альфа1-адреноблокаторов (α1-АБ), антибактериальных препаратов, нестероидных противовоспалительных средств и фитотерапии, поскольку эти средства являются апробированными и имеют те или иные уровни доказательности. Тем не менее их применение в большинстве случаев не позволяет добиться должного клинического эффекта.

Цель исследования

Цель исследования. Сравнительный анализ эффективности терапии 1-й линии в виде комбинации α1-АБ и анальгетика из группы НПВС с одной стороны и терапии 1-й линии в виде комбинации α1-АБ и анальгетика из группы НПВС, дополненной местным физическим воздействием на предстательную железу, с другой.

Материалы и методы

Материалы и методы. 73 пациента с ранее установленным диагнозом ХП/СХТБ III Б. Формат работы - проспективное рандомизированное простое сравнительное исследование. Ключевой оценочный критерий - скорость артериального интрапростатического кровотока. Клиническую оценку пациентов осуществляли анкетированием (опросники I-PSS, NIH-CPPS и МИЭФ-5) до и после приема медикаментозных препаратов. Медикаментозную терапию проводили в течение 30 дней. Рандомизация: 1-я группа - терапия первой линии (α1-АБ + НПВС). 2-я группа - терапия 1-й линии (α1-АБ + НПВС), дополненная массажем предстательной железы. Статистический анализ произведен методами непараметрической статистики.

Результаты

Результаты. Боль: снижение интенсивности боли - на 7,7 и 26,9% для 1-й и 2-й групп соответственно. СНМП: снижение степени тяжести/редукция - на 18,2/0% и 50/15,4% случаев соответственно для 1-й и 2-й групп соответственно. Удовлетворение от лечения - 3,8 и 26,9% пациентов для 1-й и 2-й групп соответственно. Статистически значимого улучшения эректильной функции не отмечено у пациентов обеих групп.

Заключение

Заключение. В случае, когда ХП/СХТБ III Б сопровождается нарушениями артериальной гемодинамики простаты умеренной степени выраженности, достичь улучшения результатов стандартной терапии 1-й линии, рекомендованной Европейской ассоциацией урологов, возможно. При этом удается снизить интенсивность боли и тяжесть СНМП. Однако, улучшения эректильной функции у этих пациентов не отмечается.

Introduction

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

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

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

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

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.

больэректильная дисфункциямассаж простатымедикаментозная терапияСНМПХП/СХТБ III БCP/CPPS III Bdrug therapyerectile disfunctionLUTSpainprostate massageReferencesEngeler D, Baranowski AP, Borovicka J, Cottrell AM, Elneil S, Hughes J, Messelink E (Vice-chair), de C Williams AC. Guidelines Associates: Parsons B, Goonewardene S. EAU Guidelines on Chronic Pelvic Pain. European Association of Urology, 2018 [internet publication]. - URL: https://uroweb.org/guideline/chronic-pelvic-pain/Engeler D, Baranowski AP, Borovicka J, Cottrell AM, Elneil S, Hughes J, Messelink E (Vice-chair), de C Williams AC. Guidelines Associates: Parsons B, Goonewardene S. EAU Guidelines on Chronic Pelvic Pain. European Association of Urology, 2018[internetpublication]. - URL: https://uroweb.org/guideline/chronic-pelvic-pain/Thakkinstian A, Attia J, Anothaisintawee T, Nickel JC. 2. a-Blockers, antibiotics and anti-inflammatories have a role in the management of chronic prostatitis/chronic pelvic pain syndrome. BJU Int. 2012;110(7):1014-1022. DOI: 10.1111/j.1464-410X.2012.11088.xThakkinstian A, Attia J, Anothaisintawee T, Nickel JC. 2. a-Blockers, antibiotics and anti-inflammatories have a role in the management of chronic prostatitis/chronic pelvic pain syndrome. BJU Int. 2012;110(7):1014-1022. DOI: 10.1111/j.1464-410X.2012.11088.xCohen JM, Fagin AP, Hariton E, Niska JR, Pierce MW, Kuriyama A, Whelan JS, Jackson JL, Dimitrakoff JD. Therapeutic intervention for chronic prostatiti s/chronic pelvic pain syndrome (CP/CPPS): a systematic review and meta-analysis. PLoS One. 2012;7(8):e41941. DOI: 10.1371/journal.pone.0041941Cohen JM, Fagin AP, Hariton E, Niska JR, Pierce MW, Kuriyama A, Whelan JS, Jackson JL, Dimitrakoff JD. Therapeutic intervention for chronic prostatitis/chronic pelvic pain syndrome (CP/ CPPS): a systematic review and meta-analysis. PLoS One. 2012;7(8):e41941. DOI: 10.1371/journal.pone.0041941Pontari M, Giusto L. New developments in the diagnosis and treatment of chronic prostatitis/chronic pelvic pain syndrome. Curr Opin Urol. 2013;23(6):565-569. DOI: 10.1097/MOU.0b013e3283656a55.Pontari M, Giusto L. New developments in the diagnosis and treatment of chronic prostatitis/chronic pelvic pain syndrome. Curr Opin Urol. 2013;23(6):565-569. DOI: 10.1097/MOU.0b013e3283656a55.Ismail M, Mackenzie K, Hashim H. Contemporary treatment options for chronic prostatitis/chronic pelvic pain syndrome. Drugs Today (Barc). 2013;49(7):457-462. DOI: 10.1358/dot.2013.49.7.1990152Ismail M, Mackenzie K, Hashim H. Contemporary treatment options for chronic prostatitis/chronic pelvic pain syndrome. Drugs Today (Barc). 2013;49(7):457-462. DOI: 10.1358/dot.2013.49.7.1990152Taylor BC, Noorbaloochi S, McNaughton-Collins M, Saigal CS, Sohn MW, Pontari MA, Litwin MS, Wilt TJ; Urologic Diseases in America Project. Excessive antibiotic use in men with prostatitis. Am J Med. 2008;121(5):444-449. DOI: 10.1016/j.am-jmed.2008.01.043Taylor BC, Noorbaloochi S, McNaughton-Collins M, Saigal CS, Sohn MW, Pontari MA, Litwin MS, Wilt TJ; Urologic Diseases in America Project. Excessive antibiotic use in men with prostatitis. Am J Med. 2008;121(5):444-449. DOI: 10.1016/j.amjmed.2008.01.043Nickel JC, Downey J, Clark J, Casey RW, Pommerville PJ, Barkin J, Steinhoff G, Brock G, Patrick AB, Flax S, Goldfarb B, Palmer BW, Zadra J. Levofloxacin for chronic prostatitis/chronic pelvic pain syndrome in men: a randomized placebo-controlled multicenter trial. Urology. 2003;62(4):614-617. PMID: 14550427Nickel JC, Downey J, Clark J, Casey RW, Pommerville PJ, Barkin J, Steinhoff G, Brock G, Patrick AB, Flax S, Goldfarb B, Palmer BW, Zadra J. Levofloxacin for chronic prostatitis/ chronic pelvic pain syndrome in men: a randomized placebo-controlled multicenter trial. Urology. 2003;62(4):614-617. PMID: 14550427Zhao WP, Zhang ZG, Li XD, Yu D, Rui XF, Li GH, Ding GQ. Celecox-ib reduces symptoms in men with difficult chronic pelvic pain syndrome (Category IIIA). Braz. J. Med. Biol Res. 2009;42(10): 963-967. DOI: 10.1590/S0100-879X2009005000021Zhao WP, Zhang ZG, Li XD, Yu D, Rui XF, Li GH, Ding GQ. Celecox-ib reduces symptoms in men with difficult chronic pelvic pain syndrome (Category IIIA). Braz. J. Med. Biol Res. 2009;42(10): 963-967. DOI: 10.1590/S0100-879X2009005000021Elist J. Effects of pollen extract preparation Prostat/Poltit on lower urinary tract symptoms in patients with chronic nonbacterial prostatiti s/chronic pelvic pain syndrome: a randomized, double-blind, placebo-controlled study. Urology. 2006;67(1):60-63. DOI: 10.1016/j.urology.2005.07.035. Elist J. Effects of pollen extract preparation Prostat/Poltit on lower urinary tract symptoms in patients with chronic nonbacterial prostatiti s/chronic pelvic pain syndrome: a randomized, double-blind, placebo-controlled study. Urology. 2006;67(1):60-63. DOI: 10.1016/j.urology.2005.07.035Wagenlehner FM, Schneider H, Ludwig M, Schnitker J, Brahler E, Weidner W. A pollen extract (Cernilton) in pa-ti ents with inflammatory chronic prostatitis-chronic pelvic pain syndrome: a multicentre, randomised, prospective, double-blind, placebo-controlled phase 3 study. Eur Urol. 2009;56(3):544-551. DOI: 10.1016/j.eururo.2009.05.046Wagenlehner FM, Schneider H, Ludwig M, Schnitker J, Brahler E, Weidner W. A pollen extract (Cernilton) in patients with inflammatory chronic prostatitis-chronic pelvic pain syndrome: a multicentre, randomised, prospective, double-blind, placebo-controlled phase 3 study. Eur Urol. 2009;56(3):544-551. DOI: 10.1016/j.eururo.2009.05.046Shoskes D.A., Zeitlin S.I., Shahed A. Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial. Urology. 1999;54(6):960-963. PMID: 10604689Shoskes D.A., Zeitlin S.I., Shahed A. Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial. Urology. 1999;54(6):960-963. PMID: 10604689Tugcu V, Ta§?i AI, Fazlioglu A, Gurbuz G, Ozbek E, Sahin S, Kurtulu§ F, Cek M. A placebo-controlled comparison of the efficiency of triple- and monotherapy in category III B chronic pelvic pain syndrome (CPPS). Eur Urol. 2007;51(4):1113-1117. DOI: 10.1016/j.eururo.2006.09.036Tugcu V, Ta§?i AI, Fazlioglu A, Gurbuz G, Ozbek E, Sahin S, Kurtulu§ F, Cek M. A placebo-controlled comparison of the efficiency of triple- and monotherapy in category III B chronic pelvic pain syndrome (CPPS). Eur Urol. 2007;51(4):1113-1117. DOI: 10.1016/j.eururo.2006.09.036Murphy AB, Nadler RB. Pharmacotherapy strategies in chronic prostatiti s/chronic pelvic pain syndrome management. Expert Opin Pharmacother. 2010;11(8):1255-1261. DOI: 10.1517/14656561003709748Murphy AB, Nadler RB. Pharmacotherapy strategies in chronic prostatiti s/chronic pelvic pain syndrome management. Expert Opin Pharmacother. 2010;11(8):1255-1261. DOI: 10.1517/14656561003709748Nickel JC, Shoskes DA, Wagenlehner FM. Management of chronic prostatitis /chronic pelvic pain syndrome (CP/CPPS): the studies, the evidence, and the impact. World J. Urol. 2013;31(4):747-753. DOI 10.1007/s00345-013-1062-yNickel JC, Shoskes DA, Wagenlehner FM. Management of chronic prostatitis /chronic pelvic pain syndrome (CP/CPPS): the studies, the evidence, and the impact. World J. Urol. 2013;31(4):747-753. DOI 10.1007/s00345-013-1062-yKartha GK, Kerr H, Shoskes DA. Clinical phenotyping of uro-logic pain patients. Curr. Opin. Urol. 2013;23(6):560-564. DOI: 10.1097/MOU.0b013e3283652a9dKartha GK, Kerr H, Shoskes DA. Clinical phenotyping of urologic pain patients. Curr. Opin. Urol. 2013;23(6):560-564. DOI: 10.1097/MOU.0b013e3283652a9dCalhoun EA, Clemens JQ, Litwin MS, Walker-Corkery E, Mar-kossian T, Kusek JW, and McNaughton-Collins M, the Chronic Prostatitis Collaborative Research Network. Primary care physician practices in the diagnosis, treatment and management of men with chronic prostatiti s/chronic pelvic pain syndrome. Prostate Cancer Prostatic Dis. 2009;12(3):288-295. DOI: 10.1038/pcan.2009.9Calhoun EA, Clemens JQ, Litwin MS, Walker-Corkery E, Mar-kossian T, Kusek JW, and McNaughton-Collins M, the Chronic Prostatitis Collaborative Research Network. Primary care physician practices in the diagnosis, treatment and management of men with chronic prostatiti s/chronic pelvic pain syndrome. Prostate Cancer Prostatic Dis. 2009;12(3):288-295. DOI: 10.1038/pcan.2009.9Vahlensieck W, Ludwig M, Wagenlehner FM, Naber K, Fabry W. Prostatitis - diagnostics and therapy. Aktuelle Urol. 2013;44(2):117-123. DOI: 10.1055/s-0033-1337934Vahlensieck W, Ludwig M, Wagenlehner FM, Naber K, Fabry W. Prostatiti s - diagnosti cs and therapy. Aktuelle Urol. 2013;44(2):117-123. DOI: 10.1055/s-0033-1337934Schaeffer AJ. Clinical practice. Chronic prostatitis and the chronic pelvic pain syndrome. N Engl J Med. 2006;355(16):1690-1698. DOI: 10.1056/NEJMcp060423Schaeffer AJ. Clinical practice. Chronic prostatitis and the chronic pelvic pain syndrome. N Engl J Med. 2006;355(16):1690-1698. DOI: 10.1056/NEJMcp060423Nickel JC, Tripp D, Gordon A, Pontari M, Shoskes D, Peters KM, Doggweiler R, Baranowski AP. Update on urologic pelvic pain syndromes: highlights from the 2010 international chronic pelvic pain symposium and workshop, August 29, 2010, Kingston, Ontario, Canada. Rev Urol. 2011;13(1):39-49. PMID: 21826127Nickel JC, Tripp D, Gordon A, Pontari M, Shoskes D, Peters KM, Doggweiler R, Baranowski AP. Update on urologic pelvic pain syndromes: highlights from the 2010 international chronic pelvic pain symposium and workshop, August 29, 2010, Kingston, Ontario, Canada. Rev Urol. 2011;13(1):39-49. PMID: 21826127Andersen JT. Treatment of prostatodynia (pelvic floor myalgia or chronic non-inflammatory pelvic pain syndrome). Textbook of Prostatitis. C - Oxford: United Kingdom, Isis Medical Media, 1999: 357-364.Andersen JT. Treatment of prostatodynia (pelvic floor myalgia or chronic non-inflammatory pelvic pain syndrome). Textbook of Prostatitis. C - Oxford: United Kingdom, Isis Medical Media, 1999: 357-364.Shoskes DA, Nickel JC, Kattan MW. Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study using UPOINT. Urology. 2010;75(6):1249-1253. DOI: 10.1016/j.urology.2010.01.021Shoskes DA, Nickel JC, Kattan MW. Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study using UPOINT. Urology. 2010;75(6):1249-1253. DOI: 10.1016/j.urology.2010.01.021Samplaski MK, Li J, Shoskes DA. Clustering of UPOINT domains and subdomains in men with chronic prostatitis/ chronic pelvic pain syndrome and contribution to symptom severity. J Urol. 2012;188(5):1788-1793. DOI: 10.1016/j.juro.2012.07.036.Samplaski MK, Li J, Shoskes DA. Clustering of UPOINT domains and subdomains in men with chronic prostatitis/ chronic pelvic pain syndrome and contribution to symptom severity. J Urol. 2012;188(5):1788-1793. DOI: 10.1016/j.juro.2012.07.036.

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