urovestВестник урологииUrology Herald2308-6424Rostov State Medical University10.21886/2308-6424-2021-9-4-51-59urovest-503Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESВозможности периферической магнитной нейромодуляции в лечении симптомов нижних мочевых путей у мужчинPossibilities of peripheral magnetic neuromodulation in the treatment of lower urinary tract symptoms in menhttps://orcid.org/0000-0001-9813-7483ЛабетовИ. А.LabetovI. A.

Лабетов Иван Антонович — врач-ординатор Клиники высоких медицинских технологий им. Н.И. Пирогова СПбГУ.

199034, Санкт-Петербург, Университетская наб., д. 7-9.

Ivan A. Labetov — Resident, Pirogov Clinic of Advanced Medical Technologies, St. Petersburg State University.

199034, St. Petersburg, 7-9 Universitetskaya Qy.

ivanlabetov@gmail.comhttps://orcid.org/0000-0003-4884-6884КовалевГ. В.KovalevG. V.

Ковалев Глеб Валерьевич — врач-уролог Клиники высоких медицинских технологий им. Н.И. Пирогова СПбГУ; врач-уролог СЗЦДМ.

199034, Санкт-Петербург, Университетская наб., д. 7-9; 198095, Санкт-Петербург, пл. Стачек, д. 5.

Gleb V. Kovalev — M. D.; Urologist, Pirogov Clinic of Advanced Medical Technologies, St. Petersburg State University; Urologist, JSC «North-West Centre for Evidence-Based Medicine».

199034, St. Petersburg, 7-9 Universitetskaya Qy.; 198095, St. Petersburg, 5 Stachek Sq.

kovalev2207@gmail.comhttps://orcid.org/0000-0002-8655-7234ШульгинА. С.ShulginA. S.

Шульгин Андрей Сергеевич — кандидат медицинских наук; врач-уролог Клиники высоких медицинских технологий им. Н.И. Пирогова СПбГУ; врач-уролог СЗЦДМ.

199034, Санкт-Петербург, Университетская наб., д. 7-9; 198095, Санкт-Петербург, пл. Стачек, д. 5.

Andrey S. Shulgin — M. D., Cand.Sc. (Med); Urologist, Pirogov Clinic of Advanced Medical Technologies, St. Petersburg State University; Urologist, JSC «North-West Centre for Evidence-Based Medicine».

199034, St. Petersburg, 7-9 Universitetskaya Qy.; 198095, St. Petersburg, 5 Stachek Sq.

shulginandrey74@mail.ruhttps://orcid.org/0000-0001-5189-4639КубинН. Д.KubinN. D.

Кубин Никита Дмитриевич — доктор медицинских наук; врач-уролог Клиники высоких медицинских технологий им. Н.И. Пирогова СПбГУ; врач-уролог СЗЦДМ.

199034, Санкт-Петербург, Университетская наб., д. 7-9; 198095, Санкт-Петербург, пл. Стачек, д. 5.

Nikita D. Kubin — M. D., Dr.Sc. (Med); Urologist, Pirogov Clinic of Advanced Medical Technologies, St. Petersburg State University; Urologist, JSC «North-West Centre for Evidence-Based Medicine».

199034, St. Petersburg, 7-9 Universitetskaya Qy.; 198095, St. Petersburg, 5 Stachek Sq.

nikitakubin@gmail.comhttps://orcid.org/0000-0003-0489-3451ШкарупаД. Д.ShkarupaD. D.

Шкарупа Дмитрий Дмитриевич — доктор медицинских наук; заместитель директора по организации медицинской помощи Клиники высоких медицинских технологий им. Н.И. Пирогова СПбГУ; врач-уролог СЗЦДМ.

199034, Санкт-Петербург, Университетская наб., д. 7-9; 198095, Санкт-Петербург, пл. Стачек, д. 5.

Dmitry D. Shkarupa — M. D., Dr.Sc. (Med); Deputy CEO for Medical, Pirogov Clinic of Advanced Medical Technologies, St. Petersburg State University; Urologist, JSC «North-West Centre for Evidence-Based Medicine».

199034, St. Petersburg, 7-9 Universitetskaya Qy.; 198095, St. Petersburg, 5 Stachek Sq.

shkarupa.dmitry@mail.ruСанкт-Петербургский государственный университетРоссияSt. Petersburg State University — Pirogov Clinic of Advanced Medical TechnologiesRussian FederationСанкт-Петербургский государственный университет; Северо-Западный Центр доказательной медициныРоссияSt. Petersburg State University — Pirogov Clinic of Advanced Medical Technologies; JSC «North-West Centre for Evidence-Based Medicine»Russian Federation202124122021945159Copyright © Лабетов И.А., Ковалев Г.В., Шульгин А.С., Кубин Н.Д., Шкарупа Д.Д., 20212021Лабетов И.А., Ковалев Г.В., Шульгин А.С., Кубин Н.Д., Шкарупа Д.Д.Labetov I.A., Kovalev G.V., Shulgin A.S., Kubin N.D., Shkarupa D.D.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/503Введение

Введение. Симптомы нижних мочевых путей (СНМП) широко распространены у мужчин и ассоциированы со значительным снижением качества жизни. На сегодняшний день нет универсального подхода к лечению СНМП, что определяет необходимость поиска новых методов воздействия на нижние мочевые пути.

Цель исследования

Цель исследования. Проверить гипотезу, заключающуюся в том, что применение метода периферической магнитной нейромодуляции (ПМН) у мужчин с СНМП будет способствовать снижению интенсивности субъективных симптомов и объективных проявлений.

Материалы и методы

Материалы и методы. В проспективном рандомизированном исследовании приняли участие 68 мужчин с СНМП. Пациенты были рандомизированы в пропорции 1:1 для проведения ПМН или медикаментозной терапии альфа1-адреноблокатором (Тамсулозин). Первичная конечная точка — снижение выраженности симптомов нижних мочевых путей, таких как учащённое мочеиспускание в дневное время, ноктурия и ургентность, которая была оценена с помощью опросника IPSS и дневника мочеиспусканий. Улучшение уродинамических параметров, таких как максимальная скорость потока мочи (Q max), средняя скорость потока мочи (Q ave), остаточный объём мочи (PVR), являлись вторичной конечной точкой исследования. Результаты оценены на равных сроках (10 дней и 1 месяц) в обеих группах.

Результаты

Результаты. 67 (98,5%) испытуемых были включены в итоговую базу. Через 10 дней после начала терапии в группе магнитной стимуляции облегчение симптомов отметили 21 человек (61,7%), средний балл IPSS продемонстрировал снижение с 18,1 ± 2,1 до 16,9 ± 3,2 баллов (р = 0,037). Число мочеиспусканий за сутки снизилось с 14 (6 - 20) до 10 (6 - 14) раз (p < 0,001). Объективные показатели уродинамики не изменились в обеих группах. На сроке в 1 месяц в группе ПМН улучшение отметили 22 (64,7%) пациента, опросник IPSS составил 16,6 ± 3,7 баллов (p = 0,032), число мочеиспусканий — 9 (6 - 14) раз (p < 0,001). Объективные показатели не изменились. В группе тамсулозина IPSS изменился с 19,27 ± 5,08 до 15,4 ± 4,85 (p < 0,001). Q max возросла с 14,36 ± 2,82 мл/с до 15,94 ± 2,71 мл/с (p = 0,032), при этом Q ave не изменилась (p = 0,17). Число мочеиспусканий снизилось с 13 (6-19) раз до 10 (6 - 14) раз (p < 0,001).

Заключение

Заключение. Исследование продемонстрировало перспективность метода ПМН у мужчин с СНМП в отношении улучшения качества жизни, являясь предпочтительным для пациентов, не удовлетворенных медикаментозной терапией. Требуются дальнейшие плацебо-контролируемые исследования, которые помогут определить роль ПМН в лечении пациентов с СНМП.

Introduction

Introduction. Lower urinary tract symptoms (LUTS) are common in men and are associated with a significant decrease in quality of life. To date, there is no universal approach to the treatment of LUTS, which determines the need to search for new methods for influencing the lower urinary tract.

Purpose of the study

Purpose of the study. To test the hypothesis that the use of peripheral magnetic neuromodulation (PMN) in male patients with LUTS will reduce the severity of LUTS.

Materials and methods

Materials and methods. Sixty-eight men with LUTS were enrolled in a prospective, randomized study. Patients were randomized in a 1:1 ratio for PMN or drug therapy with an alpha-1-blocker (tamsulosin). The primary endpoint was a reduction the LUTS severity such as urinary frequency during the day, nocturia and urgency as assessed using the IPSS questionnaire and urination diary. Improvements in urodynamic parameters such as maximum urine flow rate (Q max), mean urine flow rate (Q ave), and residual urine volume (PVR) were the secondary endpoint of the study. The results were evaluated on equal terms (10 days and 1 month) in both groups.

Results

Results. Sixty-seven (98.5%) subjects were included in the final base. Ten days after the start of therapy in the magnetic stimulation group, symptom relief was noted by 21 people (61.7%), the mean IPSS score showed a decrease from 18.1 ± 2.1 to 16.9 ± 3.2 points (p = 0.037). The number of urinations per day decreased from 14 (6 - 20) to 10 (6 - 14) times (p < 0.001). Objective indicators of urodynamics did not change in both groups. At a period of 1 month, PMN occurred in 22 (64.7%) patients, the IPSS score was 16.6 ± 3.7 points (p = 0.032), the number of urinations 9 (6 - 14) times (p < 0.001). Objective indicators have not changed. In the tamsulosin group, IPSS score changed from 19.27 ± 5.08 to 15.4 ± 4.85 (p < 0.001), Q max 14.36 ± 2.82 ml/s increased to 15.94 ± 2.71 ml/s (p = 0.032), while the Q ave did not change (p = 0.17). The number of urinations decreased from 13 (6 - 19) times to 10 (6 - 14) times (p <0.001).

Conclusion

Conclusion. The study demonstrated the promise of PMN in men with LUTS in terms of improving the quality of life. The proposed method may be preferable for patients dissatisfied with drug therapy. Further placebo-controlled studies are required to help determine the role of PMN in the management of patients with LUTS.

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