Лечение больных с симптомами нижних мочевых путей и эректильной дисфункции после трансуретральных операций на предстательной железе

Abstract

Objective: to assess the clinical utility of a comprehensive multimodal treatment including phosphodiesterase type 5 (PDE5) inhibitors + extracorporeal shockwave therapy (ESWT) + inhalations with a heated mixture of helium and oxygen (Thermogeliox technology) in patients with urination disorders and erectile dysfunction that had undergone transurethral surgery for benign prostatic hyperplasia (BPH). Patients and methods. This prospective single-blind randomized study was conducted at the Medical Research and Educational Center, M.V.Lomonosov Moscow State University and included 60 patients aged 50 to 80 years that were randomly assigned to one of the two groups matched for the main characteristics. Patients in the experimental group received basic pharmacotherapy (tamsulosin 0.4 mg and tadalafil 5 mg daily) plus courses of anti-ischemic treatment (10 procedures in each course; two procedures per week). The anti-ischemic treatment included ESWT using the Dornier MedTech ARIES device (Germany) and oxygen-helium therapy using the BreezeLite device (InertGaz medical, Russia). Arterial blood flow in the peripheral prostate was assessed using the rectal probe of the Philips EPIQ 7 ultrasound scanner (USA); peak systolic velocity (Vps, cm/sec) and the arterial resistance index (RI) were measured in the right and left prostatic arteries. The severity of the disease was evaluated by assessing both subjective (International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF)) and objective parameters (frequency and quality of nocturnal penile tumescences using the Androscan MIT recorder and maximum urine flow at uroflowmetry). Data analysis was conducted using the Statistica 10 software; differences were considered significant at р < 0.05. Results. Patients in both groups reported a significant improvement of their condition (both IPSS and IIEF scores decreased) and maximum urine flow. Treatment also improved arterial blood flow in the peripheral prostate in both groups: in the experimental group, Vps increased from 7.95 ± 0.12 cm/sec to 14.05 ± 0.16 cm/sec; in the control group, Vps increased from 8.07 ± 0.11 cm/sec to 11.42 ± 0.17 cm/sec. Patients in the experimental group had a more pronounced treatment effect 3 months after its completion (13.01 ± 0.20 cm/sec vs 10.40 ± 0.20 cm/sec; p < 0.05). Erectile function (IIEF and androscan) was restored in 10 patients (33.3%) from the experimental group and 5 patients (16.7%) from the control group. The ratios of patients with ED of varying severity also changed: in the experimental group, the number of patients with grade I disease increased to 14 (46.7%), while the number of patients with grade II and grade III disease decreased to 5 (16.67%) and 1 (3.3%), respectively. In the control group, these numbers were 13 (43,3%), 9 (30%), and 3 (10%), respectively. Conclusion. Patients may develop prostatic ischemia in the late postoperative period due to infravesical obstruction and concomitant diseases. Further development of treatment techniques aimed to prevent the consequences of such ischemia will reduce the incidence of complications, improve the outcomes of transurethral surgeries for BPH, and significantly improve the quality of life of patients.