Segmental Electrical Stimulation and Basic Pharmacotherapy in the Treatment of Chronic Prostatitis/chronic Pelvic Pain Syndrome

Abstract

The objective: assessment of the efficacy and safety of the segmental effects of sinusoidal electric current alone and in combination with basic pharmacotherapy in treatment of chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS).Materials and methods. The study involved 64 patients with CP/CPPS who were equally randomized into 2 groups. Patients filled out questionnaires NIH-CPSI, PHQ-9, GAD-7. An enzyme immunoassay revealed changes in the concentration of testosterone, dihydrotestosterone (DHT) and prostate-specific antigen (PSA) in the blood, as well as ejaculate cytokines. All patients received segmental electrical stimulation, which was performed using the «Amplipulse» apparatus, 10 sessions of 15 minutes. Group 2 patients additionally received basic pharmacotherapy. The latter included diclofenac sodium (Dicloberl® retard, 100 mg/day, oral, 2 weeks), modified release tamsulosin (Flosin®, 0.4 mg/day, oral, 1 month), extract from the fruit of the Serenoa repens palm tree (Prostamol® Uno, 320 mg/day, orally, 6 months). Treatment was prescribed regardless of the presence and severity of symptoms of CP / CPS. The reduction in NIH-CPSI by 6 points, PHQ-9 by 6 points, GAD-7 by 5 points were considered clinically significant.Results. A significant decrease in prostatitis symptoms was observed in both groups after 2 weeks and persisted throughout the observation period (6 months). In group 2 patients, unlike group 1, there was a statistically significant increase in testosterone level, a decrease in DHT and PSA blood, a significant decrease in the pro-inflammatory cytokine in the ejaculate (interleukin-1β), along with an increase in the content of the anti-inflammatory cytokine (interleukin-10), a significant improvement depression and anxiety. The clinical efficacy of electrotherapy was 47 % and 34 % (at 2 weeks and 6 months of treatment, respectively). The combination ofelectrotherapy with basic pharmacotherapy reduced the intensity of the symptoms of prostatitis significantly more (p<0.05). Its clinical efficacy was 85 % and 69 %, respectively. A significant link between the duration of the disease and the effectiveness of treatment was revealed: the greatest effectiveness and the minimum risk of relapse were observed with a disease duration of up to 1 year. Treatment tolerance was good in both groups of patients, especially in the electrotherapy group, in which no side effects were detected.Conclusion. The use of segmental electrotherapy and its combination with basic pharmacotherapy in the treatment of CP/CPPS is quite effective and safe. Using a combination of these techniques is significantly more effective, especially with a disease duration of up to 1 year. The advantage of electrotherapy is the safety of the technique.