Hypothesis / aims of study
The relevance of the chronic prostatitis/chronic pelvic pain syndrome (CP/CPРS) treatment is currently determined by a fairly high prevalence of the disease, a tendency to recurrent course and the quality of life decrease. The objectives was to evaluate the effectiveness of the treatment of patients with CP/CPPS by drug "Longidaza®" (reg.№ LS-000764) and extracorporeal shock wave therapy (ESWT).
Study design, materials and methods
The study included 70 men with CP/CPPS, fibrotic changes and/or calcifications in the prostate according to TRUS. The mean age was 44.8±7.3 years. The average duration of CP/CPРS was 16.6±7.9 months. 28.6% (n=20) were identified with bacterial CP/CPPS (II), 20% (n=14) with inflammatory CP/CPPS (IIIA), 51.4% (n=36) with non-inflammatory CP/CPPS (IIIB) according to the NIDDK/NIH. Men with CP/CPPS II were distributed into group 1 (n=20) - ESWT, “3-As” therapy. The remaining patients were randomly assigned into group 2 (n=20) with ESWT only and group 3 (n=30) with ESWT plus drug "Longidaza®". All men received ESWT (Dornier Aries) on prostate twice a week for 6 weeks. Men were examined before and 3 months after therapy by NIH-CPSI, IPSS, VAS, TRUS of the prostate, the culture of seminal/prostate fluid, spermogram/prostate fluid analysis, serum total PSA (for men over 50 years of age).
Results
Treatment was tolerated in all patients. Total PSA was less than 4 ng/ml in all patients. The level of leukocytes was normal in spermogram/prostate fluid analysis in all CP/CPPS (IIIA) patients. Bacterial growth wasn’t found in 6 patients' seminal/prostate fluid, 14 patients had a decrease of the bacterial concentration. The average NIH-CPSI decreased from 15.4±2.9 to 6.6±2.2 in group 1 (p<0.05), from 16.5±2.5 to 7.1±3.1 in group 2 (p<0.05), from 18.1±2.5 to 2.7±2.1 in group 3 (p<0.05). IPSS decreased from 15.1±2.9 to 6.1±2.1 in group 1 (p<0.05), from 12.7±2.3 to 6.8±3.1 in group 2 (p<0.05), from 18.5±2.9 to 3.5±2.3 in group 3 (p<0.05). VAS decreased from 5±1.3 to 1.9±1.4 in group 1 (p<0.05), from 4.1±1.6 to 2.1±1.3 in group 2 (p<0.05), from 6±2.1 to 1±0.9 in group 3 (p<0.05). The fibrosis zone decreased from 10.3±1.7 mm to 6±2.1 mm (p<0.05), calcifications from 5.6±1.9 mm to 3.2±1.8 mm (p<0.05) in group 1. The fibrosis decreased from 8.6±1.6 mm to 6.1±2.2 mm (p<0.05), calcifications from 4.4±1,7 mm to 3.1±1.6 mm (p<0.05) in group 2. Fibrosis were completely resolved in 19 men (63%), in 11 men (37%) the fibrosis zone decreased from 7.3±2,0 mm to 2.3±1,8 mm (p<0.05), the calcifications size from 4.2±1.4 mm to 1.2±0.8 mm (p<0.05) in group 3.
Interpretation of results
The presented methods of therapy effectively decreased the prostate inflammation, pain, dysuria, stimulates the lysis of the fibrosis zone and calcinates. Finally there are improved the quality of life.