Benign prostatic hyperplasia: a new metabolic disease?

BACKGROUND

Benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) are conditions extremely prevalent in the aging male. Although androgens are involved in prostate growth during developmental age, their role in the pathogenesis of BPH/LUTS is debated. Recent data indicate that low testosterone and high estradiol favor disease progression. In addition, the role of other determinants, such as metabolic syndrome or prostate inflammation, is emerging.

AIM

We reviewed the evidence regarding the pathogenesis of BPH/LUTS with particular attention to metabolic influence.

MATERIALS AND METHODS

A review of published evidence was performed using Medline.

RESULTS

Available evidence shows that a three-hit hypothesis can be drawn. An overt, or even a subclinical, bacterial or viral infection could induce prostatic inflammation (first hit) that could be autosustained or exacerbated by the presence of an altered metabolism and in particular by hypercholesterolemia (second hit). Hypogonadism and/or hyperestrogenism could act as a third hit, favoring the maintenance of this inflammatory state. The combined action of all three hits, or even two of them, may result in overexpression of Toll-like receptors (TLRs), transformation of prostatic cells into antigen-presenting cells and activation of resident human prostate-associated lymphoid tissue ending in overproduction of growth factors which, in turn, will induce prostate remodeling and further prostate enlargement. The mechanical obstruction, along with the direct action of the unfavorable metabolic and hormonal milieu on the bladder neck, helps in generating LUTS.

CONCLUSION

Inflammation, dyslipidemia and altered sex-steroid milieu mutually concur in determining BPH/LUTS.

The impact of depression and somatic symptoms on treatment outcomes in patients with chronic prostatitis/chronic pelvic pain syndrome: a preliminary study in a naturalistic treatment setting

AIM

The aim of this study was to evaluate the impact of depression and somatic symptoms on treatment outcomes in Korean male patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) attending a routine clinical practice.

METHODS

This was a 12-week prospective observational study (n = 80). The Korean version of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) to measure the severity of CP/CPPS, the Korean version of the Patient Health Questionnaire-9 (PHQ-9) to assess depression, the Korean version of the Patient Health Questionnaire-15 (PHQ-15) to evaluate somatisation and the Korean version of the EuroQol Questionnaire-5 Dimensions (EQ-5D), specifically the EQ-5D utility index and the EQ-5D visual analogue scale (EQ-5D VAS), to assess quality of life, were utilised and given at baseline and week 12. The primary and secondary end-points in this study were changes in the NIH-CPSI total score from baseline to week 12 according to depression and somatisation.

RESULTS

The change in NIH-CPSI total score was significantly higher in those without depression than in those with depression (p = 0.003), with a magnitude of difference of 2.8. The responder rate (a ≥ 4 point decrease in NIH-CPSI total score from baseline) was significantly higher in those without depression (42.9%) than in those with depression (17.2%, p = 0.023). However, significant differences were not observed between the two groups in the other outcome measures or in all study outcomes between subjects with or without somatisation. A logistic regression analysis revealed that the presence or absence of depression may be a principal predictor of response to treatment.

CONCLUSION

These preliminary results indicate that depression may have a negative impact on treatment outcome and is a likely predictor of response to treatment in patients with CP/CPPS. However, additional studies with adequate power and improved design are necessary to further support the present findings.

[Peculiarities of clinical course, diagnostics and treatment of overactive bladder in men older than 60 years]

The article presents the issues of the characteristics of the course, diagnostics and treatment of hyperactive urinary bubble in older men. Conservative treatment of urinary incontinence includes changes in lifestyle, behavioural and medical therapy with m-anticholinergic drugs. The combination solifenacini in a dose of 5 mg/day and α1-adrenoceptor blocking agent terasolini in a dose of 2 mg/day significantly improves the results of treatment and well tolerated.

Epidural anesthesia can block the negative effects of prostaglandin mediators during prostate surgery

INTRODUCTION

Inflammation plays a key role in the development of benign prostatic hyperplasia. Prostaglandin E2 (PGE2) is an important inflammation factor found in enlarged prostatic tissue that can be the main cause of inflammatory pain. The aim of this study was to investigate whether epidural anesthesia can block the negative effects of prostaglandin mediators during prostate surgery.

MATERIALS AND METHODS

The study included 60 patients who underwent open prostatectomy. All patients were randomly allocated to one of two study groups. The first group received general anesthesia and the second group a combination of general and epidural anesthesia. Main outcome measures were plasma concentration of PGE2, adrenaline, noradrenaline, and dopamine, before induction of anesthesia and at the time of enucleation.

RESULTS

Preoperative serum concentrations of PGE2 were high in both groups. During enucleation, serum concentrations of adrenaline, noradrenaline, and dopamine increased, followed by a rise of systolic and diastolic blood pressure in the group of patients that received only general anesthesia. Serum concentration of PGE2 was at the same level as before induction of anesthesia in both groups.

CONCLUSION

Epidural anesthesia blocks transmission of painful stimulus through the spinal cord caused by prostaglandin release and prevents the rise of catecholamines and blood pressure. Open prostatectomy can become a safer procedure performed under a combination of general and epidural anesthesia. Negative intraoperative effects of inflammatory prostate mediators during other techniques for prostate surgery could also be blocked with epidural anesthesia.

[IgG4-related prostatitis associated with retroperitoneal fibrosis: a case report]

A 70-year-old male was referred to our hospital because of an abnormally high prostate specific antigen (PSA) level (4.4 ng/ml) associated with lower urinary tract symptoms. Needle biopsy of the prostate did not reveal any malignant tissue. Four months later, the patient presented again with hydronephrosis, which was diagnosed using ultrasonography. Furthermore, contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) revealed left hydronephrosis caused by a soft tissue mass around the left iliac artery compressing the left ureter. Serum IgG4 level was 918 mg/dl. On immunohistochemical reevaluation of the prostate biopsy specimens, the samples were positive for IgG4 immunostaining. The patient was finally diagnosed with IgG4-related prostatitis with retroperitoneal fibrosis. With steroid therapy, the hydronephrosis and urinary symptoms were ameliorated. Our experience with this case suggests that in a male patient with urinary symptoms, biopsy of the prostate may be useful for exact diagnosis when IgG4-related disease is suspected.

[Clinical efficacy of Shuganyiyang capsule combined with Western medicine for the treatment of type III prostatitis complicated by erectile dysfunction]

OBJECTIVE

To investigate the clinical efficacy of Shuganyiyang Capsule combined with conventional Western medicine (tamsulosin hydrochloride sustained release tablets + prostat tablets) for the treatment of type III prostatitis complicated by erectile dysfunction (ED).

METHODS

Eighty patients with type III prostatitis complicated by ED were equally randomized to an experimental and a control group, the former treated with Shuganyiyang Capsule combined with tamsulosin hydrochloride sustained release tablets and prostat tablets, while the latter with tamsulosin hydrochloride and prostat only, both for 8 weeks. Then the prostatitis symptoms, erectile function and psychological conditions of the patients were evaluated using NIH-CPSI, IIEF-5, and hospital anxiety and depression scale (HADA and HADD) respectively. The rates of recovery, excellence, effectiveness and ineffectiveness were calculated.

RESULTS

The scores on NIH-CPSI, IIEF-5, HADA and HADD obtained at 4 and 8 weeks after treatment showed statistically significant differences between the two time points as well as from the baseline (P < 0.01). At 8 weeks, the scores on NIH-CPSI, IIEF-5, HADA and HADD were 6.83 +/- 4.96, 21.03 +/- 2.54, 6.05 +/- 1.62, and 5.35 +/- 3.30 in the experimental group, as compared with 7.55 +/- 4.89, 17.68 +/- 4.15, 6.88 +/- 2.45, and 7.85 +/- 3.77 in the control (P < 0.05). The rate of effectiveness was significantly higher in the experimental than in the control group (90% [36/40] vs 70% [28/40], P < 0.05).

CONCLUSION

Shuganyiyang Capsule combined with conventional Western medicine, such as alpha blockers and galenica, produces definite effect on chronic prostatitis complicated by ED, improves the psychological conditions of the patient, and enhances the therapeutic efficiency of chronic prostatits.

[Experience of the use of extracorporeal shock wave therapy in the treatment of category III B chronic prostatitis]

The randomized controlled study was aimed to the evaluation of the efficacy of extracorporeal shock wave therapy (ESWT) compared with drug treatment in patients with chronic prostatitis category IIIB. The study included 30 patients with category IIIB chronic prostatitis (CP IIIB), divided into two groups of 15 subjects. In group 1, prostate ESWT was used as monotherapy, in the group 2--only drug treatment. The impact was carried on the perineal region using standard radial ESWT device. The procedure was performed 1 time per week for 4 weeks according to the accepted protocol. All patients completed the treatment at outpatient settings. Control examinations of 30 patients were performed at 1, 2, 4 and 12 weeks after treatment. Efficacy was evaluated using the NIH-CPSI score. All patients in group 1 had a statistically significant reduction in pain intensity and improvement of quality of life compared with group 2. The study showed that prostate ESWT is a simple and effective method of treatment of CP IIIB not accompanied by the development of side effects.

Association of depression/anxiety with lower urinary tract symptoms and erectile dysfunction in Chinese men aged from 22 to 50 years

OBJECTIVE

To examine the relationships among lower urinary tract symptoms (LUTS), erectile dysfunction (ED) and mental health in Chinese men aged from 22 to 50.

METHODS

The subjects were 907 men aged between 22 and 50 years. The symptoms of mental distress were evaluated by the Zung Self-rating Depression Scale questionnaires and Zung Self-rating Anxiety Scale questionnaires. The symptoms of chronic prostatitis/chronic pelvic pain syndrome (CPPS), LUTS and ED were assessed by the US National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function 5 (IIEF-5) score.

RESULTS

In the study, 894 subjects had their complete data. Their mean NIH-CPSI score was higher for the men with depression and anxiety than for those without (6.2±6.2 vs. 5.0±5.8, P=0.015; 8.7±8.1 vs. 4.7± 5.3, P<0.001), with the mean IPSS score (5.9±6.6 vs. 4.7±5.8, P=0.029; 8.4±8.0 vs. 4.4±5.5, P<0.001). The mean IIEF-5 score was lower for the men with depression and anxiety than for those without (18.3±4.4 vs. 20.2±3.5; 17.2±4.1 vs. 20.1±3.6, both P<0.001). The proportion of total ED was higher for the men with depression and anxiety than for those without (69.7% vs. 57.8%, P=0.002; 81.1% vs. 57.0%, P<0.001).

CONCLUSION

Our study reveals associations among depression, anxiety, and CPPS, LUTS and ED in Chinese men aged 50 years and younger.

[Correlation of IPSS with IL-8 and COX-2 levels in patients with benign prostatic hyperplasia and prostatitis]

OBJECTIVE

To investigate the correlation of International Prostate Symptom Score (IPSS) with the levels of interleukin-8 (IL-8) and cyclooxygenase-2 (COX-2) in the prostate tissue and expressed prostatic secretion (EPS) in patients with benign prostatic hyperplasia (BPH) complicated by prostatitis.

METHODS

We divided 80 BPH patients to be treated by transurethral resection of the prostate (TURP) into a simple BPH group (n = 30) and a BPH with prostatitis group (n = 50) based on the pathologic features. We statistically analyzed IPSS and the levels of IL-8 and COX-2 in EPS before surgery and the IL-8 and COX-2 levels in the prostate tissue after surgery.

RESULTS

IPSS was positively correlated with the IL-8 and COX-2 levels in the prostate tissue and EPS of the BPH patients, moderately in the simple hyperplasia group (r > 0.5) and highly in the other (r > 0.8). The levels of IL-8 and COX-2 in the prostate tissue and EPS were significantly higher in the BPH with prostatitis group than in the simple BPH group (P < 0.05).

CONCLUSION

The levels of IL-8 and COX-2 in EPS indirectly reflect those in the prostate tissue. IPSS and the levels of IL-8 and COX-2 in EPS can help determine whether BPH is complicated by histological prostatic inflammation.

Prostatitis and andrological implications

AIM

The prostatitis syndrome is a frequent disease affecting men in their reproductive age. The prostatitis syndrome is classified according to the National Institutes of Health (NIH) definition. Andrological implications of the prostatitis syndrome might encompass fertility issues, sexual dysfunctions and endocrinological alterations and influences.

METHODS

A medline query using the terms prostatitis AND andrological implication, fertility, sexual dysfunction or endocrinology was performed.

RESULTS

Acute bacterial prostatitis and andrological implications have not been adequately addressed. Patients with chronic bacterial prostatitis and chronic pelvic pain syndrome have been investigated evaluating sperm parameters. Some studies showed impaired sperm parameters. In chronic bacterial prostatitis, half of the patients reveal significant bacteriospermia with still debatable deleterious effects on sperm quality. Few interventional studies have addressed fertility issues in those patients. Anti-inflammatory treatment perhaps could have a positive impact on sperm parameters. Sexual dysfunction can be described by different components such as erectile, ejaculatory, orgasmic and sexual desire dysfunctions. Sexual dysfunction in chronic prostatitis adds to the number of positive symptom phenotypes and correlates therefore with increasing symptom scores in patients with chronic prostatitis syndromes. However, prospective interventional studies on the role of sexual dysfunctions are missing. Hormones have been found to modulate the inflammatory response via different receptors, particularly via estrogen receptor alpha. This evidence, however, is mainly limited to pre-clinical studies currently.

CONCLUSION

Andrological implications are heterogenous and frequently described in patients with chronic prostatitis syndrome. Nonetheless, andrological factors have not been routinely addressed as primary variables in the different studies, which makes further research necessary.

Association between chronic prostatitis/chronic pelvic pain syndrome and anxiety disorder: a population-based study

BACKGROUND

This case-control study utilized a population-based dataset to examine the association of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with prior anxiety disorder (AD) by comparing the risk of prior AD between subjects with CP/CPPS and matched controls in Taiwan.

METHODS

We study used data sourced from the Taiwan Longitudinal Health Insurance Database. The cases comprised 8,088 subjects with CP/CPPS and 24,264 randomly matched subjects as controls. We used a conditional logistic regression to calculate the odds ratio (OR) for having been previously diagnosed with AD between subjects with and without CP/CPPS.

RESULTS

Of the 24,264 sampled subjects, 2309 (7.1%) had received an AD diagnosis before the index date; AD was found in 930 (11.5%) cases and 1379 (5.7%) controls (p<0.001). The conditional logistic regression analysis revealed that compared to controls, the OR for prior AD among cases was 2.10 (95% CI = 1.92∼2.29, p<0.001) after adjusting for diabetes, hypertension, hyperlipidemia, and sexually transmitted diseases. Our results show that CP/CPPS was consistently and significantly associated with prior AD in all age groups (18∼39, 40∼59, and >59 years). In particular, subjects aged 40∼59 years had the highest adjusted OR (of 2.53) for prior AD among cases compared to controls.

CONCLUSIONS

We concluded that CP/CPPS is associated with previously diagnosed AD. Urologists should be alert for the association between CP/CPPS and AD in subjects suffering from AD.

[Expressions of SIgA and alpha 1-AR in benign prostatic hyperplasia combined with chronic prostatitis and their implications]

OBJECTIVE

To explore the expressions of SIgA and alpha l-AR in benign prostatic hyperplasia (BPH) complicated by chronic prostatitis (CP) and their implications.

METHODS

According to the preoperative findings of expressed prostatic secretion (EPS), transrectal prostate ultrasonography, prostate-specific antigen (PSA), international prostate symptom score (IPSS), clinical symptoms, chronic pelvic pain syndrome (CPPS) and postoperative histopathology, 62 cases of BPH pathologically confirmed after transurethral plasma kinetic resection of the prostate (PKRP) were divided into a BPH group (n = 32) and a BPH + CP group (n = 30). The expressions of SIgA and alpha 1-AR in the prostate tissue were determined by immunohistochemistry and PT-PCR.

RESULTS

Of the 62 cases, 30 were found to be BPH + CP, and the other 32 to be BPH. The expressions of SIgA and alpha1-AR were significantly higher in the BPH + CP than in the BPH group (0.380 8 +/- 0.144 3 vs 0.295 4 +/- 0.008 4 and 0.440 5 +/- 0.104 1 vs 0.383 2 +/- 0.013 6, P < 0.05).

CONCLUSION

The upregulated expressions of SIgA and alpha1-AR expression in BPH complicated by CP suggest a certain association between CP and BPH, and that inflammation may be a pathogenic factor of BPH and correlate with its pathological development.

[New approaches to the treatment of pathospermia]

The study included 75 patients with various forms of pathospermia due to chronic inflammatory diseases of the urinary tract and after surgeries on the organs of the reproductive system (varicocelectomy). The mean age was 34.5 +/- 5.2 years. All the patients were divided into 3 groups of 25 individuals. Group 1 of patients with chronic bacterial prostatitis, along with the standard treatment received a biologically active supplement androdoz; Group 2 of patients after varicocelectomy (3-6 months after surgery) received a biologically active supplement androdoz, Groop 3 of patients with chronic bacterial prostatitis--only standard therapy. As a result of the treatment, spermogram parameters were improved in 46 patients (92%) of 50 patients in Group 1 and 2, deteriorated--in 1 (2%) patient, and have not changed in 3 (6%) patients. The study demonstrated a statistically significant increase in the concentration, the proportion of active sperm, and in the number of morphologically normal sperm forms. The good tolerability and safety of dietary supplement androdoz were detected.

Clinical utility of the UPOINT phenotype system in Chinese males with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a prospective study

BACKGROUND

Recent data showed that a six-domain UPOINT is a flexible and responsive new classification system that has the clinical applicability in CP/CPPS. However, the utility of UPOINT algorithm in men in China with CP/CPPS has not been comprehensively studied. For international validation and adoption, we evaluated this clinical phenotype system for a large cohort of Chinese CP/CPPS patients and correlated it with patient symptoms and erectile dysfunction (ED). We also investigated the addition of an ED domain in regard to symptom correlation.

METHODS

A total of 389 Chinese males with CP/CPPS were prospectively collected and classified in each domain of the UPOINT system. Symptom severity was measured using the NIH-CPSI and IPSS. The erectile function was evaluated using the IIEF-5. Clinically relevant associations were calculated.

RESULTS

The percentage of patients positive for each domain was 54.0%, 42.1%, 41.9%, 20.8%, 26.7%, and 40.4% for the Urinary, Psychosocial, Organ-specific, Infection, Neurological/systemic, and Tenderness, respectively. There were significant correlations between the number of positive UPOINT domains and total NIH-CPSI (r = 0.706, p<0.001), IPSS (r = 0.682, p<0.001) and IIEF-5 scores (r = 0.631, P = 0.007) in Chinese cohort. Except for patients age, symptom duration was associated with a significantly greater number of positive domains (r = 0.638, P  = 0.005). After adding an ED domain to create a modified UPOINT system, the correlation between the number of phenotypic domains and symptom severity was improved (0.706 to 0.844, p<0.001).

CONCLUSIONS

The clinical applicability of using UPOINT phenotyping system has been validated in the Chinese patients with CP/CPPS. In our cohort, the number of positive domains was also correlated with ED symptoms and the significant association between the number of UPOINT domains and NIH-CPSI scores was further refined by adding a domain for ED. Our findings presented here support the utility of using ED as a stand-alone item in the UPOINT domain.

[LUTS in BPH patients with histological prostatitis before and after transurethral resection of the prostate]

OBJECTIVE

To investigate the effects of transurethral resection of the prostate (TURP) on lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) complicated by histological prostatitis.

METHODS

This study included 432 cases of BPH pathologically confirmed after TURP. Excluding those with LUTS-related factors before and after surgery and based on the international prostatitis histological classification of diagnostic criteria, the remaining 144 cases were divided into groups A (pure BPH, n = 30), B (mild inflammation, n = 55), C (moderate inflammation, n = 31), and D (severe inflammation, n = 28). Each group was evaluated for LUTS by IPSS before and a month after surgery.

RESULTS

A total of 399 cases (92.4%) were diagnosed as BPH with histological prostatitis, 269 (67.4%) mild, 86 (21.6%) moderate and 44 (11.0%) severe. The preoperative IPSS was 21.43 +/- 6.09 in group A, 21.75 +/- 5.97 in B, 27.84 +/- 4.18 in C and 31.00 +/- 2.92 in D, with statistically significant differences among different groups (P < 0.001) except between A and B (P = 1.000); the postoperative IPSS was 5.60 +/- 2.16 in A, 7.36 +/- 2.77 in B, 11.55 +/- 3.39 in C and 16.89 +/- 3.37 in D, with statistically significant differences among different groups (P < 0.01), and remarkably lower than the preoperative one (P < 0.001). Almost all the infiltrating inflammatory cells in BPH with histological prostatitis were lymphocytes.

CONCLUSION

BPH is mostly complicated with histological chronic prostatitis. The severity of LUTS is higher in BPH patients with histological prostatitis than in those without before and after TURP, and positively correlated with the grade of inflammation. Those complicated with moderate or severe histological prostatitis should take medication for the management of LUTS.

[Chronic pelvic pain syndrome]

Chronic prostatitis are caused by infection in 5-10% of cases and other entities are called "chronic pelvic pain syndrome". The current classifications are based on the presence or absence of inflammation or infection in the prostatic secretions. The new concept of clinical phenotype "UPOINT" offers six domains (urinary, psychosocial, organ-specific, infectious, neurological, systemic and related to muscle tension) and can guide treatment according to the phenotype expressed by the patient. The therapeutic approach is based on the first use of antibiotics with or without alpha-blockers. Depending on clinical response, supportive treatment should be considered. The role of psychological support remains essential. Few studies of effectiveness of a level 1 of evidence are available and the chronic pelvic pain syndrome remains a controversial entity in the etiology whose treatments are empirical. The authors review current knowledge on the best treatment suited to the "chronic prostatitis".

Do the medical treatment reduces the rate of surgical treatment in suspected cases of chronic prostatitis before prostatectomy?

AIM

Our aim is to investigate how the chronic intraprostatic inflammation affect the course of the BPH (benign prostatic hyperplasia).

PATIENTS AND METHODS

Between the dates of 2007-2011, the files of the patients who had TUR-P (transurethral resection of the prostate) and underwent open surgery were retrospectively reviewed because of BPH, and the patients were divided into two groups who were operated due to AUR (acute urinary retention) or LUTS (lower urinary tract symptoms) and the clinical data and pathology results of the two groups were compared in terms of chronic intraprostatic inflammation.

RESULTS

There were evaluable data of 130 of 150 patients. The age range of the patients was 50-88. 52 of the 130 patients due to AUR and 78 of them due to LUTS underwent surgery. While there was chronic inflammation in 59 of the 130 patients, there was not in 71. The volume of the prostate and the average age of those who had chronic prostatitis with the combination of AUR were greater compared to the LUTS.

CONCLUSIONS

It seems that chronic prostatitis is a factor which is often accompanied by BPH and affects the progression and pathology of the disease. The risk of acute urinary retention is more frequent in patients with chronic inflammation than in those who lack. In the future, related clinical trials with the relationship between the intraprostatic inflammation and BPH treatment are necessary and should include more cases and longer period of follow-up for these studies.

[Large benign prostatic hiperplasia]

BACKGROUND

the term prostatic hyperplasia is most frequently used to describe the benign prostatic growth, this being a widely prevalent disorder associated with age that affects most men as they age. The association between prostate growth and urinary obstruction in older adults is well documented.

OBJECTIVE

large benign prostatic hyperplasia is rare and few cases have been published and should be taken into account during the study of tumors of the pelvic cavity.

CLINICAL CASE

we report the case of an 81-year-old who had significant symptoms relating to storage and bladder emptying, with no significant elevation of prostate specific antigen.

CONCLUSIONS

this is a rare condition but it is still important to diagnose and treat as it may be related to severe obstructive uropathy and chronic renal failure. In our institution, cases of large prostatic hyperplasia that are solved by suprapubic adenomectomy are less than 3%.

[Efficacy of compound Xuanju capsule in the treatment of chronic prostatitis with erectile dysfunction]

OBJECTIVE

To evaluate the efficacy and safety of Compound Xuanju Capsule (CXC) in the treatment of chronic prostatitis with erectile dysfunction (ED).

METHODS

We obtained NIH-CPSI and IIEF-5 scores from 132 chronic prostatitis patients with ED and divided the patients into a control (n = 70) and a treatment group (n = 62), the former treated with oral levofloxacin 0.2 g bid for 4-6 weeks and oral Terazosin at 2 mg qd for 2 months, and the latter with oral CXC once 2 capsules tid for 2 months in addition to the above.

RESULTS

None of the patients had serious medication-related adverse reactions. After treatment, the control group showed significantly decreased NIH-CPSI scores and slightly increased IIEF-5 scores as compared with the baseline (16.5 +/- 5.9 vs 25.1 +/- 5.5, P < 0.05 and 13.1 +/- 5.2 vs 11.3 +/- 4.5, P > 0.05), while the treatment group exhibited significant improvement in both NIH-CPSI (13.4 +/- 5.7 vs 25.5 +/- 5.3, P < 0.05) and IIEF-5 scores (17.5 +/- 6.5 vs 10.8 +/- 3.8, P < 0.05). The total effectiveness rate for ED was significantly higher in the treatment than in the control group (74.2% vs 20%, P < 0.05).

CONCLUSION

Compound Xuanju Capsule can significantly alleviate both the symptoms of chronic prostatitis and ED in the treatment of chronic prostatitis patients with ED.

[Cytoflavin in the treatment of patients with chronic abacterial prostatitis and erectile dysfunction]

The problem of chronic prostatitis (CP) and erectile dysfunction (ED) involves not only their high prevalence, but also the insufficient effectiveness of their treatments. In this regard, there is need for administration the pathogenetic drugs with antihypoxic, antioxidant and neuroprotective effects and improving blood flow to the genitals. The study included 60 men with CP associated with ED, aged 22 to 60 years. Patients were randomized into 2 groups of 30 people. Patients of comparison group received baseline therapy (alpha1-adrenoblockers, non-specific anti-inflammatory drugs, digital prostate massage and vacuum phallostimulation). Antibiotics were applied on the basis of their potential effectiveness in chronic abacterial prostatitis. In addition to the above treatment, patients of main group received step-down therapy with cytoflavin (in infusion, then oral administration). Positive dynamics was noted in both groups of patients; however, according to the indicators of the severity of pain and dysuria, as well as quality of life, positive dynamics in the main group of patients was more significant. Similarly, the dynamics of objective criteria for inflammation in the prostate gland was more pronounced when using cytoflavin. After treatment, the rigid phase of erection during vacuum fallotest occurred within 2-3 min from the beginning of the procedure in 16 (53.3%) patients of main group and only in 9 (30%) patients of comparison group. During follow-up examination at 6 months after treatment, stable remission was found in 75% of patients of main group. Thus, the inclusion of cytoflavin in the scheme of complex treatment of patients with abacterial CP associated with ED is pathogenetically justified, makes it more efficient and provides good DFS.

[Treatment of erectile dysfunction in patients with chronic prostatitis using vibromagnetic lazer]

The study was aimed to evaluation of the effectiveness of vibromagnitic lazer therapy (VMLT) of erectile dysfunction (ED) in patients with chronic prostatitis (CP). The study included 40 patients with CP, aged 22 to 45 years. CP duration ranged from 6 months to 9 years, ED--from 6 months to 7 years. All the patients underwent a survey on "Chart of sexological examination of man" with the calculation of sex constitution index, an transrectal ultrasonography of prostate gland (PG), uroflowmetry, clinical and functional assessment of components of the copulatory interval, and assessment of blood plasma concentrations of peptide and steroid hormones. All patients underwent a psychotherapeutic correction of sexual disadaptation, sex therapy using Masters-Johnson, Kaplan, and Lo Piccolo methods, and VMLT using "Matrix-Urologist" device. The control group included 20 healthy men aged 22 to 45 years. All studies were performed Before and 30 days after the end of the last VMLT session. As a result of the treatment, integral IIEF indicators were normalized in 60% of patients, the volume of the prostate--in 70%, hemodynamics in the phase of relaxation and erection--in 70%, venous blood flow in the PG--in 70%, dorsal artery hemodynamics in the phase of relaxation and erection--in 60%, and penile hemodynamics--in 60% of patients. Voiding bladder function was optimized in 75% of patients. The functional activity of the pituitary-adrenal-testicular system returned to normal level in 60% of patients. 1 year after treatment, sexual function was maintained at attained levels in 47.5% of patients. As a matter of findings, it was concluded that VMLT is high effective method of combined non-pharmacological correction of erectile dysfunction in CP patients with strong and medium sex constitution.