Introduction. the issue of choosing a proper method of treatment and diagnosticsfor chronic abacterial prostatitis/ chronic pelvic pain syndrome (CPPS) is a topic for extensive scientific discussion. Etiology of this condition isinsufficiently studied, and guidelines on itstreatment are controversial. Moreover, patients with CPPS and their partners experience negative impact of pain on sexual and interpersonal relations, sexual activity, satisfaction and quality of life.
Materials and methods. Our study was aimed to improve outcomes of treatment and quality of life of men with CPPS and associated sexual dysfunction by developing effective algorithms of diagnostics and treatment.
This study included 134 patients who met the CPPS criteria (NIH category IIIB). All patients underwent standard evaluation, which included IPSS, QoL, NIH-CPSI,IIEF and ICF questionnaires, visual analog scale for pain (VAS); uroflowmetry with postvoid residual volume measurement (twice); complete urodynamic investigation (CUDI), neurophysiological diagnostics (pelvic floor needle electromyography with concentric electrodes, measurement of penile dorsal nerve conduction velocity and latent period of bulbocavernous reflex).
According to the results, all patientswere divided into 4 groups: group Iincluded patientswith impaired voidingwho had II-III grade infravesical obstruction as confirmed by pressure-flowstudy (n = 52); group IIincluded patientswith severe erectile dysfunction and 0-I grade infravesical obstruction (n = 39); group IIIincluded patientswho had prevalent pain syndrome and altered neurophysiological responses as confirmed by electromyography of urethral sphincter, anus, bulbocavernous and puborectal muscles and / orincreased latent period of bulbocavernousreflex and / or decreased penile dorsal nerve conduction velocity (n = 31); group IV included patients with prevalent pain syndrome without neurophysiological abnormalities (n = 12). Depending onwhich symptomswere prevalent, urodynamic and neurophysiological parameters, patients underwent trial treatment by botulinum toxin typeA(BTA)for group I, phosphodiesterase-5 inhibitorsfor group II, central myorelaxants(GABAB antagonist) for group III and psychotherapy for group IV.
Results. A complex evaluation has revealed objective (urodynamic, neurophysiological, radiological) evidence of abnormality associated with neurogenic dysfunction of pelvic floor and pelvic organs in 91% patients with CPPS. Trial treatment had positive symptomatic effect. Mean VAS score decreased by 40.6% (group I), 57.3% (group II), 54.9% (group III), 15.6% (group IV). Mean NIH-CPSI score decreased by 40.6%, 45.3%, 41.0%, 12.9% for groups I to IV respectively. Decrease in IPSS was 45.3%, 31.6%, 25.0% and 10.0% for groupsIto IV respectively.
IIEF score increased by a mean of 33.65% in patients from group I, by 21.4% in patients from group II, by 23.2% in patients from group III and by 8.9% in patients from group IV. Urodynamic study has revealed that Qmax in group I increased by 47.0%, in group II – by 11.0%, in group III – by 7.5% and in group IV – by 1.8%. Pura decreased by 17.8%, 8.1%, 2.3% and 1.6% in groupsI-IV respectively. Patient from group IV were observed to have a non-significant trend towards normalization of studied parameters.
Conclusion.According to urodynamic and neurophysiologicalstudies, CPPS in most of the cases represents a neurogenic dysfunction of pelvic floor and pelvic organs. Detailed study of condition of patients with CPPS allowsto prescribe them pathogenetically rational treatment and to achieve a decrease in symptom intensity, pain, improvement in urodynamic parameters, sexual function and quality of life.
Authors declare lack of the possible conflicts of interests.
