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Хронический простатит/синдром хронической тазовой боли (ХП/СХТБ) является одной из наиболее распространенных урогенитальных патологий у мужчин трудоспособного возраста. Данная патология может в значительной степени отрицательно влиять на качество жизни. Принятая стандартная медикаментозная терапия 3-As в ряде случаев не оказывает корректирующего влияния, и в зависимости от фенотипа заболевания могут применяться дополнительно другие группы лекарственных препаратов и физиотерапевтические методы лечения. В настоящее время ведется поиск наиболее эффективных немедикаментозных и медикаментозных методов лечения ХП/СХТБ. К таким методам можно отнести экстракорпоральную ударно-волновую терапию (ЭУВТ) и терапию препаратом «Лонгидаза®». В данном обзоре проанализированы и обобщены результаты крупных клинических исследований, оценивающих эффективность применения ЭУВТ в комбинации (или без нее) с фармакологическими препаратами, а также «Лонгидазой®» у пациентов с ХП/СХТБ. Подробно рассмотрен механизм действия и продемонстрированы ключевые эффекты ЭУВТ, а именно: купирование болевого синдрома, дизурических явлений, противовоспалительное и антибактериальное действие, лизис кальцинатов и фиброза предстательной железы.Ключевые слова: хронический простатит, синдром хронической тазовой боли, экстракорпоральная ударно-волновая терапия, «Лонгидаза®», бовгиалуронидаза азоксимер Для цитирования: Епифанова М.В., Костин А.А., Гамеева Е.В. и др. Применение экстракорпоральной ударно-волновой терапии в сочетании с другими немедикаментозными методами при лечении хронического простатита с позиций современной доказательной медицины.

Varicocele is a disease that is diagnosed in approximately 10% of males' population. There is data of varicocele which consider the condition as one of the most common causes of male infertility. It is only surgical treatment, to date, that is effective one. However, there is still a group of patients whose fertility problem have not been resolved with the varicocelectomy, that have led scientists to find new ways for treating male infertility. Regenerative medicine and platelet-rich plasma (PRP), in particular, have recently grown up rapidly worldwide. Many preclinical and clinical trials have already demonstrated PRP-therapy effectiveness and safety, despite the novelty of the method. This is why the interest in use PRP-therapy for treating male infertility has increased.

Introduction. This article presents the results of treatment of patients with chronic prostatitis (CP) type II, IIIA and IIIB by extracorporeal shock wave therapy (ESWT).The study objective was to evaluate the effectiveness of ESWT in the treatment of CP.Materials and methods. The research included 43 patients with CP. The patient’s age was 38.8 (27–65). The mean CP duration was 13.5 (3–24) months. 43 patients were assigned into 3 groups based on transrectal ultrasound (TRUS) examination. Group 1 had fibrotic changes in the prostate (n = 21). Group 2 had prostate calcifications (n = 5). Group 3 had fibrotic changes and calcifications in the prostate (n = 17). Treatment included ESWT (Dornier Aries) twice per week during 6 weeks. Each ESWT-session was comprised 2000–3500 pulses (0.05–0.062 mJ/mm2) and 8–6 Hz of frequency. All men were evaluated on 0 and 60 days of the study using NIH-CPSI (National Institutes Health Chronic Prostatitis Symptom Index), IPSS (International Prostate Symptom Score), TRUS of the prostate, the culture of seminal or prostate fluid, spermogram or prostate fluid analysis, serum prostatic specific antigen for men over 50 years of age.Results. The patients over 50 years-old had total prostatic specific antigen less than 4 ng/ml. Bacterial growth was found in the culture of seminal/prostate fluid of the 26 patients. They were additionally prescribed antibiotics according to antibiogram. All patients got the treatment well. Control study pointed at lower scores of NIH-CPSI – grade decreased from 13.39 (1–34) to 5.54 (0–24) (p <0.05), IPSS decreased from 11.39 (0–34) to 4.39 (0–29) (p <0.05). Prostate volume decreased from 25.18 (12.2–58.8) cm3 to 22.78 (12–56.6) cm3 according to TRUS (p >0.05). In the group 1 in 3 cases local fibrosis were completely resolved, in 18 cases fibrotic changes decreased from 5.3 (0–13) mm to 3.24 (0–8.1) mm (p <0.05). In the second group the number and the size of calcifications decreased from 6.92 (2–21) mm to 4 (0–20) mm (p >0.05). In the group 3 calcifications were completely resolved (p <0.05), the volume of fibrosis decreased from 6.8 (3.2–15) mm to 4.5 (1–17) mm (p <0.05). Bacterial growth wasn’t found in 9 patients’ seminal/ prostate fluid, 16 patients had a decrease of the causative agent concentration on 60 day, WBC count normalized in all subjects with CP/chronic pelvic pain syndrome IIIA.Conclusion. ESWT is an effective and non-invasive method of treatment of CP type II, IIIA and IIIB. The proposed treatment to relieve pain syndrome, inflammation, to promote lysis of fibrosis zone and calcinates, improves the draining function of prostate, contributing to accelerated elimination of microflora.