Management of prostatodynia in younger patients with sub-ablative erbium: YAG intrauretral laser

Gaspar A1, Silva J1, Silva G1, Anchelerguez R1, Prats J1

Research Type

Clinical

Abstract Category

Prostate Clinical / Surgical

Abstract 762
Non Discussion Abstracts
Scientific Non Discussion Abstract Session 36
Male Pain, Pelvic/Perineal Prospective Study Quality of Life (QoL) Urgency/Frequency
1. Uroclinica Mendoza Argentina
Links

Abstract

Hypothesis / aims of study
This prospective study aimed to compare the clinical outcomes between the use of the Erbium: YAG laser, administered in long sub-ablative pulses applied at the level of the male prostatic urethra, to the use of the standard treatment of oral tadalafil. for the treatment of prostatodynia symptoms in young patients.
Study design, materials and methods
This study, conducted between April and September of 2017, comprises two groups of patients: the Laser Group, composed of 16 patients between 31 and 47 years of age; and, the Control Group, represented by 20 patients between 30 and 45 year old. Both groups of patients were affected by prostatodynia, with characteristic symptoms: perineal pain, dysuria and urinary frequency. Both groups were evaluated with urine culture after prostatic massage, prostatic ultrasound and urinary flow studies. All urine cultures were negative. The prostatic volume was, in all cases, less than 50 cc. In all patients the initial Qmax measurement was between 10 and 15 ml/sec. In the laser group, the patients received two sessions of Erbium: YAG intraurethral laser in sub-ablative mode, separated by 8 weeks. The control group was treated with tadalafil, at a dose of 5 mg/day, for two months.                                                                                                                                                                    Follow-up, in both groups, was performed at one month, three months and six months from the initiation of the treatment. The quality of life (QoL) in pain was evaluated, through the Visual Analog Scale (VAS). The subjective improvement of the symptoms of dysuria and frequency was evaluated using the “Quality of Life Due to Urinary Symptoms” questionnaire. It consists of a single question to determine quality of life, the answer can be from 0 to 6, where zero is “Very Satisfied” and 6 is “Terribly Dissatisfied”. The pattern of urination after treatment was evaluated: objectively, by Qmax measurement and subjectively, with The International Prostate Symptom Score” (I-PSS). The answers are assigned points from 0 to 5, the total score ranging from 0 to 35, from asymptomatic to very symptomatic. There were no serious adverse events during or after the laser sessions.
Results
All the evaluated symptoms showed a statistically-significant improvement in the follow-up at one month and three months in both groups. The improvement in chronic perineal pain measured by VAS showed a fall from severe to minimal or absent, and from moderate or minimal to absent. The urinary symptoms of dysuria and frequency, evaluated by the “Quality of Life Due to Urinary Symptoms Questionnaire” and by I-PSS, also showed a statistically-significant improvement in both groups at the month of follow-up, which was even more evident at three months in the laser group and not so evident at three months in the control group. The Qmax showed a clear improvement in both groups, from 2 to 5 ml/sec with respect to the initial values, and it was maintained after three months in the laser group. Of the 16 patients treated in the laser group, 13 remained asymptomatic and with a normal Qmax at six months of follow-up, while of the 20 patients treated in the control group, only 10%, 2 patients, were asymptomatic at six months of follow-up.
Interpretation of results
Prostatitis syndrome comprises a broad spectrum of nonspecific symptoms of the lower genitourinary tract, characterized by perineal or genital pain, voiding symptoms, such as dysuria, frequency, and sexual dysfunction in its various manifestations. If we add to these ambiguous clinical symptoms: the high prevalence, partially-unknown physio-pathological mechanisms, complex diagnostic techniques and sometimes frustrating therapeutic strategies, we can be assured that we are facing a very important urological problem. Prostatodynia has become one of the pathologies that, without compromising the patient's life, are uncomfortable both for the patient and for the professional who tries to help, not always successfully. The consultation in our daily practice of patients affected by prostatodynia has been increased due to chronic stress factors accompanied by emotional state disorders. Drach et al. (1) classified prostatitis into: acute bacterial prostatitis, chronic bacterial prostatitis, non-bacterial chronic prostatitis and prostatodynia (pelviperineal pain). However, the boundaries between these processes remained unclear, so recently the US NIH has proposed a new classification (2), into: acute prostatitis, chronic bacterial prostatitis, chronic inflammatory or non-inflammatory pelvic pain syndrome, and asymptomatic inflammatory prostatitis. 
Traditionally, the symptoms of prostatodynia were attempted to be resolved with measures aimed at improving the oxygenation and vascularization of the prostatic urethra, such as the combination of kinesiotherapy and the use of tadalafil at 5 mg/day, a drug inhibitor of the enzyme phosphodiesterase type 5 (PDE-5), responsible for the release of nitric oxide vasodilator. By improving the vascularization of the prostatic portion of the urethra, the prostatic parenchyma is indirectly improved, thus explaining the improvement of voiding symptoms and pelviperineal pain. The technique proposed with the sub-ablative intraurethral laser of Erbium: YAG allows us to improve the local circulatory conditions by: initially, promoting a strong effect of vasodilation in the prostatic portion of the urethra that markedly increases oxygenation and nutrition with a loco-regional action; and, finally, producing an anti-inflammatory and angiogenic effect.
Concluding message
Few of the ailments of the genitourinary tract confuse the patient and the doctor more than the prostatic inflammatory processes. Prostatodynia remains a complex and difficult problem to solve. The systematic approach to these conditions constitutes a progress for their understanding and treatment. A good doctor-patient relationship is necessary, since it takes time, patience and understanding on both sides to arrive at positive results. The multiple treatments proposed do nothing but show that a clear knowledge of the problem has not yet been reached. Based on the knowledge of the benefits of laser-tissue interaction (3), we demonstrated that laser light in sub-ablative pulses of Erbium: YAG, may represent a safety and effective option in the therapeutic arsenal that we have today to deal with this condition. It is necessary to perform prospective, randomized and controlled studies with a larger number of patients and longer follow-up to confirm these initial good results.
References
  1. Drach GW,Meares EM,Fair WR,Stamey TA. Classification of benign disease associated with prostatic pain prostatitis or prostatodynia. J Urol, 120 (1978), pp. 266-76
  2. Krieger JN,Nyberg L,Nickel JC. NIH consensus definition and classification of prostatitis. JAMA, 282 (1999), pp. 236-7
  3. Gaspar A, Brandi H. Non-ablative erbium YAG laser for the treatment of type III stress urinary incontinence (intrinsic sphincter deficiency). Lasers Med Sci DOI 10.1007/s10103-017-2170-5. Lasers in Medical Science ISSN 0268-8921.February 2017.
Disclosures
Funding None Clinical Trial Yes Public Registry No RCT No Subjects Human Ethics Committee Uroclinica Ethics Committee Helsinki Yes Informed Consent Yes
27/03/2024 15:58:30