madman
Super Moderator
Abstract
Aims: This prospective study aimed to compare the clinical outcomes between the use of Erbium: YAG (Er: YAG) laser in a nonablative mode, to the use of the pharmacological treatment of oral tadalafil for the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).
Methods: The laser group received two sessions of Erbium: YAG laser, administered intraurethrally in a long, nonablative train of long pulses (SMOOTH™ mode), applied at the level of the male prostatic urethra. Tadalafil group received oral tadalafil at a dose of 5 mg/day, consecutively for 2 months. Effectiveness was assessed using the International Prostate Symptom Score (IPSS) questionnaire, VAS (visual analog scale) pain score, and maximum urethral flow at follow‐up visits up to 12 months after initiating treatment. Adverse effects were recorded after each treatment and follow‐up sessions.
Results: The results show a significant decrease in the IPSS score in both groups up to the 12‐month follow‐up. The increase in Q‐max was evident up to 3‐months follow‐up in the tadalafil group and up to 6 months in the laser group. The decrease in the VAS pain score was also significant in both treatment groups, lasting up to 3 months in the tadalafil group and up to 6 months in the laser group.
Conclusions: The nonablative Er: YAG SMOOTH™ laser seems to be a promising treatment for this widely occurring condition. More studies are needed to confirm its safety and efficacy.
1 | INTRODUCTION
Chronic prostatitis is very common among adult men, with a prevalence of up to 14% of the entire male population.1,2 Prostatitis is the most common diagnosis (>50%) in men visiting outpatient urological clinics.3 Although category III or chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most prevalent form of prostatitis,4 its causes are largely unknown and treatments often fail to alleviate symptoms in the long term. In contrast, patients suffering from type I and II prostatitis are successfully treated with antibiotics, as a uropathogen or an infectious agent is usually identified as the cause.2
CP/CPPS is characterized by pain in the perineum and tenderness in the prostate along with various urological symptoms (urgency, frequency, and low urethral pressure) and sometimes also ejaculatory symptoms, such as painful ejaculation. More than 20% of patients affected by CP/ CPPS also suffer from depressive symptoms, illustrating the highly debilitative nature of the condition.1
Currently used treatments for CP/CPPS are mainly pharmacological, including α‐blockers, 5‐α reductase inhibitors, anti‐inflammatories, antibiotics, phytotherapy, allopurinol, botulinum toxin, and traditional Chinese medicine.5 Nonpharmacological therapies include acupuncture, prostatic massage, extracorporeal shockwave therapy, pulsed magnetic field therapy, transrectal and transurethral thermotherapy, and others.6 Some of the abovementioned therapies alleviate symptoms by improving vascularization and blood flow of the prostate and periprostatic area. In this study, we aimed to evaluate a new approach to the treatment of CP/CPPS— using the transurethral application of the Erbium: YAG (Er: YAG) laser with nonablative SMOOTH™ mode. It works by the thermal pulsing of the treated surface, with pulses in the microseconds‐range combined into long (several hundred milliseconds) sequences. Each laser micropulse sharply increases tissue temperature and acts as a stimulative trigger.7,8 Long pulse trains cause slower diffusion of heat to deeper layers of the skin or mucosa, up to several hundred micrometers in depth. Initially, the trigger vasodilation and then stimulation of fibroblasts and collagen remodeling.9,10 It has been shown to improve vascularization and alleviate symptoms of genitourinary syndrome of menopause (GSM) in women, including irritation, dryness, and pain.11,12 It has also been used intraurethrally in women to alleviate urinary symptoms of GSM.13,14 Transurethral thermal therapy using microwaves has previously been shown to be promising in the treatment of CP/CPPS in men.6 In this study, we aimed to assess the safety and effectiveness of transurethral nonablative Er: YAG laser therapy applied at the level of the male prostatic urethra and to compare it with pharmacological treatment (5 mg oral tadalafil) for the treatment of CP/CPPS.
5 | CONCLUSION
This study indicates that innovative nonablative transurethral Er: YAG laser treatment with thermal SMOOTH™ mode is a promising minimally invasive therapy for relieving symptoms of CP/CPPS.
Aims: This prospective study aimed to compare the clinical outcomes between the use of Erbium: YAG (Er: YAG) laser in a nonablative mode, to the use of the pharmacological treatment of oral tadalafil for the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).
Methods: The laser group received two sessions of Erbium: YAG laser, administered intraurethrally in a long, nonablative train of long pulses (SMOOTH™ mode), applied at the level of the male prostatic urethra. Tadalafil group received oral tadalafil at a dose of 5 mg/day, consecutively for 2 months. Effectiveness was assessed using the International Prostate Symptom Score (IPSS) questionnaire, VAS (visual analog scale) pain score, and maximum urethral flow at follow‐up visits up to 12 months after initiating treatment. Adverse effects were recorded after each treatment and follow‐up sessions.
Results: The results show a significant decrease in the IPSS score in both groups up to the 12‐month follow‐up. The increase in Q‐max was evident up to 3‐months follow‐up in the tadalafil group and up to 6 months in the laser group. The decrease in the VAS pain score was also significant in both treatment groups, lasting up to 3 months in the tadalafil group and up to 6 months in the laser group.
Conclusions: The nonablative Er: YAG SMOOTH™ laser seems to be a promising treatment for this widely occurring condition. More studies are needed to confirm its safety and efficacy.
1 | INTRODUCTION
Chronic prostatitis is very common among adult men, with a prevalence of up to 14% of the entire male population.1,2 Prostatitis is the most common diagnosis (>50%) in men visiting outpatient urological clinics.3 Although category III or chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most prevalent form of prostatitis,4 its causes are largely unknown and treatments often fail to alleviate symptoms in the long term. In contrast, patients suffering from type I and II prostatitis are successfully treated with antibiotics, as a uropathogen or an infectious agent is usually identified as the cause.2
CP/CPPS is characterized by pain in the perineum and tenderness in the prostate along with various urological symptoms (urgency, frequency, and low urethral pressure) and sometimes also ejaculatory symptoms, such as painful ejaculation. More than 20% of patients affected by CP/ CPPS also suffer from depressive symptoms, illustrating the highly debilitative nature of the condition.1
Currently used treatments for CP/CPPS are mainly pharmacological, including α‐blockers, 5‐α reductase inhibitors, anti‐inflammatories, antibiotics, phytotherapy, allopurinol, botulinum toxin, and traditional Chinese medicine.5 Nonpharmacological therapies include acupuncture, prostatic massage, extracorporeal shockwave therapy, pulsed magnetic field therapy, transrectal and transurethral thermotherapy, and others.6 Some of the abovementioned therapies alleviate symptoms by improving vascularization and blood flow of the prostate and periprostatic area. In this study, we aimed to evaluate a new approach to the treatment of CP/CPPS— using the transurethral application of the Erbium: YAG (Er: YAG) laser with nonablative SMOOTH™ mode. It works by the thermal pulsing of the treated surface, with pulses in the microseconds‐range combined into long (several hundred milliseconds) sequences. Each laser micropulse sharply increases tissue temperature and acts as a stimulative trigger.7,8 Long pulse trains cause slower diffusion of heat to deeper layers of the skin or mucosa, up to several hundred micrometers in depth. Initially, the trigger vasodilation and then stimulation of fibroblasts and collagen remodeling.9,10 It has been shown to improve vascularization and alleviate symptoms of genitourinary syndrome of menopause (GSM) in women, including irritation, dryness, and pain.11,12 It has also been used intraurethrally in women to alleviate urinary symptoms of GSM.13,14 Transurethral thermal therapy using microwaves has previously been shown to be promising in the treatment of CP/CPPS in men.6 In this study, we aimed to assess the safety and effectiveness of transurethral nonablative Er: YAG laser therapy applied at the level of the male prostatic urethra and to compare it with pharmacological treatment (5 mg oral tadalafil) for the treatment of CP/CPPS.
5 | CONCLUSION
This study indicates that innovative nonablative transurethral Er: YAG laser treatment with thermal SMOOTH™ mode is a promising minimally invasive therapy for relieving symptoms of CP/CPPS.
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