Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a complex medical problem. Comorbid depression and chronic pain are highly prevalent in individuals suffering with chronic abacterial prostatitis (CAP) perhaps due to the direct or indirect effects of cytokines. Cytokines interact with the neuronal environment, and thus modulation of the duration of inflammation may alleviate depressive and pain symptoms. The aim of our study was to evaluate the effectiveness of combination of rectal electrostimulation and a selective serotonin reuptake inhibitor, sertraline, in the treatment of patients with chronic abacterial prostatitis and to determine the dynamics and links of pro-inflammatory and anti-inflammatory cytokine levels in the ejaculate.
The interrelation of CP/CPPS symptoms, depression and cytokines in patients with CAP was studied. For the assessment of severity of CP/CPPS the National Institutes of Health (NIH)-Chronic Prostatitis Symptom Index (CPSI) was used. For the assessment of depression, the Patient Health Questionnaire-9 (PHQ-9) was used. The levels of cytokines [Interleukin (IL)-1β (IL-1β), IL-8, IL-10, tumor necrosis factor-alpha (TNF-α) and transforming growth factor-β1 (TGF-β1)] in semen were assessed by ELISA (Diaclon, DRG, Ukrmedservice). All enrolled patients (n = 81) with CAP aged 19 to 38 years received basic treatment with rectal electrostimulation every other day for 10 sessions lasting 15 minutes each. Patients in Group 1 (n = 42) who additionally received oral sertraline with an initial dose of 50 mg gradually being increased to 200 mg were treated for 1 month. Patients in Group 2 (n = 39) received basic treatment only. Distribution of patients was random. All the statistical analyses were performed using SPSS.
The data from patients in Group 1 and Group 2 demonstrated that after treatment, a statistically significant (p <0.05) decrease in the concentration of pro-inflammatory cytokines (TNF-α, IL-1β, IL-8) in ejaculate was observed. At the same time, there was a significant increase (p <0.05) in the content of anti-inflammatory cytokines (IL-10 and TGF-β1) in Group 1 only. Clinical efficacy of combined treatment of patients with CP/CPPS was 83% in Group 1 and 62% in Group 2 compared to the symptoms of prostatitis, and 76% in Group 1 and 41% in Group 2 compared to the symptoms of depressive disorders.
The results demonstrate the effectiveness (83%) of the combination of rectal electrostimulation and an antidepressant (sertraline) in the treatment of CAP, and also show the role of neuro-immune regulation and its disorders (including depressive disorders) in the pathogenesis of СAP.
Central European journal of urology. 2019 Jan 10 [Epub]
Alexander Shulyak, Igor Gorpynchenko, George Drannik, Tatiana Poroshina, Viktoria Savchenko, Kamil Nurimanov
State Institution "Institute of Urology of National Academy of Medical Sciences of Ukraine", Kiev, Ukraine.