A Multi-Center Study Of Transcutaneous Neuromuscular Electrical Stimulation Combined With Drug Therapy For Type Ⅲ Prostatitis

【Objective】Type Ⅲ prostatitis is one of the most common diseases in urology,usually causing patients to experience pain,lower urinary tract symptoms(LUTS),sexual dysfunction and psychopsychological symptoms,which seriously affect their quality of life.Due to individual differences and side effects of drug treatment,the efficacy is not very ideal.Transcutaneous neuromuscular electrical stimulation(TNES)and other physiotherapy methods,due to their characteristics of safety,effectiveness and minor adverse reactions,are increasingly being used in the treatment of various diseases,while in male diseases are not common.This research was conducted a multi-center study of TNES combined with medication in the treatment of type Ⅲ prostatitis to explore the effect of TNES combined with drug therapy on improving the symptoms of patients with type Ⅲ prostatitis.【Methods】1)Patients with type Ⅲ prostatitis admitted to Xijing Hospital,Xi ’an Daxing Hospital and Xi ’an People’s Hospital from May 2021 to October 2022 were randomly divided into single-drug group and combined treatment group after screening according to the inclusion criteria.The single-drug group was treated with Tamsulosin sustained-release tablets,while the combined treatment group was treated with TNES on the basis of drug therapy.2)The primary observation index was the total score of the national institutes of health chronic prostatitis symptoms index(NIH-CPSI).Secondary observation indexes were the small particle of lecithin(SPL)and white blood cell(WBC)in the expressed prostatic secretion(EPS),5-item international index erectile function(IIEF-5),premature ejaculation diagnostic tool(PEDT),generalized anxiety disorder-7(GAD-7),patient health questionnaire-9(PHQ-9)after treatment.3)Data of all the above scoring indicators were collected from patients at different periods of the treatment.4)The Wilcoxon test and Mann-Whitney test were used to compare all the primary and secondary outcome indexes within and between groups,respectively.The efficacy index was calculated according to the total score of NIH-CPSI,the Chi-square test and Spearman correlation analysis were used respectively to compare the efficacy differences between the two groups and conduct correlation analysis.Multiple comparisons of all grading measures were performed using repeated measures to analyze the difference in symptom improvement between the two groups.【Results】1)A total of 256 patients were enrolled in this study,and 34 patients fell off due to various reasons during treatment.Finally,a total of 120 patients in the single-drug group and 102 patients in the combined treatment group completed the study.2)The total score of NIH-CPSI was statistically different in the intra-group comparison compared with pre-treatment in both groups(P<0.001).The total score of NIH-CPSI was statistically different in the intergroup comparison(P<0.001).3)All secondary observation indexes such as SPL,WBC and scores of IPSS,IIEF-5,PEDT,GAD-7,PHQ-9 were statistically different in the intra-group comparison compared with pre-treatment in both groups(P<0.001).The scores of IPSS,IIEF-5,PEDT,GAD-7 were statistically different in the intergroup comparison(P<0.001),while the SPL,WBC and the score of PHQ-9 were no significant difference(P>0.05).4)The overall effective efficiency of the combined treatment group(88.2%)was higher than that of the single-drug group(77.5%),and the significant efficiency of the combined treatment group(73.5%)was significantly higher than that of the single-drug group(5.8%).5)In the correlation analysis of efficacy,there was a significant negative correlation between alcohol consumption level and efficacy level in both groups(P<0.05),while there was no statistical correlation between the objective indicators SPL and WBC and efficacy level(P>0.05).6)In the multiple comparisons of graded observation indicators at different follow-up periods,statistical differences in the total score of NIH-CPSI between the two groups began to appear at the second week of treatment until the end of treatment(P<0.001),and were still statistically significant at the later follow-up(P<0.001).Statistical differences in IPSS and PEDT scores between the two groups appeared from the 4th week of treatment to the end of treatment(P<0.01),and were still statistically significant at later follow-up(P<0.01).The IIEF-5 score was statistically different between the two groups at the end of treatment(P=0.011)and remained statistically different at later follow-up(P=0.014).The GAD-7 score was statistically different between the two groups at the end of treatment(P=0.002),but there was no statistically significant difference between the two groups at the later follow-up(P>0.05).The statistical difference of PHQ-9 score between the two groups began to appear at the 4th week of treatment(P=0.028),and disappeared at the end of treatment(P>0.05),but reappeared at the later follow-up(P=0.002).7)No treatment-related serious adverse events occurred in all patients during the treatment.【Conclusion】1)The two treatment methods of single-drug and TNES combined drug have certain efficacy in improving many symptoms of patients with type Ⅲ prostatitis,and the efficacy of TNES combined drug is better than that of single-drug therapy.2)Compared with single-drug therapy,TNES combined with drugs exerts the advantage of pain symptom improvement earlier,followed by LUTS and premature ejaculation symptoms,and the advantage of improving erectile function exerts late.3)There was no significant correlation between improving patients’ perceived symptoms and changing laboratory indicators,such as SPL and WBC in the EPS.Drinking was not conducive to treatment.4)TNES combined with drugs is an effective and safe treatment for type Ⅲ prostatitis.