O.V. Knigavko

Treatment optimisation of chronic prostatitis and secondary premature ejaculation

Premature ejaculation (PE) - a persistent attack of orgasm and ejaculation in a man before the onset of orgasm in a woman - a fairly common disease, which according to different authors suffers from 25 to 40% of men, mostly young. Despite such a wide spread of premature ejaculation, there are still no clear guidelines for its treatment in Ukraine, especially the secondary (acquired) form, which manifested itself sometime after a successful sexual life. In this work, we consider the etiopathogenetic factors of secondary premature ejaculation (SPE) and the variants of their treatment.

Materials and methods. In 2007-2019 in the andrological department of the KZOZ “RCCUN them. V. I. Shapoval“, 968 patients with premature ejaculation were examined. In this sample, the results of diagnosis and treatment of 393 patients with secondary PE with an Intravaginal ejaculation latency time (IELT) were evaluated for less than 2 minutes. Based on penile biothesiometry, sexual history, International Index of Erectile Function (IIEF)? study of urological complaints, doppler ultrasound examination of the prostate and scrotum, analyzes for sexually transmitted infections, and the use of the Hamilton Rate Depression Scale (HRDS), there are suggestions for the most likely cause of PE. This allowed the patients to be divided into 4 groups:

Group 1 - 62 patients with normal penile sensitivity without deviations in the psychoneurological status with diagnosed chronic prostatitis (CP), who underwent antibacterial treatment according to EAU guidelines (levofloxacin 0.5 for 6 months), Group 2 - 145 patients with chronic prostatitis were treated according to the sensitivity of the isolated infectious agents; Group 3 consisted of 92 patients with CP and the presence of varicocele, which, in addition to antibiotic therapy, were underwent Marmara surgery; Group 4 - 94 patients with neurological complaints and high anxiety HRDS>14, whose treatment consisted in the appointment of a selective serotonin reuptake inhibitor (SSRI) sertraline by a course of 6 months at a dose of 50 mg per day.

Results. After 1 and 7 months, the effectiveness of the treatment was determined by the lengthening of the intravaginal ejaculatory latent time (IELT), the satisfaction of sexual intercourse on IIEF, the number of patients satisfied with the results of treatment and the absence of prostatic symptoms and infection agents.

In group 1, the duration of IELT increased by 1.76 times, eradication of the disease reached 68.2%, high results were observed in the absence of complaints in 83.8% of patients, but in respect of the SPE, the efficacy was not high - only 56.4%. In the 2nd group, high eradication cure was noted - 86.9%, almost complete absence of complaints and high efficiency with respect to the SPE - 89.6%, increase in IELT - by 2.54 times. In the third group, eradication cure reached 89.6%, almost no complaints and high efficiency with respect to the SPE - 89.1%, increased by 2.72 times. In the fourth group of patients receiving sertraline, the average increase in IELT was 2.36 times, the efficacy with respect to SPE was 64.9%.

Conclusions. 1. The cause of SPE is most often chronic prostatitis and prostatevisculitis (76.6%). 2. The appointment of SSRI in case of SPE is rational only in the presence of neurological symptoms (HRDS> 14) and absence of CP. 3. Varicocele (especially bilateral) is a comorbid factor of CP, causing venous hyperemia of the prostate, and may be one of the causes of SPE. 4. Operation Marmar reduces venous hyperemia of the prostate, reduces the score of IPSS, improves IELT in patients with comorbid pathology (varicocele + CP). 5. Antibacterial therapy of CP allows to cure SPE in 56.4%, so almost half of patients stay dissatisfied. 6. Bacteriological examination detects more often Trichomonas (68.3%), Mycoplasma (55.2%) and polymicrobal association in different combinations. 7. Prescribing of antiprotozoal medicine optimizes treatment of chronic prostatitis and increases effectiveness of treatment Secondary PE up to 89.1%.