[Regenerative effect of comprehensive physiotherapeutic programs in the early postoperative period in patients with chronic paraproctitis]. / Regenerativnyi effekt primeneniya kompleksnykh fizioterapevticheskikh programm v rannem posleoperatsionnom periode u bol'nykh khronicheskim paraproktitom.

The modern lifestyle is often associated with low physical activity and blood stasis in the pelvic organs, which leads to increased incidence of proctological diseases, and increasingly in people of young working age. Chronic paraproctitis is the third most common proctological disorder that requires surgical treatment. The disease occurs commonly in the age group of 30-50 years, predominantly in men, which determines its socio-economic significance. It indicates the urgent need for advanced comprehensive physiotherapeutic programs for early rehabilitation of patients after surgery for chronic paraproctitis, and the application of new diagnostic technologies for assessment of surgery effectiveness and postoperative changes to provide adequate and effective medical rehabilitation. One of the main goals in the early postoperative period is the acceleration of adequate scar formation and reduction of the postoperative wound healing time; therefore, it seems reasonable to assess regeneration processes using transrectal ultrasound examination and sonoelastography of the scar tissue, which have great potential for use in coloproctology. OBJECTIVE: To study the role of the medical rehabilitation program in the early postoperative period on the adequate scar formation and postoperative wound healing processes (by transrectal ultrasound investigation and scar tissue sonoelastography) as well as postoperative complications rate and long-term (up to 12 months) treatment outcomes in patients with chronic paraproctitis. MATERIAL AND METHODS: The study included 60 patients 20-69 years with chronic pararectal fistulas (ICD-10: K60.4). The patients were assigned into two groups. The control group consisted of 30 patients who received standard of care in the early postoperative period, including analgesics, local antibacterial ointments (Levomekol, etc.), and rectal suppositories (Relief Pro, etc.). The main group also consisted of 30 patients who received standard of care and a 5-day comprehensive physiotherapeutic program starting the second day after the surgery. Effectiveness was assessed by complex transrectal ultrasound investigation with color Doppler mapping, Doppler sonography, and sonoelastography at various post-surgery time points. RESULTS: The higher efficacy of the rehabilitation program, including intravenous ozone therapy, rectal laser therapy, recto-tibial myostimulation, and biofeedback therapy in the early postoperative period, versus the standard of care, was shown. CONCLUSION: The introduction of rehabilitation program including intravenous ozone therapy, rectal laser therapy, recto-tibial myostimulation, and biofeedback therapy in the early postoperative period significantly reduced the average postoperative wound healing time by accelerating the formation of an adequate scar (according to transrectal ultrasound investigation and scar tissue sonoelastography) and the incidence of postoperative complications and improved the long-term treatment outcomes (up to 12 months) in patients with chronic paraproctitis.

[Arterial blood flow in the prostate in the syndrome of chronic pelvic pain/chronic prostatitis].

Causes and mechanisms of chronic pelvic pain/chronic prostatitis (CPP/CP) syndrome are not well investigated yet. It is suggested that pain in an inflammatory form of this syndrome may be due to tissue inflammation. In the non-inflammatory form pain may result from neurogenic factors. Standard diagnostic methods in the absence of inflammation often fail to detect pathological changes in the prostate. We made duplex mapping of the prostate and obtained quantitative characteristics of arterial hemodynamics of the prostate. Control values of arterial prostatic blood flow were developed after examination of healthy volunteers. These values were compared with similar values of arterial blood flow in CPP/CP syndrome. We found a significant decrease of the peak systolic velocity in patients with non-inflammatory CPP/CP syndrome. There is a direct correlation between intensity of pain syndrome and peak systolic velocity of arterial blood flow. Thus, pain may arise from chronic prostatic ischemia.