OMM: GU Male Considerations

00:00 So let's see how we could implement OMM in treating patients that come in with prostate disorder.

00:07 So benign prostatic hyperplasia or BPH is prevalent up to 50% of men by the age 50 and this also increases with age. Prostate cancer is the most common cancer in men in the U.S. Over 6.5 million of the 27 million Caucasian men ages 50 to 79 in the United States in 2000 expect to meet the criteria for discussing treatment options for BPH. Another common presentation for men to the physician is treatment of erectile dysfunction. There is overall prevalence of men over 20 of about 18.4%. So that suggest that erectile dysfunction affects over 18 million men in the U.S. It's higher among men who have one or more cardiovascular risk factors and among men with diabetes the prevalence is roughly about 50%. So let's take a look at how OMM could potentially help patients with prostate and erectile dysfunction disorders. So, first we're going to look at the autonomics. The autonomics are divided to sympathetic and parasympathetic and so the sympathetic innervation for the prostate and genital cavernous tissue is T12 to L2. Normal effects of sympathetic tone lead to orgasm and ejaculation in the male. Effects of increase sympathetic tone though will cause premature or retrograde ejaculation. Parasympathetic innervation of the prostate comes from the pelvic splanchnic nerves. The normal effects of parasympathetic tone cause the erection but effects of decreased parasympathetic tone can lead to impotence. Lymphatic drainage of the prostate, the prostate will drain through the internal iliac and the sacral nodes and the prostate itself lies between the bladder and the deep transverse perineal muscle. Enlargement of masses can compress and prevent proper voiding. You could get Chapman points related to the prostate. Anteriorly, they're going to be on the lateral aspect of the femur from the trochanter to within 2 inches of the knee.

02:18 Posteriorly, you could find them between the PSIS and the L5 spinous process. This corresponds to the broad ligament also in females. So, can osteopathic treatment benefit patients with GU disorders? So, there has been a couple of pilot studies done looking at different aspects of GU conditions with men. So here, we have 64 men between the ages of 41 and 69 years and they had diagnosis of benign prostatic hyperplasia and also lower urinary tract symptoms and overall what happened was they had 4 treatments over a period of 8 weeks in the OMM group and the OMM group shows significant positive changes to their symptoms and also their quality of life compared to the group that were not treated with OMM. There was another study looking at patients with chronic prostatitis and pelvic pain. So they looked at the patients and how they responded to OMM. There were 20 patients treated for 5 OMM treatment sessions and overall OMM improved the pain and symptoms of chronic prostatitis and chronic pelvic pain acutely and also at 1-1/2 years and also at 5-year follow-up. So there was a long-term improvement of the patients that were treated with OMM.