Heidi L Sha¡ord DVM, Peter W Hellyer DVM, MS, Dipl ACVA, Kenneth T Crump CVT, Ann E Wagner DVM, MS, Dipl ACVA, Khursheed R Mama DVM, MS, Dipl ACVA & James S Gaynor DVM, MS, Dipl ACVA
Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State Uni-versity, Fort Collins, USA

Uso della magnetoterapia per il trattamento post-operatorio nei cani: uno studio pilota.

Abstract

L’obiettivo era determinare se la magnetoterapia riduceva il dolore post operatorio in cani dopo l’ovariectomia e determinare l’interazione della magnetoterapia con l’analgesia da morfina post-operatoria.

Introduzione

L’interesse nell’uso terapeutico della magnetoterapia è cresciuto negli ultimi anni da quando la magnetoterapia ha guadagnato in USA l’approvazione da parte dell’ente “Food and Drug Administration” per la terapia di pazienti umani con fratture scom-poste e pseudoartrosi congenite (Basset 1993).

L’uso della magnetoterapia è stato incorporato nel trattamento delle tendiniti sia negli umani (Binder et al. 1984) che nei cavalli (Auer et al.1983). Inoltre, è stato dimostrato che la magnetoterapia migliora la guarigione delle ferite nel cane. Il sollievo dal dolore cronico è stato un problema comune associato al trattamento con magnetoterapia nei pazienti umani (Binder et al.1984; Ellis 1993,Trock et al.1994)
Nessuno studio ha studiato il sollievo dal dolore mediato dalla magnetoterapia negli animali. L’obiettivo di questo studio pilota era di ottenere informazioni preliminari per valutare gli effetti analgesici della magnetoterapia nei cani.
In particolare, abbiamo analizzato la capacità di una magnetoterapia terapeutica di controllare il dolore post-operatorio e valutato la sua interazione con l’analgesia della morfina post-operatoria nei cani sottoposti a ovarioisterectomia di routine.

Sedici cagne intatte non gravide ,di peso corporeo di 18 Kg (10 -32 di media) e 13 mesi (3 – 36 mesi di media) sono stati i soggetti di questo studio pilota.

Sono stati presentati all’Ospedale Veterinario della Colorado State University dalla Larimer County Humane Society per ovarioisterectomia elettiva.
Il Comitato per la cura degli animali della Colorado State University ha approvato l’uso dei cani per gli studi.

Tutti i cani sono stati verificati in buona salute sulla base di esami fisici e concentra-zione totale delle proteine plasmatiche determinata il giorno prima dell’intervento chirurgico.

Trattamento elettromagnetico ad impulsi

L’unità magnetica è stata fissata all’esterno della gabbia e il campo magnetico è stato misurato utilizzando un gaussometro a tre vie e controllato per essere all’interno della gabbia.
L’unità magnetica ha emesso un campo elettromagnetico pulsato a 0,5 Hz per periodi alternati di 20 minuti e poi per 20 minuti spento per il periodo di recupero di 6 ore.
La configurazione dell’unità elettromagnetica pulsata è stata raccomandata dal produttore per il sollievo dal dolore negli animali (Peppin 1998).
Durante il periodo di recupero, i cani in morfina sono stati esposti a un’unità elettromagnetica non funzionale, benché visibilmente identica.

Valutazione del dolore

Sono stati valutati nove criteri differenti di risposta comportamentale e fisiologica al dolore per determinare il punteggio del dolore cumulativo.
Il criterio include il comfort, movimento, aspetto, comportamento non provocato, comportamento interattivo, vocalizzazione, frequenza cardiaca, frequenza respiratoria e pressione media arteriosa.

I cani sono stati osservati per circa 10 minuti al giorno in un momento preciso.
Qualsiasi cane che esibiva un eccesso di dolore, definito come un punteggio di dolore cumulativo di più di 17, è stato somministrato immediatamente morfina (0,5 mg kg 1, IV) e rimosso dallo studio.

Discussione

In questo studio pilota, abbiamo scoperto che la magnetoterapia ha contribuito all’analgesia post-operatoria nei cani sottoposti a ovarioisterectomia elettiva.
La MAP di entrambi i gruppi morfina e morfina / magnete tendeva a ritornare ai valori basali di T 1/4 300, mentre quella dei gruppi di controllo e dei magneti tendeva ad aumentare. Sammarco et al. (1996) hanno riportato una tendenza simile alla MAP postoperatoria che aumenta nel tempo in un gruppo di controllo di cani. Sebbene l’analgesia e la sedazione della morfina fossero diminuite di T 1/4 300, i cani trattati con morfina potrebbero aver sperimentato maggiore analgesia e sedazione e ridotto rilascio di catecolamina endogena nel corso dello studio, il che avrebbe potuto contribuire a ridurre la MAP rispetto ai cani non ricevendo la morfina.

Use of a pulsed electromagnetic field for treatment of post-operative pain in dogs: a pilot study

Heidi L Sha¡ord DVM, Peter W Hellyer DVM, MS, Dipl ACVA, Kenneth T Crump CVT, Ann E Wagner DVM,
MS, Dipl ACVA, Khursheed RM ama DVM, MS, Dipl ACVA & James S Gaynor DVM, MS, Dipl ACVA
Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University,
Fort Collins, USA
(Veterinary Anaesthesia and Analgesia, 2002, 29, 43^48)

Correspondence: Peter Hellyer, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences,
Colorado State University, Fort Collins, CO 80523, USA.

Abstract

Objective To determine if pulsed electromagnetic
¢eld (PEMF) therapy reduces post-operative pain in
dogs following ovariohysterectomy, and to evaluate
PEMF interaction with post-operative morphine
analgesia.

Study design Randomized controlled clinical trail.

Animals Sixteen healthy dogs weighing 18 (10^32)
kg [median (range)] and aged13 (3^36) months.

Materials and methods Anesthesia consisted of
atropine (0.04 mg kg
1, SC), acepromazine (0.02 mg
kg
1, SC), fentanyl (00.1mg kg
1, SC), thiopental
(10^15 mg kg
1, IV) and halothane in oxygen. Ovariohysterectomies
were performed by senior veterinary
students. Pain score (numeric rating scale,
0^28), pulse rate, respiratory rate, indirect mean
arterial pressure (MAP), and body temperature were
evaluated prior to anesthetic premedication, at extubation,
30m inutes after extubation, and then hourly
for 6 hours. Following extubation, dogs were randomly
divided into four groups: a control group that
received 0.9%NaCl, IV, and no PEMF; a magnet group
that received 0.9% NaCl, IV, and PEMF; a morphine
group that received morphine 0.25 mg kg
1, IV,
and no PEMF; and, a magnet/morphine group that
received morphine 0.25 mg kg
1, IV, and PEMF. A
single observer, blinded to treatment, obtained all
behavioral observations and physiologic data. Data
were analyzed using the Kruskal^Wallis statistical
test with a signi¢cance of p < 0.05.

Results Signi¢cant di¡erences in MAP (mm Hg)
[median (range)] occurred at 300 minutes [morphine
108 (83^114) and magnet/morphine 90
(83^97) [magnet/morphine 93 (81^100) < control 127
(111^129) and magnet 126 (111^129)]. At 30m inutes
the total pain score for the magnet/morphine
group [1.5 (0^5)] was signi¢cantly less than control
[8 (6^13)], but not di¡erent from magnet [5.5 (4^7)]
ormorphine [4.5 (2^9)].

Conclusions and clinical relevance Although no
clear bene¢t was seen in this study, the results
suggest that PEMF may augment morphine analgesia
following ovariohysterectomy in dogs, and
that further study of the analgesic e¡ects of PEMF is
warranted.

Keywords analgesia, pulsed electromagnetic ¢eld.

Introduction

Interest in the therapeutic use of electromagnetic
¢elds has grown over the past two decades since
pulsed electromagnetic ¢eld (PEMF) therapy gained
Food and Drug Administration (USA) approval for
the treatment of humanpatientswith nonunion fractures
and congenital pseudoarthrosis (Bassett1993).
Use of PEMF has been incorporated into the treatment
of tendinitis in both humans (Binder et al.
1984) and horses (Auer et al.1983). In addition, PEMF
has been shown to enhance wound healing in the
dog (Scardino et al. 1998). Relief from chronic pain
has been a common ¢nding associated with PEMF treatment in human patients (Binder et al.1984; Ellis
1993,Trock et al.1994), however, PEMF therapy does
not appear to provide analgesia in acute pain models
(Kavaliers&Ossenkopp1985;Reed et al.1987).No studies
have investigated PEMF-mediated pain relief in
animals. The objective of this pilot study was to
obtain preliminary information evaluating the analgesic
e¡ects of PEMF in dogs. Speci¢cally, we investigated
the ability of a therapeutic PEMF to control
post-operative pain, and evaluated its interaction
with post-operative morphine analgesia in dogs
undergoing routine ovariohysterectomy

Pulsed electromagnetic ¢eld treatment

The magnetic ¢eld unitwas attached to the outside of
the cage and the magnetic ¢eld was measured using
a tri¢eld gaussmeter and con¢rmed to be within the
cage. The magnetic ¢eld unit delivered a pulsed electromagnetic
¢eld at 0.5 Hz for alternating periods of
20m inutes on and 20m inutes o¡ for the 6-hour
recovery period. The pulsed electromagnetic ¢eld
con¢guration was recommended by the manufacturer
for relief of pain in animals (Peppin 1998).
Control and morphine dogs were exposed to a nonfunctional,
though visibly identical, electromagnetic
¢eld unit during the recovery period.

Evaluation of pain

Nine di¡erent criteria re£ecting behavioral and physiologic
responses to pain were evaluated to determine
the cumulative pain score (Appendix A). Criteria included comfort, movement, appearance,
unprovoked behavior, interactive behavior, vocalization,
heart rate, respiratory rate and mean arterial
pressure. Dogs were observed for approximately
10m inutes at each data collection point. Any dog
exhibiting excessive pain, de¢ned as a cumulative
pain score of 17, was administered morphine
(0.5 mg kg
1, IV) immediately, and removed from
further study.

Discussion

Inthis pilot study, we found that PEMFcontributed to
post-operative analgesia in dogs undergoing elective
ovariohysterectomy. The MAP of both the morphine
and morphine/magnet groups tended to return
towards baseline values by T ¼ 300, whereas that of
the control and magnet groups tended to increase.
Sammarco et al. (1996) reported a similar trend of
post-operativeMAP increasing over time in a control
group of dogs. Although morphine analgesia and
sedation were expected to have diminished by
T ¼ 300, dogs receiving morphine may have experienced
greater analgesia and sedation, and decreased
endogenous catecholamine release throughout the
study, all of which could have contributed to lower
MAP than dogs not receiving morphine. As found in
a previous study,MAP, heart rate and respiratory rate
did not appear to correlate with behavioral indications
of pain (Conzemius et al.1997). Pain scores for
all groups tended to be greatest at the time of extubation.
Post-anesthetic delirium may have contributed
to high scores at this time. The pain scores of control
dogs tended to be greater than all other groups for
the ¢rst 180m inutes. Lascelles et al. (1997) reported
a similar trend in pain scores of control dogs following
ovariohysterectomy. In this study, the magnet
group tended to have lower pain scores than the control
and morphine groups during the ¢rst 180m inutes
following extubation. It is possible that PEMF
potentiation of morphine analgesia contributed to
the ¢nding that morphine/magnet pain scores were
signi¢cantly less than control at T ¼ 30. Our results
suggest that exposure to a PEMF does not interfere with morphine analgesia, unlike a previous study
which found that exposure to a rotating magnetic
¢eld, not a PEMF, inhibited morphine analgesia in
rats (Kavaliers & Ossenkopp1985).
Ovariohysterectomy has been used by other investigators
as a standardized model of surgical pain
(Lascelles et al. 1997, 1998) and for description of
post-operative behavioral parameters indogs (Hardie
et al. 1997).We used both objective (MAP, HR, RR)
and subjective (behavioral observation) measures to
help determine the severity of post-operative pain.
We tried to minimize observer variability by having
a single person obtain all pain score data. The behavioral
comments o¡er insight into individual animal
responses to treatments and suggest that all dogs in
the control group were uncomfortable. Quantitative
behavioral measurements may have detected
more subtle di¡erences between groups and are
recommended for future studies of PEMF-mediated
analgesia.
PEMF therapy has proven successful in the treatment
of pain associated with chronic tendinitis and
osteoarthritis in people (Binder et al. 1984; Trock
et al. 1994). Results of this pilot study suggest that
PEMF may mediate acute post-surgical pain relief
and that further research on clinical application and
mechanisms of action is warranted.

L'articolo Studio sul dolore post-operatorio dopo ovariectomia proviene da Happy Care.

Scardino MS1, Swaim SF, Sartin EA, Steiss JE, Spano JS, Hoffman CE, Coolman SL, Peppin BL.

OBIETTIVO

Attività del CNS dei cani. Valutare gli effetti del trattamento con un campo elettromagnetico pulsato (PEMF).

ANIMALI:

12 Beagles femmina adulta

PROCEDURE:

Ferite aperte e suturate. I cani sono stati divisi in 2 gruppi. Un gruppo ha ricevuto un trattamento PEMF e 1 gruppo è stato valutato non trattato (controllo). I cani sono stati trattati con PEMF un giorno prima dell’intervento chirurgico. Le ferite sono state valutate mediante l’uso di tensiometria, planimetria, imaging di perfusione laser Doppler e esame istologico. Sono state anche valutate le variabili clinopatologiche e i tracciati elettroencefalografici.

RISULTATI:

L’uso del trattamento con PEMF ha portato a un’epitelizzazione si-gnificativamente maggiore delle ferite aperte 10 e 15 giorni dopo l’intervento. Cinque giorni dopo l’intervento, le ferite dei cani di con-trollo avevano un valore negativo per la contrazione della ferita, mentre le ferite trattate con PEMF avevano un valore positivo.
Il trattamento con PEMF non ha causato cambiamenti significativi nei risultati a breve termine planimetrici, perfusione, tensiometrici, istologici, clinicopatologici o elettroencefalografici

CONCLUSIONI:

Il trattamento con PEMF ha potenziato l’epitelizzazione nelle ferite cutanee aperte e fornito indicazioni sulla contrazione precoce senza significative variazioni a breve termine in altre variabili.

ORIGINAL SCIENTIFIC DOCUMENT

Evaluation of treatment with a pulsed electromagnetic
field on wound healing, clinicopathologic variables,
and central nervous system activity of dogs.

Scardino MS1, Swaim SF, Sartin EA, Steiss JE, Spano JS, Hoffman CE, Coolman SL,
Peppin BL.

Abstract

OBJECTIVE:

To evaluate effects of treatment with a pulsed electromagnetic field (PEMF) on
healing of open and sutured wounds, clinicopathologic variables, and CNS
activity of dogs.

ANIMALS:

12 adult female Beagles.

PROCEDURE:

Open and sutured wounds were created in the skin of the trunk of the dogs.
Dogs were divided into 2 groups. One group received PEMF treatment and 1
group served as untreated (control) dogs. The PEMF-treated dogs received
treatment twice a day starting the day before surgery and lasting through day 21
after surgery. Wounds were evaluated by use of tensiometry, planimetry, laser
Doppler perfusion imaging, and histologic examination. Clinicopathologic
variables and electroencephalographic tracings were also evaluated.

RESULTS:

Use of PEMF treatment resulted in significantly enhanced epithelialization of
open wounds 10 and 15 days after surgery. Five days after surgery, wounds of
control dogs had a negative value for wound contraction, whereas PEMF-treated
wounds had a positive value. The PEMF treatment did not cause significant
changes in short-term planimetric, perfusion, tensiometric, histologic,
clinicopathologic, or electroencephalographic results.

CONCLUSIONS:

The PEMF treatment enhanced wound epithelialization in open cutaneous
wounds and provided indications of early contraction without significant shortterm
changes in other variables.

L'articolo Valutazione del trattamento con pulsazione elettromagnetica su ferite in guarigione proviene da Happy Care.

Leoci R1, Aiudi G, Silvestre F, Lissner E, Lacalandra GM.

SFONDO

L’iperplasia prostatica benigna (IPB) è il risultato dell’invecchiamento urogenitale. Recenti studi suggeriscono che una compromissione senile dell’afflusso di sangue alle basse vie urinarie gioca un ruolo nello sviluppo dell’IPB e quindi può essere un fattore che contribuisce alla patogenesi dell’IPB.

La prostata canina è un modello per comprendere la crescita anor-male della ghiandola prostatica umana.
Abbiamo studiato l’efficacia della terapia a campi elettromagnetici pulsati (PEMF) nei cani per modificare il flusso sanguigno della prostata e valutato il suo effetto su BPH.

RISULTATI

Le 3 settimane di PEMF hanno prodotto una significativa riduzione del volume prostatico (57% medio) senza alcuna interferenza con la qualità dello sperma, i livelli di testosterone o la libido.

I parametri Doppler hanno mostrato una riduzione delle resistenze periferiche e una riduzione progressiva durante lo studio della velocità sistolica del picco, della velocità diastolica terminale, della velocità media, della media e del gradiente di picco del flusso sanguigno nel ramo dorsale dell’arteria prostatica.
L’indice di pulsatilità e l’indice di resistenza non variano significati-vamente nel tempo.

Per lo studio sono stati selezionati 20 cani maschi adulti e sani di età compresa tra 8 e 14 anni (media = 9,5 anni, DS = 1,5 anni), del peso di 13-39 chilogrammi (kg) (media = 23,8 kg, DS = 8,8 kg). Nessun sintomo di malattia prostatica è stato rilevato in cani speri-mentali a parte un ingrandimento prostatico uniforme all’esplorazione del retto e un aumento del volume prostatico all’ecografia che suggeriva la diagnosi di BPH semplice [43].

La valutazione citologica mediante biopsia di aspirazione con ago sottile della prostata ha confermato la natura benigna dell’amplia-mento del volume della prostata [49]. Sono state eseguite anche analisi delle urine e un esame andrologico (inclusi esami di ultrasonografia, qualità dello sperma e valutazione dei liquidi prostatici). I cani selezionati erano tutti di proprietà e non soggetti a cambiamenti nelle abitudini durante lo studio.

Gli esami clinici sono stati effettuati presso la Facoltà di Medicina Veterinaria dell’Università di Bari Aldo Moro. Le indagini sono state condotte con il consenso dei proprietari in conformità con i Principi per la cura e l’uso degli animali da ricerca, promulgati dalla Comu-nità europea.

ORIGINAL SCIENTIFIC DOCUMENT

Effect of Pulsed Electromagnetic Field Therapy on
Prostate Volume and Vascularity in the Treatment of
Benign Prostatic Hyperplasia: A Pilot Study in a Canine
Model

Raffaella Leoci,1,* Giulio Aiudi,1 Fabio Silvestre,1 Elaine Lissner,2 and Giovanni Michele
Lacalandra1

BACKGROUND

Benign prostatic hyperplasia (BPH) is a result of urogenital aging. Recent
studies suggest that an age-related impairment of the blood supply to the
lower urinary tract plays a role in the development of BPH and thus may
be a contributing factor in the pathogenesis of BPH. The canine prostate is
a model for understanding abnormal growth of the human prostate gland.
We studied the efficacy of pulsed electromagnetic field therapy (PEMF) in
dogs to modify prostate blood flow and evaluated its effect on BPH.

METHODS

PEMF (5 min, twice a day for 3 weeks) was performed on 20 dogs affected
by BPH. Prostatic volume, Doppler assessment by ultrasonography, libido,
semen quality, testosterone levels, and seminal plasma volume, composition
and pH were evaluated before and after treatment.

RESULTS

The 3 weeks of PEMF produced a significant reduction in prostatic volume
(average 57%) without any interference with semen quality, testosterone
levels or libido. Doppler parameters showed a reduction of peripheral
resistances and a progressive reduction throughout the trial of the systolic
peak velocity, end-diastolic velocity, mean velocity, mean, and peak
gradient of the blood flow in the dorsal branch of the prostatic artery. The
pulsatility index and the resistance index did not vary significantly over
time.

CONCLUSIONS

The efficacy of PEMF on BPH in dogs, with no side effects, suggests the
suitability of this treatment in humans and supports the hypothesis that impairment
of blood supply to the lower urinary tract may be a causative factor
in the development of BPH. Prostate 74:1132–1141, 2014. © 2014 The
Authors. The Prostate published by Wiley Periodicals, Inc.
Keywords: BPH, prostate, electromagnetic therapy, PEMF, dog

INTRODUCTION

Benign prostatic hyperplasia (BPH) is an age-related enlargement of the
prostate gland and is one of the most frequent medical disorders of elderly
men throughout the world [1]. BPH also has a serious public health impact.
Direct and indirect annual costs related to BPH treatment are estimated
to be $3.9 billion in the United States [2–4] and €858 per patient per
year in Europe [5]. BPH can present with hematuria, lower urinary tract
symptoms and sexual dysfunction. If untreated, BPH leads to reduced quality
of life and may result in severe complications such as acute urinary retention
and urinary tract infections [6,7].

Generally the main goals of therapy for BPH are to improve symptoms,
improve quality of life, arrest the disease process and prevent some of the
adverse outcomes associated with BPH. The goals of BPH therapy may
differ, however, depending on the individual’s point of view: patients focus
on the quality-of-life issues and alleviation of symptoms and prefer a natural
product with minimal side effects, particularly effects that impair sexual
function or alter ejaculation; primary care physicians are concerned
with safety of treatment used; and insurers and funders of national healthcare
systems seek to minimize and defer treatment costs [8].

At the moment there are no therapies that meet all objectives. The available
therapeutic options are surgical or pharmaceutical, each with pros and
cons. Transurethral resection of the prostate (TURP) has been the goldstandard
treatment in men with symptomatic BPH. However, the morbidity
of TURP approaches 20%, and less invasive techniques being developed
are reducing the need for this method [9]. Available drug therapies for
BPH fall under two general categories: alpha-blockers and 5 alpha-reductase
inhibitors, both of which can improve urine flow, but they do not reduce
the size of the prostate, and can contribute to sexual dysfunction or
hypotension as side effects.

Phytotherapies or dietary supplements (saw palmetto, pygeum africanum,
etc.) are widely available and commonly used remedies, with evidence of
efficacy, but may not have the quality and safety profiles of medicines
regulated by the Food and Drug Administration and may have variable potency
and pharmacological activity [10].

Each new therapeutic approach should not ignore BPH pathophysiology,
even if not completely understood [11]. BPH is a disease with multiple etiologies,
including hormone signaling, disruption of proliferation, and
apoptosis dynamics, and chronic inflammation, with changes in the morphology
and phenotype of the prostate stroma. Inflammation of the
prostate represents a mechanism for hyperplastic changes to occur in the
prostate. Both chronic and acute inflammation may lead to events that can
cause proliferation within prostatic tissue through oxidative stress. Both
tissue damage and oxidative stress may lead to compensatory cellular proliferation
with resulting hyperplastic growth [12].

Systemic conditions such as hypercholesterolemia [13], obesity [14] and
stress [15,16] may be important risk factors for BPH. Several studies suggested
an association between prostatic disease and the presence of vascular
disorders such as coronary heart disease [17,18] or diabetes mellitus
[19,20]. Generalized or localized vascular damage may cause hypoxia.
Ghafar and colleagues [1] postulated that hyperplasia in the stromal and
glandular compartments of the prostate might be induced by stromal
growth secondary to hypoxia, which in turn results from abnormal blood
flow patterns. In a recent study using a cell-culture model of human prostatic
stromal cells, the cells responded to hypoxia by up-regulating the secretion
of several growth factors in vitro, which suggests that hypoxia
might trigger prostatic growth [21].

These findings led our team to consider a new therapeutic option for BPH:
pulsed electromagnetic field therapy (PEMF). We focused our attention on
the following main concepts: (1) the prostatic vascular system is an important
component of prostate growth and regulation, and the dysfunction in
blood flow to the prostate gland may be involved in the process through
which BPH develops and is controlled [1]; (2) inflammation represents a
mechanism for hyperplastic changes to occur in the prostate [12]; and (3)
PEMF has a positive effect on vascularization and hemodynamics of the
prostate [22] and tissues in general [23]. Thus, reducing tissue hypoxia that
results from abnormal blood flow patterns by improving oxygen delivery
and reducing inflammation might be a healing measure or a preventive
measure in patients with or at risk of BPH.

Nevertheless, there is some confusion about PEMF. In general, electromagnetic
modalities include any modality which uses electricity and therefore
generates both an electric field and a magnetic field. This includes
PEMFs, microcurrent therapy (MCT) and microwave diathermy (MWD).
Ultrasound is a commonly used modality in which the resultant acoustic
wave is mechanical and not electromagnetic [24].

Many other energy delivery
system used to treat BPH [including transurethral electrovaporization
of the prostate (TUVP), transurethral electrovapor resection of the
prostate (TUVRP), transurethral electrovaporization of the prostate using
bipolar energy (plasmakinetic vaporization of the prostate [PKVP]), visual
laser ablation of the prostate (VLAP), transurethral microwave thermotherapy
(TUMT)] have been developed as alternatives to surgical
transurethral prostatectomy (TURP) [25].

PEMF is very low frequency pulsed energy waves in the range of 1–50 Hz
and is also identified as a weak non-thermal electromagnetic field [26]
generally used to expedite recovery [24] or to reduce post surgical side effects
[27,28].

It is important to distinguish magnetostatic therapies (with natural stones)
with electromagnetic ones. Magnetostatic therapies are based on the application
of a motionless magnetic field.

Electromagnetic therapies are based on the application of time-varying
magnetic fields, usually generated at low frequencies by an alternating current
passing through a coil [29]. The essential difference with static fields
is that time-varying magnetic fields can generate electric fields with significant
intensity inside the body, and its value may be estimated using physical
laws like the Faraday’s equation. Magnetostatic fields do not have an
associated electric field and cannot transfer magnetic energy to moving
charged particles, indicating the ineffectiveness of this treatment and explaining
the absence of firm medical evidence in the scientific literature to
support its use [29]. In this article, we use the term magnetotherapy or
PEMF to refer to electromagnetic therapy by PEMF, where there is always
an electrical field that influences the body’s electrical charges.

Over the past several decades, physicians and scientists have used a rigorous
scientific approach to clinical application of PEMF to treat therapeutically
resistant problems, mainly in the musculoskeletal system. PEMF has
been proven to be clinically safe, and it is well accepted that PEMF provides
a practical non-invasive method for inducing cell and tissue modification
that can correct selected pathological states. Many publications
suggest that exogenous electromagnetic fields can have profound effects
on a large number of biological processes [30–33].

PEMF is a relatively widespread method used in several medical disciplines
such as orthopedics, neurology, and urology [34]. The mechanism for
the advantageous action of the pulsed magnetic field on the living organism
is not quite clear yet, but clinical investigations have revealed a favorable
anti-inflammatory, angioedematous, and analgesic therapeutic effect
[35]. A number of clinical studies suggest that magnetic stimulation can
accelerate the healing process [27,32,33,36]. Its use on the prostate gland
led to a decrease in the number of postoperative complications after TURP
[28] and was found to stimulate prostate glands and improve circulation
[23], having a positive effect on vascularization and hemodynamics of the
prostate [22].

The objective of the current study was to evaluate the efficacy of magnetotherapy
for the treatment of BPH as a conservative therapy with high compliance,
no drug interactions and low cost. As a preliminary study, the dog
was used as experimental model. The dog is considered a reliable animal
model for the study of human BPH [11,37–39] and few differences are noticeable
between the two species in terms of prostatic anatomy [40], histology
[41,42], physiology, BPH pathogenesis [43–45], diagnosis [46] and
symptoms.

The most common clinical sign of BPH in dogs is bloody fluid dripping
from the penis unassociated with urination. Although urethral obstructive
disease occurs in men with BPH, it is extremely rare in dogs [47]. While
blood is frequently observed in semen samples and the volume of ejaculate
is decreased [43], total sperm count and fertility are not affected by BPH in
dogs. However, most cases of BPH in dogs do not evidence clinical signs
despite being viewable on ultrasonography as prostatic volume enlargement.
It is only when the prostate becomes large enough to compress the
colon and interferes with defecation that serious effects result and rectal
tenesmus and constipation may be present [48]. Despite the differences,
there are sufficient similarities between the two species to regard the canine
condition as a useful model for comparison to the human disease
[38,43].
In this study, we evaluated the effect of PEMF on prostate volume, semen
quality, testosterone and hemodynamic changes by ultrasonography.

MATERIALS AND METHODS

Animals

For the study, 20 mature, healthy male dogs 8 to 14 years of age (mean =
9.5 years, SD = 1.5 years), weighing 13–39 kilograms (kg) (mean = 23.8
kg, SD = 8.8 kg) were selected. No symptoms of prostatic disease were detected
in experimental dogs apart from a uniform prostatic enlargement at
rectal exploration and an increase of prostatic volume at ultrasonography
that suggested diagnosis of simple BPH [43].
Cytological evaluation by fine-needle aspiration biopsy of the prostate
confirmed the benign nature of the prostate volume enlargement [49].
Urinalysis and an andrological examination (including ultrasonography
exams, semen quality, and prostatic fluid evaluation) were also performed.
The selected dogs were all owned and not subjected to changes in habits
during the study.

Clinical exams were performed at the Faculty of Veterinary Medicine,
University of Bari Aldo Moro. Investigations were conducted with the owners’ consent in accordance with the Principles for the Care and Use of
Research Animals, promulgated by the European Community.

Experiment

At day 0 (T0), the prostate gland was scanned by transabdominal ultrasonography
and volume was calculated. Prostatic hemodynamic patterns
were checked by Doppler. Semen collection and blood samples were performed
to check semen quality, seminal plasma volume, and serum testosterone
concentration.
Dogs were then treated two times a day (every 12 hours) with magnetotherapy
for 5 min each session for three weeks. At day 7, 14, and 21 (T1,
T2, T3) the prostatic volume and hemodynamic changes were checked by
ultrasonography.
At day 0 and 21 (T0, T3), semen was evaluated for quality (total sperm
concentration, motility), seminal plasma contents, volume and pH; blood
samples were evaluated for testosterone content. Throughout the trial, the
dogs were under clinical observation.
Magnetotherapy
Magnetotherapy was performed by a physical therapy device (Magcell®
Vetri, Physiomed Elektromedizin AG, Schnaittach, Germany) (Fig. 1).

L'articolo Effetto della terapia a campi elettromagnetici pulsati sul volume della prostata proviene da Happy Care.