Uromexil Forte Official site
Share this

Drug therapy of chronic prostatitis

Prostatitis is acute or chronically leaking inflammation of the glandular (parenchymal) and interstitial tissue of the prostate gland.Medicines for the treatment of prostatitisInflammation of the prostate gland, as an independent nosological form, was first described by Ledmish in 1857.However, despite almost a 150-year history, prostatitis remains very common, non-table studied and poorly treating the disease.Including this is also due to the fact that in most cases of chronic prostatitis, its etiology, pathogenesis and pathophysiology remain unknown.

Today in urology there is no other problem where it is true, dubious data and frank fiction would be so closely intertwined as in the case of chronic prostatitis (CP).

This is largely due to the high degree of commercialization of the treatment of the disease, for which a huge number of different methods and drugs are proposed, which begin to be advertised even before reliable information about their effectiveness and safety.Moreover, aggressive advertising, conducted using all types of media, is focused, first of all, to a patient who is not able to evaluate all the advantages and disadvantages of the proposed treatment.

On the other hand, the development of modern medical science has led to the emergence of a number of new principles and methods of treating CP.Each of the methods has its own advantages and disadvantages.However, a practicing urologist is not able to familiarize themselves and analyze the ever -increasing amount of information published on the problem of prostatitis.Despite a large number of methodological materials, dissertations and publications on the diagnosis and treatment of CP data in the necessary, for acceptance as a standard, there are practically no form.

Various methods of treating prostatitis promote and use numerous medical centers (sometimes not having a urologist in the state), pharmacological companies and even paramedicine institutions.

This complicates the adoption of effective clinical decisions, limits the use of reliable methods of diagnosis and treatment, leads to the "main" treatment, when, after the failure of the use of one method, another is prescribed by another, etc.As a result, a violation of the balance between clinical and economic efficiency and the increase in the costs of a medical care.To fill this gap helps knowledge of the basics and the introduction of the principles of evidence -based medicine to unify approaches to the diagnosis and the choice of tactics of treatment of chronic prostatitis.

What to mean by chronic prostatitis?The modern interpretation of the term "chronic prostatitis" and the classification of the disease are ambiguous.Under its mask, a wide range of states of the prostate gland and lower urinary tract may be hidden, starting from infectious prostatitis, chronic pelvic pain or the so -calledProstatodinia for abacterial prostatitis and ending with neurogenic dysfunctions, allergic and metabolic disorders.The absence of terminological unity is especially relevant in the case of non-infectious CP, which is interpreted by various authors as: prostatinia, syn-drum chronic pelvic pain, post-infectious prostatitis, myalgia of the pelvic floor muscles, and consultant prostatitis.

Many experts consider chronic prostatitis as an inflammatory disease of predominantly infectious genesis with the possible attachment of autoimmune disorders, characterized by damage to the parenchyma and interstitial tissue of the prostate gland.

It should be noted that chronic abacterial prostatitis is 8 times more common than the bacterial form of the disease, which is up to 10% of all cases.

Specialists of the US National Institute of Health are as follows by the clinical concept of chronic prostatitis:

  • the presence of pain in the pelvic/perineum, organs of the genitourinary system for at least 3 months;
  • the presence (or absence) of obstructive or irritive symptoms of urination disorders;
  • A positive (or negative) result of a bacteriological study.

Chronic prostatitis is one of the widespread diseases, and its manifestations are distinguished by a variety of symptoms.Often there are publications indicating the extremely high incidence of CP.It is reported that prostatitis leads to a significant decrease in the quality of life in men of working age: its influence is compared with angina pectoris, Crohn's disease or myocardial infarction.According to the consolidated data of the American Association of Urologists, the incidence of chronic prostatitis varies from 35 to 98% and from 40 to 70% in men of reproductive age.

The absence of clear clinical and laboratory criteria for the disease and the abundance of subjective complaints determine the disguise under the diagnosis of CP of various pathological states of the prostate, urethra, as well as neurological diseases of the pelvic area.The lack of a whole idea of the pathogenesis of CP is evidenced by the disadvantages of existing classifications, which is a serious barrier to understanding and successful treatment of this disease.

In modern scientific literature, more than 50 classifications of prostatitis are found.

Currently, abroad is widely used and adopted as the main classification of the US National Institute of Health, according to which: acute bacterial prostatitis (I), chronic bacterial prostatitis (II), chronic abacterial prostatitis or chronic pelvic pains (III), including with inflammatory component (IIII), as well as it (IIIB), as well asAsymptomatic prostatitis with the presence of inflammation (IV).

Clinical features of chronic prostatitis:

  • Mostly, young men from 20-50 years old (average age 43 years) suffer;
  • The main and most frequent manifestation of the disease is the presence of pain or discomfort in the pelvis;
  • lasting at least 3 months;
  • The intensity of symptomatic manifestations varies significantly;
  • The most common localization of pain is the crotch, but a sense of discomfort can occur in any area of the pelvis;
  • one -sided localization of pain in the testicle is not a sign of prostatitis;
  • imperative symptoms are more characteristic than obstructive;
  • Erectile dysfunction may accompany CP;
  • The pain after ejaculation is the most specific for CP, and distinguishes it from benign prostate hyperplasia and healthy men.

In our country, huge material has been accumulated on the use of various methods of diagnosis and treatment of CP.However, most of the available data do not meet the requirements of evidence -based medicine: the research is not randomized, performed on a small number of observations, in one center, without placebo control, and sometimes without a control group at all.

In addition, the absence of a single classification of CP often does not give an idea of which categories of patients are actually a question in described work.Therefore, the effectiveness of most treatment methods, which are widely advertised and used today (transurethral vacuum-extraction, transurethral electromagnetic stimulation of the prostate, therapy- transrectal, top-lobed, transurethral or intravascular low-energy laser irradiation, extraction of prostrate gland on Buzha and Buzha and BuildingT.P.), not to mention the "miraculousness" of domestic and foreign "patented means," cannot be considered proved.

Even the effectiveness of such a traditional method as massage of the prostate gland, and indications for it are still not clearly defined.

The problem of choosing a drug for the treatment of patients with chronic bacterial (non -infectious) prostatitis related to the classification of NIH to IIia and IIIB categories is a significant difficulty.This is due to the uncertainty of the self-and-and-to-and-chronic abacterial prostatitis, which stems from the ambiguity of the etiology and pathogenesis of this disease.First of all, such a formulation of the issue concerns prostatitis of category IIIB, also defined as "chronic abacterial prostatitis / chronic pelvic pain" (HAP / STBB).

Paradoxically, the fact that many authors are proposed for the treatment of abacterial prostatitis, the use of antibacterial agents is proposed, and data indicating a fairly high efficiency of such treatment are given.This once again testifies to the insufficient development of issues of etiopathogenesis of the disease, the possible influence of the infection on its development and inconsistency of the adopted terminology, which we indicated earlier, proposing to divide the concepts of "abacterial" and "non-infectious" prostatitis.It is most likely that the diagnosis of HAP/CTB hides a whole gamut of different states, including those when the prostate gland is involved in the pathological process only indirectly or not at all, and the diagnosis itself is a forced trimal companies in need of a clear term to determine indications for the prescription of drugs.

Today we can say with confidence that a single approach to the treatment of patients with HAP/CTB has not yet been formed.For the same reason, a variety of various drugs is proposed for the treatment of these conditions, the main groups of which can be represented by the following classification:

  • antibiotics and antibacterial drugs;
  • non -steroidal anti -inflammatory agents (diclofenac, ketoprofen);
  • muscle relaxants and antispasmodics (Baclofen);
  • A1-blockers (Therazozin, doxazin, alfuzosin, tamsulosin);
  • Plant extracts (Serenoa Repens, Pigeum Africanum);
  • 5A reductase inhibitors (finsterida);
  • anticholinergic drugs (oxibutinin, Tolterodine);
  • Modules and stimulants of immunity;
  • bioregulatory peptides (prostates extract);
  • complexes of vitamins and trace elements;
  • antidepressants and tranquilizers (amitriptylin, diazepam, salbutamine);
  • analgesics;
  • drugs that improve microcirculation, rheological properties of blood, anticoagulants (dextra, pentoxyphillin);
  • enzymes (hyaluronidase);
  • antiepileptic agents (gabapentin);
  • xanthinoxidase inhibitors (allopurinol);
  • extraction of pepper pepper (capsaicin).

It is impossible to disagree with the opinion that the therapy of CP should be aimed at all the links of the etiology and pathogenesis of the disease, take into account the activity, category and degree of prevalence of the process, and to be complex.At the same time, since the cause of the CP IIIA and IIIB is not exactly established, the use of many of the above drugs is based only on episodic messages about the experience of their use, often doubtful from the point of view of evidence -based medicine.To date, the complete cure of the HAP seems to be a difficult goal, so symptomatic treatment, especially for patients of the IIIB category, is the most likely way to improve the quality of life.

Antibacterial therapy

In the treatment of chronic abacterial prostatitis, antibiotics are often empirically exciting, often with a positive effect.Up to 40% of CP patients respond to antibiotics treatment both in the presence of a bacterial infection in the analysis and without it.It was shown that the well-being of some patients of the HAP improved after conducting an an-character therapy, which may indicate the presence of infection not detected by conventional methods.Nickel and Costerton (1993) found that in 60% of patients with previously diagnosed bacterial prostatitis, in which, after antimicrobial therapy against the background of negative crops of the 3rd portion of urine and/or the secret of prostate and/or ejaculate, symptoms were preserved, a positive increase in the bacterial flora in Prost-you biopotes was revealed.It should be borne in mind that the role of some microorganisms (coagulazo-neiger staphylococci, chlamydia, ureaplasm, anaerobes, mushrooms, trichomonads) as etiological factors of the CP has not yet been confirmed and is the subject of discussion.On the other hand, it cannot be excluded that some comments of the lower urinary tract, which are usually harmless, under certain conditions become pathogenic.In addition, using more sensitive methods, unknown infectious agents can still be recognized.

Today, many authors consider it justified to conduct a trial course of antibiotic therapy for patients with a HAP, and in cases where prostatitis is treated, they advise you to continue it for another 4-6 weeks or even a longer period.In case of relapse after the cessation of antimicrobial therapy, it is necessary to resume its conduct with the use of low dosages of drugs.Despite the fact that the latest position causes certain doubts, it included in the recommendations of the European Association of Urologists (2002).

Perhaps there is a logical substantiation of the use of antibiotics that penetrate the tissue of the prostate gland.Only some antimicrobial drugs penetrate the prostate gland.To do this, they must be lipid-constant, have the property of low protein binding and have a high dissociation constant (PKA).The worship of the RCC of the medication, the higher the plasma of the blood, the fraction of unrelated (non-ionized) molecules that can penetrate the epithelium of the prostate gland and spread in its secret.Lipid-and-soluble and minimally associated with plasma proteins, the drug can easily penetrate into the electrically charged lipid membrane of the epithelium of the prostate gland.Therefore, in order to achieve good penetration of the antibiotic in the prostate gland, it is necessary that the drug used is lipid-isable, has RKA> 8.6, characterized by optimal activity against gram-negative bacteria in pH> 6.6.

It should be borne in mind that the results of the prolonged use of the trimetrome-sulfametoxazole remain unsatisfactory (Drach G.W. et al. 1974; Meares E.M. 1975; McGuire Ej, Lytton B. 1976).Data on the treatment of doxycycline and fluoroquinolones, including Norfloxacin (Schaeffer a.j, Darras F.S. 1990), ciprofloxacin (Childs S.J. 1990; Weidner W. et al. 1991) and offloxacin (Remy G. et al. 1988; COX C.E. 1989;PUST R.A.Nickel J.C.et al.(2001) They found that offloxacin showed an odic effect with prostatitis of groups II, III and IIIV.Recently, for this purpose, levofloxacin began to be used with success, which was demonstrated by Nickel C.J.et al.(2003) in patients HAP/KTB.

Alfa-1-adrenal shit

Some scientists suggest that the pain and symptoms of irritative or difficulty urination in patients with a Hab/KTB can be due to obstruction of the lower urinary tract caused by dysfunction of the neck of the bladder, the scrapier, stricture of the urethra or dysfunctional urination with high urethral pressure.When a trace of men under the age of 50 years with a clinical diagnosis of CP, the functional ov-structure of the neck of the bladder is detected in more than half of them, obstruction due to pseudo-deck sphincter in another 24% and detrusor instability in about 50% of patients.

Thus, some forms of chronic prostatitis are associated with the initial impaired function of the sympathetic nervous system and the hyperactivity of the Alpha-1-adrenergic receptors.This is also evidenced by the work of domestic authors and our own observations.

Intraprostatic proto reflux is described, caused by turbulent urination with high intra -ruble pressure.Reflux urine into the ducts and slices of the prostate gland can stimulate a sterile inflammatory reaction.

Literature data indicate that alpha-1-adrenal switches, muscle relaxants and physiotherapy reduce the degree of manifestation of symptoms in patients with a hub/KTB.Osborn D.E.et al.(1981) The first to use a positive effect of phenoxibenzamin in a placebo-controlled study with a positive effect with prostatodinia.The improvement of the outflow of urine during the blockage of the alpha-1-receptors of the neck of the bladder and the prostate gland leads to a weakening of symptoms.According to the results of studies of alpha-blockers, clinical progress is observed in 48-80% of cases.Generalized data of the 4-recent and similar research design? 1 1-blockers in HP/CTB, indicate a positive result of treatment, on average, in 64% of patients.

Neal D.E.Jr.and Moon T.D.(1994) investigated Terasosos in patients with HAP and prostatinia in an open study.After a month of treatment, 76% of patients noted a decrease in symptoms from 5.16 ± 1.77 to 1.88 ± 1.64 points on a 12-ballast scale (p<0.0001) при использовании доз от 2 до 10 мг/сут. При этом через 2 месяца после окончания лечения симптомы отсутствовали у 58% пациентов положительно ответивших на ?1-адреноблокатор. В недавнем двойном слепом исследовании, через 14 недель отметили улучшение 56% пациентов на фоне приема теразозина и 33% - плацебо. Причем, 50% снижение боли по шкале NIH-CPSI было выявлено у 60% в груп-пе активного лечения по сравнению с 37% в группе плацебо (Cheah P.Y. et al. 2003). При этом, в итоге, группы достоверно не отличались по скорости мочеиспускания и объему остаточной мо-чи. Gul et al. (2001) при анализе результатов наблюдения 39 пациентов с ХАП/СХТБ, прини-мавших теразозин и 30 - плацебо, выявили снижение выраженности симптомов в основной группе в среднем на 35%, и лишь на 5% в группе плацебо. Различия между исходным и итого-вым показателями группы теразозина и между нею и группой плацебо были статистически дос-товерны. Тем не менее, авторы сделали вывод о том, что 3-х месячного курса приема ?1-адреноблокаторов недостаточно для получения стойкого и выраженного снижения симптомов. Они также указали, что доза теразозина в 2 мг/сут - слишком низка.

Alfuzosin was used in a recently prospective randomized placebo -controlled study lasting 1 year, which included 6 months of active treatment and the same amount of observation time.After 6 months, patients taking Alfuzosin, a more pronounced decrease in symptoms on the NiH-Cpsi scale was recorded, which reached statistical significance compared to placebo and control: 9.9;3.8 and 4.3 points, respectively (p = 0.01).Inside this scale, only symptoms characterizing the pain decreased significantly, unlike others associated with urination and quality of life.In the Alfuzosin group, 65% of patients had an improvement in the NIH-CPSI scale by more than 33%, compared with 24% and 32% in placebo and control groups (p = 0.02).6 months after the abolition of the drug, the symptoms began to gradually increase, both in the Alfuzosin and placebo group.

The use of selective alpha-1a/D-adreno-reinforced controller of tamsulosin for hp/KTB also demonstrates a good clinical effect.According to Chen Xiao Song et al.(2002) Against the background of the use of 0.2 mg of the drug, a decrease in symptoms on the NIH-CPSI scale in 74.5% of patients, as well as an increase in QMAX and QAVE by 30.4% and 65.4%, respectively, was recorded within 4 weeks.Narayan P. et al.(2002) reported on the results of a 6-week double blind randomized placebo-controlled study of tamsulosin in patients with HAP/STBB.27 men received the drug, a placebo - 30. A reliable decrease in symptoms in patients taking Tamsulosin and their growth in the placebo group was revealed.Moreover, the heavier the initial symptoms in the main group were, the more impressed the improvement was expressed.The number of side effects was comparable in the groups of tamsulosin and placebo.A positive effect was achieved in 71.8% of patients.After a year of therapy, the decrease on the i-PSS scale is 5.3 points (52%), and the reduction in QOL-3.1 points (79%).

Today, most experts express an opinion on the need for a long-term reception of Alpha-1-blockers, since short courses (less than 6-8 months) often lead to relapse of symptoms.This is also evidenced by one of the latest works with alfuzosin: in most patients 3 months after the completion of the 3-month course of treatment, a relapse of symptoms was noted.It is assumed that prolonged therapy can lead to a change in the receptor apparatus of the lower urinary tract, but such data need confirmation.

In general, one gets the impression that, as with DHCH, the patients of the HAP have clinical efficiency of all? 1-adrenal-blocking are almost the same, and they differ only in the profile of their safety.At the same time, as our observations testify, although the use of? 1-adrenal switch and does not allow to completely avoid relapse of the disease in the abolition of the drug, it significantly reduces the severity of symptoms and increases the time before relapse.

Musorelaxants and antispasmodics

Some scientists adhere to the neuro-muscular theory of the pathogenesis of HAP/KTB (Osborn D.E. et al. 1981; Egan K.J., Krieger J.L. 1997; andersen J.T. 1999).A detailed study of symptoms and a neurological examination may indicate the presence of sympathetic reflex dystrophy of the muscles of the perineum and the same bottom.Various damage at the level of regulatory centers of the spinal cord can lead to a change in muscle tone, more often by a hyperspastic type, in which urodynamic disorders (spasm of the neck of the bladder, pseudo -detission) are accompanied or the result of these conditions.

In some cases, the pain can act as a result of a violation of the attachment of the pelvic muscles in the so -calledtrigger points to the sacrum, coccyx, pubic, sciatic bones, endopelvical fascia.The reasons for the formation of such phenomena are ranked: pathological changes from the lower extremities, operations and anamnesis injuries, a certain sports, repeated infections, etc.In this situation, the inclusion of muscle relaxants and antispasmodics in the complex therapy can be considered pathogenetically justified.It is reported that muscle relaxants are effective for sphincter dysfunction, taze and perineum muscle spasm.Osborn D.E.et al.(1981) priority belongs to the first study of the action of muscle relaxants for prostatodinia.The authors conducted a comparative double-blind-controlled study of the effectiveness of the adrenan-blocking phenoxibenzamine, Baclofen (GABA-B Agonist receptors, a relaxant of the transverse-striped muscles) and the placebo in 27 patients with prostatodinia.Symptomatic improvement was registered in 48% of patients after the use of phenoxibenzamine, in 37% - Baclofen and in 8% - when using a placebo.However, large-scale prospective clinical trials that could confirm the effectiveness of the drugs of this group in patients with HAP/KTB, have not yet been undertaken.

Non -steroidal anti -inflammatory drugs and analgesics

The use of non -steroidal anti -inflammatory drugs, such as diclofenac, ketoprofen or nimesulide, may turn out to be effective in the treatment of some HAP/KTB patients.Analgesics are often used in the treatment of patients with KTB, however, there is little data about their effectiveness for a long period of time.

Plant extracts

Among plant extracts, the most studied are Serenoa Repens and Pygeum Africanum.The anti -inflammatory and decongestant effect of Permixon is realized by inhibiting the phospholipase A2, other enzymes of the arachidon cascade - cyclooxygenase and lipoxygenase, responsible for the formation of prostaglandins and leukotrienes, as well as the influence on the vascular phase of inflammation, the permeability of capillaries, vascular stasis.As recently completed by the recently completed morphological studies in patients with DGPS, treatment with Permixon, against the background of a decrease in the proliferative acute acting by 32% and an increase in the stromal-epithelial ratio by 59%, significantly reduced the severity of the inflammatory reaction in the tissue of the prostate compared to the initial indicators and the control group (p (p<0.001).

Reissigl A. et al.(2003) The first to report the results of the multicenter study of Permixon in patients with STBB.Permixon treatment for 6 weeks received 27 patients, and 25 were observed in the control group.After treatment in the main group, a decrease in symptoms on the NiH-CPSI scale was recorded by 30%.The positive effect of treatment was registered in 75% of patients receiving Permixon, compared with 20% in the control group.It is characteristic that in 55% of patients of the main group the improvement was regarded as moderate or significant, while in the control group - only in 16%.At the same time, 12 weeks after treatment, there were no reliable differences between the groups.The data presented indicate that Permixon has a positive effect in HAP/CTB patients, however, treatment courses should be longer.

In another pilot study, a decrease in the inflammatory markers of FNO and Interleukin-1b was shown against the background of Permixon therapy, which correlated with its symptomatic effect (Vela-Navarrete R. et al. 2002).Many authors indicate the anti -inflammatory effect of the Pygeum Africanum extract, its effect on the regeneration of glandular epithelial cells and the secretory activity of the prostate gland, a decrease in hyperactivity and an increase in threshold of excitability.However, these experimental data need to be confirmed by clinical studies in patients with HAP/CTB.

There are separate reports about the positive effect of flower pollen extract (Cernetonon) in patients with CP and prostatinia.

In general, for the use of plant extracts in patients with HAP/CTB, primarily containing Serenoa Repens and Pygeum Africanum, there are sufficiently theoretical and experimental justifications, which, however, should be confirmed by correct clinical studies.

5-alpha reductase inhibitors

Several short-term pilot studies of 5A reductase inhibitors confirm the opinion that finsteride has a beneficial effect on urination and reduces pain in CP/CTB.The conducted morphological study in patients with DGPZ indicates a significant decrease in the average area occupied by inflammatory in-filt with the original 52%, to 21% after treatment (p = 3.79*10-6).On the successful treatment with finatoride 51 patients KP IIIA for 6-14 months.(2002).There is a decrease in pain on the SO-CHP scale from 11 to 9 points, dysuria from 9 to 6, the quality of life from 9 to 7, the general severity of the symptoms from 21 to 16 and the clinical index from 30 to 23 points.

Justification of the use of finsteride in chronic abacterial prostatitis of the NIH-IIIA category (according to Nickel J.C., 1999):

  • From the standpoint of etiology.

    The growth and development of the prostate gland depends on androgens.

    On experimental animals, models showed that abacterial inflammation can be caused by hormonal changes in the prostate gland.

    The potential effect of finsteride with dysfunctional urination with high intra -ruble pressure, causing the development of intrastrostatic refluxes.

  • In terms of morphology.

    Inflammation occurs in the tissue of the prostate gland.

    Finasteride leads to regression of the glandular tissue of the prostate.

  • From a clinical point of view.

    Clinical success is associated with the caused estrogen inhibition of androgens.

    Finasteride eliminates symptoms of impaired function of the lower urinary tract in patients with DHGPZ, especially with a large volume of prostate, when glandular tissue prevails in it.

    Finasteride is effective in the treatment of hematuria associated with the DGPS, which is associated with focal inflammation of the prostate.

    Opinions of individual urologists about the effectiveness of finsteride for prostatitis.

    The results of three clinical studies indicate the potential effectiveness of finsteride in a decrease in prostatitis symptoms.

Anticholinergic agents

The beneficial effect of anticholinergic agents is to weaken the symptoms of imperative urination, day and night pollakiuria and maintain normal sexual activity.There is a positive experience in the use of various M-cholinoblocators in patients with HAP/CTB with the presence of pronounced irritative symptoms, but without signs of in-fravezical obstruction, both in monotherapy and in combination with? 1-adrenergic shutters.Additional studies are needed to determine the place of drugs of this group in the treatment of patients with abacterial prostatitis.

Immunotherapy

Some authors support the point of view that the occurrence of non -bacterial prostatitis is due to immunological processes accelerated by an unknown antigen or autoimmune reaction.Recently, more and more attention has been paid to the role of cytokines in the development and maintenance of HP.They communicate about the discovery of prostate in the secret of increased, compared with the control of the level of interferon-gamma, interleukins 2, 6, 8, and a number of other cytokines.John et al.(2001) and DOBLE A. et al.(1999) found that with abacterial prostatitis IIIV, the ratio of CD8 (cytotoxic) to CD4 (Helper) types of T-lymphocytes, as well as the level of cytokines, was increased.This may indicate that the term "non -inflammatory" prostatitis is, perhaps, not quite adequate.In this situation, immune modulation using cytokine inhibitors or other approaches can be effective, but before recommending this type of treatment, the relevant tests should be completed.

Various immunotherapy options are very popular among domestic experts.Of the drugs stimulating cellular and humoral immunity,: the preparations of the thymus, interferons, inducers of the synthesis of endogenous interferon, and synthetic agents are distinguished.These results are of particular interest in the light of the latest data on the important role of Interleukin-8 under HP IIia, where it is considered as a potential therapeutic target (Hochreiter W. et al. 2004).At the same time, it should be noted that in our opinion, the appointment of special immunocorrective therapy should be treated with great caution and undertaken only if pathological shifts are detected according to the results of the immunological examination.

Transquilizers and antidepressants

The study of the mental status of patients with CP/KTB has led to an understanding of the contribution of psycho-somatic disorders to the pathogenesis of the disease.Among patients with CP, a rather frequent find is depression.In this regard, HAP/STB patients are recommended for the appointment of tranquilizers, antidepressants and psychotherapy.From the latest works, one can note the publication on the use of salboutiamine, which has an antidepressant and psychostimulating effect due to the effect on the reticular formation of the brain.The author observed 27 patients with CP IIIB who received salbutamine in complex therapy and 17 patients of the control group.It was established that in patients taking this drug the duration of remission was significantly higher: 75% after 6 months in the main group against 36.4% in the control group.The treaters with salbutamine noted an increase in libido, general vital tone, and a positive mood for treatment.

Blood circulation drugs

It was established that in patients of CP, various shifts of microcirculation, hemocoagulation and fibrinolysis are recorded.For the correction of hemodic disorders, it is recommended to use reopoliglyukin, trendal, and escults.There are reports about the use of prostaglandin E1 in patients with HAPs.Additional studies are needed, both for the development of methods for evaluating blood circulation disorders in patients with HAP/CTB, and for creating schemes for their optimal correction.

Bioregulatory peptides

Prostalen and vitaprost are widely used by domestic experts in the head of abacterial prostatitis.The drugs are complexes of biologically active peptides isolated from the prostate glands of cattle.In addition to the pushing immunomodulating effects described above, its symptomatic effect in CP, anti -inflammatory, microcirculatory and trophic effects is noted.At the same time, studies in which modern methods for evaluating the clinical picture of HAP/KTB would have been used, for the drugs of this group, have not been carried out yet.

Vitamins and trace elements

Complexes of vitamins and trace elements play important auxiliary value in the treatment of patients with CP.Among them, the most important is the vitamins of group B, vitamins A, E, C, zinc and selenium.It is known that the prostate gland is the most rich in zinc and accumulates zinc.Its antibacterial protection is associated with the presence of free zinc (the prostatic antibacterial factor - zinc peptide complex).With bacterial prostatitis, a decrease in zinc level is noted, which changes little against the background of the oral administration of this trace element.In contrast, with abacterial prostatitis, there is a restoration of zinc level during its exogenous intake.Against the background of HP, a reliable decrease in the level of citric acid is noted.Vitamin E. Selena is a anti -caulifratic agent and is considered high antioxidant and anti -radical activity and is considered as an oncoprotector, including in relation to RPG.In connection with the stated, the use of drugs containing balanced volumes of necessary vitamins and microelenas is justified.One of these drugs is a drug containing selenium, zinc, vitamin E,? -Carotine and vitamin S.

Enzymotherapy

For many years, lidase preparations have been used in the complex therapy of patients with CP.Recently, several reports of domestic authors have appeared about the positive experience of using Vobenzim, as a drug of systemic enzyme therapy in the complex treatment of patients with CP.

Today, in countries with developed health systems, recommendations for the diagnosis and treatment of diseases are compiled taking into account the principles of evidence -based medicine, based on studies that have a high degree of reliability.With regard to drug therapy HAP/STB, such studies are clearly not enough.The criteria for evidence-based medicine correspond only to materials on the use of antibiotics and? 1-adreno-blocking and, with certain tolerances, plant extracts from Serenoa Repens.Data on the use of all other groups of drugs is mainly empirical.

According to the recommendations of the US Institute of Health (NIH), the most commonly used methods of treatment of abacterial prostatitis, according to priority, in accordance with the criteria of evidence -based medicine, can be represented by the following sequence:

  • Treatment method Priority (0-5);
  • Antibacterial agents (antibiotics) 4.4;
  • Alpha1-blockers 3.7;
  • Prostate massage (course) 3.3;
  • Anti -inflammatory therapy (non -steroidal anti -inflammatory drugs, hydroxyzine) 3.3;
  • Anesthetic therapy (analgesics, amitriptyin, size) 3.1;
  • Treatment of reverse biological communication method (anorectal BioFeeedBack) 2.7;
  • Phytotherapy (Serenoa Repens/Saw Palmetto, Quercetin) 2.5;
  • 5 alpha reductase inhibitors (finsteride) 2.5;
  • Musorelaxants (Diazepam, Baclofen) 2.2;
  • Thermotherapy (transuretral microwave thermotherapy, transurethral needle ablation, laser) 2.2;
  • Physiotherapy (general massage, etc.) 2.1;
  • Psychotherapy 2.1;
  • Alternative therapy (meditation, acupuncture, etc.) 2.0;
  • Anticoagulants (Pentosana Polisulfate) 1.8;
  • Capsaicin 1.8;
  • Allopurinol 1.5;
  • Surgical treatment (a tour of the neck of the bladder, prostate, transurethral prostate incisions, radical prostatectomy) 1.5.

Somewhat different accents of the priority of treatment methods for chronic prostatitis in Tenke P. (2003)

  • Antimicrobial therapy ++++;
  • Alpha1-blockers +++;
  • Anti -inflammatory drugs ++;
  • Phytotherapy ++;
  • Hormone therapy ++;
  • Hyperthermia / thermotherapy ++;
  • Prostate massage course ++;
  • Alternative treatment methods ++;
  • Psychotherapy ++;
  • Allopurinol +;
  • Surgical treatment (tour) +.

Thus, a large number of various drugs and groups of drugs are proposed for the treatment of chronic abacterial prostatitis and KTB, the use of which is based on information about their effect at various stages of the pathogenesis of the disease.With no exception, all this is poorly confirmed by evidence and evidence and evidence.For improving the results of the treatment of HAPs and, especially, groups of patients with pelvic pain, are associated with the progress in the field of diagnosis and differential diagnosis of these conditions, the improvement and detailing of the clinical classification of the disease, the accumulation of reliable clinical results characterizing the effectiveness and safety of drugs in clearly defined groups of patients.