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Chronic prostatitis drug therapy

Prostatitis is acute or chronically leakage inflammation of the glandular and interstitial tissue of the prostate gland.Drugs for the treatment of prostatitisInflammation of the prostate gland, as an independent nosological form, was first described by Ledmish in 1857. However, despite almost 150 years of history, prostatitis remains very common, not studied and treating disease badly.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 as closely intertwined as in the case of chronic prostatitis (PC).

This is largely due to the high degree of marketing of the treatment of the disease, for which a large number of different methods and medications are proposed, which begin to be announced even before reliable information about their effectiveness and safety.In addition, 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 led to the emergence of various new PC treatment principles and methods.Each method has its own advantages and disadvantages.However, a practicing urologist is not able to familiarize himself and analyze the increasing amount of published information about the problem of prostatitis.Despite a large number of methodological materials, dissertations and publications on the diagnosis and processing of PC data required, for standard acceptance, there is virtually no form.

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

This complicates the adoption of effective clinical decisions, limits the use of reliable diagnostic and treatment methods, leads to "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 increasing costs of medical care.To fill this gap helps the knowledge of the basics and the introduction of the principles of evidence -based medicine to unify approaches to the diagnosis and the choice of chronic prostatitis treatment tactics.

What about chronic prostatitis?The modern interpretation of the term "chronic prostatitis" and the classification of the disease is ambiguous.Under its mask, a wide range of states of the prostate gland and lower urinary tract may be hidden from infectious prostatitis, chronic pelvic pain or prostatodinia so called to abactile prostatitis and ending with allergic and metabolic disorders.The absence of terminological unit is especially relevant in the case of non-infectious PC, which is interpreted by several authors such as prostatinia, chronic sin-drum pelvic pain, postinfecious prostatitis, pelvic floor muscles and consultant prostatitis.

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

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

Experts from the US National Institute of Health are as follows for 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 irratative symptoms of urination disorders;
  • A positive (or negative) result of a bacteriological study.

Chronic prostatitis is one of the generalized diseases and their manifestations are distinguished by a variety of symptoms.Often there are publications indicating the extremely high incidence of PC.It is reported that prostatitis leads to a significant decrease in quality of life in professional men: its influence is compared to angina pectoris, Crohn's disease or myocardial infarction.According to the consolidated data of the American Urologists Association, the incidence of chronic prostatitis ranges from 35 to 98% and 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 PC from various pathological states of the prostate, urethra, as well as neurological diseases of the pelvic area.The lack of a whole idea of PC pathogenesis is evidenced by the disadvantages of existing classifications, which is a serious barrier to understanding and the successful treatment of this disease.

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

Currently, Abroad is Widiely Used and Adopted As the main classification of the US National Institute of Health, According to Which: Acute Bacterial Prostatis (I), Chronic Bacterial Prostatis (II), Chronic Abactorial Prostatis or Chronic Pelvic Pains (III)Component (IIII), the well as it (IIIB), the wells asyptomatic prostatis with the presence of inflammation (IV).

Clinical characteristics of chronic prostatitis:

  • Mainly young people from 20 to 50 years old (average age 43) suffer;
  • The main and most frequent manifestation of the disease is the presence of pain or discomfort in the pelvis;
  • duration of at least 3 months;
  • The intensity of symptomatic manifestations varies significantly;
  • The most common location of pain is the groin, but a feeling of discomfort can occur in any area of the pelvis;
  • The location of pain in the testis is not a sign of prostatitis;
  • Imperative symptoms are more characteristic than obstructive;
  • Erectile dysfunction can accompany CP;
  • Pain after ejaculation is the most specific to PC and distinguishes it from benign prostate hyperplasia and healthy men.

In our country, the huge material was accumulated in the use of various methods of diagnosis and treatment of PC.However, most available data do not meet evidence -based medicine requirements: research is not randomized, conducted in a small number of observations, in a center, without placebo control and sometimes without a control group.

In addition, the absence of a single PC classification usually gives you an idea of which patient categories are really a question in the described work.Therefore, the effectiveness of most treatment methods, which are widely announced and used today (transureral vacuum extraction extraction, transuretral electromagnetic stimulation of the prostate, transtrene by therapy, low-energy laser, non-retald, extract, extract, extract, extract, extract, extract, extract, extract, extract, extract, extract, extract, extractThe extract, the extract.

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

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

Paradoxically, the fact that many authors are proposed for the treatment of abactry prostatitis, the use of antibacterial agents is proposed and data indicating a very high efficiency of this treatment.This once again witnesses the insufficient development of disease etiopatogenesis issues, the possible influence of infection on its development and inconsistency of the adopted terminology, which we previously indicated, proposing to divide the concepts of "abactry" and "non -infectious" prostatitis.The diagnosis of HAP/CTB is more likely to occur an entire range of different states, including those when the prostate gland is involved in the pathological process only indirectly or not, and the diagnosis itself is a forced trimal company that needs a clear term to determine indications for medicines prescription.

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 medicines is proposed to treat these conditions, whose main groups can be represented by the following classification:

  • antibiotics and antibacterial medicines;
  • Non -steroidal anti -inflammatory agents (diclofenac, ketoprofen);
  • muscle and antispasmodic relaxants (baclofen);
  • A1 blockers (telazozine, doxazine, alfuzosin, tamsulosin);
  • Vegetable extracts (Serenoa Reins, Pigeum Africanum);
  • 5th Reductase Inhibitors (Finsterido);
  • Anticholinergic medications (oxybutinine, tolterodine);
  • Immunity modules and stimulants;
  • Bioregulatory peptides (prostate extract);
  • Vitamin complexes and traces elements;
  • antidepressants and tranquilizers (amitriptillin, diazepam, salbutamine);
  • painkillers;
  • Medicines that improve microcirculation, rheological properties of blood, anticoagulants (dextra, pentoxifilline);
  • enzymes (hyaluronidase);
  • Antiepiletic agents (gabapentin);
  • Xantinoxidase (allopurinol) inhibitors;
  • Pepper extraction (capsaicin).

It is impossible to disagree with the opinion that PC therapy should be directed to all bonds 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, as the cause of CP IIIA and IIIB is not exactly established, the use of many of the above medications is based only on episodic messages about the experience of its use, often doubtful from the point of view of evidence -based medicine.So far, complete HAP healing seems to be a difficult goal, so symptomatic treatment, especially for category IIIB patients, is the most likely way to improve quality of life.

Antibacterial therapy

In the treatment of chronic abacterial prostatitis, antibiotics are often empirically exciting, usually with a positive effect.Up to 40% of PC patients respond to antibiotic treatment,both in the presence of a bacterial infection in the analysis and without it.It was shown that the well-being of some HAP patients has improved after a 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 negative background of the 3rd portion of the urine and/or the secrecy of the prostate and/or ejaculate, the symptoms were preserved, the positive increase of bacterial bacterial in biologist and/orEjaculated, it was preserved, the positive increase of the bacterial biologist in a biologist and/or ejaculated was preserved, the positive increase of the bacterial biologist in a biologist and/or ejaculated was preserved, the positive increase of the bacterial biologist in a biologist and/or ejaculate was preserved, a positive increase in the biologist was preserved, a positive increase was preserved in the biologist.Bacterial in bacteria.It should be borne in mind that the role of some microorganisms (coagulazo-lifes, chlamydia, urereaplasma, anaerobes, mushrooms, trichomonads) as etiological factors of PC have not yet been confirmed and is the subject of the discussion.On the other hand, it cannot be excluded that some comments from 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 justified to take a antibiotic therapy testing course for Patients with HAP and, where prostatitis is treated, they advise you to continue 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 doses of medicines.Despite the fact that the last position causes certain doubts, it included in the recommendations of the European Urologists Association (2002).

Perhaps there is a logical proof of the use of antibiotics that penetrate the prostate gland tissue.Only a few antimicrobial medications penetrate the prostate gland.To do this, they must be constant lipid, have low protein -liaison property and have a high dissociation constant (PKA).The worship of the CCR of the medication, the greater the blood plasma, the fraction of non -related (non -ionized) molecules that can penetrate the prostate gland epithelium and spread in its secret.Lipids and soluble and minimally associated with plasma proteins, the drug can easily penetrate the electrically carried lipid membrane of the prostate gland epithelium.Therefore, in order to achieve good antibiotic penetration in the prostate gland, it is necessary that the drug used is lipid, has RKA> 8.6, characterized by ideal activity against gram-negative bacteria at pH> 6.6.

It should be borne in mind that the results of prolonged use of 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 fluorocinolones, including norfloxacin (Schaeffer A.J, Darras F.S. 1990), Ciprofloxacin (Childs S.J. 1990; Weidner W. et al. 1991) and Offloxacin (Rey G. et al. Offloxacin showed an Odic effect with group prostatitis II, III andIIIV.

Alpha-1-adrenal shit

Some scientists suggest that the pain and symptoms of irritative or difficulty urination in patients with a hab/ktb may be due to lower urinary tract caused by bladder neck dysfunction, scratching, urethine stripigue or dysfunctional urination with high urethral pressure.When a trace of men under 50 with clinical PC diagnosis, the functional OV bladder neck structure is detected in more than half of them, obstruction due to sphincter pseudo-confidence 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 alpha-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 -rubible pressure.Reflux urine in prostate gland ducts and slices can stimulate a sterile inflammatory reaction.

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

Neal D.E. Jr. e Moon T.D. (1994) investigaram terasosos em pacientes com HAP e prostatinia em um estudo aberto. Após um mês de tratamento, 76% dos pacientes observaram uma diminuição dos sintomas de 5,16 ± 1,77 para 1,88 ± 1,64 pontos em uma escala de 12 blastões (P<0.0001) при использовании доз от 2 до 10 мг/сут. При этом через 2 месяца после окончания лечения симптомы отсутствовали у 58%пациентоork положительно ответиizes на?В недаснем двном слепом и исследоgroundии, через 14 недель оетили уnter 56% пациенто Jealsплацебо.Причем, 50% снижение боли по шшаlle nih-cpsi бы drops 60% в в ге актиcherоо ления по сраснен also с 37%(Cheah P.Y. et al. 2003).При этом, в итоге, группы достоork нерно ое отлись по скорости мочеиспускания и еу оеуance.Gul et al.(2001) при анализе результатоiff нulations 39 пациентоork сап/схтб, прини-михихинин и 30 - плацебо,выраженности сиптомо porte в внуппе в в в сннем 35%, и лишь 5% в пруппе плацебо.Рзличия межу исходным и итого-вм показателяи группы теразозина и и и ирупп ппцебо были еelsдос-тоzy.Тем не мене, а's аоры сделали выdy о ото 3-х месячного урса приема?стойкого и враженного снижения сиптомов.Они также ууазали, что доза теразозина в 2 м/сут - слишком низза.

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

The use of the alpha-1a/d-adre-reform selective controller from Tamsulosin to HP/KTB also demonstrates a good clinical effect.According to Chen Xiao Song et al.(2002) Against the bottom 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 QEVE by 30.4% and 65.4%, respectively, was recorded in 4 weeks.Narayan P. et al.(2002) reported on the results of a 6 -week randomized placebo -controlled, 6 -week tamsulosin -controlled study in HAP/STBB patients.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.In addition, the heavier the initial symptoms of 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 reached in 71.8% of patients.After one year of therapy, decreased I-PSS scale is 5.3 points (52%) and the reduction in QV-3.1 (79%) points.

Today, most experts express an opinion on the need for a long-term reception of Alfa-1 blockers, as short courses (less than 6-8 months) usually lead to the relapse of symptoms.This is also evidenced by one of the latest work with alfuzosin: in most patients 3 months after the completion of the three -month treatment course, a relapse of symptoms was observed.Prolonged therapy is supposed to lead to a change in the lower urinary tract receiving apparatus, but this data need confirmation.

In general, do you have the impression that, as in DHCH, HAP patients have everyone's clinical efficiency?The 1-adrenal block is almost the same, and they differ only in the profile of your safety.At the same time, how do our observations witness, although use?1-adrenal switch and does not allow to completely avoid the relapse of the disease in the abolition of the drug, significantly reduces the severity of symptoms and increases the time before relapse.

Muslaxing and antispasmodic

Some scientists adhere to the neuro-muscular theory of 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 of the perineum and the same fund muscles.Several damage to the spinal cord regulatory centers can lead to a change in muscle tone, more often by a hyperespastic type, in which urodynamic disorders (bladder neck spasm, pseudo -tission) are accompanied or the result of these conditions.

In some cases, pain may act as a result of a violation of pelvic muscles in the loan luggins points to the sacred, coccyx, pubic, sciatic bones, endopelvical fascia.The reasons for the formation of such phenomena are classified: pathological changes of the lower extremities, operations and anamnesis injuries, certain sports, repeated infections, etc.In this situation, the inclusion of muscle and antispasmodic relaxants in complex therapy can be considered pathogenically justified.It is reported that muscle relaxants are effective for sphincter dysfunction, taze muscle spasm and perineum.Osborn D.E.et al.(1981) The priority belongs to the first study of the action of muscle relaxants for prostatodinia.The authors conducted a comparative study of double idleness, the effectiveness of phenoxibenzamine blocker Adrenan, baclofen (Gaba-B agonist receptors, a relaxing muscle with transverse stripes) and placebo in 27 patients with prostatodynia.Symptomatic improvement was recorded in 48% of patients after phenoxibenzamine, 37% - baclofen and 8% - when using a placebo.However, large -scale prospective clinical trials that could confirm the effectiveness of drugs in this group in HAP/KTB patients have not yet been performed.

Anti -non -esteroids and painkillers

The use of non -esteroid anti -inflammatory drugs, such as diclofenac, ketoprofen or nimesulide, may be effective in treating some Patients with HAP/KTB.Analgesics are often used to treat patients with KTB, however, there are few data on their effectiveness for a long time.

Plant extracts

Among the plant extracts, the most studied are serenea rees and pygeum Africanum.The anti -inflammatory and decongestant effect of permixon is read by inhibiting the phospholipase A2, other enzymes of the arachidon cascade - Cyclooxygenase and lipoxygenase, responsive for the formation of prostaglandins and leukotrienes, the well as the influence on the vascular phaseOf infmmation, the permeability of capillaries, vascular stasis.AS RECENTLY COMPLETED BY THE RECENTLY COMPLETED MORPHOLOGICAL STUDIES IN PATIES WITH DGPS, TREATMENT WITH PERMISON, AGAINST THE BACKGRAND OF A DECREASE IN THE PROCELATIVE ACUTE ACUTE BY 32% AND AN INCREASE IN THE STROMAL-EPICETHELIAL RATIO BY 59%Infummary Reaction in the Tissue of the Prostate Compreded to the Initial Indicates and the Control Group (P (P<0,001).

Reissigl A. et al.(2003) the first to report the results of permixon's multicenter study in STBB patients.Permixon's 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 at 30%.The positive effect of treatment was recorded in 75% of patients who received permixon, compared to 20% in the control group.It is characteristic that in 55% of patients in the main group the improvement was considered 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 patients with HAP/CTB;However, treatment courses should be longer.

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

There are separate reports on the positive effect of flower pollen extract (Cernetotonon) in PC and prostatinia patients.

In general, for the use of plant extracts in Patients with HAP/CTB, containing mainly serenea rees 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 5th reductase inhibitors confirm the opinion that the finishing has a beneficial effect on urination and reduces PA/CTB pain.The morphological study conducted in patients with DGPZ indicates a significant decrease in the average area occupied by inflammatory line with the original 52%, to 21% after treatment (p = 3.79*10-6).In successful treatment with ending 51 KP III patients for 6 to 14 months.(2002).There is a decrease in SO-CHP scale pain from 11 to 9 points, Dysuria from 9 to 6, the quality of life from 9 to 7, the general severity of symptoms from 21 to 16 and the clinical index of 30 to 23 points.

Justification of the use of Finsteride in Chronic Avactry Prostatitis of the NIH-II Category (according to Nickel J.C., 1999):

  • From the point of view of etiology.

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

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

    The potential effect of the dysfunctional urination with high -rubible high pressure, causing the development of intrastastatic refluxes.

  • In terms of morphology.

    Inflammation occurs in the prostate gland tissue.

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

  • From the clinical point of view.

    Clinical success is associated with androgen estrogen inhibition.

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

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

    Opinions of individual urologists about the effectiveness of the Finsteride for Prostatitis.

    The results of three clinical studies indicate the potential efficacy of the finstary in a decrease in prostatitis symptoms.

Anticholinergic agents

The beneficial effect of anticholinergic agents is to weaken symptoms of imperative urination, daytime and night polakiuria and maintain normal sexual activity.Is there a positive experience in using several M-C-collocators in Patients with HAP/CTB with the presence of pronounced irritating symptoms, but without signs of international obstruction, both in monotherapy and in combination?1-adrenergic employees.Additional studies are required to determine the medication site of this group in the treatment of patients with abactile 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 given to the role of cytokines in the development and maintenance of HP.They communicate on the discovery of the prostate at the secret of the increase compared to the control of interferon-gamm, interleukins 2, 6, 8 and several other cytokines.John et al.(2001) and doble A. et al.(1999) found that with ABACTERIAL IIIV prostatitis, the proportion of CD8 (cytotoxic) for T CD4 (auxiliary) of T lymphocytes, as well as the level of cytokines, increased.This may indicate that the term "no -inflammatory" prostatitis is perhaps not quite suitable.In this situation, immunological modulation using cytokine inhibitors or other approaches can be effective, but before recommending this type of treatment, relevant tests should be completed.

Several immunotherapy options are very popular among domestic specialists.Of the medicines that stimulate cellular and humoral immunity: the preparations of the thymus, interferons, inducers of interferon endogenous synthesis and synthetic agents are distinguished.These results are of particular interest in the light of the latest data on the important role of interleucine-8 under HP IIIA, where a potential therapeutic target (Hochreiter W. et al. 2004) are considered.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 performed only if pathological changes are detected according to the results of the immune examination.

Transquilizers and Antidepressants

The mental state study of patients with CP/KTB led to an understanding of the contribution of psycho-seomatic disorders to disease pathogenesis.Among PC patients, a very frequent finding is depression.In this sense, patients with HAP/STB are recommended for the appointment of tranquilizers, antidepressants and psychotherapy.From the latest works, it can be observed 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 from the control group.It was established that in patients taking this medicine, the duration of remission was significantly longer: 75% after 6 months in the main group against 36.4% in the control group.Salbutamine vines observed an increase in libido, general vital tone and a positive mood for treatment.

Blood circulation drugs

It was established that in PC patients, several changes in microcirculation, hemocoagulation and fibrinolysis are recorded.For the correction of hemodic disorders, it is recommended to use refoliglyukin, trend and sculpts.There are reports on the use of prostaglandin E1 in patients with happy.Additional studies are needed for the development of methods to evaluate blood circulation disorders in HAP/CTB patients and for creating schemes for their ideal correction.

Bioregulatory Peptides

Prostalen and Vitaprost are widely used by domestic specialists in the head of ABACTERIAL prostatitis.Medicines are complex biologically active peptides isolated from the cattle prostate glands.In addition to the immunomodulatory effects that pushed above described above, its symptomatic effect on the effects of PC, anti -inflammatory, microcirculatory and trophic is observed.At the same time, studies in which modern methods to evaluate the clinical image of the HAP/KTB would have been used for the medicines of this group have not yet been performed.

Vitamins and tracking elements

Vitamin complexes and tracking elements perform an important auxiliary value in the treatment of PC patients.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 richest 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 observed, which changes little compared to the background of the oral administration of this tracking element.On the other hand, with the abactry prostatitis, there is a restoration of the level of zinc during its exogenous intake.At the bottom of the HP, a reliable decrease in citrus acid level was observed.Vitamin E. Selena is an anti -califratic agent and is considered a high antioxidant and anti -radical activity and is considered an oncoprotector, including in relation to RPG.In connection with the indicated, the use of medicines containing balanced volumes of vitamins and microelens required is justified.Is one of these medications a medicine that contains selenium, zinc, vitamin E?-Carotine and vitamin S.

Enzyme therapy

For many years, Lidase preparations have been used in complex PC patients.Recently, several reports from domestic authors have appeared on the positive experience of using vobenzim, such as a systemic systemic drug therapy in the complex treatment of PC patients.

Today, in developed health systems, recommendations for disease diagnosis and treatment are compiled by considering evidence -based medical principles based on studies that have a high degree of reliability.With regard to HAP/STB drug therapy, these studies are clearly not enough.Do evidence -based medicine criteria correspond only to materials on the use of antibiotics and?1-thereno-blocker and, with certain tolerances, sereneous vegetable extracts.Data on the use of all other groups of medicines are mainly empirical.

According to the recommendations of the US Health Institute (NIH), the most used methods of treatment of abactry prostatitis, according to priority, according to evidence -based medicine criteria, may be represented by the following sequence:

  • Treatment method Priority (0-5);
  • Antibacterial agents (antibiotics) 4.4;
  • Alpha1-Bloquers 3.7;
  • Prostate massage (course) 3.3;
  • Anti -inflammatory therapy (non -esteroid anti -inflammatory drugs, hydroxyzine) 3.3;
  • Anesthetic therapy (analgesic, amitriptyina, size) 3.1;
  • Treatment of Reverse Biological Communication Method (Anorectal Biofeeedback) 2.7;
  • Phytotherapy (Serenoa Reins/Serra Palmetto, Quercetin) 2.5;
  • 5 alpha reductase inhibitors (finishing) 2.5;
  • Muslaxantes (diazepam, baclofen) 2.2;
  • Thermotherapy (transureral microwave thermotherapy, transureral needle ablation, laser) 2.2;
  • Physiotherapy (general massage, etc.) 2.1;
  • Psychotherapy 2.1;
  • Alternative therapy (meditation, acupuncture, etc.) 2.0;
  • Anticoagulants (Pentosan Polyulfate) 1,8;
  • Capsaicin 1.8;
  • Allopurinol 1.5;
  • Surgical treatment (a bladder neck ride, prostate, transureral prostate incisions, radical prostatectomy) 1.5.

Accents slightly different from the priority of treatment methods for chronic prostatitis in Tenke P. (2003)

  • Antimicrobial therapy ++++;
  • Alpha1-Blockers +++;
  • Anti -inflammatory drugs ++;
  • Phytotherapy ++;
  • Hormonal therapy ++;
  • Hyperthermia / thermotherapy ++;
  • Prostate Massage Course ++;
  • Alternative treatment methods ++;
  • Psychotherapy ++;
  • Allopurinol +;
  • Surgical Treatment (Tour) +.

Thus, a large number of various medications and groups of medicines are proposed for the treatment of chronic and KTB abacterial prostatitis, whose use is based on information on its effect on various stages of disease pathogenesis.Without exception, all of this is poorly confirmed by evidence, evidence and evidence.To improve the results of HAPS treatment and, especially, groups of patients with pelvic pain, are associated with progress in the field of diagnosis and differential diagnosis of these conditions, the improvement and detail of the clinical classification of disease, the accumulation of reliable clinical results that characterize the effectiveness and safety of medicines in clearly defined groups of patients.