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Medicinal therapy of chronic prostatitis

Prostatitis is acute or chronic leakage of inflammation of the glandular (parenchymal) and interstitial tissue of the prostate.Medicines for the treatment of prostatitisThe inflammation of the prostate as an independent nosological form was first described by Ledmish in 1857.Despite an almost 150-year anamnesis, prostatitis remains very often, not examined and the disease treats poorly.This is also due to the fact that in most cases chronic prostatitis remain unknown to their etiology, pathogenesis and pathophysiology.

In urology there is no other problem today that is true that dubious data and Frank fiction are as closely intertwined as with chronic prostatitis (CP).

This is mainly due to the high level of marketing degree of treatment of the disease, for which a large number of different methods and medication are proposed that are already advertised before reliable information about their effectiveness and security.In addition, aggressive advertising, which is carried out with all types of media, is first concentrated on a patient who cannot evaluate all the advantages and disadvantages of the proposed treatment.

On the other hand, the development of modern medical science has led to the development of a number of new principles and methods for the treatment of CP.Each of the methods has its own advantages and disadvantages.However, a practicing urologist is unable to familiarize himself and to create the increasing amount of information about the problem of prostatitis.Despite a large number of methodological materials, dissertations and publications for the diagnosis and treatment of CP data that have the required assumption as standard, there is practically no shape.

Various methods for the treatment of prostatitis promote and use numerous medical centers (sometimes no urologist in the state), pharmacological companies and even paramedics institutions.

This complicates the introduction of effective clinical decisions, limits the use of reliable diagnosis and treatment methods, leads to the "main" treatment if, after the use of a method, another is prescribed by another, etc. As a result, a violation of the balance between clinical and economic efficiency and increase in the costs of medical care.In order to close this gap, knowledge of the basics and the introduction of the principles of evidence medicine helps to combine approaches to diagnose and the selection of the tactics of the treatment of chronic prostatitis.

What does chronic prostatitis mean?The modern interpretation of the term "chronic prostatitis" and the classification of the disease are ambiguous.Under his mask, a wide range of prostate conditions and the lower urinary tract can be hidden, depending on infectious prostatitis, chronic pelvic pain or the so -called prostate mode for abacterial prostatitis and ends with neurogenic dysfunts, allergic and metabolic disorders.The lack of a terminological unit is particularly relevant in the event of a non-infectious CP, which is interpreted by various authors, as: prostatina, chronic pelvic pain in syn-drum, post-infectious prostatitis, myalgia of pelvic floor muscles and advisory prostatitis.

Many experts regard chronic prostatitis as an inflammatory disease of the predominantly infectious formation with the possible binding of autoimmune diseases, which are characterized by damage to the parenchyma and the 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, like the clinical concept of chronic prostatitis, are as follows:

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

Chronic prostatitis is one of the widespread diseases, and their manifestations differ in a variety of symptoms.There are often publications that display the extremely high incidence of CP.It is reported that prostatitis leads to a significant withdrawal of the quality of life for men of working age: their influence is compared to 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 between 35 and 98% and in men's reproductive age of 40 to 70%.

The lack of clear clinical and laboratory criteria for the disease and the wealth of subjective complaints determine the disguise under the diagnosis of CP of various pathological states of the prostate, the urethra and the neurological diseases of the pelvic area.The lack of a whole idea of the pathogenesis of CP is demonstrated by the disadvantages of existing classifications, which is a serious obstacle for 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 What: Acute Bacterial Prostatitis (I), Chronic Bacterial Prostatitis (II), Chronic Abacterial Prostatitis or Chrinic Pelvic Pains (III), Including Wigh InflammatoryComponent (IIII), as well as it (iiib), as well as asymptomatic prostatic prostatic with the presence of inflammation (IV).

Clinical characteristics of chronic prostatitis:

  • Most of the time, young men from 20 to 50 years suffer (average age 43 years);
  • The main and most common manifestation of the disease is the presence of pain or symptoms in the pool;
  • lasts at least 3 months;
  • The intensity of symptomatic manifestations varies significantly;
  • The most common localization of the pain is the step, but a feeling of symptoms can occur in every area of the pelvis.
  • A defined localization of pain in the testicles is not a sign of prostatitis.
  • Imperative symptoms are more characteristic than obstructive;
  • The erectile dysfunction can accompany CP;
  • The pain after ejaculation is most specific for CP and distinguish it from benign prostate hyperplasia and healthy men.

In our country, a huge material was accumulated for the use of various diagnostic procedures and treatment of CP.However, most of the available data does not meet the requirements for evidence medicine: research is not randomized, on a small number of observations, in a center, without placebo control and sometimes without a control group.

In addition, the lack of a single classification of CP often does not give an idea of which categories of patients are actually a question in the work described.Therefore, The Effectiveness of Most Treatment Methods, which Are Widely Advertized and Used Today (Transurethral Vacuum-Extraction, Transurethral Electromagnetic Stimulation of the Prostate, Therapy Transrectal, Top-Lobed, Transurethral Or Intravascular LaserIrradiation, extraction of prostrate gland on Buzha and Buzha and Building T.P.), Not to mention the "Miraculousness" of domestic and foreign "patented means" cannot be regarded as proven.

Even the effectiveness of such a traditional method as massage of the prostate and information for this is still not clearly defined.

The problem of choosing a drug for the treatment of patients with chronic bacterial (non -infectious) prostatitis in connection with the classification of NIH according to IIIA and IIIB categories is a significant difficulty.This is due to the uncertainty of the self and the and chronic abacterial prostatitis, which results from the ambiguity of the etiology and pathogenesis of this disease.First, such a wording of the problem concerns the prostatitis of category IIIB, which is also defined as "chronic abacterial prostatitis / chronic pelvic pain" (HAP / StBB).

Paradoxically, the fact that many authors are proposed to treat abacterial prostatitis proposed the use of antibacterial active ingredients, and data that indicate rather high efficiency of such treatment are specified.This once again testifies the inadequate development of questions of the disease of the disease, the possible influence of infection on its development and inconsistency of the terminology that we have previously announced, and proposed to share the concepts of the "abacterial" and "non-infectious" prostatitis.It is most likely that the diagnosis of HAP/CTB hides a whole range of different conditions, including those if the prostate gland is only indirectly or not at all involved in the pathological process, and the diagnosis itself is a forced trimal company that requires a clear term to determine indications for the prescription of medicinal products.

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

  • Antibiotics and antibacterial medication;
  • Non -steroid anti -inflammatory agents (diclofenac, ketoprofen);
  • Muscle relaxants and anti -spas modos (baclofen);
  • A1 blocker (Therazozin, Doxazin, Alfuzosin, Tamsulosin);
  • Plant extracts (Serenoa Repens, Pigeum Africanum);
  • 5a -Reductase inhibitors (Finsterida);
  • Anticholinergica (oxibutinin, tolterodin);
  • Modules and stimulants of immunity;
  • Bioregulative peptides (prostate extract);
  • Complexes of vitamins and trace elements;
  • Antidepressants and sedatives (amitriptylin, diazepam, salbutamine);
  • Analgetics;
  • Medicines that improve the microcirculation, rheological properties of blood, anticoagulants (dextra, pentoxyphillin);
  • Enzymes (hyaluronidase);
  • Antiepileptic agent (gabapentin);
  • Xanthinoxidase inhibitors (allopurinol);
  • Extraction of pepper pepper (capsaicin).

It is impossible to believe that the therapy of CP should be focused on all connections of etiology and pathogenesis of the disease, the activity, category and degree of prevalence of the process is taken into account and be complex.At the same time, the use of many of the above medication is based, since the cause of the CP IIIA and IIIB is not precisely defined, only on episodic messages about the experience of their use, which is often doubtful from the perspective of evidence medicine.So far, the full healing of the HAP seems to be a difficult goal.Therefore, symptomatic treatment, especially for IIIB category patients, 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 react both in the presence of a bacterial infection in the analysis and without them.It has been shown that the well-being of some patients of the HAP improved after the HAP is carried out, which can indicate the presence of an infection that has not been proven using conventional methods.Nickel and Costerton (1993) found that in 60% of patients with previously diagnosed bacterial prostatitis, in which the symptoms were spent on the background of negative harvesting the 3rd part of the 3rd part of the 3rd part of the prostate and ////- ejakulate.It should be taken into account that the role of some microorganisms (Coagulazo-Neiger-Staphylococci, Chlamydia, urea, anaerobes, mushrooms, trichomonades) has not yet been confirmed as an etiological factors of the CP and the topic of the discussion is.On the other hand, it cannot be ruled out that some comments from the lower urinary tract, which are usually harmless, become pathogenic under certain conditions.In addition, unknown infectious agents can be used using more sensitive methods.

Nowadays, many authors for patients with a HAP are carrying out an experimental course of antibiotic therapy, and in cases where prostatitis is treated, they advise them to continue them for a further 4-6 weeks or even a longer period of time.In the event of a relapse after the termination of antimicrobial therapy, it is necessary to resume its behavior using low drug doses.Despite the fact that the latest position causes certain doubts, it contained the recommendations of the European Association of Urologists (2002).

Perhaps there is a logical justification for the use of antibiotics that penetrate the tissue of the prostate.Only a few antimicrobial medication penetrates into the prostate gland.For this purpose, you must be lipid -constant, have the property of low protein binding and have a high dissociation constant (PKA).By worshiping the RCC of the drug, the higher the plasma of the blood, the proportion of non -related (non -ionized) molecules that penetrate the epithelium of the prostate and can spread in its secret.Lipid and soluble and minimally associated with plasma protein, the medication can easily penetrate into the electrically charged lipid membrane of the epithelium of the prostate gland.In order to achieve a good penetration of the antibiotic in the prostate gland, it is therefore necessary that the drug used is lipid, which has RKA> 8.6, which is marked by optimal activity against gram-negative bacteria in ph> 6.6.

It should be taken into account that the results of the longer use of the Trimetrom Sulfametoxazole remain unsatisfactory (Drach G. W. et al. 1974; Meares E. M. 1975; McGuire EJ, Lyton B. 1976).Data for the treatment of doxycycline and fluorchinolons, including Norfloxacin (Schaeffer A.J, Darras F. 1990), Ciprofloxacin (Childs S. J. 1990; Weidner W. et al. 1991) and Offloxacin (Remy G. et al. 1988; COX C.E. 1989; Offloxacin showed an odic effect at theProstatitis of Group II, III and IIIV.

Alfa-1-nebrene-shit

Some scientists suggest that the pain and symptoms of irritative or difficult urination in patients with HAB/KTB can be attributed to the obstruction of the lower urinary tract, which is caused by a dysfunction of the neck of the bladder, the turmoil, the stricture of the urethra or the dysfunctions with high urethral pressure.If a trace of men under 50 is diagnosed with a clinical diagnosis of CP, the functional OV structure of the neck of the bladder is proven in more than half of them, which, due to the pseudo-decks closure closes in a further 24% and in about 50% of the patients, is constantly constipated by pseudo-deck sphincter and the instability of detrusion.

Thus, some forms of chronic prostatitis are associated with the initial impairment of the sympathetic nervous system and the hyperactivity of the alpha-1 adrenergic receptors.This is also evident on the basis of the work of domestic authors and our own observations.

The intraprostatic Proto -Reflux is described, which is caused by turbulent urination with a high intra -territory pressure.Refluxurine in the channels and cuts of the prostate gland can stimulate a sterile inflammatory reaction.

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

Neal D.E. Jr. und Moon T.D. (1994) untersuchten Terasosos bei Patienten mit HAP und Prostatinien in einer offenen Studie. Nach einem Monat der Behandlung stellten 76% der Patienten eine Abnahme der Symptome von 5,16 ± 1,77 auf 1,88 ± 1,64 Punkte auf einer 12-Ballast-Skala fest (p<0.0001) при использовании доз от 2 до 10 мг/сут. При этом через 2 месяца после окончания лечения симптомыотсутствовали у 58% пациентов полотельно ответивших на? 1-million.В недавнем двойном исследовании, через 14 недель отметили улучшение 56% пациентов ноне приема и 33% -плацебо.Причем, 50% сниhus поли по шкале nih-cpsi было выявлено у 60% г гу-пе активного ло сравнению с 37% групеплацебо (Cheah P.Y. et al. 2003).При этом, в групfter, достоверно не отличались по скорости мочеиспускания и объему остаточной мо-close.Gul et al.(2001.выраjecte симптомов в основной групе в среднем на 35%, и лAш н 5% в гaut пле плацебо.Различия методным и итого-вы then гоказелями групfterдос-narratives.Тем менее, авторы сделали вывод о том, что 3-х месячного криема? 1-адрено matcheстойкого и выраjecte снисния симптомов.Они так< fterlазали, что доза теразозина в 2 м/сут - слишком низка.

Alfuzosin was used in a recently prospective randomized, placebo -controlled study with one year that included 6 months of active treatment and the same observation time.After 6 months, patients who took alfuzosin were recorded more strongly on the NIH-CPSI scale, which achieved 9.9;3.8 and 4.3 points (p = 0.01).In this size, only symptoms that characterize the pain took significantly, in contrast to others who were associated with urination and quality of life.In the Alfuzosin group, 65% of the patients had an improvement in the NIH-CPSI scale by more than 33% compared to 24% and 32% in placebo and control groups (p = 0.02).6 months after the drug was abolished, the symptoms gradually increased, both in the Alfuzosin and the placebo group.

The use of a selective alpha-1a/d-adreno-reinforced controller from Tamsulosin for HP/KTB also shows 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 the symptoms of the NIH-CPSI scale in 74.5% of the patients as well as an increase in QMAX and QAVE by 30.4% or 65.4% within 4 weeks.Narayan P. et al.(2002) reported on the results of a 6-week double-blind randomized, placebo-controlled study by tamsulosine in patients with HAP/StBB.27 men received the medication, a placebo - 30. A reliable decrease in symptoms in patients who took tamsulosine and their growth in the placebo group was uncovered.The heavier the initial symptoms in the main group, the more the improvement was expressed.The number of side effects was comparable in the groups of tamsulosine and placebo.A positive effect was achieved in 71.8% of the patients.After a year of therapy, the decrease in the I-PSS scale is 5.3 points (52%) and the reduction in QOL 3.1 points (79%).

Nowadays, most experts express an opinion on the need for long-term receipt of alpha-1 blockers, since short courses (less than 6-8 months) often lead to a relapse of the symptoms.This is also evident through one of the latest work with alfuzosin: In most patients, a relapse of the symptoms was found in most patients 3 months after the 3-month treatment course has been completed.It is believed that longer therapy can lead to a change in the receptor apparatus of the lower urinary tract, but such data must be confirmed.

In general, one has the impression that the patients have clinical efficiency of all of the HAP as with DHCH?1-nebuly blocking is almost the same and differ only in the profile of your security.At the same time, as our observations say, even though the use of?1-adrenal switch and does not allow to completely avoid the disease in the abolition of the drug, but significantly the severity of the symptoms and increase the time before the relapse.

Musorelaxants and anti -spasmodics

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 examination of the symptoms and a neurological examination can indicate the presence of a sympathetic reflex dystrophy of the muscles of the perineum and the same soil.Various damage to regulatory centers of the spinal cord can lead to a change in the muscle tone, more often by a hyperpastic type, in which urodynamic diseases (cramp of the neck of the bladder, pseudo detection) or the result of these conditions.

In some cases, due to a violation of the binding of the pelvic muscles, the pain can be in the so -called trigger points to the sacrum, coccyx, shame, sciatic bone, endopelvic fascia.The reasons for the formation of such phenomena are classified: pathological changes from the lower extremities, operations and anamnesis injuries, certain sports, repeated infections, etc. In this situation, the inclusion of muscle relaxants and antipasium models in the complex therapy can be regarded as pathogenetically justified.It is reported that muscle relaxants are effective for the sphincter functional disorder, takeo and perinum muscle spasm.Osborn D.E.et al.(1981) belongs to the first study on the effect of muscle relaxants on prostate death line.The authors carried out a comparative double-blind-controlled examination of the effectiveness of the adrenan-blocking phenoxibenzamine, baclofen (GABA-B agonist receptors, a relaxation agent of the transverse muscles) and the placebo in 27 patients with prostate death.In 48% of the patients after using phenoxibenzamine, at 37% - baclofen and 8% - when using a placebo, 48% of the patients were registered.However, no large prospective clinical studies have yet been carried out on a large scale that could confirm the effectiveness of the drugs of this group in patients with HAP/KTB.

Non -steroidal anti -inflammatory medication and analgesics

The use of non -steroidal anti -inflammatory drugs such as Diclofenac, Ketoprofen or Nimesulid can be effective in the treatment of some HAP/KTB patients.Analgesics are often used in the treatment of patients with KTB.However, there is only a few data about its effectiveness over a long period of time.

Plant extracts

The most examined Serenoa Repens and Pygeum Africanum are under plant extracts.The anti -inflammatory and determined effect of permixon is realized by the phospholipase A2, other enzymes of the arachidon cascade - cyclooxygenase and lipoxygenase, for the formation of prostaglandins and leukotria, as well as the vascular phase of the dismantling, the vascular phase of the dismissalVascular phase of the decision, the vascular phase of determination, the vascular phase of determination, the vascular phase of determination, the VASK phase of determination, the VASK phase of determination, is realized.As by the recently completed morphological studies in patients with DGPS, treatment with permixon, against the background of a decrease in the proliferative acute effect company by 32% and an increase in the current ratio by 59% compared to the control group (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p ((P (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p (p. p.<0,001).

Reissigl A. et al.(2003) he reported the first the results of the multicenter study with 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 the treatment was registered in 75% of patients who received permixion, compared to 20% in the control group.It is characteristic that in 55% of patients in the main group, improvement was considered moderate or significant, while in the control group - only in 16%.At the same time, 12 weeks after the treatment, there were no reliable differences between the groups.The data presented show that Permixon is positively influenced in HAP/CTB patients, but the treatment courses should be longer.

Another pilot study showed a decrease in the inflammatory markers from FNO and interleukin-1b against the background of permixone therapy, which correlated with its symptomatic effect (Vela-Navarrete R. et al. 2002).Many authors provide the anti -inflammatory effect of the Pygeum Africanum extract, its effect on the regeneration of glandular epithelial cells and the secretor activity of the prostate gland, a decrease in hyperactivity and an increase in the stability threshold.However, this experimental data must be confirmed by clinical studies in patients with HAP/CTB.

There are separate reports on the positive effects of flower pollen extract (Cernetonone) in patients with CP and prostatias.

In general, there are sufficient theoretical and experimental reasons for the use of plant extracts in patients with HAP/CTB, which mainly contain Serenoa Repens and Pygeum Africanum, this should be confirmed by correct clinical studies.

5-alpha reductase inhibitors

Several short-term pilot studies with 5A reductase inhibitors confirm that FinsterID has an advantageous influence on urination and reduces the pain in CP/CTB.The morphological study carried out in patients with DGPZ shows a significant decrease in the average area, which is occupied by anti-inflammatory in-filt with the original 52% to 21% after treatment (p = 3.79*10-6).In the successful treatment with Finatorid 51 patients KP IIIA for 6-14 months.(2002).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 symptoms from 21 to 16 and the clinical index of 30 to 23 points.

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

  • From the point of view of etiology.

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

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

    The potential effect of darkide with dysfunctional urination with a high intrable pressure, which causes the development of intrastrostatic reflux.

  • In terms of morphology.

    Inflammation occurs in the tissue of the prostate.

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

  • From a clinical point of view.

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

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

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

    Opinions of individual urologists on the effectiveness of finsteride in prostatitis.

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

Anticholinergic remedies

The advantageous effect of anticholinergic active ingredients is to weaken the symptoms of imperative urination, the 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 pronounced irritative symptoms, but without signs of an obstruction in the period, both in monotherapy and in combination with?1-adrenergic shutters.Additional studies are required to determine the drug location of this group in the treatment of patients with lower prostatitis.

Immunotherapy

Some authors support the view that the occurrence of non -bacterial prostatitis is due to immunological processes that are accelerated by an unknown antigen or autoimmune reaction.Recently, the role of cytokines in the development and maintenance of HP has been given more and more attention.They communicate via the discovery of the prostate in the secret of increased compared to the control of the interferon-gamma, interleukins 2, 6, 8 and a number of other cytokines.John et al.(2001) and dolle A. et al.(1999) found that the ratio of CD8 (cytotoxic) to CD4 (helper) types of T -lymphocytes and the content of cytokines increased with abacterial prostatitis IIIV.This can indicate that the term "non -inflammatory" prostatitis may not be quite appropriate.In this situation, the immune modulation using cytokin inhibitors or other approaches can be effective, but the corresponding tests should be completed before the method is recommended.

Various immunotherapy options are very popular with domestic experts.Cellular and humoral immunity stimulating from the drugs: the preparations of the thymus, interferons, inductors of the synthesis of endogenous interferon and synthetic agents are differentiated.These results are of particular interest in the latest data on the important role of interleukin-8 under HP IIIA, where it is regarded as a potential therapeutic goal (Hochreiter W. et al. 2004).At the same time, it should be noted that in our opinion the appointment of a special immunogoric therapy should be treated with great caution and should only be carried out if pathological shifts are determined according to the results of the immunological examination.

Transquilizers and antidepressants

The examination of the intellectual status of patients with CP/KTB has led to an understanding of the contribution of psycho-Somatic disorders on the pathogenesis of the disease.In patients with CP, a fairly frequent find is depression.In this regard, HAP/STB patients are recommended for the appointment of sedatives, antidepressants and psychotherapy.From the latest work, the publication for the use of salboutiamine can be observed, which has an antidepressant and psychostimulating effect due to the impact on the reticular formation of the brain.The author observed 27 patients with CP IIIB who received salbutamine in complex therapy and 17 patients in the control group.It was found that in patients who were taking this medication, the remission period was significantly higher: 75% after 6 months in the main group around 36.4% in the control group.The characteristics with salbutamine determined an increase in libido, the general vital tone and a positive mood for the treatment.

Circulatory medication

It was found that various shifts of microcirculation, hemokoagulation and fibrinolysis are recorded in patients of CP.For the correction of hemodic disorders, it is recommended to use reopoliglyukin, trendal and escult.There are reports on the use of prostaglandin E1 in patients with haps.Additional studies are required for the development of methods for evaluating blood circulation diseases in patients with HAP/CTB as well as to create schemes for their optimal correction.

Bioregulative peptides

Prostal and vitaprost are often used by domestic experts in the head of abacterial prostatitis.The drugs are complexes of biologically active peptides that have been isolated from the prostate glands of cattle.In addition to the pushes described above, its symptomatic effect in CP, anti-inflammatory, microkernic and trophic effects is determined.At the same time, studies in which modern methods for evaluating the clinical image of HAP/KTB have been used for the medication in this group have not yet been carried out.

Vitamins and trace elements

Complexes of vitamins and trace elements play an important auxiliary value in the treatment of patients with CP.Among them are the vitamins of group B, vitamins A, E, C, zinc and selenium.It is known that the prostate is the richest in zinc and collects zinc.Its antibacterial protection is connected to the presence of free zinc (the prostate antibacterial factor - zinc peptide complex).In bacterial prostatitis, a decrease in zinc mirror is determined, which hardly changes against the background of the oral administration of this trace element.In contrast, there is a recovery of zinc mirror during its exogenous admission.Against the background of HP, a reliable decrease in the citric acid level is determined.Vitamin E. Selena is an anti -cauliflatic remedy and is considered a high antioxidant and anti -radical activity and is regarded as an onkoprotector, also with regard to RPG.In connection with the specified use, the use of medication that contains balanced volumes of necessary vitamins and microelenas is justified.One of these drugs is a medication that contains selenium, zinc, vitamin E?-Carotine and vitamin S.

Enzyme

Lidase preparations have been used in the complex therapy of patients with CP for many years.Recently, several reports of domestic authors have occurred on the positive experience of using Vabenzim as a drug of systemic enzyme therapy in the complex treatment of patients with CP.

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

According to the recommendations of the US Health Institute (NIH), the most frequently used treatment methods of abacterial prostatitis can be shown by the following sequence according to the priorities in accordance with the criteria of the medical criteria of Evidence Base:

  • Priority of the treatment method (0-5);
  • Antibacterial means (antibiotics) 4.4;
  • Alpha1 blocker 3.7;
  • Prostate massage (course) 3.3;
  • Anti -inflammatory therapy (non -steroidal anti -inflammatory medication, hydroxyzin) 3.3;
  • Anesthesia therapy (analgesics, amitriptyin, size) 3.1;
  • Treatment of the reverse biological communication method (anorectal biofeedback) 2.7;
  • Phytotherapy (Serenoa Repens/Saw Palmetto, Quercetin) 2.5;
  • 5 alpha reductase inhibitors (finsterid) 2.5;
  • Musorelaxants (diazepam, baclofen) 2.2;
  • Thermotherapy (Transurtral microwave thermotherapy, transurethral needleblation, 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 prostate) 1.5.

Something different accents for the priority of treatment methods for chronic prostatitis at Tennke P. (2003)

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

Therefore, a large number of different medicines and drug groups for the treatment of chronic abacterial prostatitis and KTB are proposed, the use of which is based on information on their effects in different stages of the pathogenesis of the disease.With the exception, all of this is poorly confirmed by evidence and evidence and evidence.In order to improve the results of the treatment of haps and in particular groups of patients with pelvic pain, with the progress in the field of diagnosis and the differential diagnosis of these diseases, the improvement and detail of the clinical classification of the disease are the accumulation of reliable clinical results, which characterize the effectiveness and safety of drugs in clearly defined groups of patients.