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Chronic prostatitic drug therapy

Prostatitis is acute inflammation or chronically flee from the glandular (parenchymal) and interstitial tissue of the prostatic gland.Prostatitic treatment drugsThe inflammation of the prostate gland, as an independent nosological form, was described for the first time by LEDMISH in 1857. However, despite almost 150 years of history, prostatitis remains very common, the non -able has studied and misunderstands the disease.Inclusion is also due to the fact that in most cases of chronic prostatitis, its etiology, its pathogenesis and its pathophysiology remain unknown.

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

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 drugs are offered, which are starting to be announced even before reliable information on their effectiveness and safety.In addition, aggressive advertising, carried out using all types of media, is concentrated, first of all, to a patient who is unable to assess all the advantages and disadvantages of the treatment offered.

On the other hand, the development of modern medical science has led to the emergence of a number of new principles and methods of treatment of CP.Each of the methods has its own advantages and disadvantages.However, a practicing urologist is unable to familiarize himself and analyze the ever -increasing quantity of information published on the problem of prostatitis.Despite a large number of methodological materials, theses and publications on the diagnosis and processing of CP data in the necessary, for acceptance as a standard, there is practically no form.

Various prostatitic treatment methods favor and use many medical centers (sometimes having no urologist in the state), pharmacological societies and even paramedical institutions.

This complicates the adoption of effective clinical decisions, limits the use of reliable diagnostic and treatment methods, leads to "main" treatment, when, after failure to use one method, another is prescribed by another, etc.Consequently, a violation of the balance between clinical and economic efficiency and the increase in the costs of medical care.To fill this gap, help in knowledge of the bases and the introduction of the principles of medicine based on evidence to unify approaches to the diagnosis and the choice of tactics for the 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 his mask, a wide range of prostate gland and lower urinary tract can be hidden, from infectious prostatitis, chronic pelvic pain or prostatodinia if called for abacterial prostatitis and ending with neurogenic dysfunctions, allergic and metabolic disorders.The absence of a terminological unit is particularly relevant in the case of a non-infectious CP, which is interpreted by various authors as follows: prostatinia, chronic pelvic pain Syn-Drum, post-infectious prostatitis, myalgia of the muscles of the pelvic floor and consultant prostatitis.

Many experts consider chronic prostatitis as an inflammatory disease of Genesis mainly infectious with the possible attachment of autoimmune disorders, characterized by damage to parenchyma and interstitial fabric of the prostatic gland.

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

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

  • The presence of pain in the pelvic / perineum, the organs of the genitarine system for at least 3 months;
  • the presence (or absence) of obstructive or irritative 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 quality of life in men of working age: its influence is compared to angina, Crohn's disease or myocardial infarction.According to consolidated data from the American Association of Urologists, the impact 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, the urethra, as well as the neurological diseases of the pelvic area.The absence of an entire idea of CP pathogenesis is highlighted by the disadvantages of existing classifications, which is a serious obstacle to understanding and successful treatment of this disease.

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

Currently, Abroad is widely used and adopted as the hand classification of the national institute of health, According to which: acute bacterial prostatitis (i), chronic bacterial prostatititis (II), chronic abacterial prostatitis or chronic pelvic breads (III), include with inflammatory component (iiii)it (iiib), as well as asymptomatic prostatitis with the presence of inflammation (IV).

Clinical characteristics of chronic prostatitis:

  • Above all, young men aged 20 to 50 (average age of 43) suffer;
  • The main and most common manifestation of the disease is the presence of pain or discomfort in the basin;
  • lasts at least 3 months;
  • The intensity of symptomatic manifestations varies considerably;
  • The most common location of pain is the crotch, but a feeling of discomfort can occur in any area of the basin;
  • The location of pain in the testicle is not a sign of prostatitis;
  • Imperative symptoms are more characteristic than obstructive;
  • Erectile dysfunction can accompany CP;
  • The pain after ejaculation is the most specific of CP and distinguishes it from the benign prostate hyperplasia and healthy men.

In our country, enormous materials have accumulated on the use of various methods of diagnostic and treatment of CP.However, most data available do not meet the requirements of evidence -based medicine: research is not randomized, carried out on a small number of observations, in a center, without placebo control, and sometimes without a control group at all.

In addition, the absence of a single CP classification often does not give an idea of the categories of patients who are in fact a question in described works.Consequently, the effectiveness of most treatment methods, which are widely announced and used today (transientral, transrectral transrectral, trans -retiretral, transureral or intravascular, stimulating laser irradiation, extraction of the prossrat on Buzle and Buzha and T.P., does not mention the "patented "national and foreign cannot be considered proven.

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

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

Paradoxically, the fact that many authors are offered for the treatment of abacterial prostatitis, the use of antibacterial agents is offered and data indicating a fairly high efficiency of this processing is given.This shows once again to the insufficient development of issues of etiopathogenesis of the disease, the possible influence of the infection on its development and inconsistency of the terminology adopted, which we indicated earlier, proposing to divide the concepts of "abacactory" and "non -infectious" prostatitis.It is very likely that the diagnosis of HAP / CTB is hiding an entire range of different states, including those where the prostate gland is involved in the pathological process indirectly or not at all, and the diagnosis itself is a forced tromal company which needs a clear term to determine the indications of the prescription of drugs.

Today, we can say with confidence that a single approach to the treatment of HAP / CTB patients has not yet been trained.For the same reason, various various drugs are offered 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 and antispasmodic (baclofen);
  • A1-Bloquants (Therazozin, Doxazine, Alfazosin, Tamsulosine);
  • Plant extracts (Serenoa repens, pigeum Africanum);
  • 5a Reductase inhibitors (Finsterida);
  • Anticholinergic drugs (oxubtinin, tolerodine);
  • Modules and stimulants of immunity;
  • Bioregulatory peptides (extract from prostates);
  • vitamin and origin complexes;
  • Antidepressants and tranquilizers (amitriptylin, diazepam, salbutamin);
  • analgesics;
  • Drugs that improve microcirculation, rheological blood properties, anticoagulants (dextra, pentoxyphillin);
  • Enzymes (hyaluronidase);
  • Antiepileptic agents (gabapentine);
  • Xanthinoxidase inhibitors (allopurinol);
  • Pepper extraction (capsaicin).

It is impossible to disagree with the opinion that PC therapy should be intended for all links of etiology and the 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 CP IIIA and IIIB is not exactly established, the use of many drugs above is only based on episodic messages on the experience of their use, often doubtful from the point of view of medicine based on evidence.To date, the healing of the HAP seems to be a difficult objective, therefore the symptomatic treatment, especially for patients in category IIIB, is the most likely way to improve quality of life.

Antibacterial therapy

In treatmentFrom chronic abacterial prostatitis, antibiotics are often empirically exciting, often with a positive effect.Up to 40% of CP patients respond to the treatment of antibiotics both in the presence of a bacterial infection in the analysis and without it.It has been shown that the well-being of certain HAP patients has improved after carrying out a characteristic treatment, which may indicate the presence of an 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 in the context of the negative cultures of the 3rd part of the urine and / or the secrecy of prostate and / or ejaculate, have been preserved, has been revealed a positive increase in the bacterial flora in the bacterial flora in the bacterial floraPre -heating Biopotes of the Pretest.It should be kept in mind that the role of certain microorganisms (Staphylococci, Chlamydia, Uablasme, Anaerobies, Mushrooms, Trichomonades) as etiological factors of CP, fungi, trichomonades).On the other hand, it cannot be excluded that certain comments from the lower urinary tract, which are generally harmless, under certain conditions, become pathogenic.In addition, using more sensitive methods, unknown infectious agents can still be recognized.

Today, many authors consider that it is justified to carry out an antibiotic treatment test for patients with a HAP, and in cases where prostatitis is treated, they advise you to continue it for 4 to 6 weeks or even a longer period.In the event of a relapse after the cessation of antimicrobial therapy, it is necessary to resume driving with the use of low doses of drugs.Despite the fact that the last position caused certain doubts, it included the recommendations of the European Association of Urologists (2002).

There may be a logical justification for the use of antibiotics that penetrate the fabric of the prostate gland.Only certain antimicrobial drugs enter the prostate gland.To do this, they must comply with lipids, have the property of a low protein bond and have a high dissociation constant (PKA).The cult of the drug RCC, the higher the plasma of the blood, the fraction of unrelated molecules (not ionized) which 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 enter the lipid membrane electrically charged with the epithelium of the prostate gland.Consequently, in order to reach a good penetration of the antibiotic into the prostate gland, it is necessary that the drug used is lipidic, a RKA> 8.6, characterized by an optimal activity against the gram negative bacteria in pH> 6.6.

It should be kept 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, in particular norfloxacin (Schaeffer A.J, Darras F.S. 1990), Ciprofloxacin (Childs S.J.1990; Weidner W. et al.1991) and Offloxacin (Remy G. and Al.1988; Cox C.E. 1989; Pust R.A.Nickel J.C. et al.

Alfa-1-Surrenale shit

Some scientists suggest that the pain and symptoms of irritative or difficulty urination in patients with an inhab / KTB may be due to the obstruction of the lower urinary tracts caused by a dysfunction of the neck of the bladder, the tract, the rupture of the urethra or the dysfunction at high urethral pressure.When a trace of men under the age of 50 with a clinical diagnosis of CP, the functional UFO structure of the bladder is detected in more than half of them, the obstruction due to the pseudo-pont sphincter in 24% and to destroying instability in around 50% of patients.

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

Intraprostatic proto reflux is described, caused by turbulent urilation with high intra-growing pressure.Reflux urine in the conduits and slices of the prostate gland can stimulate a sterile inflammatory reaction.

The data in the literature indicate that alpha-1-surrenial switches, muscle relaxants and physiotherapy reduce the degree of manifestation of symptoms in patients with a concentrator / KTB.Osborn D.E. et al.(1981) the first to use a positive effect of phenomena in a placebo -controlled study with a positive effect with prostatodinia.Improving the flow of urine during the blocking of alpha-1 receptors in the bladder and the prostatic gland leads to a weakening of the symptoms.According to the results of studies on alpha-blockers, clinical progress is observed in 48 to 80% of cases.Generalized data design 4 recent and similar data?1 1 Blocking in HP / CTB, indicates a positive result of treatment, on average, in 64% of patients.

Neal D.E. Jr. et Moon T.D. (1994) ont étudié les terrasos chez les patients atteints de HAP et de prostatinia dans une étude ouverte. Après un mois de traitement, 76% des patients ont noté une diminution des symptômes de 5,16 ± 1,77 à 1,88 ± 1,64 points sur une échelle de 12 balles (P<0.0001) при использовании доз от 2 до 10 мг/сут. При этом через 2 месяцаПосле окончания лечения симптомы отсутвовали у 58% Пациентов Положительно ответившив на? 1-Esenger?В недавнем двойном Слепом исследовании, через 14 недель отметили улулеение 56% Пациентов на фоне Приема\Плацебо.Причем, 50% Снижение боли По шкале nih-cps было Выявлено у 60% В гпternalПлацебо (Cheah P.Y. et al. 2003).При этом, В итоге, гппы достоверно не отлисьались По скорости мочеиспускания и оъему остаточ мо-чи.Gul et al.(2001) При анализе результатов наблююения 39 Пациентов с хаП/схтб, Прини -мавших теразин и 30 - Плацебо, Вы basВыраженности симптомов В основной гППп В Среднем на 35%, и лиш на 5% В гП?Разлиü между исходным и и и ито -вым Показателями гппы теразина и между нею ипппой Плацодос-товерны.Тем не менее, авторы Сделали Вывод о том, что 3-месячно contextстойкого и Выраженного Снижения симптомов.Они также указали, что доза теразина В 2 мг/сут - слишком низка.

ALFUZOSINE was used in a recently prospective randomized controlled study for a 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 has reached statistical service compared to placebo and control: 9.9;3.8 and 4.3 points, respectively (p = 0.01).Inside this scale, only the symptoms characterizing the pain have decreased significantly, unlike other associated for urination and quality of life.In the group of alfuzosin, 65% of patients had an improvement in the NIH-CPSI scale of more than 33%, against 24% and 32% in placebo and control groups (p = 0.02).6 months after the abolition of the medication, the symptoms began to gradually increase, both in the alfuzosin and placebo group.

The use of an alpha-1a / d-adreno-renforced tamsulosin selective controller for HP / KTB also demonstrates a good clinical effect.According to Chen Xiao Song et al.(2002) In the context of the use of 0.2 mg of the drug, a decrease in symptoms of the NIH-CPSI scale in 74.5% of patients, as well as an qmax and qave increase by 30.4% and 65.4%, respectively, were recorded within 4 weeks.Narayan P. et al.(2002) reported the results of a double -blind placebo -randomized placebo study of 6 weeks of tamsulosin 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 has been revealed.In addition, the more heavy the initial symptoms of the main group, the more the improvement was impressed.The number of side effects was comparable in Tamsulosin and placebo groups.A positive effect was obtained in 71.8% of patients.After a year of therapy, the decrease in the I-PSS scale is 5.3 points (52%) and the reduction in Q-3.1 points (79%).

Today, most experts express an opinion on the need for long-term reception of alpha-1 blockers, because short courses (less than 6 to 8 months) often result in a relapse of symptoms.This is also highlighted by one of the last work with alfuzosin: in most patients 3 months after the end of the 3 -month treatment course, a relapse of the symptoms was noted.It is assumed that prolonged therapy can lead to a change in the unit of the lower urinary tract receivers, but this data must be confirmed.

In general, it feels like, as with DHCH, HAP patients have clinical efficiency of everyone?The 1-surrenal blocking is almost the same, and they only differ in the profile of their safety.At the same time, as our observations testify, although the use of?1-surrenal switch and does not completely avoid relapse of the disease in the abolition of the drug, it considerably reduces the severity of the symptoms and increases time before relapse.

Musorelaxing 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 the symptoms and a neurological examination can indicate the presence of a sympathetic reflex dystrophy of the muscles of the perineum and the same background.Various damage to the centers of regulation of the spinal cord can cause a change in muscle tone, more often by a hyperspastic type, in which urodynamic disorders (spasm of the bladder neck, pseudo-detection) are accompanied or the result of these conditions.

In some cases, the pain can act following a violation of the attachment of the pelvic muscles in the trigger of So-Salled points to the sacrum, the coccyx, the pubic, the sciatic bones, the endopelvical fascia.The reasons for the formation of such phenomena are classified: pathological changes compared to the lower limbs, operations and injuries of anamnesis, certain sports, repeated infections, etc.In this situation, the inclusion of muscle relaxants and antipasmodics in complex therapy can be considered as pathogenetically.It is reported that muscle relaxants are effective in the dysfunction of the sphincter, the muscle spasm of delay and perineum.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 comparative study of the efficiency of the Adrenan blocking phenomena, baclofen (GABA-B-B agonist receptors, a relaxing muscles with transverse stripes) and placebo in 27 patients with prosatodinia.Symptomatic improvement was recorded in 48% of patients after using phenomenazamine, in 37% - baclofen and 8% - when using a placebo.However, large -scale prospective clinical trials that could confirm the effectiveness of this group's medicines in Patients with HAP / KTB, have not yet been undertaken.

Non-steroidal anti-inflammatory drugs and anti-inflammatory drugs

The use of non-steroidal anti-inflammatory drugs, such as diclofenac, ketoprofen or nimesulid, can be effective in the treatment of certain HAP / KTB patients.Analgesics are often used in the treatment of KTB patients, however, there is little data on their effectiveness for a long time.

Plant extracts

Among the plant extracts, the most studied are the REPES of Serenoa and Pygeum Africanum.The anti -inflammatory and decongestant effect of permixon is made by inhibiting phospholipase A2, other enzymes of the arachidon cascade - cycloxygenase and lipoxygenase, responsible for the formation of prostaglandins and leukotriens, as well as the influence on the vascular phase of inflammation, the permability of the capillaries.As Rececently Copled by the Recently Cotted 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 Severity of the Severity ofInflammatory Reaction in the Tissue of the 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 percentric permixon study 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 of the NIH-CPSI scale was recorded by 30%.The positive effect of treatment was recorded in 75% of patients receiving permixon, 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 treatment, there were no reliable differences between groups.The data presented indicate that the permixon has a positive effect in HAP / CTB patients, however, treatment courses should be longer.

In another pilot study, a decrease in inflammatory markers of the FNO and interleukin-1B was shown in the context of permixon therapy, which was correlated with its symptomatic effect (Vela-Navarrete R. et al. 2002).Many authors indicate the anti-inflammatory effect of the extract of Africanum Pygeum, 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 the excitability threshold.However, this experimental data should be confirmed by clinical studies in patients with HAP / CTB.

There are distinct relationships on 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, mainly containing Serenoa RENSE 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 on 5A Reducitase inhibitors confirm the opinion that the endsteride has a beneficial effect on urination and reduces pain in the CP / CTB.The morphological study conducted in patients with DGPZ indicates a significant decrease in the average zone occupied by an inflammatory wire with the 52% original, at 21% after treatment (p = 3.79 * 10-6).On successful treatment with the FINCTORIDE 51 KP IIIA patients for 6 to 14 months.(2002).There is a decrease in pain on the SO-CHP scale from 11 to 9 points, the dysuria from 9 to 6, the quality of life from 9 to 7, the general severity of symptoms from 21 to 16 years old and the clinical index of 30 to 23 points.

Justification for the use of finteride in chronic abacterial prostatitis of the NIH-IIIA 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.

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

    The potential effect of the finsteride with dysfunctional urination with high intrauble pressure, causing the development of intrastostatic reflux.

  • In terms of morphology.

    Inflammation occurs in the fabric of the prostate gland.

    The finasterid leads to a regression of the glandular fabric of the prostate.

  • From a clinical point of view.

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

    The finasterid eliminates the symptoms of the altered function of the lower urinary tract in patients with DHGPZ, in particular with a large volume of prostate, when the glandular fabric prevails there.

    The finasteride is effective in the treatment of hematuria associated with DGPs, which is associated with a focal inflammation of the prostate.

    Opinions of individual urologists on the effectiveness of fine prostatitis.

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

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-cholinobloccaters in patients with HAP / CTB with the presence of pronounced irritative symptoms, but without signs of fraily obstruction, both in monotherapy and in combination with?1-Volet-Adrenergic.Additional studies are necessary to determine the place of drugs in 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 on the discovery of the prostate in the secrecy of the increase, compared to the control of the level of interferon-gamma, the interleukins 2, 6, 8 and a number of other cytokines.John et al.(2001) and Doble A. et al.(1999) found that with the abacterial prostatitis IIIV, the ratio of CD8 types (cytotoxic) to CD4 (seat) of T lymphocytes, as well as the level of cytokines, increased.This may indicate that the term "non-inflammatory" prostatitis may not be entirely adequate.In this situation, immune modulation using cytokine inhibitors or other approaches can be effective, but before recommending this type of processing, relevant tests must be carried out.

Various immunotherapy options are very popular among domestic experts.Among 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 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 immunocorcorce therapy must be treated with great caution and undertaken only if pathological changes are detected according to the results of the immunological examination.

Transquilizers and antidepressants

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

Blood circulation drugs

It has been established that in patients with CP, various changes in microcirculation, hemocoagulation and fibrinolysis are recorded.For the correction of hemodic disorders, it is recommended to use the reopoliglyukin, the trend and the escular.There are reports on the use of E1 prostaglandin in patients with HAP.Additional studies are necessary, both for the development of methods of evaluating blood circulation in patients with HAP / CTB, and to create patterns for their optimal correction.

Bioregulatory peptides

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

Vitamins and trace elements

Vitamin and element traces have a significant auxiliary value in the treatment of CP patients.Among them, the most important is the vitamins of group B, vitamins A, E, C, zinc and selenium.We know that the prostatic gland is the richest in zinc and accumulates zinc.Its antibacterial protection is associated with the presence of free zinc (the prostate antibacterial zinc peptide complex).With bacterial prostatitis, a decrease in zinc level is noted, which does not change in the background of the oral administration of this trace element.On the other hand, with abacterial prostatitis, there is a restoration of the zinc level during its exogenous contribution.In the context of HP, a reliable decrease in the level of citric acid is noted.Vitamin E. Selena is an anti-califratic agent and is considered a high and anti-radical antioxidant activity and is considered an oncoprotector, including compared to the RPG.As part of the indication, the use of drugs containing balanced volumes of necessary vitamins and micro -colors is justified.One of these drugs is a drug containing selenium, zinc, vitamin E?-Carottine and vitamin S.

Enzymotherapy

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

Today, in countries with developed health systems, the recommendations for the diagnosis and treatment of diseases are compiled taking into account the principles of evidence -based medicine, based on studies which have a high degree of reliability.Regarding HAP / STB pharmacotherapy, these studies are clearly not sufficient.Medicine criteria based on evidence only correspond to materials on the use of antibiotics and?1-Adreno-Blocking and, with certain tolerances, plant extracts from Serenoa Repens.The data on the use of all other groups of drugs are mainly empirical.

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

  • Priority of the treatment method (0-5);
  • Antibacterial agents (antibiotics) 4.4;
  • Alpha blockkers1 3.7;
  • Prostate massage (course) 3.3;
  • Anti-inflammatory therapy (non-steroidal anti-inflammatory drugs, hydroxyzine) 3.3;
  • Anesthetic therapy (pain relievers, amitriptyin, size) 3.1;
  • Treatment of the reverse organic communication method (Anorectal Biofeedback) 2.7;
  • Phytotherapy (Serenoa Repens / Palmetto with saw, Quercetine) 2.5;
  • 5 alpha reductase inhibitors (Finsteride) 2.5;
  • Musorelaxants (diazepam, baclofen) 2.2;
  • Thermotherapy (transuretral microwave therapy, transureral needle removal, laser) 2.2;
  • Physiotherapy (general massage, etc.) 2.1;
  • Psychotherapy 2.1;
  • Alternative therapy (meditation, acupuncture, etc.) 2.0;
  • Anticoagulants (Pentosana Polisulfate) 1.8;
  • Capsaicine 1.8;
  • Allopurinol 1.5;
  • Surgical treatment (a visit to the bladder of the bladder, prostate and incisions of the transureral prostate, radical prostatectomy) 1.5.

Something differently different from the priority of chronic prostatitis treatment methods in Tenke P. (2003)

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

Thus, a large number of drugs and groups of various drugs are offered for the treatment of chronic abacterial prostatitis and the KTB, the use of which is based on information on their effect at various stages of the pathogenesis of the disease.Without exception, all of this is poorly confirmed by evidence, evidence and evidence.To improve the results of the treatment of HAP and, in particular, groups of patients with pelvic pain, are associated with progress in the field of diagnosis and differential diagnosis of these conditions, the improvement and details of the clinical classification of the disease, the accumulation of reliable clinical results characterizing the efficiency and safety of drugs in clearly defined groups of patients.