Pharmacological therapy of chronic prostatitis

Prostatitis is acute inflammation or with chronic leaks of the glandular tissue (parenchymal) and interstitial of the prostate gland.Ledmish first described the inflammation of the prostate gland, as an independent nosological form, in 1857. However, despite almost 150 years of history, prostatitis remains very common, the disease is not studied and treated badly.Including this is also due to the fact that in most cases of chronic prostatitis, its etiology, pathogenesis and pathophysiology is still unknown.

Today in Urology there is no other problem in which it is true, doubtful 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 commercialization of the treatment of the disease, for which a large number of different methods and medications are proposed, which begin to announce even before reliable information about its effectiveness and safety.In addition, aggressive advertising, performed with all types of media, focuses, first, with 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 appearance of a series of new principles and methods to treat the PC.Each of the methods has its own advantages and disadvantages.However, a urologist in exercise cannot familiarize and analyze the growing 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 in what is necessary, for acceptance as standard, there is practically no form.

Several methods to treat prostatitis promote and use numerous medical centers (sometimes without having a urologist in the state), pharmacological companies 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 the failure of the use of one method, another is prescribed by another, etc.As a result, a violation of the balance between clinical and economic efficiency and the increase in the costs of medical care.To fill this emptiness, it helps knowledge of basic concepts and the introduction of evidence -based medicine principles to unify diagnosis approaches and the choice of tactics of chronic prostatitis treatment.

What to mean by chronic prostatitis?The modern interpretation of the term "chronic prostatitis" and the classification of the disease are ambiguous.Under its mask, a wide range of states of the prostate gland and the lower urinary tract can be hidden, starting with infectious prostatitis, chronic pelvic pain or prostatodynia called SO for abacential prostatitis and ending with neurogenic dysfunctions, 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 Pelvic Pain Syn-Drum, post-infectious prostatitis, myalgia of the pelvic floor muscles and consulting prostatitis.

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

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

The specialists of the National Institute of Health of the United States are the following by the clinical concept of chronic prostatitis:

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

Chronic prostatitis is one of the generalized diseases, and its manifestations are distinguished by a variety of symptoms.There are often publications that indicate the extremely high incidence of PC.It is reported that prostatitis leads to a significant decrease in the quality of life in working men: its influence is compared to the angina pectoris, Crohn's disease or myocardial infarction.According to the consolidated data of the American Association of Urologists, the incidence of chronic prostatitis varies from 35 to 98% and 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 of several pathological states of the prostate, urethra, as well as neurological diseases of the pelvic area.The lack of a complete idea of CP's pathogenesis is evidenced by the disadvantages of existing classifications, which is a serious barrier to the 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 the main classification of the US National Institute of Health, According to Which: Bacterial Acute Prostatitis (I), Chronic Bacterial Prostatitis (II), Chronic Abacterial Prostatitis or Chronic Pelvic Pains (III), Including with inflamComponent (IIII), as well as it (IIIB), as Well Asymptomatic Prostatitis with the witness of inflammation (IV).

Clinical characteristics of chronic prostatitis:

• Most young men aged 20 to 50 (average age of 43) suffer;
• The main and most frequent manifestation of the disease is the presence of pain or discomfort in the pelvis;
• lasting at least 3 months;
• The intensity of symptomatic manifestations varies significantly;
• The most common pain of pain is the crotch, but a sense of discomfort can occur in any area of the pelvis;
• 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;
• Pain after ejaculation is the most specific for the PC and distinguishes it from the hyperplasia of the benign prostate and healthy men.

In our country, huge material has been accumulated on the use of several diagnostic methods and PC treatment.However, most of the available data do not meet the requirements of the evidence -based medication: the research is not raised, it is carried out 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 CP classification 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 Advertiseed and used todayIrradiation, Extraction of Prostrate Gland On Buzha and Buzha and Building T.P.), Not To Mention The "Miraculousness" of Domestic and "Patented Media" foreign, cannot be considered proven.

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

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

Paradoxically, the fact that many authors are proposed for the treatment of abacterial prostatitis, the use of antibacterial agents is proposed and data is provided that indicate a fairly high efficiency of said treatment.Once again, this testifies the insufficient development of the problems of the ethiopathogenesis of the disease, the possible influence of infection in its development and inconsistency of the terminology adopted, which we indicate above, proposing to divide the concepts of prostatitis "abacteria" and "non -infectious".The diagnosis of HAP/CTB is more likely to hide an entire range of different states, including when the prostate gland is involved in the pathological process only indirectly or not at all, and the diagnosis in itself is a forced trimal company that needs a clear term to determine the indications of the prescription of the medications.

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

• antibacterial antibiotics and drugs;
• Non -steroidal anti -inflammatory agents (diclofenaco, ketoprofen);
• muscle and antispasmodic relaxants (baclofen);
• Blocadores A1 (Therazozin, Doxazin, Alfuzosina, Tamsulosina);
• Plant extracts (serene reverp, Pigeo Africanum);
• 5a reductase inhibitors (finsterida);
• anticholinergic drugs (oxybutinine, tolterodine);
• Immunity modules and stimulants;
• Biorregulators (prostate extract);
• Vitamin complexes and trace elements;
• antidepressants and tranquilizers (amitriptylin, diazepam, salbutamine);
• analgesics;
• Drugs that improve microcirculation, rheological properties of blood, anticoagulants (dextra, pentoxifilin);
• enzymes (hyaluronidase);
• antiepileptic agents (gabapentin);
• Xantinoxidase inhibitors (allopurinol);
• Pepper pepper extraction (capsaicin).

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

Antibacterial therapy

In the treatment of chronic abacerial prostatitis, antibiotics are often empirically exciting, often 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 improved after performing characters, which may indicate the presence of infection not detected by conventional methods.Nickel and Costerton (1993) found that in 60% of patients with previously diagnosed bacterial prostatitis, in which, after antimicrobial therapy against the background of negative crops of the third portion of urine and/or the secret of the prostate and/or ejaculated, the symptoms were preserved, a positive increase in the bacterial flora was revealed inProstinium-Bio-Potes.It should be taken into account that the role of some microorganisms (Coagulazo-Neiger staphylococci, clamidia, ureplasma, anaerobes, fungi, tricomonadas) as etiological factors of the PC has not yet been confirmed and is the issue of discussion.On the other hand, it cannot be excluded that some 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 perform an antibiotic therapy test course for patients with a HAP, and in cases where prostatitis is treated, they advise you to continue it for another 4-6 weeks or even a longer period.In case of relapse after the cessation of antimicrobial therapy, it is necessary to resume their behavior with the use of low doses of medicines.Despite the fact that the last position causes certain doubts, it is included in the recommendations of the European Association of Urologists (2002).

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

It should be taken into account that the results of the prolonged use of trimethromo-sulfamethoxazole remain unsatisfactory (Drach G.W. et al. 1974; MEARES E.M. 1975; McGuire EJ, Lytton B. 1976).Data on the treatment of doxycycline and fluoroquinolones, including norfloxacin (Schaeffer A.J, Darras F.S. 1990), Ciprofloxacin (Childs S.J. 1990; Weidner W. et al. 1991) and Offloxacin (Remy G. 1988; Cox C.e. 1989; Pust R.A. Nickel).Offloxacin showed a hate effect with prostatitis of groups II, III and IIIV.

ALFA-1-ADRENAL Shit

Some scientists suggest that the pain and symptoms of irritating urine or difficulty in patients with a Hab/KTB may be due to the obstruction of the lower urinary tract caused by the dysfunction of the bladder's neck, the most scratch, the stricture of the urethra or the dysfunctional urination with high urethral pressure.When a trace of men under 50 with a clinical diagnosis of PC, the functional OV structure of the bladder neck is detected in more than half of them, obstruction due to the pseudo sphincter floors in another 24% and detrusor instability in approximately 50% of patients.

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

Intraprostatic reflux, caused by turbulent urine with high intra -rocle pressure, is described.The urine of reflux in the ducts and slices of the prostate gland can stimulate a sterile inflammatory reaction.

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

Neal D.E. Jr. y Moon T.D. (1994) investigaron los terasosos en pacientes con HAP y prostatinia en un estudio abierto. Después de un mes de tratamiento, el 76% de los pacientes notaron una disminución en los síntomas de 5.16 ± 1.77 a 1.88 ± 1.64 puntos en una escala de 12 bolas (P<0.0001) при использовании доз от 2 до 10 мг/сут. При этом через 2 месяца после окончания лечениястомы отсутствовали and 58% пациенто regard.В недавнем двойном с Eveningпацебо.Shortпацебо (Cheeah P.y. et al. 2003).При этом, в итоге, груы достоверно не оичались по сороOLulated мочеиспания и бъ о о о о о о о о о о о иGul et al.(2001) прoteвражености сиомов в оновной груе в среднем на 35%, и лишь на 5% в груе пацебо.Рoteдос-specific.Тем не менее, авторы ддали вод о т, что 3-х месячного урса приема? 1 -адренобобатороballстойого и враженного снижения стомов.Ои таже уазали, что доза теразозина в 2 м/ст - сишом н н н.

Alfuzosina was used in a recently randomized study controlled with placebo that lasted 1 year, which included 6 months of active treatment and the same amount of observation time.After 6 months, patients who take Alfuzosina, a more pronounced decrease in symptoms on the NIH-CPSI scale, 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 decreased significantly, unlike others associated with urination and quality of life.In the Alfuzosina group, 65% of patients had an improvement in the NIH-CPSI scale in more than 33%, compared to 24% and 32% in placebo and control groups (p = 0.02).6 months after the abolition of the medication, the symptoms began to increase gradually, both in the Alfuzosina group and in placebo.

The use of the selective alpha-1A/D-Ad-Reforted Tamsulosin controller for HP/KTB also demonstrates a good clinical effect.According to Chen Xiao Song et al.(2002) at 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 QAVE in 30.4% and 65.4%, respectively, was recorded within 4 weeks.Narayan P. et al.(2002) reported on the results of a randomized randomized dual -blind study of 6 weeks of tamsulosin in patients with HAP/STBB.27 men received the medicine, a placebo - 30. A reliable decrease in symptoms in patients who take tamsulosin and their growth in the placebo group was revealed.In addition, the heavier the initial symptoms in the main group were, the more impressed the improvement was expressed.The number of side effects was comparable in the groups of tamsulosin and placebo.A positive effect was achieved in 71.8% of patients.After a year of therapy, the decrease in the I-PSS scale is 5.3 points (52%) and the reduction in QOL-3.1 points (79%).

Today, most experts express an opinion on the need for a long-term reception of alpha-1 blockers, since short courses (less than 6-8 months) often lead to a relapse of symptoms.This is also evidenced in one of the last works with Alfuzosina: in most patients, 3 months after the completion of the 3 -month treatment course, a relapse of symptoms was observed.Prolonged therapy is supposed to lead to a change in the lower urinary urinary tract receptor, but these data need confirmation.

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

Musorelaxantes and antispasmodics

Some scientists adhere to the neuromuscular theory of HAP/KTB pathogenesis (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 a sympathetic reflex dystrophy of the perineum muscles and the same background.Several damage to the level of the spinal cord regulatory centers can lead to a change in muscle tone, more frequently by a hyperspastic type, in which urodynamic disorders (bladder neck spasm, pseudo -detisión) are accompanied or the result of these conditions.

In some cases, pain can act as a result of a violation of the union of pelvic muscles in the trigger points called the bones of sacrum, cocix, pubic, sciatic, endopelvical fascia.The reasons for the formation of such phenomena are classified: pathological changes of the lower extremities, operations and anamnesis lesions, certain repeated infections, etc.In this situation, the inclusion of muscle and antispasmodic relaxants in complex therapy can be considered pathogenetically 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 prostatodynia.The authors conducted a comparative dual-blind study controlled the effectiveness of phenoxibenzamine that blocks adrenán, baclophene (Gaba-B agonist receptors, a relaxant of the transverse stripe muscles) and placebo in 27 patients with prostatodynamics.The symptomatic improvement was recorded in 48% of patients after the use of phenoxibenzamine, in 37% - baclofen and 8% - when a placebo is used.However, prospective large -scale clinical trials have not yet been carried out that could confirm the effectiveness of medications in this group in patients with HAP/KTB.

Non -steroid anti -inflammatory medications and analgesics

The use of non -steroid anti -inflammatory drugs, such as diclofenaco, ketoprofen or nimesulide, can be effective in the treatment of some patients with HAP/KTB.Analgesics are often used in the treatment of patients with KTB, however, there are few data on their effectiveness for a long period of time.

Plant extracts

Among plant extracts, the most studied are Serenea Repens and Pygeum Africanum.The anti -inflammatory and decongestant effect of the permixon is performed by inhibiting phospholipase A2, other enzymes of the Arachidon waterfall - cyclooxygenase and lipoxigenase, responsible for the formation of prostaglandins and leukotrners, as well as the influence in the vascular phase of inflammation, the permeations of the capillaries, the vain.As Recently Completed by the Recently Completed Morphological Studies in Patieves With DGPS, Treatment With Permixon, Against The Background of A Decree 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 of the severity of the severity ofINFLAMMATORY REACTION IN THE TISSUE OF THE PROSTA COMPART TO THE INITIAL INDICATORS AND THE CONTROL GROUP (P (P (P<0.001).

Reissigl A. et al.(2003) The first to inform the results of the permixon multicentric 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, 30%recorded a decrease in symptoms on the NIH-CPSI scale.The positive effect of treatment was recorded in 75% of the patients they 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 groups.The data presented indicate that Permixon has a positive effect on patients with HAP/CTB, however, treatment courses should be longer.

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

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

In general, for the use of plants extracts in patients with HAP/CTB, which contains mainly serene reverp and Pygeum Africanum, there are sufficiently theoretical and experimental justifications, which, however, should be confirmed by correct clinical studies.

5-INHIBITORS OF THE ALFA REDUCASA

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

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

• From the point of view of the etiology.

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

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

  The potential effect of finsteride with dysfunctional urine with high intra -rubal pressure, which causes the development of intratratic reflux.

• In terms of morphology.

  Inflammation occurs in the fabric of the prostate gland.

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

• From a clinical point of view.

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

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

  Finasteride is effective in the treatment of hematuria associated with DGP, which is associated with the 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 effectiveness of finsteride in a decrease in prostatitis symptoms.

Anticholinergic agents

The beneficial effect of anticholinergic agents is to weaken the symptoms of imperative urine, the poakiuria of day and night and maintain normal sexual activity.There is a positive experience in the use of several m collotors in patients with HAP/CTB with the presence of pronounced irritating symptoms, but without signs of in-frávez obstruction, both in monotherapy and in combination with?1 adrenergic authorities.Additional studies are needed to determine the place of medicines of this group in the treatment of patients with abacerial prostatitis.

Immunotherapy

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

Several immunotherapy options are very popular among national experts.From drugs that stimulate cell and humoral immunity:: the preparations of the thymus, the interferons, the inductors of the synthesis of the endogenous interferon and the synthetic agents are distinguished.These results are of particular interest in the light of the latest data on the important role of interleucin-8 under HP IIIA, where a potential therapeutic objective is considered (Hochreiter W. et al. 2004).At the same time, it should be taken into account that, in our opinion, the appointment of special immunocorrective therapy should be treated with great caution and carried out only if pathological changes are detected according to the results of the immune exam.

Transquilizers and antidepressants

The mental state study of patients with CP/KTB has led to the understanding of the contribution of psycho-symptomatic disorders to disease pathogenesis.Among PC patients, a quite 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, the publication on the use of salboutiamine can be observed, 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 salbutamine in complex therapy and 17 patients from the control group.It was established that in patients who took 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 treaters noticed an increase in libido, the 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 reopoliglyukin, trendal and sculptures.There are reports on the use of prostaglandin E1 in patients with HAP.Additional studies are needed, both for the development of methods to evaluate blood circulation disorders in patients with HAP/CTB, and to create schemes for optimal correction.

Biorregulators peptides

Prostalen and Vitaprost are widely used by national experts in the head of abacerial prostatitis.Drugs are complex of biologically insulated biologically active peptides of the cattle prostate glands.In addition to the thrust immunomodulatory effects described above, its symptomatic effect on CP, anti -inflammatories, microcirculatory and trophic is observed.At the same time, the studies in which the modern methods to evaluate the clinical image of HAP/KTB would have been used, for the medications of this group, they would not have been carried out yet.

Vitamins and trace elements

Vitamin and Elements Trace complexes play an important auxiliary value in the treatment of PC patients.Among them, the most important thing are Group B vitamins, 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 prostate antibacterial factor - zinc peptides complex).With bacterial prostatitis, there is a decrease in the level of zinc, which changes little at the bottom of the oral administration of this element traces.On the contrary, with abacterial prostatitis, there is a restoration of the zinc level during its exogenous intake.At the bottom of HP, a reliable decrease in the level of citric acid is observed.Vitamin E. Selena is an anti -coulifratic agent and is considered a high antioxidant and anti -Radical activity and is considered an oncoprotector, even in relation to RPG.In relation to those established, the use of medicines that contain balanced volumes of vitamins and microelena is justified.One of these medications is a medication containing selenium, zinc, vitamin E?-CAROTINA Y VITAMINA S.

Enzymotherapy

For many years, Lidase preparations have been used in the complex therapy of PC patients.Recently, several reports of national authors have appeared about the positive experience of the use of Vobenzim, such as a systemic enzymatic therapy drug in the complex treatment of PC patients.

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

According to the recommendations of the United States Institute of Health (NIH), the most commonly used abacerial prostatitis treatment methods, according to priority, according to evidence -based medicine criteria, can be represented by the following sequence:

• Priority of the treatment method (0-5);
• Antibacterial agents (antibiotics) 4.4;
• ALFA1 BLOCATORS 3.7;
• Prostate massage (course) 3.3;
• Anti -inflammatory therapy (non -steroid anti -inflammatory drugs, hydroxycine) 3.3;
• Anesthetic therapy (analgesics, amitripado, size) 3.1;
• Treatment of the inverse biological communication method (anorectal biofack) 2.7;
• Phytotherapy (serenea reverp/saw palmetto, Quercetin) 2.5;
• 5 Alfa Redtase inhibitors (finsteride) 2.5;
• Musorelaxants (Diazepam, Baclofen) 2.2;
• Thermotherapy (Transuretral microwave therapy, transureral needle ablation, laser) 2.2;
• Physiotherapy (general massage, etc.) 2.1;
• Psychotherapy 2.1;
• Alternative therapy (meditation, acupuncture, etc.) 2.0;
• Anticoagulants (Pentosana polysulfate) 1.8;
• Capsaicin 1.8;
• ALOPURINOL 1.5;
• Surgical treatment (a tour of the bladder neck, the prostate, the incisions of the transurethral prostate, the radical prostatectomy) 1.5.

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

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

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