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Therapy of the drugs of chronic prostatitis

Prostatitis is an acute or chronic leakage of glitchful (parenchymal) and intersticial of the prostate tissue.Prostatitis treatment medicationsInflammation of prostate, as an independent nasosological form, was the first to describe Ledmish in 1857. years.However, despite almost 150-year history, prostatitis remains very common, the non-table has studied poor treatment of diseases.Including that this is also due to the fact that in most cases chronic prostatitis, its etiology, pathogenesis and pathophysiology remain unknown.

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

This is largely due to the high degree of commercialization of disease, which is proposed by a huge number of different methods and drugs that are beginning to advertise even before reliable information on their efficiency and security.Moreover, aggressive advertising, spent using all types of media, is focused on a patient who is unable to rate all the advantages and disadvantages of the proposed treatment.

On the other hand, the development of modern medical science has led to the occurrence of a series of new principles and methods of CP treatment.Each of the methods has its advantages and disadvantages.However, exercise urologist is unable to meet and analyze ever -insisting the amount of information published on prostatitis.Despite the large number of methodological materials, dissertations and publications on the diagnosis and treatment of CP data in necessary, for acceptance as a standard, practically no forms.

Various methods of prostatitis process promote and use numerous medical centers (sometimes do not have urologist in the state), pharmacological company, and even major institutions.

This makes it difficult to adopt effective clinical decisions, limits the use of reliable methods of diagnosis and treatment, when, after the failure of the use of a method, as a result of the balance between clinical and economic efficiency and increasing medical care costs.To meet this gap helps with the knowledge of the basics and the introduction of the principles of medicine that are united evidence of access to the diagnosis and choosing tactics treatment of chronic prostatitis.

What does chronic prostatitis mean?Modern interpretation of the expression "Chronic prostatitis" and classification of diseases are ambiguous.Under his mask, a wide range of prostate and lower urinary tract can be hidden, starting with infectious prostatitis, chronic pulp pain or thus-were calculated prostathomic for acacterial prostatitis and ending neurogenic dysfunction, allergic and metabolic disorders.The absence of terminological unity is especially relevant in the case of an ineffective CP, which interpret various authors as: more prostatin, synum chronic pelvic pain, post-infectious prostatitis, pelvis muscles and consultant prostatitis.

Many experts believe that chronic prostatitis is as an inflammatory disease predominantly infectious genesis with the possible contribution of autoimmune disorder, which characterizes damage to the parenchyms and interspace prostate tissue.

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

The U.S. National Institute of Health Institute are next according to the clinical concept of chronic prostatitis:

  • The presence of pain in the pelvis / perineum, the bodies of the genitourin system for at least 3 months;
  • the presence of (or absence) of obstructive or irritative symptoms of urination disorders;
  • Positive (or negative) result of a bacteriological study.

Chronic prostatitis is one of the widespread diseases, and its manifestations are characterized by various symptoms.There are often publications that indicate an extremely high CP frequency.Prostatitis leads to a significant reduction in the quality of life in working age men: its influence is compared to Angin Pectoris, Crohn's illness or myocardial infarction.According to the consolidated data of the American Association of Urologists, the frequency of chronic prostatitis varies from 35 to 98%, and from 40 to 70% in the men of reproductive age.

The absence of clear clinical and laboratory criteria for disease and plenty of subjective complaints determine the concealment diagnosed with a variety of pathological states of prostate, urethra, as well as neurological diseases of the Zrnkovica area.The lack of an entire idea of the CP pathogenesis testifies to the lack of existing classifications, which is a serious obstacle to understanding and successful treatment of this disease.

There are more than 50 classifications of prostatitis in the modern scientific literature.

Currently, abroad is widely used and adopted as the main classification of the American National Institute of Health, according to: acute bacterial prostatitis (s), chronic acacterial prostatitis or chronic poultry pain (IIII), as well as asymptomatic prostatitis with the presence of inflammation (IV).

Clinical characteristics of chronic prostatitis:

  • Basically, young men aged 20-50 (the average age of 43 years) suffer;
  • The main and most common manifestation of the disease is the presence of pain or discomfort in the pelvis;
  • lasts at least 3 months;
  • The intensity of the symptomatic manifestations varies significantly;
  • The most common localization of pain is crotch, but a sense of discomfort can appear in any part of the pelvis;
  • One -side localization of pain in the testis is not a sign of prostatitis;
  • Imperative symptoms are more characteristic than obstructive;
  • Erectile dysfunction can monitor CP;
  • After ejaculation pain is most full of CP and distinguishes it from benign hyperplasia of prostate and healthy men.

In our country, a huge material is accumulated on the use of different methods of diagnosis and treatment of CP.However, most available data does not meet the remedies with evidence: the research is not accidentally, performed in a small number of observations, in one center, without placebo control, and sometimes without a control group.

In addition, the absence of a unique CP classification often does not provide an idea of which patients categories are actually a question in the described work.Therefore the effectiveness of most of the methods of treatment, which are widely advertised (transuretral electromagnetic stimulation of prostate, therapy - transectran or intravascular gland on buzhu and building T.P.), not to mention "domestic and foreign" patented means ", cannotto consider proof.

Even the efficiency of such a traditional method as a prostate massage and indications are still not clearly defined.

The problem of choice for the treatment of patients with chronic bacterial (nonfective) prostatitis related to the classification of NIH to III and IIIB category is significant difficulty.This is due to the uncertainty of self-and-chronic acacterial prostatitis, which stems from the ambiguity of etiology and pathogenesis of this disease.First of all, such formulation questions relates to prostatitis category IIIB, also defined as "chronic acacterial prostatitis / chronic pelvic pain" (HAP / STBB).

Paradoxically, the fact that many authors are proposed to treat abcterial prostatitis, the use of antibacterial funds are given, and data indicating a fairly high efficiency of such treatment.This once again testifies to the insufficient development of Ethiopathogenesis of the disease, the possible impact of the infection of its development and inconsistencies of adopted terminology, which we earlier, proposing to share the concepts of "akacterial" and "ineffective" prostatitis.It is most likely that the diagnosis of HAP / CTB hides the overall gam of different conditions, including the prostate gland is included in the pathological process only indirectly or not, and the diagnosis itself is forced to be a clear term for determining drug inscriptions.

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

  • Antibiotics and antibacterial medications;
  • Not -steroidal anti-inflammatory agents (DICLOFENAC, KETOPROFEN);
  • muscular relaxants and antispasmodics (baclofen);
  • A1 blockers (therazosin, doxazin, alfuzosin, tamsulosin);
  • Plant extracts (Serenoa repair, Golum Africanum);
  • 5A reduction inhibitors (FINTERID);
  • Anticholinergic medications (oxybutin, tolterodine);
  • Modules and immunity stimulants;
  • Bioergulatory peptides (prostate extract);
  • Vitamin and trace elements complexes;
  • Antidepressants and means (amitriptylin, diazepam, salbutamine);
  • analgesics;
  • Medications that improve microcirculation, rheological properties of blood, anticoagulants (dextra, pentoxiphillin);
  • Enzymes (hyaluronidaza);
  • Antiepileptic agents (Gabapentin);
  • Xantino oxidative inhibitors (ALOPURINOL);
  • Pepper-pepper extraction (CAPSAICIN).

It is impossible to disappear with the opinion that CP therapy should be focused on all links of etiology and pathogenesis of the disease, take into account the activity, category and degree of process prevalence and being complex.At the same time, as the cause of CP III and IIIB is not exactly established, the use of many of the above drugs is based on episodic messages about the experience of their use, often suspicious from the point of view.To date, it seems that the complete cure of HAP is a difficult goal, so the 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 acacterial prostatitis, antibiotics are often empirically exciting, often with a positive effect.Up to 40% of patients with CP responds to treating antibiotics both in the presence of bacterial infection in the analysis and without it.It turned out that the benefit of some HAP patients improved after conducting the therapy analysis, which may indicate the presence of infections that have not been detected by conventional methods.Nickel and Costerton (1993) found that in 60% of patients with pre-diagnosed bacterial prostatitis, in which negative crops and / or ejaculation were prescribed, a positive increase in bacterial flora in the Prost-VI biobitote.It should be borne in mind that the role of some microorganisms (coagulazo-neiger staphylococks, chlamydia, ureplasm, anaeroba, mushrooms, trichonades) as an etiological factors of the CP are still not confirmed and the subject is discussed.On the other hand, it cannot be turned off that some comments of the lower urinary tract, which are usually harmless, under certain conditions become pathogens.In addition, using more sensitive methods, unknown contagious agents can still be recognized.

Today, many authors believe that it is justified to implement the Procedure of antibiotic therapy for patients with HAP, and in cases where prostatitis is treated, you advise more for another 4-6 weeks or even longer period.In case of relapse after the cessation of antimicrobial therapy, it is necessary to continue their behavior using low dose of drugs.Despite the fact that the latest positions causes certain doubts, it included the recommendations of the European Association of Urologists (2002).

There may be a logical venture use of antibiotics that penetrate the prostate tissue.Only some antimicrobial drugs penetrate the prostate.To do this, they must be constant in Lipid, have a low protein texting property and have a high constant of dissociation (PKA).As for RCC medications, it is greater plasma blood, the share of unrelated (non-ionized) molecules that can penetrate the epithelial prostate and spread in its secrecy.Lipid and soluble and minimally related plasma proteins, medicine can easily penetrate the electrically charged lipid membrane of the prostate epithelium.Therefore, in order to achieve a good penetration of antibiotics in the prostate, it is necessary for the drug used by Lipid-Isusible, has an RKA> 8.6, characterized by optimal activity against gram-negative bacteria in PH> 6.6.

It should be borne in mind that the results of long-term use of trimeter-sulfamethoxazole unsatisfactory (Drach G.W. et al. 1974; Mearres EJ, Lytton B. 1976).Data on the treatment of doxicycline and fluoroquinolone, including Norfloxacin (Schaeffer A.J, Darras F. 1990), Ciprofloxacin (Chiprofloxacin (Remy G. et al. 1988; Nickel J.C. et al. (2001) Taj vanksacinHe showed the ODIC effect with the prostatitis of groups II, III and IIV, for this purpose, for this purpose, for this purpose began to use the levofloxacin with success, which showed Nickel C.J. et al. (2003) in HAP / KTB patients.

Alpha-1-adrenal shit

Some scientists suggest that the pain and symptoms of irritative or hab / ktb urination can occur due to the blockage of lower urinary tract caused by the dysfunction of the bladder, scrapers, strict urethra or non-functional urination.When the clue from men under 50 years with the Clinical Diagnostics of the CP, the functional OV-structure of the urine reveals in more than half, the obstruction of the pseudo-deck with a sphincter in another 24% patients in about 50% of patients.

Therefore, some forms of chronic prostatitis are associated with the initial impaired function of the sympathetic nervous system and alpha-1 adrenergic receptor hyperactivity.The work of domestic authors and our own observations is also proving this.

Introprostatic proto reflux is described, caused by turbulent urination with high intra -uablet pressure.Reflux urine in channels and slices of prostate, can encourage a sterile inflammatory reaction.

The data of the literature show that alpha-1 overrides, muscle relaxants and physiotherapy reduce the degree of manifestation of symptoms in patients with node / KTB.OSBORN D.E.et al.(1981) The first to use the positive effect of phenoxibenzamine in a placebo-controlled study with a positive effect with prostotodine.Improving the outflow of urine during the alpha-1 bladder door block and the prostate from somewhere leads to weakening symptoms.According to the results of the alpha-blocker studies, clinical progress is observed in 48-80% of cases.Generalized data on 4-recent and similar research design?1 1-blockers in HP / CTB indicate a positive treatment result on average in 64% of patients.

Neal D.E. Jr. i Moon T.D. (1994) istražili su terasosote kod pacijenata sa HAP-om i prostatinijom u otvorenoj studiji. Nakon mjesec dana liječenja, 76% pacijenata primijetilo je smanjenje simptoma od 5,16 ± 1,77 do 1,88 ± 1,64 bodova na skali od 12 balasti (P<0.0001) при использовании доз от 2 до 10 мг/сут. При этом через 2 месяца после окончания лечения симптомы отсутствовали у 58% пациентов положительно ответивших на ?1-адреноблокатор.In the recent double blind Issendered, Čerez 14 weeks revised 56% Paciet's on the phones of Priema Terazozin and 33% - placebo.The uses, 50% lowering pain for the scales of the NIH-CPSI was high in 60% in Grup-PE active treatments by comparison with 37% in the Placebo group (Cheah p.y. et al. 2003).In this, in itoga, the group is unplugged by the speed of power and the volume of the rest of Mo-Či.GUL ET AL.(2001) When analyzing the results of the observation of the HAP / SHTB, the Prince-Mash Terazosin and 30 - placebo, reduced the significance of the symptoms in the basic group in the average to 35%, and the weight of the placebo.The various between the output and itogo-vym indicators of terazozin groups and the place of the place and the placebo group was statistical dos-tovern.TEM NO MENEE, Authors Made a Thus, What is the 3rd monthly priema course? 1-adrenoblockers Mading for the backs of Stojkogo and preset Symptoms.They also pointed out that the dose of terrazozin in 2 mg / sut - a similar low.

Alfuzosin was used in a recently promising randomized placebo-coko study lasting 1 year, which included 6 months of active treatment and the same amount of observation time.After 6 months, patients who take Alfusosin, a more pronounced crash symptom on the NIH-CPSI scale, which reached statistical significance in relation to placebo and control: 9.9;3.8 and 4.3 points, respectively (p = 0.01).Within this scale, only symptoms that characterize pain are significantly reduced, unlike others associated with the urination and quality of life.In the Alfusian group 65% of patients had 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 abolition of the drug, the symptoms began to gradually increase, both in Alfuson and placebo group.

The use of a selective alpha-1a / D-adreno-reinforced controller Tamsulosin for HP / KTB also shows a good clinical effect.According to Chen Xiao Song et al.(2002) On the background of the use of 0.2 mg of drugs, a reduction of symptoms on the NIH-CDE scale in 74.5% of QMax and QAVE, ie by 65.4%, ie by 65.4%, ie by 65.4%.Narayan P. et al.(2002) reported the results of the 6-week double-blind workplain placebo-controlled study of tamsulosine in patients with HAP / STBB.27 Men received medicine, placebo - 30. Reliable crash against symptoms in patients taking Tamsulosin and their growth in the placebo group.Moreover, the more difficult symptoms in the main group were, which is impressed improvement expressed.The number of side effects was comparable in Tamsulosin and Placeb groups.A positive effect was achieved in 71.8% of patients.After a year of therapy, the decline in I-PSS scale is 5.3 points (52%), and the reduction of QOL-3.1 points (79%).

Today, most experts express their opinion on the need for long-term reception of the alpha-1-1-blocker, because short courses (less than 6-8 months) often lead to relapse symptoms.This also depends on one of the latest works with Alfusonine: in most patients 3 months after the end of the quarterly treatment, relapse symptoms have been observed.It is assumed that long-term therapy can lead to changes in the device for the lower urinary tract receptors, but such data requires confirmation.

In general, one gets the impression that, as with DHCH, HAP patients have the clinical efficiency of everyone?1-outbred blocking are almost the same and differ only in the profile of their safety.At the same time, as our observations testify, although use?The 1-adrenal switch and does not fully allow the avoidance of recurring diseases in the abolition of the drug, significantly reduces the severity of the symptoms and increases the time before the relatement.

Musorelax and antispasmodics

Some scientists adhere to the neuro-muscular theory of Patogenesis HAP / KTB (Osborn D.E. et al. 1981; Egan K.J, Krieger J.L. 1997; Andersen J.T. 1999).A detailed study of symptoms and neurological examination may indicate the presence of cute reflective dystrophy of the muscles of the perineum and the same bottom.Different impairments at the level of spinal cord regulatory centers can lead to muscle tone, more often by hyperspastic type, in which urodynamic disorders (bubble door, pseudo -detision) or the result of these conditions.

In some cases, pain can act as a result of the injury to the attachment of the muscle headphone in such a - coded trigger of progress on the cross, KOKCYX, pubic, hazard bones, endopelvic fascia.The reasons for the formation of such phenomena are ranked: pathological changes from lower extremities, operations and anamnes, certain sports, repeated infections, etc.In this situation, the inclusion of muscle relaxants and antispasmodics in complex therapy can be considered pathogenically justified.It is reported that muscular relaxants are effective for dysfunction of sphincter, obscuring and perineum muscle spasm.OSBORN D.E.et al.(1981) The priority belongs to the first study of the action of muscle relaxants for Prostatodini.The authors conducted a comparative double-controlled study of phenoxibenzamine efficiency, baclofen (Gaba-B agonist receptors, relaxant of transverse striped muscles) and placebo in 27 patients with prostation.The symptomatic improvement was registered in 48% of patients after the use of phenoxibenzamine, in 37% - baclofen and 8% - when using placebo.However, large perspective clinical trials that could confirm the effectiveness of drugs of this group in patients with HAP / KTB have not yet been taken.

No -Shore-steroidal anti-inflammatory drugs and analgesics

The use of non-anaphalmotor drugs, such as diclofen, or namesulid, can be shown efficient in the treatment of some patients with HAP / KTB.The analgesics are often used in patient treatment with KTB, however, there are little data on their efficiency for a long time.

Herbal extracts

Among herbal extracts, serenoa reponens and Pigeum Africanum are most often.Anti -inparnatory and decongest effect of Permixon is realized by inhibiting phospholipases A2, other Arachidon Cascade - cycloking, and lipoxygenase, as well as the impact on the vascular phase of inflammation, capillary bandwidth, vascular path.As morphological studies in patients with DGPS, treatment with permixon, against the origin of a broader acute action by 32% and increasing inflammatory reaction in the prostate tissue in relation to the initial indicators and control group (P (P (P)<0,001).

Reissigl A. et al.(2003) The first is to report the results of the multicenter of the Permixon study in patients with STBB.Treatment from Permixon in 6 weeks received 27 patients, and 25 were observed in the control group.After the treatment in the main group, the reduction of symptoms on 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 the patients of the main group of improvements were considered moderate or significant, while in the control group - only in 16%.At the same time, 12 weeks after treatment, there was no reliable differences between groups.The presented data indicate that the ignition has a positive effect in HAP / CTB patients, however, treatment courses should be longer.

In the second pilot study, the reduction of inflammatory markers of the FNO and Interleukin-1B proved to the background of Permixon therapy, which is associated with its symptomatic effect (Vela-Navarrete R. et al. 2002).Many authors point to the anti-level effect of the Pigeum African extract, its influence on the regeneration of the gland gland and the secret activity of the prostate, a decline in hyperactivity and increase the threshold of excitement.However, these experimental data must be confirmed by clinical studies in patients with HAP / CTB.

There are separate reports on the positive effect of the blower pollen extract (Cernetonon) in patients with CP and prostitution.

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

5-alpha reductase inhibitors

Several short-term pilot studios of reductase inhibitors 5a confirm the opinion that FINTERID has a beneficial effect on urination and reduces pain in cp./ CTB.A morphological study in patients with DGPZ indicates a significant reduction in the average area busy in the dirt with the original 52%, to 21% after treatment (P = 3.79 * 10-6).On the successful treatment of the FINATORID 51 Patient KP IIIA in 6-14 months.(2002).The reduction is in spectrum pain for SO-CHP from 11 to 9 points, dysrch from 9 to 6, quality of 9 to 7, general seriousness of the symptom of 21 to 16 and the clinical index of 30 to 23 points.

Justification of the use of FINTERID in chronic abcterial prostatitis categories of NIH-III (according to Niku J.C., 1999):

  • From the etiology stop.

    The growth and development of the prostate for the termination depends on the androgen.

    The models have shown the models on experimental animals that the akacterial inflammation can be caused by hormone changes in the prostate.

    Potential effect of finsterides with dysfunctional urination with high pressure in internal pressure, causing the development of intrastrostatic reflux.

  • In terms of morphology.

    Inflammation occurs in the prostate gland tissue.

    Finasteride leads to prostate glandular tissue regression.

  • From the clinical point of view.

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

    Finasteride eliminates symptoms of damaged lower urinary tract function in patients with DHGPZ, especially with large quantities of prostate, when greading tissue prevails in it.

    Finasteride is effective in treating hematurally related to the DGPS, which is connected to a focal inflammation of the prostate.

    Opinions of certain urologists about the efficiency of prostatitis.

    The results of the three clinical studies indicate the potential efficiency of FINTERIDs in reducing prostatitis symptoms.

Antiholinergic agents

The beneficial effect of anticholinergic agents is to weaken the symptoms of imperative urination, days and night of Pollakiuria and maintaining normal sexual activity.There is a positive experience in using different m-cholinoblocators in patients with HAP / CTB with the presence of pronounced irritative symptoms, but without signs of reduced obstruction, both in monotherapy and in combination with?1 adrenergic blinds.Additional studies are needed to determine the location of the drugs of this group in the treatment of patients with acacterial prostatitis.

Immunotherapy

Some authors support the view that the occurrence of national prostatitis is accelerated by an unknown antigen or autoimmune reaction due to immune processes.Recently, more attention is paid to the role of cytokine in the development and maintenance of HP.They communicate on the detection of prostate in secrecy increased, compared to the control of the interferon-gamma level, Interleukins 2, 6, 8, and a number of other cytokines.John et al.(2001) and Doble A. et al.(1999) He found that with ABCTERIAL prostatitis IIV, CD8 ratio (cytotoxic) on the CD4 (helper) T-lymphocytes, as well as the level of cytokine.This may indicate that the notion of "non-soles" prostatitis, perhaps, is not very adequate.In this situation, immune modulation using cytokine inhibitors or other approaches can be effective, but before the recommendation of this type of treatment, relevant tests should be completed.

Various immunotherapy options are very popular among domestic experts.From drugs that encourage cellular and humoral immunity, the preparation of timus, interferon, inductor of the synthesis of endogenous interferon and synthetic agents.These results are of special interest for the light of the latest data on the important role of Interleukin-8 under HP IIIA, where it is considered a potential therapeutic goal (Hochreiter W. et al. 2004).At the same time, it should be noted that in our opinion, the appointment of special immunoferrative therapy is treated with great caution and take only if pathological shifts are detected in accordance with the results of immunological examination.

Transquilizers and antidepressants

The study of the mental status of patients with CP / KTB has led to understanding the contribution of psychoisomatic disorders of the pathogenesis of the disease.Among the patients with CP, a fairly common invention is depression.In this regard, HAP / STB patients are recommended for appointment by calming funds, antidepressants and psychotherapy.From the latest works, publication can be recorded on the use of Salboutiamine, which has an antidepressant and psychostimulating effect due to the impact on the reticular brain formation.The author watched 27 patients with CP IIIB received by Salbutamine in complex therapy and 17 patients of the control group.It was found that in patients taking this medicine, the duration of the remission is significantly higher: 75% after 6 months in the main group against 36.4% in the control group.Salbutamin tractors noted the rise of libid, general vital tone and a positive mood for treatment.

Blood circulation medications

It was founded to be in patients CP, various shifts of microcirculation, hemocagulation and fibrinolysis are recorded.For correction of hemod disorders, it is recommended to use reopoliglyukin, trendal and inflatable.There are reports on the use of Prostagland E1 in patients with HAPS.Additional studies are needed, both for the development of blood circulation disorders in patients with HAP / CTB, and for creating a scheme for their optimal correction.

Bioergulatory peptides

Domalj experts use prostal and vitaprocity widely in the main prostatitis head.Medications are the complexes of biologically active peptides isolated from the prostate gland of cattle.In addition to the above-described immunomodulational effects, its symptomatic effect was observed in CP, anti -inflammatory, microcirculatory and trophic effects.At the same time, studies in which modern methods for assessing the HAP / KTB clinical image, for drugs of this group have not yet been performed.

Vitamins and trace elements

The vitamin and trace elements play the important utility value in the treatment of patients with CP.Among them is the most important vitamins of the group B, Vitamins A, E, C, Zinc and Selenium.It is known that the prostatural gland is the most important zinc and accumulates zinc.Its antibacterial protection is associated with the presence of free zinc (prostatic antibacterial factor - zinc peptide complex).With bacterial prostatitis, a reduction in zinc levels was observed, which changes a little on the background of the oral administration of this trace element.Contrary to that, with acacterial prostatitis, there is a restoration of zinc level during its exogenous intake.A reliable drop in of lemong acid was observed on the HP background.Vitamin E. Selena is an anti -uli effective agent and is considered a high antioxidant and anti-worker activity and is considered an onkoprotector, including the RPG.In connection with the above, use of drugs that contain balanced amounts of vitamins and microeles needed.One of these drugs is a medicine containing selen, zinc, vitamin E,?-Karotina and Vitamin S.

Enzymotherapy

For many years, lodase preparations were used in complex patient therapy with CP.Several reports of domestic authors have recently appeared on the positive experience of using Vobenzim, as a drug system enzyme therapy in a complex treatment of patients with CP.

Today, countries with developed health systems, the recommendations for diagnosis and treatment of diseases are compiled taking into account the principles of medicine that are transferred to evidence-based evidence that have a high degree of reliability.Given the drug therapy HAP / STB, such studies are obviously not enough.Evidence-based medicine criteria suits only materials on the use of antibiotics and?1-adreno blocking and, with certain tolerances, herbal extracts of Serenoa shows again.Data on the use of all other drug groups are generally empirical.

According to the recommendations of the US Health Institute (NIH), the methods of treatment of abcterial prostatis, according to priority, in accordance with the criteria that transfer medicine, can be represented in the following order:

  • Priority treatment methods (0-5);
  • Antibacterial agents (antibiotics) 4.4;
  • Alpha1 blockers 3.7;
  • Prostate massage (course) 3.3;
  • Anti -inflammatory therapy (not -steroidal anti-inflammatory drugs, hydroxyine) 3.3;
  • Anesthetic therapy (analgesics, amitriptyin, size) 3.1;
  • Treatment of reverse biological communication methods 2.7;
  • Phytotherapy (Serenoa Reponens / Saw Palmetto, Quercetin) 2.5;
  • 5 alpha reduction inhibitors (FINTERID) 2.5;
  • Musorelax (diazepam, baclofen) 2.2;
  • Thermotherapy (transgural microwave thermotherapy, transurral needles for needles, 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;
  • Allopurinol 1.5;
  • Surgical treatment (Tour of the bladder door, prostate, transgural prostate, radical prostatectomy) 1.5.

Something different accents of priority treatment methods for chronic prostatitis in tenses P. (2003)

  • Antimicrobial therapy ++++;
  • Alfa1 blockers +++;
  • Antinupal medications ++;
  • Phytotherapy ++;
  • Hormone therapy ++;
  • Hyperthermia / thermotherapy ++;
  • Prostate Massage Course ++;
  • Alternative ways of treatment ++;
  • Psychotherapy ++;
  • Alopurinol +;
  • Surgical treatment (tour) +.

Thus, a large number of different drugs and groups of drugs are proposed to treat chronic acacterial prostatitis and KTB, whose use is used on their performance data in different stages of pathogenesis disease.Without exception, it is all poorly confirmed by evidence and evidence and evidence.To improve the results of the treatment of HAPS and, in particular, groups of patients with pelvic pain are related to the advance of diagnosis and differential diagnosis of these conditions, accuracy of reliable clinical results characterized by drugs in clearly defined patient groups.