Drug therapy of chronic prostatitis

22 September 2025

Prostatitis is an acute or chronic drainage of the glandular (parenchymal) and the interstitial tissue of the prostate gland. Medicines for the treatment of prostatitis Prostate inflammation, as an independent nosological form, was first described by LEDMISH in 1857. However, despite the almost 150-year history, prostatitis remains a very common, non-trap, studied and poor treatment of the disease.The inclusion of this is also due to the fact that in most cases of chronic prostatitis its etiology, pathogenesis and pathophysiology remain unknown.

Today, there is no other problem in urology, when it is true, doubtful data and frank 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 the treatment of the disease, for which a huge number of different methods and medicines are offered, which begin to be advertised before the reliable information about their effectiveness and safety.Moreover, aggressive advertising, conducted with the help of all types of media, is focused, first of all, for a patient who is unable to evaluate all the benefits and disadvantages of the proposed treatment.

On the other hand, the development of modern medical science has led to the emergence of a number of new principles and methods for treating CP.Each of the methods has its own advantages and disadvantages.However, the practitioner urologist is not able to get acquainted with and analyze the continuous amount of information published on the prostatitis problem.Despite a large number of methodological materials, dissertations and publications regarding the diagnosis and treatment of CP data in the necessary, for adoption as a standard, there is virtually no form.

Various methods of treating prostatitis encourage and use multiple medical centers (sometimes they have no urologist in the country), pharmacological companies and even institutions for paramedics.

This complicates the adoption of effective clinical solutions, limits the use of reliable methods of diagnosis and treatment, leads to the "basic" treatment when, after failure to use one method, another is prescribed by another, etc.As a result of this disturbance of the balance between clinical and economic efficiency and increasing the cost of medical care.In order to fill this gap, it helps to know the basics and the introduction of the principles of the drug based on evidence, to combine approaches to the diagnosis and the choice of tactics of 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 its mask, a wide range of prostate gland and lower urinary tract may be hidden, starting with infectious prostatitis, chronic pelvic pain or so -called prostatodin for abacus prostatitis and ending with neurogenic dysfunctions, allergic and metabolic dilutions.The lack of terminological unity is especially appropriate in the case of non-infectious CP, which is interpreted by various authors such as: prostatinia, chronic pelvic pain in the son-Baraban, post-infection prostatitis, pelvic muscle myalgia and prostatitis consultant.

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

It should be noted that chronic abacus 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 US National Institute of Health are the following from the clinical concept of chronic prostatitis:

The presence of pelvic/perineum pain, organs of the geniopoline system for at least 3 months;
the presence (or absence) of obstructive or irritable symptoms of urinary disorders;
Positive (or negative) result of a bacteriological study.

Chronic prostatitis is one of the widespread diseases and its manifestations are distinguished by different symptoms.There are often publications showing the extremely high frequency of CP.Prostatitis has been reported to lead to a significant reduction in the quality of life in men of working age: its influence is compared to angina, Crohn's disease or myocardial infarction.According to the consolidated data by the American Urologist Association, the frequency of chronic prostatitis ranges from 35 to 98% and from 40 to 70% in men of reproductive age.

The lack of clear clinical and laboratory criteria for the disease and the abundance of subjective complaints determine the masking under the diagnosis of CP of various pathological conditions of the prostate, urethra, as well as the neurological diseases of the pelvic region.The lack of an entire idea for the pathogenesis of CP is proven by the disadvantages of existing classifications, which is a serious barrier to understand and successfully treat this disease.

More than 50 prostatitis classifications have been found in modern scientific literature.

Currently, Abroad Is Widely used and Adopted as the Main Classification of the US National Institute of Health, Accredit to Which: Acute Bacterial Prostatitis (I), Chronic Bacterial Prostatis (I)Chronic Pelvic Pains (III), Including with Inflammatory Component (IIII), AS Well as It (IIIB), AS Well asymptomatic Prostatitis with the Prexness of Inflammation (IV).

Clinical characteristics of chronic prostatitis:

Mostly young men of 20-50 years (average age 43) suffer;
The main and most common manifestation of the disease is the presence of pain or discomfort in the pelvis;
continued at least 3 months;
The intensity of symptomatic manifestations varies greatly;
The most common localization of pain is crotch, but a feeling of discomfort can occur in any area of the pelvis;
One localization of testicular pain is not a sign of prostatitis;
The imperative symptoms are more characteristic than obstructive;
Erectile dysfunction may accompany CP;
Pain after ejaculation is the most specific CP and distinguishes it from benign prostate hyperplasia and healthy men.

In our country, a huge material accumulates in the use of various methods for diagnostics and treatment of CP.However, most of the available data do not meet the requirements based on evidence medicine: the study is not randomized, carried out on a small number of observations, in one center, without placebo control, and sometimes without a control group at all.

In addition, the lack of a single CP classification often does not give an idea of which categories of patients are actually a matter in the works described.Therefore, the effectiveness of most treatments that are advertised and used today (transurethral vacuum extraction, transurethral electromagnetic stimulation of the prostate, therapy-transrectal, the worst, transurethral or intravascular energy laser irradiation."Patented funds" cannot be considered proven.

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

The problem with the choice of medicine for the treatment of patients with chronic bacterial (non -infectious) prostatitis associated with the classification of the NIH to III and IIIb categories is a significant difficulty.This is due to the uncertainty of the abacus prostatitis of itself and chronicles, which stems from the ambiguity of the etiology and pathogenesis of this disease.First, such a formulation of the problem refers to category IIIB prostatitis, also defined as "chronic abacus prostatitis / chronic pelvic pain" (HAP / STBB).

Paradoxically, the fact that many authors have been proposed to treat abacus prostatitis are offered the use of antibacterial agents and data showing a rather high effectiveness of such treatment.This once again testifies to the insufficient development of the issues of the ethipatogenesis of the disease, the possible influence of the infection on its development and the mismatch of the adopted terminology, which we have indicated earlier, suggesting that the concepts of "abacus" and "non-infectious" prostatitis be divided.It is most likely the diagnosis of HAP/CTB to hide a whole range of different conditions, including when the prostate gland is involved in the pathological process only or not at all, and the diagnosis itself is a forced three -core company in need of a clear term to determine indications of prescribing drugs.

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

antibiotics and antibacterial drugs;
no -groid anti -inflammatory agents (diclofenac, ketoprofen);
muscle relaxants and antispasmodic (baclofen);
A1 blockers (Therazozin, Doxazin, Alfuzosin, Tamsulosin);
Plant extracts (Serenoa Repens, Pigeum Africanum);
5A reductase inhibitors (Finsterida);
Anticholinergic drugs (oxybutinin, tolterodine);
Modules and stimulants of immunity;
bioregulatory peptides (prostate extract);
complexes of vitamins and trace elements;
antidepressants and tranquilizers (amitriptyline, diazepam, salbutamine);
analgesics;
medicines that improve microcirculation, rheological properties of blood, anticoagulants (Dextra, Pentoxyphillin);
enzymes (hyaluronidase);
anti -epileptic agents (gabapentin);
Xanthinoxidase inhibitors (allopurinol);
Pepper extraction (capsaicin).

It is impossible not to agree with the view that CP therapy should be directed to all the links of the etiology and pathogenesis of the disease, to take into account the activity, category and degree of spread of the process and be complex.At the same time, since the cause of CP IIIA and IIIb is not accurately established, the use of many of the above medicines is based only on episodic reports of the experience of their use, often doubtful in terms of a drug -based drug.To date, full treatment of HAP seems to be a difficult goal, so symptomatic treatment, especially for patients in the IIIb category, is the most likely way of improving the quality of life.

Antibacterial therapy

In the treatment of chronic abacus prostatitis, antibiotics are often empirically exciting, often with a positive effect.Up to 40% of CP patients respond to antibiotic treatment, both in the presence of bacterial infection in and without.The well-being of some HAP patients has been shown to have improved after therapy with AN-characteristics, which may indicate the presence of an infection that has not been detected by conventional methods.Nickel and Costelon (1993) found that in 60% of patients with previously diagnosed bacterial prostatitis, in which, after antimicrobial therapy, the background of negative crops from the 3rd part of the urine and/or secret of prostate and/or ejaculation are preserved symptoms.It should be borne in mind that the role of some microorganisms (Coagulazo-Neiger Staphylococci, Chlamydia, ureaplasm, anaerobes, mushrooms, trichomonads), since the etiological factors of CP have not yet been confirmed and are subject to discussion.On the other hand, it cannot be ruled out that some comments on the lower urinary tract, which are usually harmless, become pathogenic under certain conditions.In addition, using more sensitive methods, unknown infectious agents can still be recognized.

Today, many authors believe that this is justified in conducting a test course of antibiotic therapy for patients with 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 the case of relapse after discontinuation of antimicrobial therapy, it is necessary to resume its behavior with the use of low doses of drugs.Despite the fact that the latter position causes some doubts, it included in the recommendations of the European Urologist Association (2002).

There may be a logical justification for 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 lipid-permanent, have the property of low protein binding and have a high constant of dissociation (PKA).The worship of the RCC of drugs, 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 to its secret.Lipid-soluble and minimally associated with plasma proteins, the drug can easily penetrate the electrically charged lipid membrane of the prostate epithelium.Therefore, in order to achieve good penetration of the antibiotic into the prostate gland, it is necessary to have the medicine used, to have 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 the prolonged use of the trime-supply-sulfamethoxazole remain unsatisfactory (Drach G.W. et al. 1974; Meares E.M. 1975; McGuire EJ, Lyton B. 1976).Doxiclin and fluoroquinolones, including Norfloxacin (Schaeffer A.J, Darras F. 1990), Ciprofloxacin (Childs S. 1990; Weidner W. 1991) and OFFLOX;Offloxacin showed the Odic effect with prostatitis of groups II, III and IIIV.

Alpha-1-adrenal shit

Some scientists suggest that the pain and symptoms of irritable or difficulty urinating in patients with hab/kTB may be due to clogging of the lower urinary tract caused by dysfunction of the bladder neck, scraper, stricture of the urethra, or dysfunctional urination with high urethral pressure.When a trace of men under the age of 50 with a clinical diagnosis of CP, the functional OV structure of the bladder neck is detected in more than half of them, clogging due to pseudo-parabery sphincter in another 24% and unstability of a detrusor in about 50% of patients.

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

Intraprostatic protlux is described, caused by high internal pressure turbulent urination.Reflux urine in the ducts and slices of the prostate gland can stimulate sterile inflammatory reaction.

Literature data show that alpha-1-adrenal switches, muscle relaxants and physiotherapy reduce the degree of symptoms in patients with Hub/KTB.Osborne D.E.et al.(1981) The first to use a positive effect of phenoxybenzamine in placebo-controlled study with a positive effect with prostatodin.Improvement of urine leakage during blocking the alpha-1-receptors of the bladder and prostate gland leads to the weakening of the symptoms.According to the results of alpha-blockers studies, clinical progress is observed in 48-80% of cases.Summary data on the 4-raccoon and similar research design?1 1-blockers in HP/CTB indicate a positive treatment result in an average of 64% of patients.

Neil DE Jr.and Moon T.D.(1994) examined terrassoso in patients with Hap and prostatia in an open study.After a month of treatment 76% of patients noted a decrease in symptoms of 5.16 ± 1.77 to 1.88 ± 1.64 points on a scale of 12 ballasts (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. В недавнем двойном слепом исследовании, через 14 недель отметили улучшение 56% пациентов на фоне приема теразозина и 33% - плацебо. Причем, 50% снижение боли по шкале NIH-CPSI было выявлено у 60% в груп-пе активного лечения по сравнению с 37% в группе плацебо (Cheah P.Y. et al. 2003). При этом, в итоге, группы достоверно не отличались по скорости мочеиспускания и объему остаточной мо-чи. Gul et al. (2001) при анализе результатов наблюдения 39 пациентов с ХАП/СХТБ, прини-мавших теразозин и 30 - плацебо, выявили снижение выраженности симптомов в основной группе в среднем на 35%, и лишь на 5% в группе плацебо. Различия между исходным и итого-вым показателями группы теразозина и между нею и группой плацебо были статистически дос-товерны. Тем не менее, авторы сделали вывод о том, что 3-х месячного курса приема ?1-адреноблокаторов недостаточно для получения стойкого и выраженного снижения симптомов. Они также указали, что доза теразозина в 2 мг/сут - слишком низка.

Alfuzosin is used in a recently prospective randomized placebo -controlled study of 1 year, which includes 6 months of active treatment and the same amount of surveillance time.After 6 months, patients receiving alfusosin recorded a more pronounced reduction of symptoms on the NIH-CPSI scale, which reaches statistical significance compared to placebo and control: 9.9;3.8 and 4.3 points, respectively (p = 0.01).In this scale, only the symptoms characterizing pain decrease significantly, unlike others related to urination and quality of life.In the alfusosin group, 65% of patients improved in the NIH-CPSI scale by more than 33%, compared to 24% and 32% in placebo and control groups (P = 0.02).6 months after the drug is eliminated, the symptoms began to increase gradually, both in the alfusosin and placebo group.

The use of selective alpha-1A/D-adrenal-supply controller of Tamsulosin for HP/KTB also demonstrates a good clinical effect.According to Chen Xiao Song et al.(2002) Against the background of the use of 0.2 mg of the drug, reducing the symptoms of the NIH-CPSI scale in 74.5% of patients, as well as the increase of Qmax and Qave by 30.4% and 65.4%, respectively, registered within 4 weeks.Narayan P. et al.(2002) are reported on the results of a 6-week double blindly randomized placebo-controlled study of tamsulosin in patients with HAP/STBB.27 men received the medicine, placebo - 30. A reliable reduction of symptoms was revealed in patients receiving Tamsulosin and their growth in the placebo group.In addition, the more severe the initial symptoms in the main group, the more impressed the improvement was impressed.The number of side effects was comparable to the groups of Tamsulosin and placebo.A positive effect was achieved in 71.8% of patients.After a year of therapy, the reduction of the I-PSS scale is 5.3 points (52%) and the decrease in QOL-3.1 points (79%).

Today, most experts express an opinion on the need for long-term intake of alpha-1-blockers, as short courses (less than 6-8 months) often lead to relapse of symptoms.This is also evidenced by one of the latest alfusosin works: in most patients 3 months after the 3-month course of treatment is completed, a relapse of symptoms is noted.Prolonged therapy is thought to lead to a change in the receptor of the lower urinary tract, but such data need confirmation.

In general, a person is left with the impression that, as with DHCH, HAP patients have clinical effectiveness from all?The 1-adrenal blockage is almost the same and they differ only in the profile of their safety.At the same time, as our observations testify, although the use of?1-dashing switch and does not allow the disease to be completely escaped to eliminate the drug, it significantly reduces the severity of the symptoms and increases the weather before relapse.

Mussorelaxants and antispasmodics

Some scientists adhere to the neuro-muscle theory of the pathogenesis of HAP/KTB (OSBORN D.E. Et al. 1981; Egan K.J., Krieger J.L. 1997; Andersen J. 1999).A detailed study of the symptoms and a neurological examination may indicate the presence of a sympathetic reflex dystrophy of the perineum muscles and the same bottom.Various damage to the level of regulatory centers of the spinal cord can lead to a change in muscle tone, more often than the hyperpastic type, in which urodynamic disorders (spasm of the bladder neck, pseudodisia) are accompanied by these conditions.

In some cases, the pain may act as a result of a disorder of the attachment of the pelvic muscles in the SO -the torn trigger points to the sacrum, coccyx, pubic, buttocks, endopelvical fascia.The reasons for the formation of such phenomena are ranked: pathological changes from the lower limbs, surgery and history injuries, certain sports, multiple infections, etc.In this situation, the inclusion of muscle relaxants and antispasmodics in complex therapy can be considered pathogenetically justified.Muscle relaxants have been reported to be effective for sphincter dysfunction, pelvis and perineum muscle spasm.Osborne D.E.et al.(1981) Priority belongs to the first study of the action of muscle relaxants for prostatodin.The authors conducted a relatively dual-blind controlled study of the effectiveness of the blocking address phenoxymine, baclofen (GABA-B agonist receptors, relaxant of transverse stripes) and placebo in 27 prostatodin patients.Symptomatic improvement was reported in 48% of patients after the use of phenoxybenzamine, in 37% - baclofen and in 8% - using placebo.However, large -scale prospective clinical trials that could confirm the effectiveness of the drugs of this group in patients with HAP/KTB have not yet been taken.

Non -steroidal anti -inflammatory drugs and analgesics

The use of non -steroidal anti -inflammatory drugs, such as diclofenac, ketoprofen or nimesulide, may be effective in the treatment of some patients with HAP/KTB.Analgesics are often used in the treatment of KTB patients, but there is little evidence of their effectiveness over a long period of time.

Plant extracts

Among the plant extracts, the most studied are Serenoa Repens and Pygeum Africanum.The Anti -inflammatory and Decongestant Effect of Permixon Is Realized by Inhibiting The Phospholipase A2, Other Enzymes of the Aracyidon Cascade and Cycloxygenase and Lipoxygenase, ResponsLeukotriese, as well as the influence on the vascular phase of inflammation, the Permeability of Capillaras, Vascular Stasis.As recently completed by recently completed morphological studies in patients with DGP, treatment with Permixon, against the background of decreased proliferative acute action by 32% and increasing the stromal-epithelial ratio by 59%, significantly reduced the severity of the inflammatory reaction in the prostate tissue compared to the initial indicInitial indicators and the control group (POP (P-Prostate compared to the original indicators and the control group (POP (P (P.<0,001).

Reissigl A. et al.(2003) The first to report the results of a multi -centered permixon study in patients with STBB.Treatment with permixone for 6 weeks received 27 patients and 25 were observed in the control group.After treatment in the main group, a reduction in symptoms on the NIH-CPSI scale is recorded by 30%.The positive effect of treatment is reported 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 is considered moderate or significant, while in the control group - only in 16%.At the same time, 12 weeks after treatment, there are no reliable differences between the groups.The data presented show that Permixon has a positive effect in patients with HAP/CTB, but treatment courses should be longer.

Another pilot study showed a decrease in FNO and Interleukin-1B inflammatory markers against the background of permixon therapy, which correlates with its symptomatic effect (Vela-Navarrette R. et al. 2002).Many authors show the anti -inflammatory effect of the Pygeum africanum extract, its effect on the regeneration of the glandular epithelial cells and the secretory activity of the prostate gland, reduction of hyperactivity and increase in the threshold of excitability.However, these experimental data should be confirmed by clinical trials in patients with HAP/CTB.

There are separate reports on the positive effect of pollen extract (Cerneton) in patients with CP and prostatia.

In general, for the use of plant extracts in patients with HAP/CTB containing mainly Serenoa Repens and Pygeum Africanum, there are enough theoretical and experimental excuses, which, however, should be confirmed through proper clinical studies.

5-alpha reductase inhibitors

Several short -term pilot studies on 5A reductase inhibitors confirm the view that finsteride has a beneficial effect on urination and reduces CP/CTB pain.A morphological study in patients with DGPZ showed a significant reduction in the average area occupied by inflammatory stroke by the original 52%, up to 21% after treatment (P = 3.79*10-6).In successful treatment with Fineorid 51 patients KP IIIA for 6-14 months.(2002).There is a reduction in the 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 total severity of the symptoms from 21 to 16 and the clinical index from 30 to 23 points.

Justification of the use of finsteride in chronic abacus 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.

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

The potential effect of finsteride with high internal pressure dysfunctional urination, leading to the development of intrastrostatic refuxes.
With regard to morphology.
Inflammation occurs in the tissue of the prostate gland.

Finasteride leads to a regression of the glandular tissue of the prostate.
From a clinical point of view.
Clinical success is related to the inhibition of androgen estrogen inhibition.

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

Finasteride is effective in treating hematuria associated with DGP, which is associated with focal inflammation of the prostate.

Opinions of individual urologists on Finsteride's effectiveness for prostatitis.

The results of three clinical studies show the potential effectiveness of finsteride when the symptoms of prostatitis are reduced.

Anticholinergic

The beneficial effect of anticholinergic agents is to weaken the symptoms of imperative urination, day and night Pollakiuria and maintain normal sexual activity.He has a positive experience in the use of various M-cholinolocautors in patients with HAP/CTB with the presence of pronounced irritable symptoms, but without signs of infravital obstruction, both in monotherapy and in combination with?1-adrenergic blinds.Further studies are needed to determine the site of drugs in this group in the treatment of patients with abacus 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 for the detection of the prostate in the secret of the increase, compared to the control of the level of interferon-gama, interleks 2, 6, 8 and a number of other cytokines.John et al.(2001) and Doble A. et al.(1999) found that with abacus prostatitis IIIV, the CD8 (cytotoxic) ratio to CD4 (helper) Types of T-lymphocytes, as well as the level of cytokines, increases.This may indicate that the term "non -inflammatory" prostatitis is, it may not be quite adequate.In this situation, immune modulation with the help of cytokine inhibitors or other approaches can be effective, but before this type of treatment is recommended, the relevant tests must be completed.

Different opportunities for immunotherapy are very popular with home experts.Medicines that stimulate cellular and humoral immunity: thymus preparations, interferons, inductors of endogenous interferon synthesis, 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 on HP III, 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 immunocrective therapy should be treated with great caution and only if pathological changes are detected according to the results of the immunological examination.

Tranquilizers and antidepressants

The study of the mental status of patients with CP/KTB has led to an understanding of the contribution of psycho-somatic disorders to the pathogenesis of the disease.Among patients with CP, a very common finding is depression.In this regard, patients with HAP/STB are recommended for the appointment of tranquilizers, antidepressants and psychotherapy.Of the latest works, it can be noted the publication of the use of salbutiamine, which has an antidepressant and psychostimulatory effect due to the effect on the reticular formation of the brain.The author observes 27 patients with CP IIIB who have received salbutamine in complex therapy and 17 patients in the control group.It has been found that in patients taking this medicine, the duration of remission is significantly higher: 75% after 6 months in the main group against 36.4% in the control group.Salbutamine travelers have noted an increase in libido, general vital tone and positive mood for treatment.

Circulation

Various changes of microcirculation, haemocoagulation and fibrinolysis have been found to be recorded in patients with CP.It is recommended to use Reopoliglyukin, Trendal and Escults to correct hemodia disorders.The use of prostaglandin E1 has been reported in patients with HAP.Further studies are needed to develop methods of assessing blood circulation disorders in patients with HAP/CTB, as well as to create schemes for their optimal correction.

Bioregulatory peptides

Prostalen and Vitaprost are widely used by domestic experts in the leader of abacus prostatitis.Medicines are complexes of biologically active peptides isolated from the prostate glands of cattle.In addition to the pressed immunomodulatory effects, the symptomatic effect of CP, anti -inflammatory, microcirculatory and trophic effects is noted.At the same time, studies that would use modern methods to evaluate the clinical picture of HAP/KTB, for the medicines of this group have not yet been carried out.

Vitamins and trace elements

Vitamin and trace elements complexes play an important auxiliary value in the treatment of patients with CP.Among them, the most important are Group B vitamins, vitamins A, E, C, zinc and selenium.It is known that the prostate gland is the most rich zinc and accumulates zinc.Its antibacterial protection is associated with the presence of free zinc (prostatic antibacterial factor - zinc peptide complex).Bacterial prostatitis shows a decrease in zinc level, which changes slightly against the background of the oral administration of this post -post element.In contrast, with abacus prostatitis, there is a restoration of zinc level during its exogenous intake.Against the background of HP, a reliable decrease in citric acid level is noted.Vitamin E. Selena is an anti -caulphratic agent and is considered to be high antioxidant and anti -radical activity and is considered to be an oncoprotector, including in connection with RPG.In connection with the stated use of medicines containing balanced volumes of the necessary vitamins and traceries, it is justified.One of these drugs is a medicine containing selenium, zinc, vitamin E?-Carotene and vitamin S.

Enzymotherapy

For many years, lidase preparations have been used in complex therapy for patients with CP.There have recently been several reports of home authors about the positive experience of using Vobenzim as a medicine from systemic enzyme therapy in the complex treatment of CP patients.

Today, in countries with developed health systems, the recommendations for diagnosis and treatment of diseases are drawn up taking into account the principles based on evidence based on studies that have a high degree of reliability.With regard to HAP/STB drug therapy, such studies are obviously not enough.Do evidence -based medicine criteria only meet materials for the use of antibiotics and?1-Adrenal-blocking and with certain deviations, plant extracts from Serenoa Repens.The data on the use of all other drug groups are mainly empirical.

According to the recommendations of the American Institute of Health (NIH), the most commonly used methods for the treatment of abacus prostatitis, according to priority, in accordance with the criteria for medical -based medicine, can be presented by the following sequence:

Priority of the treatment method (0-5);
Antibacterial agents (antibiotics) 4.4;
Alpha1-blockers 3.7;
Prostate massage (course) 3.3;
Anti -inflammatory therapy (non -steroidal anti -inflammatory drugs, hydroxisin) 3.3;
Anesthetic therapy (analgesics, amitriptin, size) 3.1;
Treatment of a method of reverse biological communication (anorectal biofiad) 2.7;
Phytotherapy (Serenoa Repens/Saw Palmetto, Quercetin) 2.5;
5 alpha reductase inhibitors (finsteride) 2.5;
Missorelaxants (Diazepam, Baclofen) 2.2;
Thermotherapy (transurethral microwave thermotherapy, transurethral needle ablation, laser) 2.2;
Physiotherapy (common massage, etc.) 2.1;
Psychotherapy 2.1;
Alternative therapy (meditation, acupuncture, etc.) 2.0;
Anticoagulants (pentosan polysulfate) 1.8;
Capsaicin 1.8;
Allopurinol 1.5;
Surgical treatment (circumference of the bladder neck, prostate, prostate prostate cuts, radical prostatectomy) 1.5.

Few different accents of the priority of the methods of treating chronic prostatitis B B. (2003)

Antimicrobial therapy ++++;
Alpha1-blockers +++;
Anti -inflammatory drugs ++;
Phytotherapy ++;
Hormonal therapy ++;
Hyperthermia / thermotherapy ++;
Prostate massage course ++;
Alternative treatments ++;
Psychotherapy ++;
Allopurinol +;
Surgical treatment (circumference) +.

This offers a large number of different drugs and groups of medicines for the treatment of chronic abacus prostatitis and KTB, whose use is based on information about their effect at different stages of pathogenesis of the disease.Without exception, all this is poorly confirmed by evidence and evidence and evidence.To improve the results of HAP treatment, and especially groups of patients with pelvic pain, are related to the progress in the area 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 that characterize the effectiveness and safety of the drugs.