Drug therapy of chronic prostatitis

22 September 2025

Prostatitis is acute or chronically loses the inflammation of the glandular (parenchymal) and interstitial tissue of the prostate gland. Medicines for the treatment of prostatitis The inflammation of the prostate gland, as an independent no-nosological form, was described for the first time by Ledmish in 1857. However, despite almost a 150-year-old story, prostatitis remains very common, studied not table and treating the disease badly.Including this is also due to the fact that in most cases of chronic prostatitis, its etiology, pathogenesis and pathophysiology remain unknown.

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

This is largely due to the high degree of marketing of the treatment of the disease, for which a huge number of different methods and drugs are proposed, which begin to be advertised even before reliable information on their effectiveness and safety.In addition, aggressive advertising, conducted using all types of media, is focused, first of all, to a patient who is unable to evaluate all the advantages and disadvantages of the proposed treatment.

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

Various methods for the treatment of prostatitis promote and use numerous medical centers (sometimes not having a urologist in the state), pharmacological companies and even paramedicine institutions.

This complicates the adoption of effective clinical decisions, limits the use of reliable diagnosis and treatment methods, leads to the "main" treatment, when, after the failure of the use of one method, another is prescribed by another, etc.Consequently, a violation of the balance between clinical and economic efficiency and the increase in medical care costs.To fill this gap it helps the knowledge of the bases and the introduction of the principles of medicine based on evidence to unify the approaches to the diagnosis and the choice of tactics of the treatment of chronic prostatitis.

What do you mean for chronic prostatitis?The modern interpretation of the term "chronic prostatitis" and the classification of the disease are ambiguous.Under his mask, a wide range of states of the prostate gland and a lower urinary tract can be hidden, starting from infectious prostatitis, chronic pelvic pain or prostatinia thus called for abacterial prostatitis and ends with neurogenic dysfunctions, allergic and metabols disorders.The absence of terminological unit is particularly relevant in the case of non-infectious CP, which is interpreted by various authors such as: prostatinia, chronic pelvic pain of synthesis, post-infectious prostatitis, myalgia of the muscles of the pelvic floor and consultant prostatitis.

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

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

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

the presence of pain in the pelvic/perineum, organs of the parental parent system for at least 3 months;
the presence (or absence) of obstructive or irrelevant symptoms of urination disorders;
A positive (or negative) result of a bacteriological study.

Chronic prostatitis is one of the widespread diseases and its manifestations are distinguished by a variety of symptoms.There are often publications indicating the extremely high incidence of CP.It has been reported that prostatitis leads to a significant reduction in the quality of life in men of working age: its influence is compared with Angina Pectoris, Crohn's disease or myocardial infarction.According to consolidated data of the American Association of Urologist, the incidence of chronic prostatitis varies from 35 to 98% and from 40 to 70% in men of reproductive age.

The absence of clear clinical and laboratory criteria for the disease and the abundance of subjective complaints determine the disguise under the diagnosis of CP of various pathological states of the prostate, urethra and neurological diseases of the pelvic area.The lack of an entire idea of the CP pathogenesis is highlighted by the disadvantages of the existing classifications, which is a serious barrier to understanding and successful treatment of this disease.

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

Currently, abroad is widely used and adopted as the main classification of the United States National Institute of Health, according to which: acute bacterial prostatitis (i), chronic bacterial prostatitis (II), chronic or antimomatic abacteric prostatitis (IIIB of III, such as IIIB, as well as chronic pelviced pains, as well as chronic pelviced pains, as well as the pains of the pain ofChronic prostates, as well as chronic prostate, as well as chronic pelviced pains, as well as chronic prostate pains, as well as chronic prostate, as well as chronic pelviced pains, as well as chronic pelviced pains, as well as the pains of chronic prostates, as well as chronic cunning, as well as chronic prostate pains, as well as chronic prostate.(IV).

Clinical characteristics of chronic prostatitis:

Mainly, young people aged 20-50 (average age 43 years) suffer;
The main and most frequent manifestation of the disease is the presence of pain or discomfort in the basin;
lasting of at least 3 months;
The intensity of symptomatic manifestations varies significantly;
The most common location of pain is the horse, but a sense of discomfort can occur in any area of the pelvis;
Location one side of pain in the testicle is not a sign of prostatitis;
The imperative symptoms are more characteristic than obstructive;
Erectile dysfunction can accompany CP;
The pain after ejaculation is the most specific for CP and distinguishes it from the hyperplasia of the benign prostate and healthy men.

In our country, a huge material has been accumulated on the use of various methods of diagnosis and treatment of the CP.However, most of the available data does not meet the requirements of medicine based on evidence: research is not randomized, carried out on a limited number of observations, in a center, without placebo control and sometimes without a control group.

Furthermore, the absence of a single classification of CP often does not give an idea of which categories of patients are actually a question in the works described.Therefore, the effectiveness of most of the treatment methods, which are widely advertised and used today (extraction of the transureral vacuum, transureual electromagnetic stimulation of the prostate, therapy-transrett, top-oliminated, transureral or not mention the "for the construction of the cut", for the construction of transuch-nineof Marthha.

Even the effectiveness of such a traditional method as the prostate gland massage and the indications are not yet clear for it.

The problem of choosing a drug for the treatment of patients with chronic (non -infectious) bacterial prostatitis related to the classification of Nih categories in IIIA and IIIB is a significant difficulty.This is due to the uncertainty of self-cord prostatitis and e-and-and-e-e-e-e, which derives from the ambiguity of theziology and pathogenesis of this disease.First of all, this formulation of the problem concerns prostatitis of category IIIB, also defined as "chronic abotteric prostatitis / chronic pelvic pain" (Hap / Stbb).

Paradoxically, the fact is proposed that many authors are proposed for the treatment of abotteric prostatitis, the use of antibacterial agents and data are provided that indicate a fairly high efficiency of this treatment.This once again testifies to the insufficient development of issues of ethiopathogenesis of the disease, the possible influence of the infection on its development and inconsistency of the terminology adopted, which we have previously indicated, proposing to divide the concepts of the prostatitis "abotterica" and "non -infectious".It is very likely that the diagnosis of Hap/CTB hides an entire range of different states, including those in which the prostate gland is involved in the pathological process only indirectly or not at all, and the diagnosis itself is a forced trimal society that requires a clear term to determine the indications for the prescription of the drugs.

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

antibiotics and antibacterial drugs;
Non -pounded anti -inflammatory agents (diclofenac, ketoprofen);
muscle and antispasmodic relaxants (baclofen);
A1-Bloccanti (Therazozin, Doxazin, Alfuzosin, Tamsulosin);
Plant extracts (Serenoa Repens, Pigeum Africano);
5A Redittasi inhibitors (Finsterida);
anticholinergic drugs (oxibutinine, tolterodine);
Modules and stimulants of immunity;
Bioregulatory peptides (prostate extract);
vitamins complexes and trace elements;
Antidepressants and tranquilizers (Amitriptylin, Diazepam, Salbutamine);
analgesics;
drugs that improve microcirculation, the rhetorical properties of the blood, the anticoagulants (Dextra, Poroxyphillin);
enzymes (hyaluronidase);
antiepileptic agents (Gabapentin);
Xantinoxidasi inhibitors (allopurinol);
Pepper pepper extraction (capsaicin).

It is impossible not to agree with the opinion that the therapy of the CP should be aimed at all the ties of etiology and pathogenesis of the disease, taking into account the activity, category and the degree of prevalence of the process and of being complex.At the same time, since the cause of the CP IIIA and IIIB is not exactly established, the use of many of the above drugs is based only on episodic messages on the experience of their use, often doubts from the point of view of medicine based on tests.To date, the complete care of the HAP seems to be a difficult goal, therefore symptomatic treatment, especially for patients in category IIIB, is the most likely way to improve the quality of life.

Antibacterial therapy

In the treatment of chronic abotic prostatitis, antibiotics are often empirically exciting, often with a positive effect.Up to 40% of patients with CP responds to the treatment of antibiotics both in the presence of a bacterial infection in the analysis and without it.It has been shown that the well-being of some HAP patients has improved after conducting an an-character therapy, which may indicate the presence of infection not detected with conventional methods.Nickel and Costeron (1993) found that in 60% of patients with previously diagnosed bacterial prostatitis, in which, after antimicrobial therapy against the background of the negative crops of the third portion of urine and/or the secret of the prostate and/or ejaculate, the symptoms have been preserved, a positive increase in the bacteric flara in the prost-you has been revealed.It should be borne in mind that the role of some microorganisms (coagulazo-neigger staphylococci, chlamydia, ureaplasma, anaerobic, mushrooms, tricomonadi) since the etiological factors of the CP have not yet been confirmed and is the subject of discussion.On the other hand, it cannot be excluded that some comments from the lower urinary tract, which are usually harmless, under certain conditions become pathogens.In addition, using more sensitive methods, unknown infectious agents can still be recognized.

Today, many authors consider justified to conduct an antibiotic therapy course for patients with HAP and, in cases where prostatitis is treated, they advise you to continue for another 4-6 weeks or even a longer period.In case of recurrence after the cessation of antimicrobial therapy, it is necessary to resume its conduct with the use of low dosages of drugs.Despite the fact that the last position causes some doubts, included in the recommendations of the European Urologists Association (2002).

Perhaps there is a logical substance 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 for lipids, have the property of a low protein bond and have a high dissociation constant (PKA).The cult of the drug of the drug, the greater the plasma of the blood, the fraction of unrelated (not ionized) molecules that can penetrate the epithelium of the prostate gland and spread in its secret.Lipids and soluble and minimally associated with plasma proteins, the drug can easily penetrate the lipid membrane electrically loaded with the epithelium of the prostate gland.Therefore, in order to obtain a good penetration of the antibiotic in the prostate gland, the drug used is lipid, it has rka> 8.6, characterized by optimal activities against gram-negative bacteria in pH> 6.6.

It should be borne in mind that the results of the prolonged use of the trimetrome-solfametoxazole remain unsatisfactory (Drach G.W. et al. 1974; Meares E.M. 1975; McGuire EJ, Lytonon B. 1976).Data on the processing of doxicicline and fluorochinoloni, including Norfloxacin (Schaeffer A.J, Darras F.S. 1990), Ciprofloxacin (Childs S.J. 1990; Weidner W. et al. 1991) and Offloxacin (Remy G. et al. 1988; COX C.E.E..Prostatitis of groups II, III and IIIV, for this purpose, levofloxacin began to be used successfully, which was demonstrated by Nickel C.J.

Alfa-1-addrenal market

Some scientists suggest that the pain and symptoms of irritative urination or difficulty in patients with Hab/KTB may be due to the obstruction of the lower urinary tract caused by the dysfunction of the bladder neck, the scratchy stenosis of the urethra or dysfunctional urine with high urethral pressure.When a trace of men under the age of 50 with a clinical diagnosis of CP, the ov functional structure of the bladder neck is detected in more than half of them, the obstruction due to the pseudo-ponte sphincter in another 24% and the instability of Detrusor in about 50% of patients.

Therefore, some forms of chronic prostatitis are associated with the initial compromised function of the sympathetic nervous system and the hyperactivity of the Alfa-1-adrenergic receptors.This is also highlighted by the work of domestic authors and our observations.

The reflux of intraprostatic proto reflux is described, caused by turbulent urination with high -pressure -tutable pressure.Reflux urine in the ducts and slices of the prostate gland can stimulate a sterile inflammatory reaction.

The literature data indicate that the Alfa-1-surgery switches, muscle relaxants and physiotherapy reduce the degree of manifestation of symptoms in patients with hub/ktb.Osborn D.E.Et al.(1981) The first to use a positive effect of Fenoxibenzamin in a controlled study with a placebo with a positive effect with prostitutinia.The improvement of the outflow of urine during blocking of the alpha-1 receptors of the bladder and prostate gland leads to a weakening of the symptoms.According to the results of the studies of alpha-blockers, clinical progress is observed in 48-80% of cases.Generalized data of the 4 -recurrence research project and similar?1 1 HP/CTB blockers, indicate on average a positive result of the treatment, in 64% of patients.

Neal D.E. Jr. e Moon T.D. (1994) hanno studiato Terasosos in pazienti con HAP e Prostatinia in uno studio aperto. Dopo un mese di trattamento, il 76% dei pazienti ha notato una diminuzione dei sintomi da 5,16 ± 1,77 a 1,88 ± 1,64 punti su una scala a 12 ballasti (P<0.0001) при использовании доз от 2 до 10 мг/сут. При этом через 2 месяца после окончания лечения симптомы отсутствовалиу 58% пациентов положительно ответивших на? 1-ареноблокатор.В недавнем дойноksi слепом stico ilolochi, через 14 недель оетили ушение, 56% пациентов на ф smellплацебо.Причем, 50% снижение боли по шctiле nih-cpsi быiant выapesicoi у 60% в в oscii-encouteплацебо (Cheah p.y. et al. 2003).При эto, в и и и ие, гvento достоверно ossi отличались по скорости мочеисани Today оъъему остаточной мset.Gul et al.(2001) при анализе резезтататов наб braska 39 пациентов с хап/схтб, прини, тшto т роозин и 30 - плацебо, выape снилен.выtiженнности сиoscichi в основной г Seventi в среднем на 35%, is л slatРазличия меж issue ° исходныchi outo ио-room показатела ’hi грπ т ° icent мина между нею и гvento плацебо быiantiдостоверны.Тем не менее, авторы селали выво hit о о, что 3-месянноtent кunti приема? 1-ареноблокат littleстойкоtenti иыhionti неннноrato снижениа симптомов.Они также уаалали, что доза теразозина в 2 м/сπ - слиш boat

The alfuzosine was used in a study controlled by recently prospective randomized placebo lasting 1 year, which included 6 months of active treatment and the same amount of observation time.After 6 months, patients with alfuzosine was recorded, a more pronounced reduction in symptoms on the NiH-Cpsi scale was recorded, which has reached a statistical meaning compared to placebo and control: 9.9;3,8 and 4.3 points, respectively (p = 0.01).Within this staircase, only the symptoms that characterize pain have significantly decreased, unlike other associated with urination and quality of life.In the Alfuzosin group, 65% of patients had an improvement in the NiH-Cpsi scale by over 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 the group of alfuzosine and placebo.

The use of selective controller Alfa-1a/D-adreno-Rin-Feding of Tamsulosine 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, a decrease in symptoms on the NiH-Cpsi scale in 74.5% of patients, as well as an increase in QMAX and QAVE by 30.4% and 65.4%, respectively, was recorded within 4 weeks.Narayan P. et al.(2002) reported the results of a 6 -week double -blind double -blind double -blind study with placebo on tamsulosine in patients with Hap/Stbb.27 men received the drug, a placebo - 30. A reliable reduction of symptoms has been revealed in patients taking tamsulosine and their growth in the placebo group has been revealed.In addition, the initial symptoms in the main group were heavier, the more the improvement was expressed.The number of side effects was comparable in the groups of tamsulosine and placebo.A positive effect was obtained in 71.8% of patients.After a year of therapy, the decrease in the I-PSS scale is 5.3 points (52%) and the reduction of Qol-3.1 points (79%).

Today, most experts expresses an opinion on the need for long-term reception of Alfa-1-Bloccanti, since short courses (less than 6-8 months) often bring symptoms to recurrence.This is also highlighted by one of the latest works with Alfuzosin: in most patients 3 months after the completion of the 3 -month treatment course, a relapse of the symptoms has been observed.It is assumed that prolonged therapy can lead to a change in the system of the lower urinary tract receptor, but such data require confirmation.

In general, do you have the impression that, as with DHCH,, the patients of the HAP have everyone's clinical efficiency?The 1-year 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?The 1-year switch and does not allow you to completely avoid the relapse of the disease in the abolition of the drug, significantly reduces the severity of the symptoms and increases the time before the impact.

Musorelaxanti and antispasmodic

Some scientists adhere to the neuro-muscular theory of the pathogenesis of Hap/Ktb (Osborn D.E. et al. 1981; Egan K.J., Krieger J.L. 1997; Andersen J.T. 1999).A detailed study on symptoms and a neurological examination can indicate the presence of reflex dystrophy nice of the perineum muscles and the fund itself.Various damage at the level of the regulatory centers of the spinal cord can lead to a change in the muscle tone, more often of a hyperspastic type, in which Urodynamic Disorders are accompanied (spasm of the neck of the bladder, pseudo -detement) or the result of these conditions.

In some cases, pain can act following a violation of the attachment of the pelvic muscles in the trigger points so called to the sacred, coccyx, pubic, sciatic bones, endopelvic band.The reasons for the formation of these phenomena are classified: pathological changes with lower ends, operations and lesions from anamnesis, a certain sport, repeated infections, etc.In this situation, the inclusion of muscle relaxants and antispasmodic in complex therapy can be considered justified pathogenetic.It has been reported that muscle relaxants are effective for dysfunction of sphincter, the spasm of the muscle from taze and perineum.Osborn D.E.Et al.(1981) The priority belongs to the first study on the action of muscle relaxants for prostatinia.The authors conducted a double-blind controlled comparative study on the effectiveness of Fenoxibenzamine, the Baclofen (Gaba-B agricultural receptors, a relaxing of the transversal stripes muscles) and the placebo in 27 patients with prostatodinia.The symptomatic improvement was recorded in 48% of patients after the use of Fenoxibenzamin, in 37% - Baclofen and 8% - when using a placebo.However, large -scale perspective clinical studies have not yet been conducted that could confirm the effectiveness of the drugs of this group in patients with hap/ktb.

Non -steering anti -inflammatory drugs and analgesics

The use of non -short anti -inflammatory drugs, such as diclofenac, ketoprofen or nimesulide, can prove to be effective in the treatment of some Hap/KTB patients.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 the extracts of plants, the most studied are Serenoa Repens and Pygeum Africanum.The anti -inflammatory and decongestant effect of the PERMIXON is built by inhibiting the A2 phospholipase, other enzymes of the Arachidone waterfall - cyclipopygenase and lipoxigenases, responsible for the formation of prostaglandins and leukotrie, as well as the influence on the vascular phase of infammation, permeability, the bathing, the tanks.AS Recently Completed by the Recently Completed Morphological Studies in Patients With Dgps, Treatment With Pemi, Against The Background of a Decrease in the proliferative acute acting by 32% and an amazing in The Stromal-Epithelial Ratio by 59%, meanInflammory Reaction in The Tissue of the Prostate Compared to the Initial Indicators and the Control Group (P (P (P<0,001).

Reissigl A. et al.(2003) The first to report the results of PERMIXON multicenter study in patients with Stbb.The treatment with Pemiixon for 6 weeks received 27 patients and 25 were observed in the control group.After treatment in the main group, a decrease in symptoms on the NiH-Cpsi scale was recorded by 30%.The positive effect of the treatment was recorded in 75% of patients who received Permixon, compared to 20% in the control group.It is characteristic that in 55% of the patients of the main group the improvement was considered moderate or significant, although 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 indicates that PERMIXON has a positive effect in patients with HAP/CTB, however, treatment courses should be longer.

In another pilot study, a decrease in the inflammatory markers of FNO and Interleukin-1b was shown against the background of PERMIXON therapy, which was related to its symptomatic effect (Vela-Navarrete R. et al. 2002).Many authors indicate the anti -inflammatory effect of the African Pygeum extract, its effect on the regeneration of the glandular epithelial cells and the secretory activity of the prostate gland, a decrease in hyperactivity and an increase in the threshold of increasingness.However, these experimental data must be confirmed by clinical studies on patients with Hap/CTB.

There are separate relationships on the positive effect of the flower pollen extract (Cernetonon) in patients with CP and Prostatinia.

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

5-ALFA inhibitors Redittasi

Numerous short -term pilot studies of the 5th Redittasi inhibitors confirm the opinion that Finsteride has a beneficial effect on urination and reduces the pain in CP/CTB.The morphological study conducted on patients with DGPZ indicates a significant reduction in the average area occupied by inflammatory in-fit with 52% original, 21% after treatment (p = 3.79*10-6).On success successfully 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 gravity of symptoms from 21 to 16 and the clinical index from 30 to 23 points.

Justification of the use of Finsteride in chronic abotic 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 depend on the androgens.

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

The potential effect of Finsteride with dysfunctional urination with high press -tuting pressure, causing the development of intrastrostatic reflux.
In terms of morphology.
Inflammation occurs in the fabric of the prostate gland.

The fine leads to the regression of the glandular tissue of the prostate.
From a clinical point of view.
Clinical success is associated with the inhibition of estrogen caused by androgens.

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

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

Opinions of individual urologists on the effectiveness of 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 urination, daytime and nocturnal polykiugia and maintain normal sexual activity.Is there a positive experience in the use of various M-cholinobrators in patients with HAP/CTB with the presence of pronounced irritative symptoms, but without signs of obstruction in noise, both in monotherapy and in combination with?Persians 1-adrenergic.Further studies are needed to determine the place of drugs of this group in the treatment of patients with abotteric prostatitis.

Immunotherapy

Some authors argue the point of view that non -kissing prostatitis occurrence is due to immunological processes accelerated by an unknown antigen or an autoimmune reaction.Recently, more and more attention has been paid to the role of cytokines in the development and maintenance of HP.They communicate on the discovery of the prostate in the secret of the increase, compared to the control of the level of the range of interferon, interleuchine 2, 6, 8 and a number of other cytokines.John et al.(2001) and Doble A. et al.(1999) found that with abacterial IIIV prostatitis, the relationship between CD8 (cytotoxic) and types of T-Linfocytes T-Linfocyte, as well as the level of cytokines has been increased.This may indicate that the term "non -inflammatory" prostatitis is perhaps not entirely adequate.In this situation, immune modulation through cytokine inhibitors or other approaches can be effective, but before recommending this type of treatment, the relevant tests should be completed.

Various immunotherapy options are very popular among domestic experts.Drugs that stimulate cellular and humoral immunity: the preparations of thyme, interferons, inductors of the synthesis of endogenous interferon and synthetic agents are distinguished.These results are of particular interest in the light of the latest data on the important role of Interleukin-8 under HP IIIA, where it is considered a potential therapeutic target (Hochreiter W. et al. 2004).At the same time, it should be noted that in our opinion, the appointment of a special immunocation therapy should be treated with great caution and undertaken only if pathological movements are detected based on the results of the immunological examination.

Transquilizer and antidepressants

The study of the mental state of patients with CP/KTB has led to an understanding of the contribution of psycho-symptoms to the pathogenesis of the disease.Among patients with CP, a rather frequent discovery is depression.In this regard, patients with Hap/STB are recommended for the appointment of tranquilizers, antidepressants and psychotherapy.From the latest works, you can see the publication on the use of salbutiamine, which has an antidepressant and psychostimulating 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 of the control group.It has been established that in patients taking this drug the duration of remission was significantly higher: 75% after 6 months in the main group against 36.4% in the control group.The shooters with salbutamine have noticed an increase in libido, vital general tone and a positive mood for treatment.

Drugs for blood circulation

It has been established that various changes in microcirculation, hemoocoagulation and fibrinolisi are registered in the CP patients.For the correction of emotional disorders, it is recommended to use Reopoliglyukin, trend and escolts.There are reports on the use of prostaglandina E1 in patients with Haps.Further studies are needed, both for the development of methods to evaluate blood circulation disorders in patients with Hap/CTB, and for the creation of patterns for their optimal correction.

Bioregulatory peptides

Prostalen and Vitaprost are widely used by domestic experts in the head of abotteric prostatitis.The drugs are complex of biologically active peptides isolated from the prostate glands of the cattle.In addition to the immunomodulating effects described above, its symptomatic effect is noted in fact CP, antimlammators, microcirculaors and trophies.At the same time, the studies in which modern methods to evaluate the clinical picture of Hap/KTB would have been used, for the drugs of this group, have not yet been conducted.

Vitamins and trace elements

The complexes of vitamins and trace elements play an important auxiliary value in the treatment of patients with CP.Among these, the most important are the 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 zinc peptide complex: zinc peptide).With bacterial prostatitis, a decrease in the level of zinc is observed, which changes little against the background of the oral administration of this trace element.On the contrary, with abotteric prostatitis, there is a restoration of the zinc level during its exogenous intake.Against the background of HP, there is a reliable reduction in the level of citric acid.Vitamin E. Selena is an anti -Caulifratic agent and is considered a high antioxidant and anti -frial activity and is considered as an oncoprotector, also in relation to the role -playing game.In connection with the declared, the use of drugs containing balanced volumes of vitamins and microelens necessary is justified.One of these drugs is a drug containing selenium, zinc, vitamin E,?-Carotin and Vitamin S.

Enzimotherapy

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

Today, in countries with developed health systems, recommendations for the diagnosis and treatment of diseases are compiled taking into account the principles of medicine based on evidence, on the basis of studies that have a high degree of reliability.As for the HAP/STB drug therapy, these studies are not clearly sufficient.Does the evidence -based medicine criteria correspond only to materials on the use of antibiotics and?1-addreno-blocker and, with some tolerances, plant extracts from Serenoa Upens.The data on the use of all other groups of drugs are mainly empirical.

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

Priority of the treatment method (0-5);
Antibacterial agents (antibiotics) 4.4;
Alpha1-Bloccanti 3.7;
Prostate massage (course) 3.3;
Anti -inflammatory therapy (non -short, hydroxyzyin anti -anti -inflammatory drugs) 3.3;
Anesthetic therapy (analgesics, amitriptyin, dimensions) 3.1;
Treatment of the reverse biological communication method (anorectal biofeemedback) 2.7;
Phytotherapy (Serenoa Repens/Saw Palmetto, Quercetin) 2.5;
5 inhibitors of Alfa Redittasi (Finsteride) 2.5;
Musorelaxants (Diazepam, Baclofen) 2.2;
Thermotherapy (transureual microwave therapy, transureral needle ablation, laser) 2.2;
Physiotherapy (general massage, etc.) 2.1;
Psychotherapy 2.1;
Alternative therapy (meditation, acupuncture, etc.) 2.0;
Anticoagulanti (Polisulfato Pentosana) 1.8;
Capsaicin 1.8;
Allopurinolo 1.5;
Surgical treatment (a tour of the bladder neck, prostate, engravings of the transureral prostate, radical prostatectomy) 1.5.

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

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

Therefore, a large number of various drugs and groups of drugs are proposed for the treatment of chronic abotic prostatitis and KTB, whose use is based on information on their effect in various phases of the disease of the disease.Without exception, all this is scarcely confirmed by evidence, evidence and evidence.To improve the results of the treatment of Hap and, in particular, groups of patients with pelvic pain, are associated with progress in the field of diagnosis and differential diagnosis of these conditions, the improvement and details of the clinical classification of the disease, the accumulation of reliable clinical results that characterize the effectiveness and safety of drugs in clearly defined groups of patients.