Chronic prostatitis drug therapy

Prostatitis is an acute or chronic inflammation of the gland (parenchymal) and the interstitial tissue of the prostate gland.Inflammation of the prostate gland, as an independent form of nosology, was first described by Ledmish in 1857. However, although almost 150 years of history, prostatitis remains very common, not examined and less treating the disease.This includes also due to the fact that in most cases of chronic prostatitis, etiology, pathogenesis and pathophysiology are still unknown.

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

This is largely due to the high commercialization of the treatment of the disease, in which a large number of different methods and drugs are proposed, which began to be advertised even before reliable information about their effectiveness and safety.In addition, aggressive advertising, which is carried out using all kinds of media, is focused, first of all, to patients who cannot evaluate all the advantages and disadvantages of the treatment.

On the other hand, the development of modern medical science has led to the emergence of several new principles and methods of treating CP.Each method has its own advantages and disadvantages.However, a practicing urologist cannot familiarize and analyze the amount of information published on prostatitis problems.Although many methodological materials, dissertations and publications on the diagnosis and treatment of CP data are needed, for acceptance as standard, no form.

Various methods of treating prostatitis promote and use many medical centers (sometimes have no urologists in the state), pharmacological companies and even paramedic institutions.

This complicates the use of effective clinical decisions, limiting the use of reliable diagnosis and treatment methods, leading to "primary" treatment, when, after failure to use one method, another is prescribed by another, and so on.As a result, a violation of a balance between clinical and economic efficiency and an increase in medical treatment costs.To fill this gap helps knowledge of the basics and the introduction of the principles of medicinal -based medicine to unify the approach to the diagnosis and choice of chronic prostatitis treatment tactics.

What does it mean by chronic prostatitis?Modern interpretation of the term "chronic prostatitis" and the classification of the disease is vague.Under its mask, various conditions of the prostate gland and lower urinary tract may be hidden, starting with infectious prostatitis, chronic pelvic pain or prostatodinia mentioned for abacterial prostatitis and ending with neurogenic dysfunction, allergic and metabolic disorders.The absence of terminological unity is very relevant in the case of non-contagious CPs, interpreted by various authors as: prostatinia, chronic pelvic pain Syn-Drum, post-infectious prostatitis, myalgia of pelvic floor muscles, and prostatitis consultants.

Many experts consider chronic prostatitis as an inflammatory disease that is mostly contagious with possible autoimmune disorders, which are characterized by damage to the parenchyma and interstitial tissue of the prostate gland.

Keep in mind that chronic abacterial prostatitis is 8 times more common than the bacterial form of the disease, which is up to 10% of all cases.

The US National Institute of Health experts is as follows by the clinical concept of chronic prostatitis:

• the presence of pelvic/perineum pain, the organ of the genitourinary system for at least 3 months;
• presence (or absence of) symptoms of unintentional or unpredictable from urinary tract disorders;
• Positive (or negative) results from bacteriological studies.

Chronic prostatitis is one of the widespread diseases, and its manifestations are distinguished by various symptoms.There are usually publications that show very high CP incidents.It is reported that prostatitis leads to a significant decline in quality of life in working men: its influence is compared to angina pectoris, Crohn's disease or myocardial infarction.According to the consolidated data from the American Urology Association, chronic prostatitis occurs from 35 to 98% and from 40 to 70% in reproductive men.

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 prostate pathology, urethra, and neurological diseases of the pelvic area.The overall lack of CP pathogenesis ideas is evidenced by the weaknesses of existing classification, which is a serious obstacle to understanding and treating the disease.

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

Currently, abroad is widely used and adopted as the main classification of the United States National Institute of Health, according to: acute bacterial prostatitis (I), chronic bacterial prostatitis (III) inflammation (IV).

Chronic clinical features of chronic prostatitis:

• Most young men from 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;
• Last at least 3 months;
• The intensity of the manifestation of symptoms varies significantly;
• The most common localization of pain is throat, but discomfort can occur anywhere in the pelvic area;
• A localization of pain in the testis is not a sign of prostatitis;
• Symptoms -important symptoms are more characteristic than obstructive;
• Erectile dysfunction can accompany CP;
• Pain after ejaculation is the most specific to CP, and distinguishes it from benign prostate hyperplasia and healthy men.

In our country, large materials have accumulated on the use of various methods of diagnosis and treatment of CP.However, most of the existing data does not meet the proof -based drug requirements: non -random research, conducted on a small number of observations, in one center, without placebo control, and sometimes without control groups at all.

In addition, the absence of a single CP classification often does not give an idea of the category of patients that is actually the question in the work described.Therefore, the effectiveness of most treatment methods, which is widely advertised and used today (transurethral vacuum extraction, electromagnetic stimulation of the grass. From domestic and foreign "patented" methods, cannot be considered.

In fact, the effectiveness of traditional methods such as the prostate gland massage, and the clues to it are still unclear.

The problem of choosing a drug for the treatment of patients with chronic bacterial prostatitis (not reduced) associated with the classification of the NIH category to IIIA and IIIB is a significant difficulty.This is due to the uncertainty of self-and-and-chronic abaterial prostatitis, which is caused by the etiological and pathogenesis of the disease.First of all, the formulation such as this issue involves category IIIB prostatitis, is also defined as "chronic abacterial / chronic pelvic disease" (HAP / STBB).

Paradoxically, the fact that many authors are suggested for the treatment of abacterial prostatitis, the use of antibacterial agents is proposed, and data that shows high treatment efficiency is given.This again testifies the inadequate development of the issues of etiopathogenesis, the possibility of infection on its development and the inconsistencies of the term adopted, which we have previously stated, suggested to divide the "abacterial" and "non-contagious" concepts of prostatitis.It is most likely that the diagnosis of HAP/CTB hides the whole state, including when the prostate gland is involved in the pathological process only indirectly or indirectly, and the diagnosis itself is a forced trimal company that requires a clear term to determine the signs for prescription drugs.

Today we can say confidently that an approach to the treatment of patients with hap/CTB has not been formed.For the same reason, various drugs proposed for the treatment of these conditions, the main group that can be represented by the following classifications:

• antibiotics and antibacterial drugs;
• Anti -non -—steroid agents (diclofenac, ketoprofen);
• muscle relaxants and antispasmodics (baclofen);
• A1-blockers (therazozin, doxazin, alfuzosin, tamsulosin);
• Plant extracts (Serenoa Repens, Pigeum Africanum);
• 5A Redukitase inhibitors (Finserides);
• anticholinergic drugs (oxibutinin, tolterodine);
• Modules and immunity stimulation;
• Bioregulatory peptides (prostate extract);
• vitamin complexes and trace elements;
• antidepressants and sedatives (amitriptylin, diazepam, salbutamine);
• analgesics;
• Medicines that improve micro -circulation, blood rheological properties, anticoagulants (dextra, pentoxyphillin);
• enzymes (hyaluronidase);
• antiepileptic agents (gabapentin);
• inhibitor xanthinoxidase (allopurinol);
• Pepper extraction (capsaicin).

It is impossible to disagree with the opinion that CP therapy should be addressed to all etiological links and pathogenesis of the disease, taking into account the activities, categories and levels of the process of the process, and become complex.At the same time, because the causes of CP IIIA and IIIB are incorrect -correctly established, the use of many drugs above is based solely on episode messages on its use experience, often doubted from the point of view of proof -based drugs.To date, complete healing is as difficult as a goal, so symptom treatment, especially for category IIIB patients, is the most possible way to improve the quality of life.

Antibacterial therapy

In the treatment of chronic abacterial prostatitis, antibiotics often enhance empirically, often with positive effects.Up to 40% of CP patients respond to good antibiotic treatment in the presence of bacterial infections in the analysis and without it.It has been shown that the well-being of some HAP patients improved after performing an-access therapy, which may indicate the presence of infection that was not detected by conventional methods.Nickel and Costerton (1993) found that in 60% of patients with previously diagnosed bacterial prostatitis, where, after antimicrobial therapy of the negative plant background from the 3rd part of the urine and/or prostate and/or ejaculation, it should be noted that the role of some microorganisms (coagulazo-neiger, chlamydia,Anaerobes, mushrooms, trichomonads) as CP etiological factors have not been confirmed and are the subject of discussion.On the other hand, it cannot be excluded that some lower urinary tract comments, 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 think it is appropriate to conduct an antibiotic therapy trial course for patients with hap, and in cases where prostatitis is treated, they advise you to continue for another 4-6 weeks or even longer.In the event of a relapse after cessation of antimicrobial therapy, it is necessary to continue its behavior with low dose use.Although the current position has caused certain doubts, it is included in the proposal of the European Urology Association (2002).

There may be logical confirmation of the use of antibiotics that penetrate the prostate gland tissue.Only a few antimicrobial drugs penetrate the prostate gland.To do this, they must be lipid-Constant, have low protein properties and have high separation (PKA).The worship of RCC drugs, the higher the blood plasma, the unrelated (unrecognized) molecular breakdown that can penetrate the epithelium of the prostate gland and secretly.Lipid-and-wrinkled and minimal is associated with plasma protein, this drug can easily penetrate electric lipid membranes that are applied electric from the prostate gland.Therefore, in order to achieve good antibiotic penetration in the prostate gland, it is necessary that the drug used is lipid-asable, has RKA> 8.6, characterized by optimal activity of gram-negative bacteria in pH> 6.6.

Keep in mind that the results of prolonged trimetrome-sulfametoxazole remain unsatisfactory (Drach G.W. et al 1974; Meares E.M. 1975; McGuire EJ, Lytton B. 1976).Data on doxycycline and fluoroquinolones treatment, 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. Offloxacin shows the effect of Odic with Prostatitis Group II, III and IIIV.

Alfa-1-Adrenal Shit

Some scientists suggest that irritating urinary tract and severe symptoms of patients with HAB/KTB may be due to lower urinary tract obstruction caused by bladder neck dysfunction, scraper, urethra tightness or urine with high uretral pressure.When male effects under the age of 50 with clinical diagnosis of CP, the OV structure of the bladder's neck function is detected more than half of them, the obstruction of pseudo-decin-decker in 24% instability and detrusor instability in about 50% of patients.

Therefore, several forms of chronic prostatitis are associated with early impaired function of the sympathetic nervous system and hyperactive alpha-1-adrenergic receptors.This is also evidenced by the work of our own domestic author and our own observations.

Intraprostatic proto reflux is described, due to the rough urine with high intra pressure.Urine reflux into the channel and sheet of prostate gland can stimulate the sterile inflammatory response.

Literature data shows that alpha-1-adrenal switches, muscle relaxants and physiotherapy reduce the level of manifestations of symptoms in patients with HAB/KTB.Osborn D.E.et al.(1981) the first to use the positive effects of phenoxibenzamin in a placebo -controlled study with positive effects with prostatodinia.Increased urine flow during obstruction of the alpha-1 reception of the bladder and the prostate gland leads to the weakness of the symptoms.According to the results of the alpha-blockers study, clinical progress was observed in 48-80% of cases.General data on research design 4 and similar?1 1-blockers in HP/CTB, showing positive results of treatment, on average, in 64% of patients.

Neal D.E. Jr. dan Moon T.D. (1994) menyiasat terasosos pada pesakit dengan HAP dan prostatinia dalam kajian terbuka. Selepas sebulan rawatan, 76% pesakit mencatatkan penurunan gejala dari 5.16 ± 1.77 hingga 1.88 ± 1.64 mata pada skala 12-ballast (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.)плацебо.Причем, 50% снижение боли по шкале nih-cpsi было выявлено у 60% в груп-пе активного лечения по сравнению с 37% в г г г г г г г г г г г г лплацебо (Cheah P.Y. et al. 2003).При этом, в итоге, групы достоверно не отличались по скорости мочеиспускания и обему остаточной мо-чи.Gul et al.(2001) при анализе результатов наблюдения 39 пациентов с хап/схтб, прини -мавших теразозин и 30 - плацебо,выраженности симптомов в основной группе в среднем на 35%, и лишь на 5% в г г плацебо.Различия между исходным и итого-вым показателями групы теразозина и между нею и групой плацебо были статистическидос-товерны.Тем не менее, авторы сделали вывод о том, что 3-х месячного курса приема?стойкого и выраженного снижения симптомов.Они также указали, что доза теразозина в 2 мг/сут - слишком низка.

Alfuzosin is used in this new placebo -controlled study that lasts for 1 year, including 6 months of active treatment and the same amount of observation time.After 6 months, patients taking alfuzosin, a more significant decrease in symptoms on the NIH-CPSi scale was recorded, which achieved statistical importance than placebo and control: 9.9;3.8 and 4.3 points, each (p = 0.01).In this scale, only symptoms that characterize pain decrease, unlike others related to urination and quality of life.In alfuzosin groups, 65% of patients had an increase in the NIH-CPSi scale by more than 33%, compared with 24% and 32% in the placebo and control groups (P = 0.02).6 months after the abolition of the drug, the symptoms begin to increase gradually, both in the alfuzosin and placebo groups.

The use of Alpha-1A/D-Adreno controllers selected for tamsulosin for HP/KTB also shows good clinical effects.According to Chen Xiao Song et al.(2002) against the background of 0.2 mg of drug use, decreased symptoms on the NIH-CPSi scale in 74.5% of patients, as well as increased QMAX and Qave by 30.4% and 65.4%, respectively, recorded within 4 weeks.Narayan P. et al.(2002) reported on the results of a placebo study controlled by a 6-week placebo in patients with HAP/STBB.27 men received the drug, placebo - 30. A reliable decrease in symptoms in patients taking tamsulosin and their growth in the placebo group was lowered.Furthermore, the more severe symptoms of the main group are, the more impressed the increase is stated.The number of side effects is comparable to the tamsulosin and placebo groups.Positive effects were achieved in 71.8% of patients.After the year of therapy, the decline in I-PSS scale was 5.3 points (52%), and Qol-3.1 point reduction (79%).

Today, most experts have expressed opinions on the need for long-term acceptance of Alpha-1-blockers, since short courses (less than 6-8 months) often cause recurrent symptoms.This is also evidenced by one of the latest works with alfuzosin: in most patients 3 months after 3 months of treatment, symptoms have been observed.It is considered that prolonged therapy can cause changes in lower urinary tract receptors, but the data requires confirmation.

In general, someone gets the impression that, like DHCH, hap patients have all clinical efficiency?The 1-adrenal barrier is almost the same, and they are only different in their security profile.At the same time, as our observations testify, despite its use?The 1-adrenal switch and do not allow to completely avoid the disease in the removal of the drug, it significantly reduces the severity of the symptoms and increases the time before recurrence.

Musorelaxants and antispasmodics

Some scientists adhere to the theory of neuro-shot pathogenesis of HAP/KTB (Osborn D.E. et al 1981; Egan K.J., Krieger J.L. 1997; Andersen J.T. 1999).Detailed studies on symptoms and neurological examinations may indicate the presence of the dysfunction of the perineum muscle sympathetic and lower back.A variety of damage to the spinal cord of the spinal cord can lead to changes in muscle tone, more frequently by hypersptastic types, where urodynamic disorders (bladder neck cramps, pseudo -Detission) are accompanied or results from this condition.

In some cases, the pain may act as a result of violations of the pelvic muscle attachment in the trigger point adjusted to the sacrum, coccyx, genitals, sciatic bones, endopelvical fascia.Causes of the formation of the phenomenon are listed: lower pathological changes from the feet, operations and injuries of anamnesis, certain sports, recurrent infections, and more.It is reported that muscle relaxants are effective for sphincter dysfunction, perineum muscle cramps and perineum.Osborn D.E.et al.(1981) Priority is the first study of muscle relaxants for prostatodinia.The authors conducted a two-controlled study of the effectiveness of phenoxibenzamine that blocked Adrenan, Baclofen (Gaba-B agonist receptor, horizontal muscle) and placebo in 27 patients with prostatodinia.Symptomatic improvements are registered in 48% of patients after phenoxibenzamine use, in 37% - baclofen and in 8% - when using placebo.However, large-scale prospective clinical trials that can confirm the effectiveness of this group's drugs in patients with HAP/KTB, have not been performed.

Medications and anti -anti -analgesic and analgesic analgesics

The use of non -ssteroid anti -medications, such as diclofenac, ketoprofen or nimesulide, can be effective in the treatment of some HAP/KTB patients.Analgesics are often used in the treatment of patients with KTB, however, there is little data on its effectiveness for a long time.

Plant extract

Among the plant extracts, the most studied are Serenoa Repens and Pygeum Africanum.The anti -inflammatory effects and decongestants of the Permixon are realized by preventing A2 phospholipase, other enzymes of Cascade Arachidon - cyclooxygenase and lipoxygenase, which is responsible for the formation of prostaglandins and leukotrien, as well as the influence of vasculars on stasis vasma phases.As recently completed by recent morphological studies that have been completed in patients with DGP, treatment with Permixon, on a background of proliferative acute decreases by 32% and an increase in stromal-epithelial ratios by 59%, significantly reduces inflammatory reactions (<0.001).

Reissigl A. et al.(2003) first reported the results of the Persixon Multisenter study in patients with STBB.Permixon treatment for 6 weeks received 27 patients, and 25 was observed in the control group.After treatment in the main group, the decrease in symptoms on the NIH-CPSI scale was recorded by 30%.The positive effects of treatment have been registered in 75% of patients receiving Permixon, compared to 20% in the control group.It is a feature that in 55% of the main group patients the improvement is considered moderate or significant, while in the control group - only in 16%.At the same time, 12 weeks after treatment, there were no reliable differences between groups.The data presented shows that Permixon has a positive effect on HAP/CTB patients, however, the course of treatment should be longer.

In another pilot study, the decrease in FNO and Interleukin-1B inflammation markers were shown to the background of Permixon therapy, which is associated with the effects of symptoms (Vela-Navarrete R. et al., 2002).Many authors show the effects of anti -pygeum Africanum extracts, their effects on regenerating cells -gland epithelial cells and prostate gland spraying activities, hyperactive decreases and increased threshold of excitement.However, this experimental data should be confirmed by clinical studies in patients with HAP/CTB.

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

In general, for the use of plant extracts in patients with hap/CTB, especially containing serenoa repens and pygeum africanum, there are quite theory and experimental reasons, which, however, should be confirmed by proper clinical studies.

5-alpha reductase inhibitors

Several short -term pilot studies on 5A Reductase inhibitors confirm the opinion that Finsteride has a good effect on urination and reduces pain in CP/CTB.Morphological studies conducted in patients with DGPZ showed a significant decrease in an average area occupied by inflammation in the filt with 52% of the original, to 21% after treatment (P = 3.79*10-6).About successful treatment with 51 KP IIIA Finatoride 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, quality of life from 9 to 7, general severity of symptoms from 21 to 16 and clinical index from 30 to 23 points.

Justification of the use of finsteride in prostatitis Chronic abacteria category NIH-IIIA (According to Nickel J.C., 1999):

• From an etiological point of view.

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

  In experimental animals, the model shows that abacterial inflammation can be caused by hormone changes in the prostate gland.

  The potential effects of finsteride with dysfunctional urination with high intra pressure, leading to the development of intrastrostatic reflux.

• In terms of morphology.

  Inflammation occurs in the prostate gland tissue.

  Finasteride leads to regression of the prostate gland tissue.

• From a clinical point of view.

  Clinical success is associated with an estrogen barrier that causes androgen.

  Finasteride eliminates the symptoms of impaired functioning of the urinary tract in patients with DHGPZ, especially with a large amount of prostate, when gland tissue occurs in it.

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

  The opinion of individual urologists on the effectiveness of the funsteride for prostatitis.

  The results of three clinical studies show the effectiveness of the potential fungal in the decrease in the symptoms of prostatitis.

Anticolinergic agents

The beneficial effects of anticholinergic agents are to undermine the symptoms of urinary tract, day and night pollakiuria and maintain normal sexual activity.There is a positive experience in the use of various m-cholinoblocators in patients with hap/CTB with the presence of regular symptoms, but without any signs of obstruction in the fravezical, both in monotherapy and combined with?1-adrenergic shutters.Additional studies are needed to determine the place of medicine in the treatment of patients with abacterial prostatitis.

Immunotherapy

Some authors support the point of view that the incidence of non -bacterial prostatitis is due to the accelerated immunological process by unknown antigen or autoimmune reactions.Recently, more attention has been given to the role of cytokin in HP development and maintenance.They communicate about prostate discoveries in secrets, compared to interferon-gamma levels, Interleukins 2, 6, 8, and several other cytokines.John et al.(2001) and Doble A. et al.(1999) found that with abacterial prostatitis IIIV, the CD8 (cytotoxic) ratio to CD4 (T-lymphocyte) type, as well as cytokine levels, has increased.This may indicate that the term "non -inflammatory" prostatitis is, perhaps, not enough.In this case, immune modulation using cytokine inhibitors or other approaches may be effective, but before recommending this type of treatment, the relevant test should be completed.

A variety of immunotherapy options are very popular among domestic experts.From medicines that stimulate cellular and humoral immunity,: Timus preparation, interferon, inducers endogenous interferon synthesis, and synthetic agents are distinguished.This decision is a specific interest in the latest data light on the important role of Interleukin-8 under HP IIIA, where it is considered a potential therapeutic target (Hochreiter W. et al., 2004).At the same time, it should be noted that in our opinion, the appointment of special immunocorrect therapy should be treated carefully and only if the pathological transition is detected according to the results of immunological examinations.

Transquilizers and antidepressants

The study of mental status of patients with CP/KTB has led to an understanding of the contribution of psycho-somatic disorders to disease pathogenesis.Between patients with CP, a quite frequent discovery is depression.In this case, hap/STB patients are recommended for the appointment of sedatives, antidepressants and psychotherapy.From the latest works, one can see publications about the use of Salboutamine, which has antidepressant and psychostimulation effects due to the effects of reticular brain formation.The author observes 27 patients with CP IIIB receiving salbutamine in complex therapy and 17 control group patients.It has been established that in patients taking this drug the remission period is much higher: 75% after 6 months in the main group compared to 36.4% in the control group.Treatment with salbutamine recorded increased libido, general important tone, and positive mood for treatment.

Blood circulation medication

It has been established that in CP patients, various transitions of micro -circulation, hemokoagulation and fibrinolysis are recorded.For hemodic disorders correction, it is recommended to use reopoliglyukin, trendal, and eskuls.There are reports on the use of Prostaglandin E1 in patients with hap.Additional studies are needed, good for the development of methods for assessing blood circulation disorders in patients with hap/CTB, and to create schemes for their optimal correction.

Bioregulatory peptides

Prostalen and vitaprost are widely used by domestic specialists in the head of abacterial prostatitis.Medicines are a biological active peptide complex that is isolated from the prostate gland.In addition to the effects of immunomodulation described above, the effects of symptoms on CP, anti -inflammation, microcures and trophic effects are noted.At the same time, studies in which modern methods for evaluating the clinical picture of HAP/KTB will be used, for medicines of this group, have not yet been performed.

Vitamins and trace elements

Vitamin complexes and trace elements play an important additional value in the treatment of patients with CP.Among them, the most important are vitamins of group B, vitamins A, E, C, zinc and selenium.It is known that the prostate gland is the richest of zinc and accumulates zinc.Antibacterial protection is associated with the presence of free zinc (prostatic antibacterial factors - zinc peptide complex).With bacterial prostatitis, a decrease in zinc levels is observed, which changes slightly to the background of the oral administration of this trace element.On the other hand, with abacterial prostatitis, there is a recovery of zinc levels during its exogenous intake.Against the HP background, a reliable decrease in citric acid levels is observed.Vitamin E. Selena is an antiulifratic agent and is considered a high antioxidant and antioxidant activity and is considered oncoprotector, including related to RPG.In connection with the stated, the use of drugs containing a balanced amount of vitamins and microelenas is appropriate.One of these drugs is drugs containing selenium, zinc, vitamin E,?-Carotine and Vitamin S.

Enzimotherapy

Over the years, lidase preparations have been used in complex therapies of patients with CP.Recently, several reports of domestic writers have emerged about the positive experience of using vobenzim, as a systemic enzyme therapy drug in the complex treatment of patients with CP.

Today, in countries with advanced health systems, suggestions for diagnosis and treatment of diseases are arranged taking into account the principles of evidence -based drugs, based on studies that have high levels of reliability.With regard to hap/STB drug therapy, such studies are clearly inadequate.The criteria for proof -based drugs are only appropriate to the use of antibiotics and?1-Adreno-blocking and, with certain tolerance, plant extract from Serenoa Repens.Data on the use of all other groups of drugs is especially empirical.

According to the suggestion of the US Institute of Health (NIH), the most commonly used prostatitis treatment method, according to priority, according to the criteria of evidence -based drugs, can be represented by the following sequences:

• Priority of treatment method (0-5);
• Antibacterial agents (antibiotics) 4.4;
• Alpha1-blockers 3.7;
• Prostate Massage (Course) 3.3;
• Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Hydroxyzine) 3.3;
• Anesthetic therapy (analgesic, amitriptyin, size) 3.1;
• Treatment of reverse biological communication methods (anorectal biofeeedback) 2.7;
• Phytotherapy (Serenoa Repens/Saw Palmetto, Quercetin) 2.5;
• 5 Inhibitors Reduktase Alpha (Finsteride) 2.5;
• Musorelaxants (Diazepam, Baclofen) 2.2;
• Thermotherapy (transurethal microwave thermotherapy, transurethral needle ablation, laser) 2.2;
• Physiotherapy (general massage, etc.) 2.1;
• Psychotherapy 2.1;
• Alternative therapy (meditation, acupuncture, etc.) 2.0;
• Anticoagulant (Pentosana Police) 1.8;
• Capsaicin 1.8;
• Allopurinol 1.5;
• Surgical treatment (bladder neck visit, prostate, transurethral prostate incision, radical prostatektomy) 1.5.

Accents are quite different from the treatment method for chronic prostatitis in Tenke P. (2003)

• Antimicrobial Therapy ++++;
• Alpha1-blockers +++;
• Anti -inflammation ++;
• Phytotherapy ++;
• Hormone ++ therapy;
• Hyperthermia / thermotherapy ++;
• Prostate Massage Course ++;
• Alternative treatment method ++;
• Psychotherapy ++;
• Allopurinol +;
• Surgical treatment +.

Therefore, a large number of drugs and drug groups are recommended for the treatment of chronic abacteria and KTB prostatitis, its use is based on information on its effects on various stages of disease pathogenesis.Without exception, all of this is less confirmed by evidence and evidence and evidence.To improve the outcome of hap and, in particular, patients with pelvic pain, are associated with advances in the field of diagnosis and the diagnosis of differential conditions, the improvement and details of clinical classification of the disease, reliable clinical outcomes that characterize the effectiveness and safety of drugs in a group that is clearly defined by patients.