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2017 About therapy of patients with chronic prostatitis

In both scientific and popular editions devoted to the problem of chronic prostatitis, there is a high incidence of the disease. Almost every third man, and according to some reports almost half of men aged 20-50 years of age suffer from chronic prostatitis [1-3]. Among etiopathogenic factors of the main chronic prostatitis is the infection of the prostate gland in chronic urethritis. This statement is based mainly on the presence in anamnesis of patients with chronic prostatitis transferred urethritis of various etiologies, is not always confirmed by clinical methods. Moreover, it is believed that the microorganisms causing the inflammation in the prostate is almost in 70% of cases penetrate from the urethra via the ejaculatory ducts, and other routes of infection are extremely rare [4]. The main role in the treatment of bacterial prostatitis is given antimicrobial therapy. This should take into account that antimicrobials penetrate poorly into the prostate and the concentration of most of them in the gland is significantly less than in the serum [3]. Nevertheless, in the treatment of patients with chronic prostatitis tend to focus on the question of suppression of infection. Thus therapeutic measures aimed at restoring the functional state of the prostate, recede into the background, although the persistence of functional abnormalities is one of the main reasons for the exacerbation and recurrence of the disease [5].
Thus, the problem of treatment of chronic prostatitis is currently still far from being resolved. It seems to us that one of the solutions woznica problem is a change of view on the nature of occurrence and development of inflammatory process in the prostate. We agree with the statement that “the primary infectious prostatitis does not exist as such, and can only be a secondary infectious prostatitis as a complication of a number of morphological changes or impaired function of the prostate” [6]. The significant role of morphological and functional disorders of the prostate gland in the pathogenesis of chronic prostatitis writing and other researchers [7-9].
During the examination of patients with chronic prostatitis 23.7% of cases revealed chronic venous insufficiency of the prostate [10], in 81.3% of cases stones prostate [11], in 40.9% of cases there is absence of bacterial growth [12]. Moreover, chronic prostatitis is diagnosed in 79.9% of patients with benign prostatic hyperplasia [13]. Confirmation of the main effects of functional or organic changes in the prostate for chronic prostatitis is a pronounced clinical effect of the use of various physiotherapeutic procedures [14-16] and the unsatisfactory results of treatment of chronic prostatitis patients with gross organic changes, despite the use of strong antibiotics [17].
Clinical characteristics of patients
Under surveillance from 1994 to 1999 was 381 patient sent to the clinic of urology for chronic prostatitis. Complex examination allowed to distribute these patients into two main groups. The first group (296 people) included patients who identified certain reasons for organic (and/or functional) that support inflammation in the prostate. The second group consisted of patients (85 people) who have organic causes for the occurrence of inflammation in the prostate gland is not revealed (table. 1).
Clinical manifestations of the disease wore the typical characteristics of chronic prostatitis, with a predominance of certain symptoms depending on the kind of organic violations on the part of the prostate gland. For example, for patients with dobrokachestvenno prostatic hyperplasia a leading role in patient complaints is irritative symptoms, whereas for patients with detrusor-sphincter the typical dyssynergia complaints mostly for difficulty urinating. As can be seen from table 1, changes in the prostate gland often wore polymorphic in nature. For example, in patients with detrusor-the sphincter dyssynergia (51) in almost all cases showed the concretions of the prostate, and 18 people are identified and atony of the prostate. The concrements revealed 33 patients with benign prostatic hyperplasia.
According to the ultrasound examination, the presence of scarring in the tissue of the prostate during prostatic Department of the urethra had patients with benign prostate hyperplasia, patients with the syndrome of spastic myalgia of the pelvic floor muscles and the patients with the syndrome intrapelvical venous congestion. In the analysis of ejaculate and prostatic juice almost all patients, with the exception of 16 people with the syndrome of spastic myalgia of the pelvic floor muscles, and identified a large number of white blood cells and macrophages. In the urine, ejaculate and prostatic juice the growth of microflora took place in 203 patients. As can be seen from table 2, the microflora is represented priemuschestvenno (33,4%) hemolytic Staphylococcus. In the second group of patients who have organic changes in the prostate has not been revealed when seeding exprimata prostate also dominated by the hemolytic Staphylococcus aureus is 29.6% of cases (table. 3).
Treatment
Medical tactics used by us is based on the principle of secondary infection of the prostate gland, already have those or other vascular, retention, and alternative changes. To study the validity of our judgments of a group of patients with chronic prostatitis with the presence of organic changes in the prostate gland was divided into two parts. The first subgroup of patients (189) treatment was carried out, considering the nature of morphological and functional abnormalities of the prostate and the available pathological changes in the prostate. Moreover, the appointment of antibacterial drugs were required. The second subgroup of patients treated only with the aim of restoring functionality of the prostate without the use of antibiotics, in spite of the presence of leucocytes in juice of a prostate and planted flora. The main emphasis in the choice of methods of treatment of these patients was done on the restoration of microcirculation in the prostate gland, which stardet almost always, regardless of the cause of morphological and functional changes in the prostate. Therefore, in addition to the complex of physical events, sposobstvuyuschih strengthen of tone of the pelvic floor muscles, normalization of microcirculation in the prostate gland, was used medical drugs with organotropism effects on the prostate gland. Such drugs refers prostatilen (Libidon), having the ability to reduce swelling of the prostate and leukocyte infiltration of the interstitial tissue. In addition, it helps to reduce blood clots and has anti-aggregating activity [18]. About the high therapeutic activity prostatilen (Libidon) in patients with chronic prostatitis has been repeatedly stated in various publications [19-22]. In the past year in the treatment of chronic prostatitis patients have used the drug Vitaprost, the active principle of which is prostatilen (Libido). It comes in the form of rectal suppositories, which is very convenient when conducting treatment of patients in an outpatient setting.
The course of treatment was 3-4 weeks., and Vitaprost candles used mainly in the last 2 weeks. After treatment, the disappearance or significant reduction of symptoms of chronic prostatitis was noted in 78.3% of cases in the subgroup of patients treated with prostatilen (Libidon) and in 69.2% of cases in the subgroups of patients receiving conventional therapy. At the control examination of patients after treatment noted that in the group of patients receiving antibiotic therapy, the growth of microflora in the prostate secretion was observed in 17.6% of cases. The high content of leukocytes in the prostate secretion was noted in 48.1% of cases (before treatment – at 69.3% of cases). Patients receiving the drug, but not treated with antibiotic therapy, of the microflora in the prostate secretion was sown in 54.8% of cases, and the content of increased number of leukocytes was noted in 38.8% of cases (before treatment – in 71.3% of cases). During examination after 6 months of complaints characteristic of chronic prostatitis, showed 48.3 percent of patients treated with traditional methods of treatment, and only 12.9% of patients treated with prostatilen (Libidon). Moreover, when sowing prostate secretion in patients treated with prostatilen (Libidon), growth of microorganisms was noted in 28.6% of cases, and the high content of leukocytes in the prostate secretion was noted in 8.7% of cases. At the same time, patients treated by traditional methods of therapy, of the microflora in the prostate secretion was sown much less – 16.8% of cases, and the high content of leukocytes in the prostate secretion was observed in 52.1% of men. At repeated course of therapy all patients were administered prostatilen injections. Due to this, the effectiveness of treatment over observation period up to 3.5 years was observed in 82,7% of patients.

Thus, the obtained results on the positive impact of recovery of the trophism of the prostate gland on the course of inflammatory process. Convincing is the fact that the reduction in the number of leukocytes in the prostate secretion will proishodit despite the presence of microflora, which is determined when planting. In cases where the function of the prostate gland were not recovered, the inflammatory process continued, despite the use of antimicrobial drugs. The use of such drugs as prototiles (Libidon) helps to restore the function of the prostate, improving its trophics, and the application of procedures aimed at the elimination of causes leading to morphological and functional disorders of the prostate, reduces persistent recovery of patients with chronic prostatitis and allows you to dispel the view of the incurability of this disease.Antibiotic drug without restoring the function of the prostate is much less effective and leads to frequent relapses.

 

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