Drug treatment for chronic prostatitis

Prostatitis is an inflammation of the prostate gland (parenchymal) and interstitial tissue that is leaked in acute or long-term.Inflammation of the prostate is a separate form of disease, originally described by Ledmish in 1857.However, despite nearly 150 years of history, prostatitis is still very common, and research and poor treatment for the disease.This is also due to the fact that in most cases of chronic prostatitis, its etiology, pathogenesis and pathophysiology are still unknown.

Nowadays, in urology, no other problem is true, and suspicious data and candid novels will be as tightly intertwined as chronic prostatitis (CP).

This is mainly due to the high commercialization of the treatment of the disease, and a large number of different methods and drugs have been proposed for this, which have been advertised before reliable information about their effectiveness and safety.Furthermore, first, active advertising was conducted using all types of media, first for patients who were unable to assess all the advantages and disadvantages of the proposed treatment.

On the other hand, the development of modern medicine has led to the emergence of many new principles and methods for treating CP.Each method has its own advantages and disadvantages.However, practice urologists cannot familiarize themselves and analyze the amount of information published about prostatitis problems.Despite the extensive methodological material, papers and publications regarding the diagnosis and treatment of CP data necessary for diagnosis and treatment, standards are accepted, but in fact there is no form.

Various methods of treating prostatitis promote and use numerous medical centers (sometimes without urologists in the state), pharmacology companies and even nursing agents.

This complicates the adoption of effective clinical decisions, limits the use of reliable diagnostics and therapeutic approaches, resulting in "primary" treatments when one method is used, another method is prescribed by another method, etc.As a result, the balance between clinical and economic efficiency and the increase in health care costs are violated.To fill this gap, it will help to understand the basics and introduce evidence-based drug principles to unify diagnostic approaches and strategies for treating chronic prostatitis.

What does chronic prostatitis mean?Modern interpretations of the term “chronic prostatitis” and disease classification are ambiguous.Under its mask, it starts with infectious prostatitis, chronic pelvic pain, or SO, prostatitis called abdominal prostatitis, and ends with neurogenic dysfunction, allergic and metabolic diseases.In the case of noninfectious CP, the lack of term uniformity is particularly important, which is interpreted by various authors as: prostaglandin, Syn-Drum chronic pelvic pain, post-infection prostatitis, myalgia in pelvic floor muscle myalgia and consultant symptoms.

Many experts believe that chronic prostatitis is a predominantly infectious Genesis inflammatory disease that may be associated with the attachment of autoimmune diseases, characterized by damage to the parenchymal and interstitial tissue of the prostate.

It should be noted that chronic catalytic prostatitis is 8 times higher than the bacterial form of the disease, with a maximum of 10% of all cases of the disease.

Experts from the National Institutes of Health are as follows: Clinical concepts of chronic prostatitis:

• Pelvic/perineal pain, organs of the urogenital system for at least 3 months;
• The presence (or absence) of obstructive or prevalent symptoms of urination disorders;
• Positive (or negative) results of bacteriological studies.

Chronic prostatitis is one of the common diseases, and its manifestations are characterized by a variety of symptoms.Publications usually show that the incidence of CP is extremely high.Prostatitis has been reported to result in a significant reduction in the quality of life in working-age men: its effects are compared with angina, Crohn's disease, or myocardial infarction.According to the American Association of Urologists, the incidence of chronic prostatitis ranges from 35% to 98%, while that of men of reproductive age ranges from 40% to 70%.

There is a lack of clear clinical and laboratory standards for the disease, and a large number of subjective complaints determine the camouflage under the CP of neurological diseases in various pathological states of the prostate, urethra, urethra, and pelvic areas.The shortcomings of the existing classification demonstrate the lack of a holistic conception of CP pathogenesis, a serious obstacle to understanding and successful treatment of the disease.

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

Currently, it is widely used abroad and is used as the main classification of the National Institutes of Health, according to the following: acute bacterial prostatitis (I), chronic bacterial prostatitis (II), chronic catalytic prostatitis or chronic pelvic pain (III), including inflammatory components (IIIIII), and II IS (III), as well as IT (IIIII), as well as IS (IIIII), as well as IS (IIIII), as well as IS (IIIII), as well as IS (IIIII), as well as IS (IIIII), as well as IT (IIIIIII), as well as IS (IIIII), as well as IT (IIIIIIIB) inflammation (IV).

Clinical characteristics of chronic prostatitis:

• Usually, young people from 20 to 50 years old (average 43 years old) are impaired;
• The main and most common manifestation of this disease is the presence of pain or discomfort in the pelvis.
• Lasts for at least 3 months;
• The intensity of symptoms varies greatly.
• The most common location for pain is the foot, but there is a discomfort in any area of the pelvis.
• One aspect of pain in the testicles is not a sign of prostatitis.
• Fate symptoms are more characteristic than obstructive.
• CP may be accompanied by erectile dysfunction;
• Pain after ejaculation is the most specific for CP and distinguishes it from benign prostatic hyperplasia and healthy men.

In our country, huge materials have been accumulated in the use of various methods of diagnosing and treating CP.However, most of the available data do not meet the requirements of evidence-based drugs: the study was not randomized, and in a center, without placebo control, and sometimes even without a control group, a few observations were performed.

Furthermore, a single classification lacking CP often does not recall patients describing which categories are in the work and which category.Therefore, the effectiveness of most treatments (now widely publicized and used) (transurethral vacuum absorption of the prostate, transurethral electromagnetic stimulation, treatment - transtherapeutic - low-energy lasers transexologic, apical bone, urethra or intravascular or intravascular, excerpts of Buzha and Buzha, extraction of buzha and Buzha, 'in domestic and foreign "patent means" cannot be considered as proof.

Even the effectiveness of traditional methods such as prostate massage, and the signs of it, are still not well defined.

The problem of selecting treatments for patients with chronic bacterial (non-infectious) prostatitis associated with NIH classifications with IIIA and IIIB is a great difficulty.This is due to uncertainty about the self-supply and intellectual prostatitis, which stems from ambiguity in the cause and pathogenesis of the disease.First, the expression of this problem involves prostatitis in class IIIB, which is also defined as “chronic killing prostatitis/chronic pelvic pain” (HAP/STBB).

Paradoxically, the fact that many authors have used to treat bactericidal prostatitis is proposed, the use of antibacterial agents is presented, and data showing that such treatment is quite efficient.This again demonstrates the development of insufficient viral effects of the disease, the possible impact of infection on its development and the inconsistency of the terminology adopted, and we propose the previously pointed out, proposing to separate the concepts of “abacus” and “non-infectious” prostatitis.The diagnosis of HAP/CTB is likely to hide a range of different states, including when the current state gland is only indirectly or at all involved in the pathological process, the diagnosis itself is an indication that requires a clear term to determine the prescription of the drug.

Today, we can say with confidence that a single approach to treating HAP/CTB patients has not yet been formed.For the same reason, various drugs have been proposed to treat these diseases, and their main groups can be expressed by the following classification:

• antibiotics and antibacterial drugs;
• Non-replacement anti-inflammatory agents (diclofenac, ketofen);
• Muscle relaxants and anti-impurities agents (Baclofen);
• A1-BLOCKERS (Therazozin, Doxazin, alfuzosin, tamsulosin);
• plant extracts (Serenoa Repens, pigeum Africanum);
• 5A reductase inhibitor (Finsterida);
• Anticholinergic drugs (oxybutylamine, Tolterodine);
• modules and stimulants for immunity;
• Bioregulatory peptide (prostate extract);
• A complex of vitamins and trace elements;
• antidepressants and sedatives (Amitriptylin, desimum, salbutamine);
• painkillers;
• Drugs that improve microcirculation, rheological properties of the blood, anticoagulants (glucose, pentaoxyfentalin);
• enzyme (hyaluronidase);
• antiepileptic agents (gabapentin);
• aphrosine oxidase inhibitor (allopurinol);
• Extraction of pepper (capsaicin).

It is impossible to disagree that the treatment of CP should target all links to the cause and pathogenesis of the disease, taking into account the activity, category and extent of the process, and be complex.Meanwhile, since the reasons for CP IIIA and IIIB are not yet fully determined, the use of many of the above-mentioned drugs is based solely on plot information about their experiences, which is often viewed from an evidence-based medical point of view.To date, a complete cure for HAP seems to be a difficult goal, and therefore, symptomatic treatment, especially for patients in the IIIB category, is the most likely way to improve quality of life.

Antibacterial treatment

Antibiotics are often empirically exciting and often have positive effects when treating chronic catalytic prostatitis.Up to 40% of CP patients responded to antibiotic treatment in the analysis and without bacterial infection.The results showed that the well-being of some patients with HAP patients improved after AN-Character therapy, which may indicate that infection was not detected by traditional methods.Nickel and Costerton (1993) found that in 60% of patients with previously diagnosed bacterial prostatitis, the symptoms were positive after antibacterial treatment with the third part of the urine and/or the secret of the prostate and/or ejaculation, which revealed positive results in Protial flora In Protost-yououubiopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopopoIt should be kept in mind that the role of certain microorganisms (cogulazo-neiger Staphylococcus, Chlamydia, urea mass, anaerobic bacteria, mushrooms, feral bones) has not been proven and has not been proven and is the subject of discussion.On the other hand, certain comments about the lower urinary tract that are usually harmless under certain conditions cannot be ruled out.Additionally, using more sensitive methods, unknown infectious agents can still be identified.

Today, many authors believe that the trial courses for antibiotic therapy for HAP patients make sense, and in the case of prostatitis, they recommend you continue for 4-6 weeks or more.If a recurrence occurs after cessation of antibacterial treatment, it is necessary to restore its behavior by using low doses of medication.Although the latest position raises some questions, it includes recommendations from the European Association of Urologists (2002).

Perhaps the logic of using antibiotics to penetrate prostate tissue can be confirmed.Only some antibacterial drugs penetrate the prostate.To do this, they must be lipid-constant, have low protein binding properties, and have high dissociation constant (PKA).In worship of drug RCC, the higher the plasma, the more irrelevant (nonionic) molecules can penetrate the prostate epithelium and spread in its secret.The drug can easily penetrate into the electric lipid membrane of the prostate epithelium, with lipids associated with minimal solubleness with plasma proteins.Therefore, in order to achieve good penetration of antibiotics in the prostate, a drug that must be lipids has RKA > 8.6, characterized by the optimal activity of Gram-negative bacteria in pH > 6.6.

It should be kept in mind that the results of prolonged use of trimethanesulfonylmethoxazole remain unsatisfactory (Drach G.W. et al., 1974; Meares E.M. 1975; McGuire EJ, Lytton B. 1976).Treatment data on doxycycline and fluoroquinolones, including norfoxacin (Schaeffer A.J, Darras F.S., 1990), ciprofloxacin (Childs S.J. 1990; Weidner W. et al., 1991), and exomycin (Remy G. et al., 1988; Cox C.E. 1988; Cost c.E. Exooxides exhibit ODIC effects on prostatitis in groups II, III and IIIV, and for this reason levofloxacin was successfully used, as demonstrated by Nickel C.J. et al. (2003).

Alfa-1-adrenal shit

Some scientists believe that the pain and symptoms of irritating or dysuria in patients with HAB/KTB may be due to lower urinary dysfunction caused by bladder and neck dysfunction, urea or urine dysfunction urine dysfunction and high urea pressure.When a male under 50 years of age performs a clinical diagnosis of CP, functional OV structure in the bladder neck is detected in more than half of them, causing obstruction in the other 24% of the pseudo-deck sphincter while unstable in about 50% of the patients.

Therefore, certain forms of chronic prostatitis are associated with the initial function of the sympathetic nervous system and ADHD of α-1-adrenergic receptors.This is also proved by the work of domestic authors and our own observations.

The original reflux in the flesh is caused by turbulent flow with high pressure in the urine.Tubes and sections of the prostate in the urine can stimulate a sterile inflammatory response.

Literature data show that α-1-adrenal switch, muscle relaxants and physical therapy reduce the symptom manifestation of HUB/KTB patients.Osborne D.E. et al.(1981) The first positive effect of using phenoxy plus benzocin in a placebo-controlled study had a positive effect on prostate tumors.During the obstruction of the α-1 receptor blocking the bladder neck and prostate neck, improvements in urine outflow lead to weakening of symptoms.According to the results of alpha blockers, clinical progress was observed in 48-80% of cases.Generalized data for 4 times and similar research designs?1 blockers in HP/CTB indicated an average positive result of treatment in 64% of patients.

尼尔D.E. Jr. and Moon T.D.（1994）在一项开放研究中研究了HAP和前列腺素患者的Terasosos。经过一个月的治疗后，有76％的患者注意到症状从12-巴拉斯特量表上从5.16±1.77降低至1.88±1.64点（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.

Alapine was used in a recent prospective randomized placebo-controlled study lasting 1 year, including 6 months of active treatment and the same amount of observation time.Six months later, patients taking afuzocin recorded a reduction in symptoms on the NIH-CPSI scale, which was statistically significant compared to placebo and controls: 9.9; 3.8 and 4.3 points, respectively (p = 0.01).Within this scale, only other symptoms associated with urine and quality of life significantly reduced the pain.In the afuzozolin group, 65% of patients had more than 33% improvement on the NIH-CPSI scale, compared with 24% and 32% in the placebo and control groups (p = 0.02).Six months after the abolition of the drug, symptoms began to gradually increase in the afcin and placebo groups.

Tamsulosin's selective α-1A/D-adrenaline-enhanced controller is used for HP/KTB and also shows good clinical effects.According to Chen Xiao Song et al.(2002) In the context of 0.2 mg of the drug, in 74.5% of patients, the symptoms of the NIH-CPSI scale decreased, the increase of QMAX and QAVE and QAVE increased by 30.4% and 65.4% in QAVE, recorded within 4 weeks.Narayan P. et al.(2002) reported results of a 6-week double-blind randomized placebo-controlled study in HAP/STBB patients.Twenty-seven men received the drug, placebo-30.It was revealed that patients taking Tamsulosin had reliable reduction in symptoms and that growth in the placebo group was found.In addition, the more severe the initial symptoms in the main group, the greater the impression of improvement.The number of side effects was comparable in the Tamsulosin and placebo groups.71.8% of patients had a positive impact.After one year of treatment, the reduction of the I-PSS scale was 5.3 points (52%) and the reduction of the QOL-3.1 points (79%).

Today, most experts express their opinions on the need to receive alpha-1 blockers for a long time, as short courses (less than 6-8 months) often lead to recurrence of symptoms.This is also demonstrated by one of the latest works used with Afuzosol: 3 months after the 3-month treatment is completed, relapses of symptoms were found in most patients.It is assumed that extended treatment can lead to changes in the receptor device in the lower urinary tract, but such data need to be confirmed.

Often, people are impressed that, like DHCH, patients with HAP have all the clinical efficiencies?1-Adrenal blocks are almost the same, they differ only in terms of safety.Meanwhile, as our observations prove, despite the use?1-Adrenal conversion, which does not allow complete avoidance of disease recurrence in abolition of drugs, greatly reduces the severity of symptoms and increases the time before recurrence.

musorelaxants and andispasmodics

Some scientists adhere to the neuromuscular theory of HAP/KTB pathogenesis (Osborn D.E. et al., 1981; Egan K.J., Krieger J.L. 1997; Andersen J.T. 1999).Detailed studies of symptoms and neurological examinations may indicate sympathetic reflex dystrophy in the perineal muscle and the same base.Various damage at the spinal cord regulates the center level can lead to changes in muscle tone, more commonly found in myodynamic diseases (bladder neck spasms, pseudo-drips) or the consequences of these conditions.

In some cases, pain may cause attachment of the pelvic muscles to the trigger point of SO stimulation, which can stimulate the pelvic, tailbone, pubic bone, sciatic bone, endothelial fascia.The causes of this phenomenon are ranked: pathological changes in lower limbs, surgical and anatomical injuries, certain exercise, repeated infections, etc.In this case, it is reasonable to incorporate muscle enzymes from muscle relaxants and complex therapies into the pathogen.Muscle relaxants are reported to be effective for sphincter dysfunction, acid and perineal muscle spasm.Osborne D.E. et al.(1981) Priority is the first study of the effect of muscle relaxants on prostate toxins.The authors conducted a double-blind controlled study of the efficacy of adrenal blockade phenoxybenzylamine, baclofen (GABA-B agonist receptor, relaxant of the stratoxin) and placebo in 27 patients with prostate toxin.When using placebo, 48% of patients with phenytobamine (37%) had symptoms improved in 48% of patients.However, large-scale prospective clinical trials have not been conducted that can confirm the effectiveness of this group of drugs in patients with HAP/KTB.

Nonsteroid anti-inflammatory and analgesics

The use of non-replacement anti-inflammatory drugs such as diclofenac, ketones or nitrogen sulfate may be effective in treating certain HAP/KTB patients.Analgesics are commonly used to treat patients with KTB, however, there is little data on their long-term effectiveness.

Plant extract

在植物提取物中，研究最多的是Serenoa Repens和pygeum Africanum。 The anti -inflammatory and decongestant effect of Permixon is realized by inhibiting the phospholipase A2, other enzymes of the arachidon cascade - cyclooxygenase and lipoxygenase, responsible for the formation of prostaglandins and leukotrienes, as well as the influence on the vascular phase of inflammation, the permeability of capillaries, vascular stasis.最近完成了最近完成的DGP患者的形态学研究（用Permixon治疗），这是基于增殖性急性作用的降低32％，并使基质上皮比的增加59％，显着降低了前列腺组织中炎症反应的严重程度与对照组和对照组相比（Prostate和对照组相比）<0.001）。

Reissigl A. et al.(2003) The first report results of the Permixon multicenter study in patients with STBB.Persixon treatment was treated for 27 patients for 6 weeks, and 25 cases were observed in the control group.After treatment in the main group, the symptoms of the NIH-CPSI scale decreased by 30%.The positive effects of treatment were registered in 75% of patients receiving persixon, compared with 20% in the control group.Characteristically, in 55% of the main group of patients, improvement was considered moderate or significant, compared with only 16% in the control group.Meanwhile, there was no reliable difference between the two groups 12 weeks after treatment.The data provided show that Permixon has a positive effect on HAP/CTB patients, however, the treatment course should be longer.

In another pilot study, a decrease in inflammatory markers of FNO and interleukin 1b was shown in the context of Permixon therapy, which was associated with their symptomatic effects (Vela-Navarrete R. et al., 2002).Many authors have shown that the anti-inflammatory effect of African abscess extract, its effect on gland epithelial cell regeneration, as well as the secretory activity of the prostate, a decrease in polyactivity, and an increase in excitability threshold.However, these experimental data need to be confirmed by clinical studies in patients with HAP/CTB.

There are separate reports on the positive effects of pollen extract (Serrin) on patients with CP and prostaglandins.

Generally, for plant extracts from HAP/CTB patients, Serenoa Repens and Africanum are mainly contained, so there are sufficient theoretical and experimental reasons, but this should be confirmed by correct clinical studies.

5-α reductase inhibitor

Several short-term preliminary studies of 5A reductase inhibitors confirm the idea that Finsteride has a beneficial effect on urination and reduces CP/CTB pain.Morphological studies in patients with DGPZ showed that the mean area of inflammation was significantly reduced in primary 52%, and 21% after treatment (p = 3.79*10-6).After 51 cases of KP IIIA were successfully treated with Finatoride for 6-14 months.(2002).The pain on the SO-CHP scale decreased from 11 to 9 points, urine disease from 9 to 6, quality of life from 9 to 7, overall severity of symptoms from 21 to 16, and clinical index from 30 to 23 points.

Reasons for the use of Finsteride in the NIH-IIIA category in chronic abortion prostatitis (according to Nickel J.C., 1999):

• From the perspective of cause.

  The growth and development of the prostate depends on androgens.

  In experimental animals, models show that hormonal changes in the prostate may cause fat inflammation.

  Finsteride has the potential effects of dysfunctional urination and high dilution pressure, resulting in the development of intraperitoneal reflux.

• In terms of morphology.

  Inflammation occurs in prostate tissue.

  Finasteride causes the decline of prostate tissue.

• From a clinical point of view.

  Clinical success is associated with estrogen inhibition that causes androgens.

  Finasteride eliminates symptoms of impaired urinary tract function in DHGPZ patients, especially when glandular tissue predominates, especially when large prostate glands are present.

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

  Personal urologists’ perceptions of Finsteride’s effectiveness for prostatitis.

  Results from three clinical studies demonstrate the potential effectiveness of Finsteride in reduced symptoms of prostatitis.

Anticholinergic agents

The beneficial effects of anticholinergic agents are to weaken symptoms of urine, day and night, and to maintain normal sexual activity.There is positive experience in using various M-channel symptoms in HAP/CTB patients with obvious irritating symptoms, but there is no sign of flash internal obstruction in monotherapy and in combination with it?1-Adrenergic blinds.Other studies are needed to determine the status of this group of drugs in the treatment of prostatitis patients.

Immunotherapy

Some authors support the view that non-bacterial prostatitis occurs due to an immune process accelerated by an unknown antigen or autoimmune response.Recently, the role of cytokines in the development and maintenance of HP has attracted increasing attention.Compared to levels of control of interferon-gamma, Platinum 2, 6, 8 and many other cytokines, they found the prostate finding in the secret of increasing secrets.John et al.(2001) and Doble A. et al.(1999) found that the ratio of T-lymphocytes of catalytic prostatitis IIIV, CD8 (cytotoxicity) to CD4 (assistant) types, as well as the levels of cytokines were increased.This may indicate that the term "non-inflammatory" prostatitis may not be sufficient.In this case, immunomodulation using cytokine inhibitors or other methods may be effective, but relevant tests should be completed before this type of treatment is recommended.

The choice of various immunotherapy is very popular among domestic experts.Among drugs that stimulate cellular and humoral immunity: preparations of thymus, inducers of endogenous interferon synthesis and synthesis of synthetic agents.These results are particularly concerned based on the latest data on the important role of interleukin 8 under HP IIIA, which is considered a potential therapeutic target (Hochreiter W. et al., 2004).At the same time, it should be noted that we believe that the appointment of special immunotherapy treatments should be treated with caution and that pathological metastasis can only be performed based on immunologic examination results.

Pressure changers and antidepressants

Research on the psychological status of CP/KTB patients has led to understanding the contribution of psychological diseases to the pathogenesis of diseases.Among CP patients, depression is frequently found.In this regard, it is recommended to use HAP/STB patients to appoint sedatives, antidepressants and psychotherapy.From the latest work one can notice the use of Salboutiamine’s publication, which has antidepressant and psychological stimulation effects due to its effects on the brain’s reticular formation.The authors observed 27 patients with CP IIIB who received salbutamine in complex therapy and 17 patients in the control group.It has been determined that the duration of remission was significantly higher in patients taking this medication: 75% of the main group after 6 months and 36.4% of the control group.Saldinamine's health device points out that sexual desire, general life tone and positive treatment mood increases.

Blood circulation drugs

It has been determined that various shifts of microcirculation, blood clotting and fibrinolysis have been recorded in CP patients.To correct blood disease, redistribution, trends and effects are recommended.There are reports on the use of prostaglandin E1 in patients with HAP.Other studies are needed, including methods for evaluating blood circulation disorders in HAP/CTB patients and creating protocols for their optimal calibration.

Bioregulatory peptides

Prostaglandins and implanted plants are widely used by national experts in the mind of abortion prostatitis.These drugs are complexes of bioactive peptides isolated from the prostate of bovine.In addition to the above-promoted immunomodulatory effects, its symptomatic effects in CP, anti-inflammatory, microcirculation and nutritional effects were also found.Meanwhile, for the drug in this group, studies of modern methods for evaluating clinical images of HAP/KTB will be used.

Vitamins and trace elements

Complexes of vitamins and trace elements play an important auxiliary value in the treatment of CP patients.Among them, the most important ones are vitamins, vitamins A, E, C, zinc and selenium in Group B.As we all know, the prostate is the most abundant zinc and accumulates zinc.Its antibacterial protection is associated with the presence of free zinc (prostate antibacterial factor-zinc peptide complex).Through bacterial prostatitis, a decrease in zinc levels was noted, and it changed very little in the context of oral administration of this trace element.In contrast, prostatitis accompanied by hypertrophy, zinc levels recover during exogenous intake.In the context of HP, reliable reduction in citric acid levels was noted.Vitamin E. Selena is an antiprotein fat agent that is considered a high antioxidant and anti-activating activity and is considered a cancer protective agent, including cancers associated with RPG.Related to the statement, it is reasonable to use drugs containing the necessary vitamins and microbials that balance volumes.One of them is a drug containing selenium, zinc, and vitamin E.- Aromatic protein and vitamin S.

Enzymatic therapy

Waste enzyme preparations have been used for many years in complex therapies for patients with CP.Recently, some positive experiences of using Vobenzim have emerged on the use of Vobenzim in complex treatments for patients with CP.

Today, in countries with developed health systems, diagnostic and therapeutic recommendations based on evidence-based medical principles are considered based on studies with high reliability.Regarding drug therapy HAP/STB, such studies are obviously not enough.Evidence-based medicine-based standards correspond only to materials using antibiotics and?1-Adrenal block, with certain tolerances, is a plant extract from Serenoa Repens.Data on the use of all other drugs are primarily empirical.

According to recommendations from the American Institute of Health (NIH), the most commonly used treatments for bactericidal prostatitis can be expressed in the following order according to evidence-based drug standards:

• Treatment methods are preferred (0-5);
• Antibacterial agent (antibiotic) 4.4;
• alpha1-blockers 3.7;
• Prostate massage (course) 3.3;
• Anti-inflammatory therapy (non-steroidal anti-inflammatory drugs, hydroxyzine) 3.3;
• Anesthesia therapy (analgesic, amiti, size) 3.1;
• Treatment of backbiological transmission methods (anorexia biological dyes) 2.7;
• Therapy therapy (Vinary replication/Saw Palmetto, Quercetin) 2.5;
• 5 alpha reductase inhibitors (Finsteride) 2.5;
• musorelaxants (Epa, baclofen) 2.2;
• Heat therapy (via microwave thermal therapy, urethral ablation, laser) 2.2;
• Physical therapy (general massage, etc.) 2.1;
• Psychological therapy 2.1;
• Alternative Therapy (Meditation, Acupuncture, etc.) 2.0;
• anticoagulant (pentosana polisulfate) 1.8;
• Capsaicin 1.8;
• Allopurinol 1.5;
• Surgical treatment (tourism of bladder neck, prostate, urethral prostate incision, radical prostate resection) 1.5.

Tenke P (2003) prioritizes the treatment of chronic prostatitis.

• Antibacterial treatment++++;
• alpha1-blockers +++;
• Anti-inflammatory drugs++;
• Therapy ++;
• Hormone therapy++;
• Hyperthermia/Hyperthermia++;
• Prostate massage course++;
• Alternative treatment++;
• Psychological Therapy++;
• Allopurinol +;
• Surgical treatment (Tour) +.

Therefore, a large number of various drugs and a set of drugs are proposed to treat chronic killing prostatitis and KTB, which are used based on information about their effects at various stages of the pathogenesis of the disease.All of this is without exception, except for the evidence and evidence, and it all proves very poorly.To improve the efficacy and safety of well-defined patients with pelvic pain, in order to improve the efficacy and safety of well-defined patients with drug treatment, and progress in the diagnostic field as well as the differential diagnosis of these diseases, improve and detailed clinical classification of diseases, and accumulation of reliable clinical outcomes.