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Treatment of chronic prostatitis against the background of prostate adenoma
Last reviewed: 18.10.2021
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Prostate adenoma is a very common disease that develops in almost all men at an older age. Recently, prostate adenoma has "grown younger", ultrasound and pathomorphological signs of prostatic hyperplasia with the corresponding clinical manifestations have been registered in ever younger men, starting from the age of 30. A large multicenter international study of REDUCE revealed a direct correlation between the degree of histological signs of inflammation in the prostate and the symptoms of the lower urinary tract.
As a rule, the pathomorphological examination of biopsies or surgical material of patients with prostatic adenoma shows signs of inflammation of one degree or another. ON. Lopatkin and Yu.V. Kudryavtsev (1999) in the morphological study of prostate tissue in patients with adnoma of the prostate gland noted the presence of histological signs of prostatitis of varying degrees of activity in 96.7% of cases, and M.F. Trapeznikova and I.A. Kazantsev (2005) - almost in 100% of cases. Similar results were obtained by A.A. Patrikeyev (2004) - 98.2%. Despite the similarity of the symptoms of prostate adenoma and chronic prostatitis, the possibility of "overlapping" the symptoms, it is competent to talk about a combination of these two diseases, and therefore, therapy aimed at curing only chronic prostatitis will be insufficient. Symptoms of the lower urinary tract (LUTS), characteristic of prostate adenoma, aggravate the course of prostatitis, as they increase the risk of urine reflux into the excretory ducts of the prostate, increase its hypoxia. Consequently, the appointment of alpha-blockers is justified. Given that patients with chronic prostatitis are predominantly young men who lead an active lifestyle, preferring treatment that does not restrict freedom of movement, tamsulosin is the optimal choice. Tamsulosin (omniks) is the only alpha-blocker that does not affect the cardiovascular system, which does not cause fluctuations in blood pressure, and is prescribed in a full dose from the first day and does not require titration. However, the omnic even though to a minimum, but had side reactions, the most unpleasant among which for sexually active men was retrograde ejaculation. Therefore, a special form of the drug, OCAS (Oral Controlled Absorption System), was created - allowing to maintain a constant concentration in the blood plasma, regardless of whether tamsulosin was taken on an empty stomach or after eating. Within 24 hours, the OCAS omnic tablet, moving along the intestine, releases tamsulosin in small doses, which, thus, enters the blood in the same amount during the day, without peak concentration.
Retrograde ejaculation in patients taking omnic OCAS, developed in 1.9% of cases, while a classic omni in capsules led to this complication in 3.1% of patients. Adverse reactions from the cardiovascular system in the form of a drop in blood pressure, orthostatic collapse were observed exceptionally rarely, in isolated cases, and in patients initially predisposed to this.
In addition to the alpha-adrenoblocker, patients with a combination of chronic prostatitis and prostatic adenoma show the appointment of tadenan for 3-6 months, afalas, suppositories "Vitaprost Forte." The efficacy, safety and tolerability studies of Vitaprost Forte suppositories rectal 100 mg in patients with prostate adenoma as monotherapy have confirmed its efficacy in patients with mild to moderate symptoms assessed by the IPSS / QoL scale, a decrease in the intensity of obstructive and irritative symptoms. Positive dynamics was also noted on the part of objective ones: an increase in the average flow rate of urine, a decrease in the volume of residual urine. A statistically significant decrease in prostate volume during the course of the therapy confirmed the presence of the antiproliferative activity of the endogenous substratum samprost (prostate extract) with respect to the cells of the prostate gland and adenomatous tissue. The secondary effect associated with the ability of the drug to improve microcirculation and activate interstitial antihistamines through the production of specific antibodies leads to a reduction and elimination of congestive changes in the prostate.
Thus, the continuation of the therapeutic effect after a two-month reception of "Vitaprost Forte" indicates a pathogenetically directed organotropic action of this drug.
In general, the choice of antibiotic therapy for patients with chronic prostatitis in combination with prostate adenoma should be based on the principles indicated above, and does not differ from those with an isolated chronic prostatitis. In this category of patients should refuse to massage the prostate, with an artificial approach to apply laser therapy. If there are indications for surgical intervention, both open and TUR of the prostate, it is necessary to prescribe neoadjuvant antibiotic therapy for 4-5 days, which must be continued in the postoperative period for at least 4-5 days.