Treatment of chronic prostatitis on the background of prostate adenoma

Prostate adenoma is a very common disease that develops in almost all men at an older age. Recently, prostate adenoma has become "younger", ultrasound and pathomorphological signs of prostate hyperplasia with corresponding clinical manifestations are registered in increasingly younger men, starting from the age of 30. A large multicenter international study REDUCE revealed a direct correlation between the degree of histological signs of inflammation in the prostate and symptoms of the lower urinary tract.

As a rule, pathomorphological examination of biopsy specimens or surgical material from patients with prostate adenoma demonstrates signs of inflammation of varying degrees of severity. N.A. Lopatkin and Yu.V. Kudryavtsev (1999) noted the presence of histological signs of prostatitis of varying degrees of activity in 96.7% of cases during a morphological examination of prostate tissue in patients with prostate adenoma, and M.F. Trapeznikova and I.A. Kazantseva (2005) - in almost 100% of cases. Similar results were obtained by A.A. Patrikeev (2004) - 98.2%. Despite the similarity of symptoms of prostate adenoma and chronic prostatitis, the possibility of "overlapping" symptoms, it is legitimate to talk about a combination of these two diseases, and, therefore, therapy aimed at curing only chronic prostatitis will be insufficient. Lower urinary tract symptoms (LUTS) typical of prostate adenoma aggravate the course of prostatitis, as they increase the risk of urine reflux into the prostate excretory ducts and increase its hypoxia. Therefore, the prescription of alpha-blockers is justified. Considering that patients with chronic prostatitis are mainly young men leading an active lifestyle, preferring treatment that does not limit freedom of movement, tamsulosin is the optimal choice. Tamsulosin (omnic) is the only alpha-blocker that does not affect the cardiovascular system, does not cause fluctuations in blood pressure, is prescribed in full dose from the first day, does not require titration. However, omnic, although minimally, had side effects, the most unpleasant of which for sexually active men was retrograde ejaculation. Therefore, a special form of the drug was created - omnic OCAS (Oral Controlled Absorption System - a system for controlling absorption in the gastrointestinal tract) - allowing to maintain a constant concentration in the blood plasma, regardless of whether tamsulosin was taken on an empty stomach or after a meal. Over 24 hours, the omnic OCAS tablet, moving through the intestines, releases tamsulosin in small doses, which thus enters the blood in the same amount during the day, without a peak concentration.

Retrograde ejaculation in patients taking omnic OCAS developed in 1.9% of cases, while the classic omnic in capsules led to this complication in 3.1% of patients. Side effects from the cardiovascular system in the form of a drop in blood pressure, orthostatic collapse were observed extremely rarely, in isolated cases, and in patients initially predisposed to this.

In addition to alpha-blocker, patients with a combination of chronic prostatitis and prostate adenoma are prescribed tadenan for 3-6 months, afaly, suppositories "Vitaprost Forte". The conducted studies of the efficacy, safety and tolerability of the drug "Vitaprost Forte rectal suppositories 100 mg" in patients with prostate adenoma as monotherapy confirmed its efficacy in patients with mild and moderate symptoms assessed by the IPSS / QoL scale, a decrease in the intensity of obstructive and irritative symptoms. Positive dynamics were also noted from the objective side - an increase in the average urine flow rate, a decrease in the volume of residual urine. A statistically significant decrease in the prostate volume during the therapy confirmed the presence of antiproliferative activity of the endogenous substrate samprost (prostate extract) in relation 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 intra-tissue antihistamine processes due to 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 two months of taking Vitaprost Forte indicates the pathogenetically directed organotropic action of this drug.

In general, the choice of antibacterial therapy for patients with chronic prostatitis combined with prostate adenoma should be based on the principles specified above and is no different from those for isolated chronic prostatitis. In this category of patients, prostate massage should be avoided and laser therapy should be used with caution. If there are indications for surgical intervention, both open and TUR of the prostate, neoadjuvant antibacterial therapy should be prescribed for 4-5 days, which should be continued in the postoperative period for at least 4-5 days.