What groups of drugs are effective for prostatitis: a complete list

Groups of drugs for prostatitis

Depending on the phase and stage of the disease, pathogenesis and clinical picture, the specialist will prescribe a complex of drugs from one or several groups of drugs:

• antibacterial;
• alpha-1 adrenergic blockers;
• non-steroidal anti-inflammatory drugs (NSAIDs);
• muscle relaxants;
• anticoagulants.

In addition to medications, the following are prescribed:

• prostate massage;
• pain therapy;
• phytotherapy;
• thermotherapy;
• acupuncture;
• psychotherapy.

Surgical intervention is also prescribed according to indications. The selection of the drug, course of treatment and dosage depends on the cause of prostatitis, the degree of damage to the gland and the severity of symptoms, therefore the doctor will select an individual regimen for each patient.

Prevention after treatment

Prevention of chronic prostatitis allows you to prevent re-infection or the development of a relapse.

Basic measures:

• Maintaining a discriminating sex life;
• Eliminate prolonged exposure to high and low temperatures;
• Timely treatment of infectious diseases of any organ system;
• Proper use of antibacterial drugs;
• Regular genital hygiene;
• Use of barrier contraception;
• Regular physical activity, sports;
• Balanced and proper nutrition;
• Taking vitamin preparations;

It is important to visit a doctor regularly and undergo preventive medical examinations.

If necessary, the attending physician may recommend a course of drug prophylaxis to the patient.

For this purpose, the drugs Vitaprost, Prostatilen, Omnic are used.

They are used in tablet form or in the form of suppositories.

Traditional medicine and chronic prostatitis

As additional methods of treatment and prevention, it is possible to use herbal medicines.

They can enhance the effect of the main therapy.

Don’t forget about the general strengthening effect.

The appointment is made by the attending physician.

Remember!

Self-medication can lead to the development of complications and irreversible reactions.

Antibiotics

Antibacterial drugs for acute prostatitis are prescribed when a pathogenic microflora is detected - it is determined by the results of bacterial culture along with its sensitivity to certain antibiotics. Antibiotics include: Solutab, Sumamed, Ofloxacin, Ciprofloxacin, Amoxiclav, etc.

Self-administration of antibiotics threatens the development of resistance in bacteria! It is safe to take antibiotics only on the recommendation of a doctor, strictly in the indicated dosage and for at least the prescribed number of days.

Pharmacodynamics and pharmacokinetics

When the drug is administered by injection, it immediately enters the bloodstream, due to which the maximum concentration of the active substance is achieved in less than half an hour. The bioavailability of Longidase is about 90 percent, and it penetrates into any tissue of the human body. The half-life in this case is one day, and the drug is completely eliminated only after 5 days. It is excreted mainly by the kidneys, partly by the intestines.

When using suppositories, the maximum concentration is achieved only after 60 minutes. This dosage form has 70% bioavailability, and its half-life is extended to 2-3 days.

NSAIDs

The inflammatory process is weakened by non-hormonal anti-inflammatory drugs. They eliminate painful symptoms of pathology: swelling, temperature, weakness. They are used in the form of tablets, suppositories, infusions, injections - the form is selected by the doctor based on the results of the examination. This group includes Diclofenac, Ketoprofen and others.

Note! NSAIDs can adversely affect the condition of the mucous membrane of the stomach and intestines and have a number of side effects. Do not take medications unless prescribed by a doctor!

pharmachologic effect

The drug is highly active and is a macromolecular complex of the proteolytic enzyme hyaluronidase. When taken, it has the following effects:

• relieves inflammation;
• eliminates swelling;
• promotes activation of humoral immunity;
• antifibrotic.

Longidaza improves tissue nutrition, eliminates adhesions, contractures, accelerates the resorption of bruises and hematomas, and also increases joint mobility.

The drug works best in the initial stages of the disease, preventing its progression and the development of complications.

Longidaza also enhances the effect of local anesthetics, increasing their bioavailability.

The medication is characterized by incredibly low toxicity and the absence of negative effects on the body.

Herbal remedies for prostatitis

Inexpensive but effective drugs for prostatitis include herbal dietary supplements - they are prescribed as part of complex therapy, as an adjuvant:

• Prostanorm;
• Prostamol Uno;
• Permixon;
• Speman et al.

Natural preparations contain antioxidants and flavonoids, which, if administered incorrectly, can worsen the patient's condition. The treatment regimen will be prescribed by the urologist after instrumental and laboratory diagnostics.

Experience of using Longidase in the complex treatment of women with chronic cystitis

The results of a study of the effect of the drug Longidaza on microcirculation of the bladder in the complex treatment of women with chronic cystitis are presented. The use of the drug Longidaza contributed to the regression of the immunoinflammatory process, an increase in the elasticity of the detrusor and better penetration of antibacterial drugs into the submucosal layer, which led to a decrease in the severity of pain, a lengthening of the interval between urination and an increase in the effective volume of the bladder. The latter is especially important for interstitial cystitis. The positive effect of using Longidase was confirmed by an improvement in the cystoscopic picture and microcirculatory processes in the bladder wall. During therapy with Longidaza, no local or general adverse or allergic reactions were observed.

Table 1. Duration of the disease in patients with chronic cystitis, abs.

Table 2. Complaints of patients of the main and control groups before and after treatment, abs. (%)

Table 3. Data from urination diaries of patients of the main and control groups before and after treatment, abs. (%)

Results of bacteriological examination of urine of patients of the main and control groups

Table 4. Data from cystoscopic examination of patients in the main and control groups before and after treatment, abs. (%)

Table 5. Indicators of basal blood flow of the mucous membrane of the bladder wall in healthy women, patients of the main and control groups before and after treatment

Table 6. Amplitude-frequency spectrum of blood flow oscillations in the mucous membrane of the bladder wall in healthy women and patients of the main and control groups before and after treatment

Introduction

Urinary disorders in most cases are associated with chronic recurrent inflammatory processes, changes in hormonal levels, and innervation disorders, which are usually accompanied by microcirculation disorders in the wall of the bladder and adjacent organs [1, 2].

According to statistical data, 26–36 million cases of acute cystitis are registered annually in Russia [3, 4]. It has been established that 50% of women after an episode of cystitis develop a relapse within a year, in 27% of young women it occurs within six months, and in 50% of cases relapses are observed more than three times a year [3, 5, 6]. Thus, chronic cystitis in women is a common disease and is characterized by a long, persistent course.

Despite the keen interest of urologists, the problem of treating chronic cystitis is still far from a final solution [7]. The insufficient effectiveness of therapy and frequent recurrence of the disease are due to the lack of a rational approach to the implementation of therapeutic measures [8–10]. The complexity lies in the polyetiological nature of cystitis and the many factors that support the course of the pathological process in the bladder wall [11–14]. Disturbances in the urodynamics of the lower urinary tract, microcirculation in the bladder mucosa and the presence of a bacterial agent largely contribute to the development and maintenance of the inflammatory process in the bladder [1, 4, 15]. A decrease in blood flow intensity leads to hypoxia and disruption of metabolic homeostasis in tissues, which plays an important role in the pathogenesis of this condition. The issues of correcting the clinical manifestations of urinary disorders in women have not yet been sufficiently studied, so therapy for such disorders is ineffective.

In recent years, significant advances have been made in the pharmacotherapy of diseases of the genitourinary tract. New drugs for the treatment of inflammatory diseases of the pelvic organs are being introduced into clinical practice. Currently, for diseases accompanied by connective tissue hyperplasia, as well as to influence the immunoinflammatory process, drugs containing the long-acting enzyme hyaluronidase are actively used [16]. One of these drugs is the domestic drug Longidase, a conjugate of hyaluronidase with an activated derivative of poly-1,4-ethylenepiperazine N-oxide. Hyaluronidase, acting on hyaluronic acid as a connective tissue substrate, increases the permeability of tissue barriers, reduces their swelling, promotes the resorption of inflammatory exudate, and increases the elasticity of sclerotic tissue. This leads to an increase in the elasticity of the detrusor, a decrease in pain, and an increase in bladder volume, which is primarily necessary for the treatment of interstitial cystitis. Presumably, activation of organ circulation significantly improves energy metabolism and adaptive properties of the detrusor, which contributes to the regression of clinical symptoms during treatment and indicates the need for further study of the effect of Longidase on the vascular system of the bladder.

Currently, the issues of microcirculation and the possibilities of determining microcirculatory disorders in clinical practice are given great importance [2, 4, 15]. According to many domestic and foreign authors, the study of regional microcirculation deserves special attention in connection with its participation in the processes of repair, morphological and functional restoration of tissue and organs after various alterations and therapeutic effects. Identification of pathology of microcirculation is important for diagnosis, assessment of the severity of pathological processes in the body, control over treatment and prediction of its effectiveness. Laser Doppler flowmetry is a modern method for assessing the state of microcirculation, based on changes in the frequency characteristics of a laser beam probing tissue when it is reflected from moving blood components, primarily erythrocytes [4].

Purpose of the study

To evaluate the effect of the drug Longidaza on microcirculation of the bladder as part of the complex treatment of women with chronic cystitis.

Material and methods

The study was conducted at the clinical base of the Department of Urology and Andrology of the Altai State Medical University in the conditions of the urology department of the departmental clinical hospital at the Barnaul station of JSC Russian Railways.

40 women with chronic cystitis aged from 20 to 58 years (average age 35 ± 2.7 years) were examined. The patients were divided into main and control groups of 20 people each. Patients in the control group received complex conservative treatment, which included Suprax/Suprax Solutab 400 mg for six to seven days, Furamag 50 mg three times a day and herbal preparations for ten days. Patients in the main group were prescribed the same complex conservative therapy and Longidase rectally once every three days (20 suppositories per course).

Previously, many patients repeatedly received treatment both in outpatient and inpatient settings. The duration of chronic cystitis ranged from ten months to ten years (Table 1). Diagnosis of the disease was carried out on the basis of a set of anamnestic and objective clinical data, laboratory and instrumental examination methods. At the first visit, a special card was created for each patient, which noted the features of the medical history and disease, and data from additional examination methods. When collecting complaints, attention was paid to the intensity and severity of pain, frequency of urination, and the feeling of incomplete emptying of the bladder. The medical history included the duration of the disease, factors preceding the onset of the disease, types of previous treatment and their effectiveness, and the duration of the relapse-free period. The gynecological status was carefully noted. Foci of chronic infection were identified as a possible source of infection of the bladder through a descending route.

All women before and after the course of therapy underwent the following studies: clinical blood test according to generally accepted methods, general urine analysis to detect leukocyturia, bacteriuria, hematuria, bacteriological urine culture to determine sensitivity to antibiotics. Biochemical blood test included determination of urea and creatinine.

Before the start and one month after the end of treatment, patients of the main and control groups kept a urination diary. Based on the results of the frequency of urination and the volume of urine excreted initially and after treatment, the dynamics of dysuric disorders were judged.

An integral part of the examination was cystoscopy to determine the condition of the bladder mucosa. Endoscopic examination was performed in all patients using a Storz endoscope. When examining the mucous membrane of the bladder, attention was paid to areas of hyperemia, hemorrhages, the presence of erosive and ulcerative defects, the condition of the mucosa in the area of ​​Lieto's triangle and the bladder neck, the severity of the vascular pattern, trabecularity, and the presence of residual urine.

To study the microcirculation system of the mucous wall of the bladder in women with urinary disorders, laser Doppler flowmetry was used using a laser blood microcirculation analyzer LAKK-02 (NPP LAZMA, Russia). It consisted of two emitters for probing tissue in the visible red region of the radiation spectrum and the infrared region, a photodetector and light guide probes, which included three light guides enclosed in a common light-proof bundle. Registration of blood flow in the bladder mucosa implies an invasive study of blood microcirculation, therefore, points with clear localization and good blood supply were selected for laser Doppler flowmetry. The parameters of basal blood flow were calculated. Initially, the average values ​​of changes in perfusion were calculated: the arithmetic mean value of the microcirculation index (M), standard deviation (σ) and coefficient of variation (Kv). Next, blood flow oscillations were analyzed. At the second stage, the amplitude-frequency spectrum of perfusion oscillations was analyzed. Vascular tone and the state of functioning of certain perfusion control mechanisms were assessed by the amplitudes of blood flow fluctuations in specific frequency ranges.

After the examination, the patients received treatment according to the above regimen. A month later, they were re-examined to assess the effectiveness of treatment, which was determined by the results of control bacteriological urine culture, relief of the inflammatory process in accordance with the data of a general urine test, and the disappearance of clinical symptoms. Changes in the bladder mucosa were assessed based on the results of repeat cystoscopy.

A comparative analysis of quantitative variables characterizing the clinical, laboratory and functional state of the urinary system was carried out using descriptive statistics using nonparametric Wilcoxon and Mann–Whitney tests. Data processing and graphical presentation were performed using Statistica 6.0 and Microsoft Excel 2003 computer programs.

results

The most common complaints of patients were pain in the projection of the bladder, frequent urination in small portions, a feeling of discomfort in the urethra, painful or uncomfortable urination, and a feeling of incomplete emptying of the bladder (Table 2). The severity of dysuric disorders was also reflected by the patients in urination diaries, which they kept for 24 hours before and a month after the end of the course of treatment (Table 3). Based on the results of the conversation and filling out urination diaries, it turned out that patients in the main group more often noted a decrease in the intensity of the clinical picture of the disease and the severity of dysuric disorders.

Indicators of clinical blood analysis and nitrogen excretory function of the kidneys in patients of both groups were within normal limits.

According to the results of a general urine test, leukocyturia, bacteriuria, and microhematuria occurred. The content of leukocytes more than 10 per field of view was observed in 11 (27.5%) patients. Red blood cells were detected in four (10%) patients. Microscopy revealed bacteriuria in 16 (40%) cases. The rest of the patients had normal urinalysis results.

All patients underwent bacteriological examination of urine to determine the type of microorganism and the microbial count of urine. In 24 (60%) cases, the urine was sterile. Escherichia coli was detected in the remaining patients

,
Enterococcus
spp.,
Staphylococcus haemolyticus
,
Staphylococcus aureus
(picture).

According to studies conducted in our clinic, in chronic cystitis, the infectious agent penetrates the wall of the bladder, and is not detected in the urine during culture, which is a sign of interstitial cystitis [17]. In this regard, all patients, even with sterile urine cultures, received antibiotic therapy.

When analyzing the endoscopic picture, areas of diffuse hyperemia were often noted, and there were growths of the bladder mucosa (Table 4). The changes mainly affected the area of ​​the bladder triangle and the bladder neck. The integumentary epithelium in the affected areas lost its shine, acquired a dark red color, became swollen, and bled easily. Thus, the cystoscopic picture in the patients of the main group after treatment was more consistent with the norm. Hyperemia, petechial hemorrhages, and bullous edema decreased, which indicates the anti-inflammatory effect of the drug Longidaza.

In both groups, no changes were found in clinical and biochemical blood tests. According to the results of bacteriological urine culture, only one (5%) patient in the control group had microflora represented by Staphylococcus epidermidis

. The remaining urine samples were sterile.

According to the results of cystoscopy, one month after the course of treatment in the control group, in contrast to the main group, pronounced changes in the mucous membrane for the better were noted (decreased hyperemia, petechial hemorrhages, bullous edema), which indicates the anti-inflammatory effect of the drug Longidaza.

When assessing the state of microcirculation using laser Doppler flowmetry, changes in basal blood flow, rhythm and amplitude-frequency spectrum of blood flow oscillations were recorded in all patients with chronic cystitis (Tables 5 and 6).

In the microvasculature of the mucous membrane of the bladder wall in healthy women (data taken from our previously published works [18]), slow rhythms prevailed with a frequency of 1–10 vibrations per minute with the highest intravascular resistance with these rhythms and an active microcirculation mechanism. In patients with chronic cystitis, compared with healthy women, the results of laser Doppler flowmetry indicated intravascular microcirculation disorders in the bladder. They were manifested by a slowdown in the average blood flow and statistically significant fluctuations in red blood cell velocity, as well as a decrease in the coefficient of variation. There was a significant decrease in neurogenic tone in the precapillary, an increase in myogenic tone, a shunt index, and a decrease in the microcirculation efficiency index. There was a deterioration in tissue perfusion compared with healthy women. This indicates a violation of microcirculation in the tissues of the bladder against the background of urination disorders as a result of a slowdown in blood flow associated with a decrease in arterial blood inflow, as well as a violation of venous outflow and creates conditions for the development of intravascular rheological disorders in the wall of the bladder. A decrease in blood flow modulation and coefficient of variation indicators, a decrease in myogenic and neurogenic tone, an increase in bypass rate and a moderate decrease in the microcirculation efficiency index were recorded. In the mucous membrane of the bladder wall, there was a statistically significant decrease in the amplitude of pulse and slow oscillations, an increase in the amplitude of fast oscillations, a significant increase in the active mechanism of microcirculation and a decrease in the parameters of the passive regulatory mechanism and vascular tension in patients of the main group (Table 6). When analyzing the amplitude-frequency spectrum, a significant decrease in blood stagnation in the venular link was determined, which was expressed by a decrease in the contribution of HF oscillations. The amplitude of CF oscillations also decreased.

During the study, no drug intolerance or side effects were observed in patients of the main and control groups during treatment.

When assessing long-term results within a month after treatment, two (10%) patients in the control group and one (5%) patient in the main group experienced a short-term episode of exacerbation of cystitis, which was relieved by taking uroseptics.

The discussion of the results

In all patients, the severity of clinical manifestations of the disease decreased, and dysuric symptoms were relieved. According to the results of a bacteriological study, against the background of conservative treatment, a persistent antimicrobial effect was observed in both groups. According to the analysis of the results of cystoscopic studies, treatment with antibiotics and uroseptics contributed to the regression of the endoscopic picture in chronic cystitis in women of both groups. However, in patients receiving Longidase, the cystoscopic picture was closer to normal.

The study of the blood circulation of the capillary vascular bed using laser Doppler flowmetry made it possible to study changes in microcirculation in the mucous membrane of the bladder wall of patients with chronic cystitis before and after treatment. After treatment, there was an increase in the neurogenic tone in the precapillary, the shunt index and the microcirculation efficiency index, as well as the microcirculation index and the coefficient of variation, which indicates an improvement in microhemocirculation. Improvement in microcirculation was observed in patients whose complex treatment included the drug Longidaza. The higher effectiveness of treatment with Longidase is associated with increased permeability of the bladder wall and improved access of antibiotics to foci of inflammation located in the submucosal layer.

conclusions

The drug Longidaza contributed to the regression of the immunoinflammatory process, increased elasticity of the detrusor and better penetration of antibacterial drugs into the submucosal layer, which led to a decrease in the severity of pain, lengthening the interval between urination and an increase in the effective volume of the bladder in patients with chronic cystitis. The positive effect of using Longidase was confirmed by an improvement in the cystoscopic picture and microcirculatory processes in the bladder wall. When using the drug Longidaza, no local or general adverse reactions or allergic reactions were observed.