The necessity of a complex approach to examination and treatment of patients with chronic abacterial prostatitis

Kul'chavenya E.V., Breusov A.A., Cherednichenko A.G., Stovbun S.V.

Introduction: The emergence of chronic prostatitis (CP) is often due to incorrect determination of the category of the disease. It is considered that in 90% of cases, CP has abacterial aetiology, which is, however, debatable.

Aim: To determine the structure of chronic abacterial prostatitis and the effectiveness of complex therapy in patients with this disease.

Materials and methods: The study included two groups of patients with abacterial CP (IIIa category), each consisted of 28 patients. All patients underwent standard examination, which included screening for intracellular pathogens and viruses. Complex therapy involved the administration of doxycyclin (Unidox Solutab) and famciclovir (Familiar), upon detection of herpes simplex virus. Patients from the main group also received panavir intravenously. The screening for pathogens was performed by PCR.

Results: At the beginning of the study, the patients had the criteria for being diagnosed with category IIIa chronic prostatitis. In all of them, the number of observable leukocytes in prostate sections was not higher that 15; no development of pathogenic microflora was present in the derivatives of gonads. Molecular-genetic approach revealed DNA of Chlamydia trachomatis (17 patients), Ureaplasma urealyticum (15 patients), Mycoplasma genitalium (22 patients), and Virus herpes (9 patients), which are not related to the aethiology of CP but play a role in the manteinance of inflammation in the prostate. All patients had mixed composition of pathogens.

According to NIH-Chronic Prostatitis Symptom Index scale, the mean intensity of pain scored 2.7 in the main group (MG) and 4.7 in the comparison group (CG); urination disorders csored 1.8 in the MG and 3.5 in the CG. The quality of life scored 3.4 and 8.1, respectively, according to the symptoms scale. The sum of scores decreased from 20.9 to 8.9 in the MG and from 20.8 to 16.3 in the CG.

Complex therapy combined with immunomodulation was shown to be more effective also for pathogen eradication. In the MG, chlamydia were identified in 2 (7.1%) patients and mycoplasma — in 3 (10.7%); in the CG, chlamydia were still present in 3 patients (10.7%), ureoplasma — in 7 (25.0%) and mycoplasma in 4 (14.3%). Therefore, pathogens were identified in 5 patients (17.6%) in the main group and in 12 patients (42.8%) in the comparison group, which is three times higher.

Conclusions: 1. Patients with chronic abacterial prostatitis IIIa category are subject to screening for intracellular infections and viruses, which also can maintain prostate inflammation

2.    The addition of immunomodulation therapy into the complex of aethiopathogenetic treatment significantly increases the effectiveness of the therapy.

Authors declare lack of the possible conflicts of interests

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chronic abacterial prostatitis, intracellular pathogens, viruses, treatment

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