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Бактериальный простатит и фиброз предстательной железы: современный взгляд на лечение и профилактику
Бактериальный простатит и фиброз предстательной железы: современный взгляд на лечение и профилактику
Зайцев А.В., Пушкарь Д.Ю., Ходырева Л.А., Дударева А.А. Бактериальный простатит и фиброз предстательной железы: современный взгляд на лечение и профилактику. Consilium Medicum. 2016; 18 (7): 14–18. DOI: 10.26442/2075-1753_2016.7.4-18
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Аннотация
Лечение хронического бактериального простатита остается трудной задачей в связи с недостаточной способностью антибактериальных препаратов проникать в предстательную железу, а также ростом резистентности уропатогенов к ним. Продолжается диагностический поиск возможных возбудителей хронического простатита (ХП). Взаимосвязь между ХП и нарушением фертильности остается спорным вопросом. Фиброз предстательной железы влияет на развитие расстройств мочеиспускания/симптомов нижних мочевых путей и результаты оперативных вмешательств. Результаты экспериментальных исследований показали потенциальную возможность регресса фиброза при устранении причины заболевания и ферментативного воздействия на этот процесс с помощью коллагеназ, способствующих деградации коллагена. Представлены результаты проведенных ранее рандомизированных клинических плацебо-контролируемых исследований по оценке безопасности, переносимости и эффективности антифибротического препарата Лонгидаза® в комплексной терапии больных ХП.
Ключевые слова: хронический простатит, фиброз предстательной железы, антифибротическая терапия, Лонгидаза.
Ключевые слова: хронический простатит, фиброз предстательной железы, антифибротическая терапия, Лонгидаза.
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Treatments of chronic bacterial prostatitis (CP) remain difficult problem. Bacterial prostatitis is a disease entity diagnosed clinically and by evidence of inflammation and infection localized to the prostate. Risk factors for UTI in men include urological interventions, such as transrectal prostate biopsy. Ensuing infections after prostate biopsy, such as UTI and bacterial prostatitis, are increasing due to increasing rates of fluoroquinolone resistance. The increasing global antibiotic resistance also significantly affects management of UTI in men, and therefore calls for alternative strategies. Prostatic inflammation has been suggested to contribute to the etiology of lower urinary tract symptoms (LUTS) by inducing fibrosis. Several studies have shown that prostatic fibrosis is strongly associated with impaired urethral function and LUTS severity. Fibrosis resulting from excessive deposition of collagen is traditionally recognized as a progressive irreversible condition and an end stage of inflammatory diseases; however, there is compelling evidence in both animal and human studies to support that the development of fibrosis could potentially be a reversible process. Prostate inflammation may induce fibrotic changes in periurethral prostatic tissues, promote urethral stiffness and LUTS. Patients experiencing CP and prostate-related LUTS could benefit from anti-inflammatory therapies, especially used in combination with the currently prescribed enzyme treatment with Longidaza. Treatment results showed that Longidaza is highly effective in bacterial and abacterial CP. Longidaza addition to standard therapeutic methods significantly reduced the disease symptoms and regression of inflammatory-proliferative alterations in the prostate.
Key words: chronic prostatitis, prostatic fibrosis, enzyme treatment, Longidaza.
Key words: chronic prostatitis, prostatic fibrosis, enzyme treatment, Longidaza.
Полный текст
Список литературы
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29. WHO Drug Information 2015; 29: 3.
2. Coyene KS, Sexton CC, Thompson CI et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int 2009; 104: 352–60.
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4. Loran O.B., Pushkar' D.Iu., Segal A.S., Iudovskii S.O. Nashe ponimanie khronicheskogo prostatita. Farmateka. 2002; 10: 69–75. [in Russian]
5. Ulleryd P. Febrile urinary tract infection in men. Int J Antimicrob Agents 2003; 22 (Suppl 2): 89–93.
6. Millan-Rodriguez F, Palou J, Bujons-Tur A et al. Acute bacterial prostatitis: twodifferent sub-categories according to a previous manipulation of the lowerurinary tract. World J Urol 2006; 24: 45–50.
7. Yoon BI, Kim S, Han DS et al. Acute bacterial prostatitis: how to prevent andmanage chronic infection? J Infect Chemother 2012; 18: 444–50.
8. Center MM et al. International variation in prostate cancer incidence and mortality rates. Eur Urol 2012; 61: 1079.
9. Loeb S et al. Systematic review of complications of prostate biopsy. Eur Urol 2013; 64: 876.
10. Zaitsev A.V., Rasner P.I., Govorov A.V., Kurdzhiev M.A. Sovremennyi vzgliad na antibakterial'nuiu profilaktiku pri transrektal'noi biopsii predstatel'noi zhelezy v usloviiakh rosta rezistentnosti mikroflory. Effektivnaia farmakoterapiia. 2011; 1: 30–4. [in Russian]
11. Nam RK, Saskin R, Lee Y et al. Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol 2010; 183: 963–8.
12. Loeb S, Carter HB, Berndt SI et al. Complications after prostate biopsy: data from SEER-Medicare. J Urol 2011; 186: 1830–4.
13. Loeb S, van den Heuvel S, Zhu X et al. Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol 2012; 61: 1110–4.
14. Wagenlehner FM, van Oostrum E, Tenke P et al. Infective complications afterprostate biopsy: outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and a prospective multinational multicentre prostatebiopsy study. Eur Urol 2013; 63: 521–7.
15. Steensels D, Slabbaert K, De Wever L et al. Fluoroquinolone-resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostatebiopsy: should we reassess our practices for antibiotic prophylaxis? Clin Microbiol Infect 2012; 18: 575–81.
16. Cai T, Tiscione D, Malossini G et al. Antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: Fosfomycin trometamol is an attractive strategy. Poster 267, EAU16, Munich.
17. Wagenlehner F et al. Urinary tract infections in men. Curr Opin Infect Dis 2014; 27: 97–101.
18. Perletti G, Marras E, Wagenlehner FM, Magri V. Antimicrobial therapy for chronic bacterial prostatitis. Cochrane Database Syst Rev 2013; 8: CD009071.
19. Thurmond P, Jing-Hua Yang, Yedan Li et al. Structural modifications of the prostate in hypoxia, oxidative stress, and chronic ischemia. Korean J Urol 2015; 56 (3): 187–96. doi: 10.4111/kju.2015.56.3.187.
20. Kudriavtsev Iu.V., Chumakov A.M. Morfologicheskie izmeneniia v predstatel'noi zheleze pri khronicheskom prostatite. Materialy konferentsii «Sovremennye aspekty diagnostiki i lecheniia khronicheskogo prostatita». Kursk, 2000; s. 81–2. [in Russian]
21. Ma J, Gharaee-Kermani M, Kunju L et al. Prostatic fibrosis is associated with lower urinary tract symptoms. J Urol 2012; 188 (4): 1375–81.
22. Cantiello F, Cicione A, Salonia A et al. Periurethral fibrosis secondary to prostatic inflammation causing lower urinary tract symptoms: a prospective cohort study. Urology 2013; 81 (5): 1018–23.
23. Wong L, Hutson PR, Bushman W. Prostatic Inflammation Induces Fibrosis in a Mouse Model of Chronic Bacterial Infection. PloS One 2014; 9 (6): e100770.
24. Wong L, Hutson PR, Bushman W. Resolution of chronic bacterial-induced prostatic inflammation reverses established fibrosis. Prostate 2015; 75 (1): 23–32. doi: 10.1002/pros.22886.
25. Pushkar' D.Iu., Zaitsev A.B., Segal A.C. Longidaza v lechenii khronicheskogo prostatita. Urologiia. 2006; 6: 26–8. [in Russian]
26. Loran O.B., Segal A.S. Urologiia. 2001; 5. Sistema kompleksnoi otsenki simptomov khronicheskogo prostatita (SOS-KhP). [in Russian]
27. Khodyreva L.A., Dudareva A.A., Karpov V.K. Longidaza v kompleksnoi terapii khronicheskogo prostatita. Effektivnaia farmakoterapiia. Urologiia i nefrologiia. 2014; 32 (3): 24–7. [in Russian]
28. Avdoshin V.P., Andriukhin M.I., Mikhailikov T.G. Opyt primeneniia fermentnoi terapii v kompleksnom lechenii khronicheskogo prostatita. Consilium Medicum. 2008; 10 (4): 114–7. [in Russian]
29. WHO Drug Information 2015; 29: 3.
2. Coyene KS, Sexton CC, Thompson CI et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int 2009; 104: 352–60.
3. Krieger JN, Lee SW, Jeon J et al. Epidemiology of prostatitis. Int J Antimicrob Agents 2008; 31 (Suppl. 1): S85–S90.
4. Лоран О.Б., Пушкарь Д.Ю., Сегал А.С., Юдовский С.О. Наше понимание хронического простатита. Фарматека. 2002; 10: 69–75. / Loran O.B., Pushkar' D.Iu., Segal A.S., Iudovskii S.O. Nashe ponimanie khronicheskogo prostatita. Farmateka. 2002; 10: 69–75. [in Russian]
5. Ulleryd P. Febrile urinary tract infection in men. Int J Antimicrob Agents 2003; 22 (Suppl 2): 89–93.
6. Millan-Rodriguez F, Palou J, Bujons-Tur A et al. Acute bacterial prostatitis: twodifferent sub-categories according to a previous manipulation of the lowerurinary tract. World J Urol 2006; 24: 45–50.
7. Yoon BI, Kim S, Han DS et al. Acute bacterial prostatitis: how to prevent andmanage chronic infection? J Infect Chemother 2012; 18: 444–50.
8. Center MM et al. International variation in prostate cancer incidence and mortality rates. Eur Urol 2012; 61: 1079.
9. Loeb S et al. Systematic review of complications of prostate biopsy. Eur Urol 2013; 64: 876.
10. Зайцев А.В., Раснер П.И., Говоров А.В., Курджиев М.А. Современный взгляд на антибактериальную профилактику при трансректальной биопсии предстательной железы в условиях роста резистентности микрофлоры. Эффективная фармакотерапия. 2011; 1: 30–4. / Zaitsev A.V., Rasner P.I., Govorov A.V., Kurdzhiev M.A. Sovremennyi vzgliad na antibakterial'nuiu profilaktiku pri transrektal'noi biopsii predstatel'noi zhelezy v usloviiakh rosta rezistentnosti mikroflory. Effektivnaia farmakoterapiia. 2011; 1: 30–4. [in Russian]
11. Nam RK, Saskin R, Lee Y et al. Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol 2010; 183: 963–8.
12. Loeb S, Carter HB, Berndt SI et al. Complications after prostate biopsy: data from SEER-Medicare. J Urol 2011; 186: 1830–4.
13. Loeb S, van den Heuvel S, Zhu X et al. Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol 2012; 61: 1110–4.
14. Wagenlehner FM, van Oostrum E, Tenke P et al. Infective complications afterprostate biopsy: outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and a prospective multinational multicentre prostatebiopsy study. Eur Urol 2013; 63: 521–7.
15. Steensels D, Slabbaert K, De Wever L et al. Fluoroquinolone-resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostatebiopsy: should we reassess our practices for antibiotic prophylaxis? Clin Microbiol Infect 2012; 18: 575–81.
16. Cai T, Tiscione D, Malossini G et al. Antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: Fosfomycin trometamol is an attractive strategy. Poster 267, EAU16, Munich.
17. Wagenlehner F et al. Urinary tract infections in men. Curr Opin Infect Dis 2014; 27: 97–101.
18. Perletti G, Marras E, Wagenlehner FM, Magri V. Antimicrobial therapy for chronic bacterial prostatitis. Cochrane Database Syst Rev 2013; 8: CD009071.
19. Thurmond P, Jing-Hua Yang, Yedan Li et al. Structural modifications of the prostate in hypoxia, oxidative stress, and chronic ischemia. Korean J Urol 2015; 56 (3): 187–96. doi: 10.4111/kju.2015.56.3.187.
20. Кудрявцев Ю.В., Чумаков А.М. Морфологические изменения в предстательной железе при хроническом простатите. Материалы конференции «Современные аспекты диагностики и лечения хронического простатита». Курск, 2000; с. 81–2. / Kudriavtsev Iu.V., Chumakov A.M. Morfologicheskie izmeneniia v predstatel'noi zheleze pri khronicheskom prostatite. Materialy konferentsii «Sovremennye aspekty diagnostiki i lecheniia khronicheskogo prostatita». Kursk, 2000; s. 81–2. [in Russian]
21. Ma J, Gharaee-Kermani M, Kunju L et al. Prostatic fibrosis is associated with lower urinary tract symptoms. J Urol 2012; 188 (4): 1375–81.
22. Cantiello F, Cicione A, Salonia A et al. Periurethral fibrosis secondary to prostatic inflammation causing lower urinary tract symptoms: a prospective cohort study. Urology 2013; 81 (5): 1018–23.
23. Wong L, Hutson PR, Bushman W. Prostatic Inflammation Induces Fibrosis in a Mouse Model of Chronic Bacterial Infection. PloS One 2014; 9 (6): e100770.
24. Wong L, Hutson PR, Bushman W. Resolution of chronic bacterial-induced prostatic inflammation reverses established fibrosis. Prostate 2015; 75 (1): 23–32. doi: 10.1002/pros.22886.
25. Пушкарь Д.Ю., Зайцев A.B., Сегал A.C. Лонгидаза в лечении хронического простатита. Урология. 2006; 6: 26–8. / Pushkar' D.Iu., Zaitsev A.B., Segal A.C. Longidaza v lechenii khronicheskogo prostatita. Urologiia. 2006; 6: 26–8. [in Russian]
26. Лоран О.Б., Сегал А.С. Система комплексной оценки симптомов хронического простатита (СОС-ХП). Урология. 2001; 5. / Loran O.B., Segal A.S. Urologiia. 2001; 5. Sistema kompleksnoi otsenki simptomov khronicheskogo prostatita (SOS-KhP). [in Russian]
27. Ходырева Л.А., Дударева А.А., Карпов В.К. Лонгидаза в комплексной терапии хронического простатита. Эффективная фармакотерапия. Урология и нефрология. 2014; 32 (3): 24–7. / Khodyreva L.A., Dudareva A.A., Karpov V.K. Longidaza v kompleksnoi terapii khronicheskogo prostatita. Effektivnaia farmakoterapiia. Urologiia i nefrologiia. 2014; 32 (3): 24–7. [in Russian]
28. Авдошин В.П., Андрюхин М.И., Михайликов Т.Г. Опыт применения ферментной терапии в комплексном лечении хронического простатита. Consilium Medicum. 2008; 10 (4): 114–7. / Avdoshin V.P., Andriukhin M.I., Mikhailikov T.G. Opyt primeneniia fermentnoi terapii v kompleksnom lechenii khronicheskogo prostatita. Consilium Medicum. 2008; 10 (4): 114–7. [in Russian]
29. WHO Drug Information 2015; 29: 3.
________________________________________________
2. Coyene KS, Sexton CC, Thompson CI et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int 2009; 104: 352–60.
3. Krieger JN, Lee SW, Jeon J et al. Epidemiology of prostatitis. Int J Antimicrob Agents 2008; 31 (Suppl. 1): S85–S90.
4. Loran O.B., Pushkar' D.Iu., Segal A.S., Iudovskii S.O. Nashe ponimanie khronicheskogo prostatita. Farmateka. 2002; 10: 69–75. [in Russian]
5. Ulleryd P. Febrile urinary tract infection in men. Int J Antimicrob Agents 2003; 22 (Suppl 2): 89–93.
6. Millan-Rodriguez F, Palou J, Bujons-Tur A et al. Acute bacterial prostatitis: twodifferent sub-categories according to a previous manipulation of the lowerurinary tract. World J Urol 2006; 24: 45–50.
7. Yoon BI, Kim S, Han DS et al. Acute bacterial prostatitis: how to prevent andmanage chronic infection? J Infect Chemother 2012; 18: 444–50.
8. Center MM et al. International variation in prostate cancer incidence and mortality rates. Eur Urol 2012; 61: 1079.
9. Loeb S et al. Systematic review of complications of prostate biopsy. Eur Urol 2013; 64: 876.
10. Zaitsev A.V., Rasner P.I., Govorov A.V., Kurdzhiev M.A. Sovremennyi vzgliad na antibakterial'nuiu profilaktiku pri transrektal'noi biopsii predstatel'noi zhelezy v usloviiakh rosta rezistentnosti mikroflory. Effektivnaia farmakoterapiia. 2011; 1: 30–4. [in Russian]
11. Nam RK, Saskin R, Lee Y et al. Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol 2010; 183: 963–8.
12. Loeb S, Carter HB, Berndt SI et al. Complications after prostate biopsy: data from SEER-Medicare. J Urol 2011; 186: 1830–4.
13. Loeb S, van den Heuvel S, Zhu X et al. Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol 2012; 61: 1110–4.
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Авторы
А.В.Зайцев*1, Д.Ю.Пушкарь1, Л.А.Ходырева2, А.А.Дударева2
1 ГБОУ ВПО Московский государственный медико-стоматологический университет им. А.И.Евдокимова Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1;
2 ГБУ НИИ организации здравоохранения и медицинского менеджмента Департамента здравоохранения г. Москвы. 115184, Россия, Москва, ул. Большая Татарская, д. 30
*msmsu@msmsu.ru
1 ГБОУ ВПО Московский государственный медико-стоматологический университет им. А.И.Евдокимова Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1;
2 ГБУ НИИ организации здравоохранения и медицинского менеджмента Департамента здравоохранения г. Москвы. 115184, Россия, Москва, ул. Большая Татарская, д. 30
*msmsu@msmsu.ru
________________________________________________
A.V.Zaitsev*1, D.Yu.Pushkar1, L.A.Khodyreva2, A.A.Dudareva2
1 A.I.Evdokimov Moscow State Medical and Dental University of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1;
2 Scientific Research Institute of Healthcare Organization and Medical Management of the Department of Health of Moscow. 115184, Russian Federation, Moscow, ul. Bol'shaia Tatarskaia, d. 30
*msmsu@msmsu.ru
1 A.I.Evdokimov Moscow State Medical and Dental University of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1;
2 Scientific Research Institute of Healthcare Organization and Medical Management of the Department of Health of Moscow. 115184, Russian Federation, Moscow, ul. Bol'shaia Tatarskaia, d. 30
*msmsu@msmsu.ru
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