Рецепт. 2019; : 569-575
Хронический простатит как причина эректильной дисфункции. Фенотипирование и органотропная терапия
Аннотация
Хронический простатит (ХП) и синдром хронической тазовой боли (СХТБ) – самые распространенные урологические диагнозы у мужчин моложе 50 лет. Кроме болевого синдрома не менее значимыми для пациентов являются сексуальные нарушения, которые значительно снижают качество их жизни. Коррекция эректильной дисфункции (ЭД) при хроническом простатите требует продолжительного времени и, соответственно, должна быть не только эффективной, но и безопасной. Решить эту проблему помогают препараты биологического происхождения и фенотипирование пациентов для подбора терапии. Основной задачей в лечении хронического простатита является восстановление функции предстательной железы. В лечении данной группы пациентов целесообразно использовать препараты, обладающие тропностью к предстательной железе, имеющие комплексное действие и являющиеся максимально безопасными.
Безопасность и эффективность природных препаратов во многом зависят от их качества. Учитывая, что для ХП характерна многофакторность, целесообразно проводить фенотипирование пациентов по классификации UPOINT для подбора терапии. Выявлена высокая корреляция между ХП/СХТБ и ЭД (соотношение шансов 3:1). Определено статистически значимое снижение суммарного балла МИЭФ-5. Мы, как и ряд исследователей, считаем, что в связи с многофакторностью ХП/СХТБ пациентов вначале необходимо фенотипировать по классификации UPOINT, а потом подобрать мультимодальную терапию в зависимости от преобладания того или иного домена.
Список литературы
1. Bat’ko A.B., Tagirov T.N., Idrisov SH.N. (2016) Vozmozhnosti primeneniya rastitel’nih preparatov v steroidogeneze u muzhchin s gipogonadizmom [Possibilities of using herbal preparations in steroidogenesis in men with hypogonadism]. Andrologiya i genital’naya hirurgiya, vol. 17(2), pp. 112–8.
2. Pushkar’ D.Yu., Kamalov A.A., Al’-Shukri S.H. (2012) Analiz rezul’tatov epidemiologicheskogo issledovaniya rasprostranennosti erektil’noi disfunktsii v Rossiiskoi Federatsii [Analysis of the results of an epidemiological study of the prevalence of erectile dysfunction in the Russian Federation]. Urologiya, vol. 6, pp. 5–9.
3. Rasner P.I., Pushkar’ D.Yu. (2014) Erektil’naya disfunktsiya – raznie resheniya odnoi problemi ili razmishleniya na zadannuyu temu [Erectile dysfunction - different solutions to one problem or reflection on a given topic]. Meditsinskii sovet, vol. 19, pp. 64–71. doi: 10.21518/2079-701X-2014-19-64-71
4. Hadzhieva B.R. (2017) Klinicheskaya otsenka vliyaniya osnovnih fitopreparatov na erektil’nuyu funktsiyu s pozitsii dokazatel’noi meditsini [Clinical assessment of the influence of basic herbal remedies on erectile function from the perspective of evidence-based medicine]. Consilium Medicum, vol. 19(7), pp. 86–8.
5. Zhang R., Sutcliffe S., Giovannucci E., Willett W.C., Platz E.A., Rosner B.A., Dimitrakoff J.D., Wu K. (2015) Lifestyle and Risk of Chronic Prostatitis/Chronic Pelvic Pain Syndrome in a Cohort of United States Male Health Professionals. J. Urol., vol. 194(5), pp. 1295–300. doi: 10.1016/j.juro.2015.05.100
6. Zhang R., Chomistek A.K., Dimitrakoff J.D., Giovannucci E.L., Willett W.C., Rosner B.A., Wu K. (2015) Physical activity and chronic prostatitis/chronic pelvic pain syndrome. Med Sci Sports Exerc., vol. 47(4), pp. 757–64. doi: 10.1249/MSS.0000000000000472
7. Zhao Y.Y., Xu D.L., Zhao F.J., Han B.M., Shao Y., Zhao W., Xia S.J. (2014) Redundant prepuce increases the odds of chronic prostati- tis/chronic pelvic pain syndrome (CP/CPPS). Asian J. Androl., vol. 16(5), pp. 774–7. doi: 10.4103/1008-682X.131706
8. Breser M.L., Motrich R.D., Sanchez L.R., Rivero V.E. (2017) Chronic Pelvic Pain Development and Prostate Infl ammation in Strains of Mice With Different Susceptibility to Experimental Autoimmune Prostatitis. Prostate., vol. 77(1), pp. 94–104. doi: 10.1002/pros.23252
9. Lee J.H., Lee S.W. (2016) Testosterone and Chronic Prostatitis/ Chronic Pelvic Pain Syndrome: A Propensity ScoreMatched Analysis. J. Sex Med., vol. 13(7), pp. 1047–55. doi: 10.1016/j.jsxm.2016.04.070
10. Shoskes D.A., Altemus J., Polackwich A.S., Tucky B., Wang H., Eng C. (2016) The Urinary Microbiome Differs Significantly Between Patients With Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Controls as Well as Between Patients With Different Clinical Phenotypes. Urology., vol. 92, pp. 26–32. doi: 10.1016/j.urology.2016.02.043
11. Chen C.Q., Yi Q.T., Chen C.H., Gong M. (2016) Effect of Interventions for Premature Ejaculation in the Treatment of Chronic Prostatitis with Secondary Premature Ejaculation. Zhongguo Yi Xue Ke Xue Yuan Xue Bao., vol. 38(4), pp. 393–8. doi: 10.3881/j.issn.1000-503X.2016.04.005
12. (2006) World Health Organization monographs. Updated supplementary guidelines for the manufacture of herbal medicine. Geneva: WHO, 357 p.
Recipe. 2019; : 569-575
Chronic Prostatitis as a Cause of Erectile Dysfunction. Phenotyping and Organotropic Therapy
Abstract
Chronic prostatitis and chronic pelvic pain syndrome is the most common urological diagnosis in men younger than 50 years. In addition to pain, no less significant for patients are sexual disorders, which significantly reduce their quality of life. Correction of erectile dysfunction in chronic prostatitis requires a long time and, accordingly, must be not only effective, but also safe. Preparations of a biological origin and phenotyping of patients for the selection of therapy help to solve this problem. The safety and efficacy of natural products largely depends on their quality. Given that CP is multifactorial, it is advisable to carry out phenotyping of patients according to the UPOINT classification to select therapy. A high correlation was found between CP/SCTB and ED (odds ratio 3:1). A statistically significant decrease in the total score of ICEF-5 was determined. We, like a number of researchers, believe that due to the multifactorial nature of CP/SCTB, patients must first be phenotyped according to the UPOINT classification, and then multimodal therapy should be selected depending on the predominance of a particular domain.
References
1. Bat’ko A.B., Tagirov T.N., Idrisov SH.N. (2016) Vozmozhnosti primeneniya rastitel’nih preparatov v steroidogeneze u muzhchin s gipogonadizmom [Possibilities of using herbal preparations in steroidogenesis in men with hypogonadism]. Andrologiya i genital’naya hirurgiya, vol. 17(2), pp. 112–8.
2. Pushkar’ D.Yu., Kamalov A.A., Al’-Shukri S.H. (2012) Analiz rezul’tatov epidemiologicheskogo issledovaniya rasprostranennosti erektil’noi disfunktsii v Rossiiskoi Federatsii [Analysis of the results of an epidemiological study of the prevalence of erectile dysfunction in the Russian Federation]. Urologiya, vol. 6, pp. 5–9.
3. Rasner P.I., Pushkar’ D.Yu. (2014) Erektil’naya disfunktsiya – raznie resheniya odnoi problemi ili razmishleniya na zadannuyu temu [Erectile dysfunction - different solutions to one problem or reflection on a given topic]. Meditsinskii sovet, vol. 19, pp. 64–71. doi: 10.21518/2079-701X-2014-19-64-71
4. Hadzhieva B.R. (2017) Klinicheskaya otsenka vliyaniya osnovnih fitopreparatov na erektil’nuyu funktsiyu s pozitsii dokazatel’noi meditsini [Clinical assessment of the influence of basic herbal remedies on erectile function from the perspective of evidence-based medicine]. Consilium Medicum, vol. 19(7), pp. 86–8.
5. Zhang R., Sutcliffe S., Giovannucci E., Willett W.C., Platz E.A., Rosner B.A., Dimitrakoff J.D., Wu K. (2015) Lifestyle and Risk of Chronic Prostatitis/Chronic Pelvic Pain Syndrome in a Cohort of United States Male Health Professionals. J. Urol., vol. 194(5), pp. 1295–300. doi: 10.1016/j.juro.2015.05.100
6. Zhang R., Chomistek A.K., Dimitrakoff J.D., Giovannucci E.L., Willett W.C., Rosner B.A., Wu K. (2015) Physical activity and chronic prostatitis/chronic pelvic pain syndrome. Med Sci Sports Exerc., vol. 47(4), pp. 757–64. doi: 10.1249/MSS.0000000000000472
7. Zhao Y.Y., Xu D.L., Zhao F.J., Han B.M., Shao Y., Zhao W., Xia S.J. (2014) Redundant prepuce increases the odds of chronic prostati- tis/chronic pelvic pain syndrome (CP/CPPS). Asian J. Androl., vol. 16(5), pp. 774–7. doi: 10.4103/1008-682X.131706
8. Breser M.L., Motrich R.D., Sanchez L.R., Rivero V.E. (2017) Chronic Pelvic Pain Development and Prostate Infl ammation in Strains of Mice With Different Susceptibility to Experimental Autoimmune Prostatitis. Prostate., vol. 77(1), pp. 94–104. doi: 10.1002/pros.23252
9. Lee J.H., Lee S.W. (2016) Testosterone and Chronic Prostatitis/ Chronic Pelvic Pain Syndrome: A Propensity ScoreMatched Analysis. J. Sex Med., vol. 13(7), pp. 1047–55. doi: 10.1016/j.jsxm.2016.04.070
10. Shoskes D.A., Altemus J., Polackwich A.S., Tucky B., Wang H., Eng C. (2016) The Urinary Microbiome Differs Significantly Between Patients With Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Controls as Well as Between Patients With Different Clinical Phenotypes. Urology., vol. 92, pp. 26–32. doi: 10.1016/j.urology.2016.02.043
11. Chen C.Q., Yi Q.T., Chen C.H., Gong M. (2016) Effect of Interventions for Premature Ejaculation in the Treatment of Chronic Prostatitis with Secondary Premature Ejaculation. Zhongguo Yi Xue Ke Xue Yuan Xue Bao., vol. 38(4), pp. 393–8. doi: 10.3881/j.issn.1000-503X.2016.04.005
12. (2006) World Health Organization monographs. Updated supplementary guidelines for the manufacture of herbal medicine. Geneva: WHO, 357 p.
