Коррекция андрогенного дефицита при хроническом инфекционном простатите как патогенетический метод преодоления неэффективности стандартной антибактериальной терапии на фоне растущей антибиотикорезистентности

Abstract

The chronic prostatitis occupies the big relative density in structure of an out-patient urological pathology in our country, however, results of its standard pharmacotherapy remain unsatisfactory that is accompanied by high risk clinical recurrence and progressing of anatomic and functional disorders in prostata. Modern methods of diagnostics of the chronic infectious prostatitis, which share in the general structure of inflammatory prostata diseases does not exceed 10 %, are based on the recommended volume of the standard tests directed only on revealing of the infectious agent in a prostatic secret, and do not consider degree of disorders of the prostatic homeostasis which key moment is prostata androgen-dependence. It leads to mainly symptomatic approach in treatment of a chronic infectious prostatitis in the modern urological practice, based exclusively on antibacterial therapy that promotes the further growth of prostate pathogens antibiotics resistance, inefficiencies of unreasonable repeated courses of antibacterial therapy and are supported by a myth about incurability of a chronic prostatitis. At the same time, intraprostatic androgen balance defines all basic functions of gland, and its safety essentially depends on testosterone blood level, therefore endogenic testosterone level it is possible to consider as universal predictor of prostata metabolic homeostasis disorders, leading to decrease in bactericidal function of gland and infections. This author’s concept allows to consider correction of an adverse hormonal and metabolic background on which the clinical picture of a chronic prostatitis (first of all, deficiency of sexual hormones) as pathogenetic therapy of all infectious chronic prostatitises against which realisation of effects of antibacterial therapy is essentially facilitated is developed or last is not so necessary, to what own clinical supervision resulted in article testify. Such interdisciplinary approach will lead to optimization of pharmacotherapy of a chronic infectious prostatitis which will come nearer inherently to pathogenetic as at planning of the program of individual therapy of disease at the concrete patient local changes in prostate, and system factors of disease will be considered also.