Chronic Prostatitis Research Articles

Thermosensitive hydrogel with emodin-loaded triple-targeted nanoparticles for a rectal drug delivery system in the treatment of chronic non-bacterial prostatitis

BackgroundThe complex etiology and pathogenesis underlying Chronic Non-Bacterial Prostatitis (CNP), coupled with the existence of a Blood Prostate Barrier (BPB), contribute to a lack of specificity and poor penetration of most drugs. Emodin (EMO), a potential natural compound for CNP treatment, exhibits commendable anti-inflammatory, anti-oxidant, and anti-fibrosis properties but suffers from the same problems as other drugs.MethodsBy exploiting the recognition properties of lactoferrin (LF) receptors that target intestinal epithelial cells (NCM-460) and prostate epithelial cells (RWPE-1), a pathway is established for the transrectal absorption of EMO to effectively reach the prostate. Additionally, hyaluronic acid (HA) is employed, recognizing CD44 receptors which target macrophages within the inflamed prostate. This interaction facilitates the intraprostatic delivery of EMO, leading to its pronounced anti-inflammatory effects. A thermosensitive hydrogel (CS-Gel) prepared from chitosan (CS) and β-glycerophosphate disodium salt (β-GP) was used for rectal drug delivery with strong adhesion to achieve effective drug retention and sustained slow release. Thus, we developed a triple-targeted nanoparticle (NPs)/thermosensitive hydrogel (Gel) rectal drug delivery system. In this process, LF, with its positive charge, was utilized to load EMO through dialysis, producing LF@EMO-NPs. Subsequently, HA was employed to encapsulate EMO-loaded LF nanoparticles via electrostatic adsorption, yielding HA/LF@EMO-NPs. Finally, HA/LF@EMO-NPs lyophilized powder was added to CS-Gel (HA/LF@EMO-NPs Gel).ResultsCellular assays indicated that NCM-460 and RWPE-1 cells showed high uptake of both LF@EMO-NPs and HA/LF@EMO-NPs, while Raw 264.7 cells exhibited substantial uptake of HA/LF@EMO-NPs. For LPS-induced Raw 264.7 cells, HA/LF@EMO-NPs can reduce the inflammatory responses by modulating TLR4/NF-κB signaling pathways. Tissue imaging corroborated the capacity of HA/LF-modified formulations to breach the BPB, accumulating within the gland's lumen. Animal experiments showed that rectal administration of HA/LF@EMO-NPs Gel significantly reduced inflammatory cytokine expression, oxidative stress levels and fibrosis in the CNP rats, in addition to exerting anti-inflammatory effects by inhibiting the NF-κB signaling pathway without obvious toxicity.ConclusionThis triple-targeted NPs/Gel rectal delivery system with slow-release anti-inflammatory, anti-oxidant, and anti-fibrosis properties shows great potential for the effective treatment of CNP.Graphical

The harmful effects of overlooking acute bacterial prostatitis.

Prostatitis is a major urological disease affecting 25%-50% of men over their lifetime. However, prostatitis is often overlooked in nonurologic departments due to its sometimes indeterminate symptoms. In this review, we describe how to recognize and treat acute bacterial prostatitis, which manifests as a clinical problem in other departments as well as urology, to help prevent this disease from being overlooked. There are several possible negative effects of not recognizing acute bacterial prostatitis (ABP). First, initial treatment can fail. In the hyperacute phase, common antibiotics are often effective, but in rare cases, such antibiotics may not be effective. In addition, once ABP progresses to form a prostate abscess, potentially avoidable surgical interventions are often needed. A second issue is the transition to chronic prostatitis. If chronic bacterial prostatitis progresses, treatment requires long-term antibiotic administration and the response rate is not high. Some patients may have to deal with urinary tract infections for the rest of their lives. Finally, there is the problem of overlooking the underlying disease. ABP is rare in healthy adult men without underlying disease, including sexually transmitted diseases as well as benign prostatic hyperplasia, urinary stones, and malignant tumors, and may not be obvious. When examining patients with fever of unknown origin, it is necessary to exclude not only infectious diseases but also collagen diseases and malignant tumors. If there are any doubts, we recommend a rectal exam and consultation with a urologist.

Quality of life of the patients with chronic prostatitis under the influence of complex balneopeloid and enzyme therapy with Longidase

BACKGROUND: In modern medicine, among the main indicators of the effectiveness of therapeutic measures, the quality of life of the patient is singled out, which allows determining the degree of recovery of physical and mental health after treatment of acute conditions.
 AIM: to evaluate the effectiveness of complex balneopeloid and enzyme therapy with longidase according to the monitoring of the quality of life of the patients suffering from chronic bacterial prostatitis.
 MATERIALS AND METHODS: There have been observed 54 patients with chronic prostatitis. They were divided into 2 groups by simple randomization: in the comparison group (n=26) the patients were prescribed exercise therapy, internal and external administration of mineral water of Zheleznovodsk type, peloidotherapy with silt sulfide mud topically, antibiotic therapy with ceftriaxone, phytomicroclysters; in the main group (n=28), the patients additionally underwent antibiotic and enzyme therapy by peripheral indirect lymphotropic therapy. The efficiency was assessed using validated Quality of Life questionnaires: Chronic Prostatitis Symptom Scale (NIH-CPS) and SF-36 General Health Questionnaire (Social Functioning-36).
 RESULTS: The analysis of the clinical effect of the new treatment technology revealed its advantage over the standardized therapy, which is proven by the monitoring of QoL indicators for 1 year after the spa treatment: recovery of QoL in the main group immediately after the treatment occurred by 59.7% (p 0.01), 6 months later ― by 72.7% (p 0.01), with a slight decrease in the rate in 12 months ― by 64.9% (p 0.01). The dynamics of physical and mental health indicators on the SF-36 scale was also observed with the same degree of confidence: compared with the baseline, the average improvement was 25.5% (p 0.01), 33.6% (p 0.01) and 27.3% (p 0.01) respectively. In the comparison group, the dynamics of indicators for all NIH-CPSI and SF-36 scales was also significant, but lower than similar indicators in the main group by 23–25% on average (p 0.01) and 12–15%, respectively.
 CONCLUSION: The results of the study indicate the high effectiveness of complex balneopeloid and lymphotropic therapy with the patients suffering from chronic prostatitis at the stage of spa treatment.

The Protective Effects of Bushen Daozhuo Granule on Chronic Non-bacterial Prostatitis.

Background: Chronic non-bacterial prostatitis (CNP), one of the most common chronic diseases in urology, leads to pain in the prostate and dysuria, critically affecting the physical or mental health of patients. However, there are no standard treatment approaches for the treatment of CNP in the clinic. Although the clinical application of Bushen Daozhuo granule (BSDZG) offers hope to CNP patients in China, the mechanisms of BSDZG in treating CNP are still not entirely clear. Hence, we aimed to investigate the novel therapeutic mechanisms of BSDZG on CNP. Methods: In this study, we first assayed the prostate index of rats and then determined the anti-inflammatory and anti-apoptotic effects of BSDZG on CNP in vivo and in vitro by employing ELISA kits and TUNEL staining. Next, we investigated whether the anti-inflammatory and anti-apoptotic mechanisms of BSDZG on prostate protein-induced rats and lipopolysaccharide (LPS) induced RWPE-1 cells were related to the AKT, p38 MAPK, and NF-κB pathways with the help of Western blot. Finally, the influence of BSDZG on the interaction between the p38 MAPK and NF-κB pathway in LPS-induced RWPE-1 cells was explored by adopting dehydrocorydaline (DHC, p38 MAPK activator) with the help of ELISA kits and Western blot. Results: In vivo, BSDZG effectively reduced the prostate index. In vivo and in vitro, BSDZG dramatically declined the level of two pro-inflammatory cytokines, TNF-α and IL-1β, as well as the apoptosis rate. Moreover, in vivo and in vitro, BSDZG memorably upregulated the expression level of p-AKT, and substantially downregulated the expression level of p-p38 MAPK and NF-κB2. The activation of p38 MAPK significantly reversed the moderation effects of BSDZG on the level of TNF-α and IL-1β, as well as the expression level of p-p38 MAPK and NF-κB2 in vitro. Conclusion: To sum up, the in vivo and in vitro therapeutic mechanisms of BSDZG on CNP were reflected as the anti-inflammation and anti-apoptosis that was formed by inhibiting the level of pro-inflammatory cytokines, TNF-α and IL-1β, to regulate the AKT, p38 MAPK, and NF-κB pathways, and the anti-inflammatory effect of BSDZG was realized by suppressing the p38 MAPK pathway to inhibit the downstream NF-κB pathway.

Dioscin protects against chronic prostatitis through the TLR4/NF-κB pathway.

This study aimed to elucidate the effects and potential mechanisms of dioscin on chronic prostatitis (CP) in vivo and in vitro. CP models were constructed in vivo and in vitro and treated with different concentrations of dioscin. Hematoxylin and eosin staining was used to investigate the morphology of the prostate tissues. The concentration of inflammatory factors in prostate tissues was determined by enzyme-linked immunosorbent assay. The release of reactive oxygen species, malondialdehyde, superoxide dismutase, and catalase was measured using detection kits. P69 cell proliferation was assessed by 3-(4, 5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide. Furthermore, the activity of the TLR4/NF-κB signaling pathway was determined by quantitative reverse transcriptase polymerase chain reaction or Western blot assay. Histopathological data suggested that dioscin exerted protective effects against prostate morphological changes. Dioscin inhibits inflammatory cytokines and oxidative stress (OS) in prostate tissues in a concentration-dependent manner. Moreover, dioscin notably inhibited the activation of the TLR4/NF-κB signaling pathway in CP rats. In vitro, dioscin remarkably reduced lipopolysaccharide-induced P69 proliferation, inflammation, OS, and TLR4/NF-κB pathway activation in a dose-dependent manner. In conclusion, dioscin exerts a protective effect in CP by decreasing the inflammatory response and OS through the TLR4/NF-κB pathways. Our findings provide a novel latent therapy for dioscin for the treatment and prevention of CP.

P2X7R Modulates NEK7-NLRP3 Interaction to Exacerbate Experimental Autoimmune Prostatitis via GSDMD-mediated Prostate Epithelial Cell Pyroptosis.

Chronic prostatitis is one of the most common urologic diseases that troubles young men, with unclear etiology and ineffective treatment approach. Pyroptosis is a novel model of cell death, and its roles in chronic prostatitis are unknown. In this study, P2X7R, NEK7, and GSDMD-NT expression levels were detected in prostate tissues from benign prostate hyperplasia (BPH) patients and experiment autoimmune prostatitis (EAP) mice. P2X7R agonist, antagonist, NLRP3 inhibitor, and disulfiram were used to explore the roles of the P2X7R-NEK7-NLRP3 axis in prostate epithelial cell pyroptosis and chronic prostatitis development. We found that P2X7R, NEK7, and GSDMD-NT were highly expressed in the prostate epithelial cells of BPH patients with prostatic inflammation and EAP mice. Activation of P2X7R exacerbated prostatic inflammation and increased NLRP3 inflammasome component expressions and T helper 17 (Th17) cell proportion. Moreover, P2X7R-mediated potassium efflux promoted NEK7-NLRP3 interaction, and NLRP3 assembly and activation, which caused GSDMD-NT-mediated prostate epithelial cell pyroptosis to exacerbate EAP development. Disulfiram could effectively improve EAP by inhibiting GSDMD-NT-mediated prostate epithelial cell pyroptosis. In conclusion, the P2X7R-NEK7-NLRP3 axis could promote GSDMD-NT-mediated prostate epithelial cell pyroptosis and chronic prostatitis development, and disulfiram may be an effective drug to treat chronic prostatitis.

Хронический простатит, ассоциированный с герпесвирусами

The most common microorganisms are herpesviruses, which are capable of infecting many organs and systems, including reproductive organs (due to their biological properties) causing in some cases the occurrence of infertility and life-threatening generalized infections. Among the many herpesviruses, there are 9 that are transmitted from humans: herpes simplex viruses types 1 and 2, varicella-zoster virus, cytomegalovirus, Epstein-Barr virus, herpes viruses types 6, 7, 8, as well as macacine herpesvirus 1. In recent decades, there has been intensive research into their role in damage to the male reproductive system, including the prostate gland. The authors attempted to assess the possible association of herpesviruses with symptoms of chronic prostatitis and infertility, for which a search was conducted in the Pubmed database for the following search query: human papillomavirus, Epstein-Barr virus, cytomegalovirus, herpes virus 1, 2, 6, sexual transmission, sperm, prostatitis. Epidemiological studies concerning the possible association of herpesviruses with chronic prostatitis (CP) / chronic pelvic pain syndrome (CPPS) symptoms in young men have shown that viruses can enter the genital organs through sexual contact or a systemic route. However, some of them do not damage the male reproductive system organs, but rather affect sperm cells, leading to infertility. Despite the contradictory isolated studies, most of them indicated the role of herpesviruses in the damage to the male reproductive system, including the prostate gland, with spermatogenesis disorder and infertility occurrence. Thus, patients with CP/CPPS should be examined for the herpesvirus detection, since atypical, uncultivated, intracellular, as well as viral pathogens (along with typical pathogens) can play a role in the prostatitis progression. KEYWORDS: herpesviruses, Epstein-Barr virus, cytomegalovirus, herpes simplex virus type 1, herpes simplex virus type 2, human herpesvirus type 6, human papillomavirus, chronic prostatitis, infertility. FOR CITATION: Kadyrov Z.A., Ramishvili Sh.V., Stepanov V.S., Ignatiev A.V., Mashaneishvili Sh.G. Chronic prostatitis associated with herpesviruses. Russian Medical Inquiry. 2024;8(4):221–227 (in Russ.). DOI: 10.32364/2587-6821-2024-8-4-6.

The histological prevalence of prostatitis at Potchefstroom Hospital: a cross-sectional study.

prostatitis is defined as a clinical condition caused by acute or chronic infectious diseases, chronic pelvic pain syndrome, or asymptomatic inflammation of the prostate gland. We conducted a study to determine the prevalence of histological prostatitis in patients with prostatic diseases at Potchefstroom Hospital. we conducted a cross-sectional study based on the review of histology report from 1st January 2015 to 31st December 2019 coupled to clinical information of patients. A total of 362 cases with complete histopathology report were included in the study. Chi-square and Fisher exact test were used to test statistical significance with a p-value of 0.05 deemed to be significant. over a total number of 362 patients, the mean age was 69.82±7.9 years. The overall prevalence of prostatitis on histology was 158 (43.65%). Chronic prostatitis was predominant and commonly associated with BPH or PCa in 142 cases (39.23%) on histopathology report, while acute prostatitis was found in 16 patients (4.42%). We further found prostate cancer in 178 patients (49.17%), BPH in 163 (45.03%). The study shows that 41 cases (23.3%) of prostate cancer were associated with prostatitis, and 96 cases (58.9%) of BPH were also associated with prostatitis on histology. The difference was statistically significant p < 0.001. The study revealed that in BPH with prostatitis the median PSA was 15 ng/ml (IQR 9-24), while in BPH without prostatitis the median PSA was 11ng/ml (IQR 7-16). (p < 0.017). This means that prostatitis increases PSA in patients with BPH. However, the presence of prostatitis did not significantly influence the PSA value in patients with prostate cancer. this study showed that close to half of the histology examined had signs of prostatitis. Chronic prostatitis was more frequent on histology done in our sample. BPH was strongly associated with prostatitis. Prostatitis contributed to a higher PSA values in patients with BPH and did not influence the PSA value in PCa.

The Effect of Chronic Bacterial Prostatitis on Levels Antioxidant in Adult Men: A Meta-Analysis of Case-control Studies

Globally, adult males are frequently affected with chronic bacterial prostatitis (CBP), a prevalent urological illness. It is believed that the inflammatory reaction linked to CBP causes oxidative stress, which may change the impacted people's levels of enzyme antioxidants the Effect of Chronic Bacterial Prostatitis on Levels Enzymatic Antioxidant. From October - 2022 to August - 2023, examined 270 clinical samples from subjects males (adults). Two groups were divided: the first group consisted of 180 male patients. In contrast, the second group consisted of 90 healthy males (adults). Blood samples of (3-5) ml were collected from all participants and the levels of zinc, selenium, glutathione peroxidase GPx, superoxide dismutase SOD, and catalase CAT were measured. The results showed that the levels of zinc, selenium, GPx, SOD, and CAT in men with chronic bacterial prostatitis were significantly lower than those in the control group of patients who were visited after ethical treatment at AL-Sader Medical City in Najaf Governorate. Aspects approved by the Medical Ethics Committee of the Iraqi Ministry of Health. The aim of this meta-analysis is to statistically evaluate and in-depth examine the case-control studies conducted so far regarding the effects of CBP on the levels of enzymatic antioxidants in adult men.

Роль цинка в здоровой предстательной железе и при хроническом простатите

The review article discusses modern aspects of the physiological role of zinc in the prostate gland, as well as the consequences for the prostate gland of deficiency of this one of the most important vital trace elements. The mechanisms of intracellular zinc transport, as well as various physiological processes in prostate tissue requiring the mandatory presence of zinc, are covered in more detail. In a separate section of the literature review, the modern evidence base of the relationship of zinc deficiency in the prostate gland with chronic prostatitis is presented and the results of modern studies showing the need for zinc replacement therapy in the framework of complex pharmacotherapy of chronic prostatitis occurring against the background of zinc deficiency are summarized.

Involvement of NOTCH1-mediated Microglia Activation in Neuromodulation of Chronic Prostatitis-related Pain.

This study aimed to investigate the role of NOTCH receptor 1 (NOTCH1)-mediated activation of microglia in the L5-S2 spinal dorsal horn in chronic prostatitis pain. Rats were divided into chronic prostatitis (CP) group and control group. Complete Freund's adjuvant was injected into the prostate, and prostate pathology and pain-related behavior were monitored to assess the successful establishment of the CP-related pain model. The dorsal horn of the L5-S2 spinal cord was collected for the detection of ionized calcium-binding adapter molecule 1 (IBA-1) and NOTCH1 expression by quantitative real time polymerase chain reaction and the detection of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) by enzyme-linked immunosorbent assay. Electrical excitability was assessed with whole-cell patch clamp. In addition, NOTCH1 receptor inhibitor or inhibitor of microglial cell activation was injected into the subarachnoid space, and the pro-inflammatory cytokines in the spinal cord were detected. In the CP group, the expression of NOTCH1, IBA-1, TNF-α and IL-1β began to increase at 4 days, peaked at 12 days, and began to decline at 24 days, and it was significantly higher than in the control group (p<0.01). Inhibition of microglia or NOTCH1 receptor markedly reduced the content of TNF-α and IL-1β in the spinal cord (p<0.05). At 4, 12 and 24 days, the amplitude and frequency of neuronal action potential increased and the threshold decreased markedly as compared to the control group (p<0.05), and spontaneous action potential was noted. NOTCH1 mediates the activation of microglia in the L5-S2 spinal cord, leading to the secretion of inflammatory factors and enhanced electrical excitability of neurons, which is related to persistent and refractory chronic prostatitis-related pain.

CD8 T cells are dispensable for experimental autoimmune prostatitis induction and chronic pelvic pain development.

Chronic Pelvic Pain Syndrome or Chronic Prostatitis (CPPS/CP) is the most prevalent urologic affliction among young adult men. It is a challenging condition to treat, which significantly decreases patient quality of life, mostly because of its still uncertain aetiology. In that regard, an autoimmune origin is a prominent supported theory. Indeed, studies in patients and in rodent models of Experimental Autoimmune Prostatitis (EAP) have provided compelling evidence suggesting a key role of CD4 Th1 cells in disease pathogenesis. However, the implication of other prominent effectors of the immune system, such as CD8 T cells, has yet to be studied. We herein analyzed the induction of prostatitis and the development of chronic pelvic pain in EAP using CD8 T cell-deficient animals. We found similarly elevated PA-specific immune responses, with high frequencies of specific IFNg+CD4+ and IL17+CD4+ T cells in prostate draining lymph nodes from PA-immunized either CD8 KO or wild type animals with respect to controls. Moreover, these peripheral immune responses were paralleled by the development of significant chronic pelvic pain, and accompanied by prostate histological lesions, characterized by hemorrhage, epithelial cell desquamation, marked periglandular leukocyte infiltration, and increased collagen deposition in both, PA-immunized CD8 KO and wild type animals. As expected, control animals did not develop prostate histological lesions. Our results indicate that CD8 T cells do not play a major role in EAP pathogenesis and chronic pelvic pain development. Moreover, our results corroborate the previous notion that a CD4 Th1 associated immune response drives the induction of prostate tissue inflammation and the development of chronic pelvic pain.

Сравнительный анализ микробиоты секрета простаты у больных хроническим абактериальным простатитом категории IIIа и IIIб

Numerous studies have established that chronic prostatitis/ chronic pelvic pain syndrome ( CP/CPPS) is the focus of attention of the global medical community, because it is the most common type of disease, the treatment of which has largely unsatisfactory results. Purpose of the work: to conduct a comparative analysis of the microbiota of prostate secretions in patients with CP/CPPS IIIa and IIIb using mass spectrometry of microbial markers (MSMM). Material and methods. A prospective comparative study was conducted from 2018 to 2023 at the SM-Clinic medical center. 205 patients with prostatitis-like symptoms and 70 males who applied for a screening examination with no complaints at the age of 25 to 50 years were selected. The subjects were divided into three groups: group 1 – patients with CP/CPPS category IIIa, group 2 ( n = 85) patients with CP/CPPS category IIIb with clinical manifestations of chronic prostatitis and group 3 ( n = 70) – without clinical manifestations prostatitis/control group. A study of the microbiota of prostate secretions was carried out using gas chromatograph mass spectrometer "Maestro" (LLC "Interlab", Russia). Results. The results of statistical analysis showed that the level of cocci and bacilli, anaerobes, actinobacteria, fungi and yeasts, as well as total viruses in patients with CP/CPPS IIIa, compared with patients with CP/CPPS IIIb and the control group, was significantly higher ( p = 0.0020 ; p &lt; 0.0001; p &lt; 0.0001; p = 0.0254; p = 0.0254). It was revealed that in patients with CP/CPPS IIIa, compared with patients with CP/CPPS IIIb and healthy people, there was a significant increase in the total load of cocci and bacilli, anaerobes, actinobacteria, fungi and yeasts, as well as total viruses . When analyzing the relationship between the absolute number of microorganisms, it was revealed that an increase in the level of many microorganisms is associated with an increase in the probability of detecting a leukocyte level ≥10. An analysis of the relationship between the occurrence of individual microorganisms and leukocyte values in prostate secretions ≥10 showed that an increase in the indicators of many microorganisms, compared with the control group, increased the chances of having a leukocyte level ≥10 several times. Conclusion. Identification of microbial associations in prostate secretions using the MSMM method and an increase in the total load of microorganisms in patients with CP/CPPS IIIa, compared with CP/CPPS IIIa and the control group, suggests the role of infection in a certain part of patients with CP/CPPS IIIa, which dictates the need to change the view of the urologist in the diagnosis and treatment strategy of these patients

Meta-analysis of the effectiveness and safety of magnetic stimulation for chronic pelvic pain.

To systematically assess the effectiveness and safety of magnetic stimulation (MS) for treating chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) through a meta-analysis. A comprehensive search of databases including PubMed, The Cochrane Library, EMbase, VIP, Web of Science, WanFang, China Biology Medicine disc (CBMdisc), and China National Knowledge Internet (CNKI) databases was conducted to retrieve randomized controlled trials (RCTs) on MS interventions for CPPS from inception to the present. The search employed keywords such as "MS", "CPPS", and "prostatitis". Data analysis was performed using RevMan 5.4 software, focusing on NIH-Chronic Prostatitis Symptom Index (NIH-CPSI), maximal urinary flow rate (Qmax), and international index of erectile function-5 (IIEF-5) score. Eight RCTs involving 636 patients were included. Our meta-analysis revealed that extracorporeal MS significantly reduced NIH-CPSI scores [MD = -6.65; 95% CI (-8.15, -5.15), P < 0.00001] and improved Qmax [MD = 2.98; 95% CI (1.36, 4.59), P = 0.0003] compared to the control group. Although a trend toward improved IIEF-5 scores was observed [MD = 0.81; 95% CI (-0.34, 1.95), P = 0.17], the results were not significant. MS is effective in alleviating clinical symptoms and enhancing Qmax in patients with CP/CPPS.

Современные возможности лечения доброкачественной гиперплазии предстательной железы и симптомов нижних мочевыводящих путей: новые данные и опыт клинического применения гексанового экстракта плодов Serenoa repens

The article discusses the pharmacological properties and results concerning the clinical use of a medicinal herbal preparation — hexane extract of Serenoa repens (HESr) (creeping palm fruit). In recent years, quite a lot of research data has been accumulated indicating a multicomponent mechanism of drug action. It has been found to have antiandrogenic, antiproliferative and anti-inflammatory effects in the tissues of the prostate gland (pancreas). Studies have been published describing a new mechanism of action of HESr — antineurogenic, the implementation of which helps to reduce infravesical obstruction, leads to inhibition of α1-adrenergic, thromboxane-induced and cholinergic contraction of the pancreatic and detrusor smooth muscles, and also inhibits the growth of pancreatic stromal cells. At present, there is evidence proving the highest clinical efficacy level of the HESr (data from several meta-analyses). The listed effects and patterns of HESr are illustrated by clinical examples of prescribing this drug to patients with lower urinary tract symptoms and benign pancreatic hyperplasia. The safety of use in conditions of polypragmasy in a comorbid patient, the possibility of long-term use without the adverse events occurrence and ensuring a higher life quality while maintaining full sexual function are also particularly noted. KEYWORDS: lower urinary tract symptoms, benign prostatic hyperplasia, chronic bacterial prostatitis, hexane extract of Serenoa repens fruit, ejaculation, life quality. FOR CITATION: Amdiy R.E., Simanov R.N. Modern treatment options for benign prostatic hyperplasia and lower urinary tract symptoms: new data and clinical picture of the hexane extract of Serenoa repens fruit. Russian Medical Inquiry. 2024;8(4):228–234 (in Russ.). DOI: 10.32364/2587-6821-2024-8-4-7.

Understanding Psoriasis as a Biobehavioral Network Disease

Psoriasis is a common immune-mediated inflammatory disease that can often be associated with psychiatric problems such as depression and anxiety. Although psychiatric disorders were initially considered secondary, the high prevalence suggests that common pathophysiological mechanisms may be involved in the development of psoriasis and psychiatric disorders. The shared neuroendocrine and immune mediators weave a web of networks with bidirectional pathways. Biopsychosocial patterns of psoriasis include psychological and behavioral consequences influencing personal social networks, psychological dispositions, and brain-skin psychoimmunological network patterns, which sums in a network of networks. The pathodynamics of other organ diseases like diabetes, liver diseases, internal organ tumors, and latent long-term inflammatory processes (chronic tonsillitis, prostatitis, abscesses and inflammations in the gums, chronic sinusitis) influence psoriasis. Vice versa, psoriasis might cause a pathological impact on other organ systems via networked connections, like arthritis or psychological dispositions. Treatment of psoriasis needs networking through the cooperation of dermatology, rheumatology, and psychiatry and by combining different therapies.

Effect of ethanol extract of Tribulus terrestris L. on immunological resistance of rats in the model of chronic turpentine prostatitis

Effect of ethanol extract of Tribulus terrestris L. on immunological resistance of rats in the model of chronic turpentine prostatitis

Multi-pharmacological treatment for young subfertile males with chronic prostatitis/chronic pelvic pain syndrome.

This study evaluated the effectiveness of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) treatments using multiple pharmaceutical agents that could simultaneously preserve or enhance fertility capability. This was a single-center-based, randomized controlled study, whereas the final analysis evaluated a total 350 CP/CPPS patients (age range, 28-40 years) and 50 patients were randomly allocated to each therapeutic group, with a 1:1 ratio. The therapeutic groups consist of tadalafil (group 1, 5 mg daily), L-carnitine (group 2, 2 g daily), Serenoa repens extract (group 3, 320 mg daily), group 4 (tadalafil+L-carnitine), group 5 (tadalafil+S. repens), group 6 (L-carnitine+S. repens), and group 7 (tadalafil+L-carnitine+S. repens). The treatment outcomes at 3 months post-therapy were analyzed. At 3 months post-therapy, the mean total sperm motility was significantly improved in all groups. A normal morphology improvement was observed in L-carnitine receiving groups. The mean total score on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the mean International Prostate Symptom Score (IPSS) showed the greatest reduction in intensity in group 7. Logistic regression analyses showed that group 5 and group 7 were significantly associated with improvements in total IPSS and total NIH-CPSI scores at 3 months post-therapy. Group 7 was a significant predictor for improving total sperm motility, leukocytospermia and normal form of sperm. Tadalafil, carnitine, and S. repens combination therapy could be considered a feasible treatment option for CP/CPPS males with subfertility.

The microbiota of sexual intercourse and its effect on prostatitis.

It is estimated that microorganisms colonize 90% of the body surface. In some tracts, such as the genitourinary tract, the microbiota varies throughout life, influenced by hormonal stimulation and sexual practices. This study evaluated the semen differences and presence of Lactobacillus crispatus, Lactobacillus iners, Gardnerella vaginalis and Atopobium vaginae in semen samples from patients with symptoms of chronic prostatitis and men asymptomatic for urogenital infections. Fifty-three semen samples were included: 22 samples from men with symptoms of chronic prostatitis and 31 asymptomatic men (control group). In addition to the presence of L. crispatus, L. iners, G. vaginalis and A. vaginae, semen parameters, total antioxidant capacity of seminal plasma, prostatic antigen and some proinflammatory cytokines were evaluated in each semen sample. Volunteers with symptoms of chronic prostatitis presented a lower percentage of sperm morphology (4.3% vs. control group 6.0%, p = 0.004); in the semen samples of volunteers in the group asymptomatic for urogenital infections, microorganisms associated with the vaginal microbiota were detected more frequently. The presence of bacteria in the vaginal microbiota can also benefit male reproductive health, which undergoes various modifications related to lifestyle habits that are susceptible to modification. Microorganisms associated with the vaginal microbiota, such as L. crispatus, L. iners, G. vaginalis and A. vaginae, may have a protective role against the development of male genitourinary diseases such as prostatitis.

In-silico evaluation of bioactive compounds from natural sources targeting NIK and NF-κB pathways for chronic prostatitis therapy and ADMET profile analysis

In-silico evaluation of bioactive compounds from natural sources targeting NIK and NF-κB pathways for chronic prostatitis therapy and ADMET profile analysis