The efficiency of various cytokine therapy regimens in the complex treatment of men with chronic abacterial prostatitis

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Introduction. Chronic prostatitis (CP) is one of the most important and discussed urological diseases. Treatment of bacterial CP with an established pathogen usually is not associated with any difficulties. Chronic abacterial prostatitis (CAP) remains the most problematic issue. Immune defense mechanisms are important in the development of CP, including a decrease in the functional activity of monocytes/macrophages, neutrophils, as well as imbalance of pro- and anti-inflammatory cytokines.

Aim. To evaluate the efficiency of various schemes of using the immunomodulatory drug Superlymph® as part of the combination therapy of men with CAP.

Materials and methods. A total of 90 patients with category IIIa CAP (NIH, 1995) were included in the study. In the control group, patients received basic therapy of CAP, namely behavioral therapy, α1-adrenoblocker and fluoroquinolone for 28 days. In the main group I basic therapy in combination with Superlymph® 25 ME in one suppository q.d. for 20 days was administered. In the main group II basic therapy in combination with Superlymph® 10 ME in one suppository b.i.d. for 20 days was given. Evaluation of treatment efficiency was carried out after 14 ± 2 days (visit 2) and 28± 2 days (visit 3) from the start of treatment.

Results. The study groups were homogeneous, and baseline characteristics did not differ significantly (p>0.05). However, significant differences were found between the results in the main groups and the control group at visit 2 for all the indicators (p<0.05). The number of daytime urinations was lower in the main group I and II compared to CG by 16.7% and 28.4%, the number of night urination by 28% and 40%, the average IPSS score by 29.1% and 38.3%, the average QoL score by 32.4% and 45.9%, the average NIH-CPSI score by 26.8% and 37.4%, the number of leukocytes in expressed prostatic secretion by 41.2% and 52.1%, prostate volume by 16.8% and 21.8%, bladder volume by 15.8% and 21.7%, and Qmax by 14.3% and 21.2%, respectively. Similar significant differences between the main groups and control group were also seen at visit 3, while the indicators in main groups I and II reached normal values after 28 days of therapy.

In this study, for the first time, a comparative analysis of two different treatment regimens with Superlymph® was carried out. In the main group I, patients received suppositories at a dose of 25ME q.d., while in the main group II, the drug was administered 10 ME b.i.d. The results indicate a comparable efficiency of both schemes after 4 weeks. However, in the main group II, after 2 weeks, there was a significantly more pronounced positive dynamics of all indicators in comparison with the main group I (p<0.05). Consequently, the use of Superlymph® at a dose of 10ME b.i.d. a day allows to reduce the severity of the inflammatory process in a shorter time.

Conclusion. The use of Superlymph® in patients with CAP allows to reduce the severity of clinical manifestations in a shorter time, and has a positive effect on the dynamics of the inflammatory process, which leads to an improvement in the quality of life. According to our results, the most effective scheme in patients with CAP is basic therapy in combination with Superlymph® 10 ME for 1 suppository 2 times a day for 10 days. In our opinion, Superlymph® can be effectively used as part of the combination therapy of men with CAP.

Full Text

Restricted Access

About the authors

T. A. Gyaurgiev

FGBOU VO «Voronezh State Medical University named after N.N. Burdenko

Author for correspondence.
Email: gta001100@yandex.ru
ORCID iD: 0000-0002-2209-6264

Ph.D., associate professor at the Department of Specialized Surgical disciplines

Russian Federation, Voronezh

A. V. Kuzmenko

FGBOU VO «Voronezh State Medical University named after N.N. Burdenko

Email: kuzmenkoav09@yandex.ru
ORCID iD: 0000-0002-7927-7015

Ph.D., MD, professor, professor at the Department of Specialized Surgical disciplines

Russian Federation, Voronezh

V. V. Kuzmenko

FGBOU VO «Voronezh State Medical University named after N.N. Burdenko

Email: kuzmenkovv2003@mail.ru
ORCID iD: 0000-0001-7803-8832

MD, professor, professor at the Department of Specialized Surgical disciplines

Russian Federation, Voronezh

References

  1. Urology. Russian clinical guidelines. Under the editorship of Yu.G. Alyaev, P.V. Glybochko, D.Yu. Pushkar. M.: GEOTAR-Media; 2018. 480 s. Russian (Урология. Российские клинические рекомендации. Под ред. Ю.Г. Аляева, П.В. Глыбочко, Д.Ю. Пушкаря. М.: ГЭОТАР-Медиа; 2018. 480 с.)
  2. Engeler D., MesselinkE.J., Baranowski A.P. et al. EAU guidelines on chronic pelvic pain. 2022. ISBN 978-94-92671-07-3. Available at: https://uroweb.org/guidelines/chronic-pelvic-pain
  3. Nickel J. Prostatitis. CUA Guidelines. Canadian Urol. Assoc. J. 2011;5(5):306–315. https://www.ncbi.nlm.nih.gov/ pubmed/22031609
  4. Schaeffer A.J. Classification (Traditional and National Institutes of Health) and Demographics of Prostatitis/ Urology. 2002;60(6 Suppl):5–6; discussion 6–7. doi: 10.1016/s0090-4295(02)02292-6.
  5. Krieger J.N., Nyberg L.Jr, Nickel J.C. NIH consensus definition and classification of prostatitis. JAMA 1999;282(3):236-237.
  6. Pushkar D.Yu., Segal A.S. Chronic abacterial prostatitis: a modern understanding of the problem. Vrachebnoe soslovie=Medical Caste 2004;(5–6):9–11. Russian (Пушкарь Д.Ю., Сегал А.С. Хронический абактериальный простатит: современное понимание проблемы. Врачебное сословие. 2004;(5–6):9–11).
  7. Gorbachev A.G., Borovets S.Yu., Al-Shukri S.H. et al. Chronic prostatitis: infectious or noninfectious? (clinical experimental research). Meditsina i obrazovanievSibiri=Journal of Siberian Medical Sciences 2013;(5):7–10. Russian (Горбачев А.Г., Боровец С.Ю., Аль-Шукри С.Х. и др. Хронический простатит: инфекционный или неинфекционный (клинико-экспериментальное исследование). Медицина и образование в Сибири 2013;(5):7–10).
  8. Kadyrov Z.А., Stepanov V.S., Ramishvili Sh.V., Mashaneishvili Sh.G. Diagnostics of chronic nonbacterial prostatitis. Andrologiya i genital’naya khirurgiya = Andrology and Genital Surgery. 2019;20(3):36–42. Russian (Кадыров З.А., Степанов В.С., Рамишвили Ш.В., Машанеишвили Ш.Г. Диагностика хронического абактериального простатита. Андрология и генитальная хирургия 2019;20(3):36–42). doi: 10.17650/2070-9781-2019-20-3-00-00.
  9. Tyuzikov I.A., Grekov E.A., Smirnov A.V. Local cytokinotherapy in the complex treatment of chronic prostatitis. Effective pharmacotherapy. 2022;18(27):26–38. Russian (Тюзиков И.А., Греков Е.А., Смирнов А.В. Локальная цитокинотерапия в комплексном лечении хронического простатита. Эффективная фармакотерапия. 2022;18(27):26–38). doi: 10.33978/2307-3586-2022-18-27-26-38.
  10. Dorofeev S.D., Kudryavtsev Yu.V., Kudryavtseva L.V. Immunohistochemical aspects of chronic abacterial prostatitis. Effective pharmacotherapy. 2014;2:26–38. Russian (Дорофеев С.Д., Кудрявцев Ю.В., Кудрявцева Л.В. Иммуногистохимические аспекты хронического абактериального простатита. Эффективная фармакотерапия. 2014;2:26–38.
  11. Jang T.L., Schaeffer A.J. The role of cytokines in prostatitis. World J. Urol. 2003;21(2):95–99.
  12. Ledneva A.V., Styazhkina S.N., Chernenkova M.L., etc. Cytokinotherapy in clinical practice. Modern problems of science and education. 2011;6:35–39. Russian (Леднева А.В., Стяжкина С.Н., Черненкова М.Л. и др. Цитокинотерапия в клинической практике. Современные проблемы науки и образования. 2011;6:35–39). https://science-education.ru/ru/article/view?id=5267
  13. Superlimf® rectal and vaginal suppositories 10 units, 25 units: instructions for the use of the drug for medical use. Russian (Суперлимф® суппозитории ректальные и вагинальные 10 ЕД, 25 ЕД: инструкция по применению лекарственного препарата для медицинского применения.) https://www.rlsnet.ru/drugs/superlimf-16414.
  14. Mazo E.B., Kovalchuk L.V., Gankovskaya L.V., Dolgina E.N., Viryasov A.V. The effectiveness of cytokines (Superlimf) in the treatment of patients with inflammatory syndrome of chronic pelvic pain Bulletin of the Russian State Medical University. 2006;6(53):51–56. Russian (Мазо Е.Б., Ковальчук Л.В., Ганковская Л.В., Долгина Е.Н., Вирясов А.В. Эффективность применения цитокинов (Cуперлимф) в лечении больных воспалительным синдромом хронической тазовой боли Вестник Российского государственного медицинского университета. 2006;6(53):51–56).
  15. Maso E.B., Kovalchuk L.V., Gankovskaya L.V., Dolgina E.N., Viryasov A.V. The drug Superlimf in the complex treatment of chronic abacterial infectious prostatitis. Modern problems of dermatovenerology, immunology and medical cosmetology. 2006;2(2):35–42. Russian (Мазо Е.Б., Ковальчук Л.В., Ганковская Л.В., Долгина Е.Н., Вирясов А.В. Препарат Суперлимф® в комплексном лечении хронического абактериального инфекционного простатита. Современные проблемы дерматовенерологии, иммунологии и врачебной косметологии. 2006;2(2):35–42).
  16. Apolikhina I.A., Saidova A.S., Teterina T.A. The effectiveness of local cytokinotherapy in the complex treatment of patients with chronic cystitis. Obstetrics and gynecology. 2019;12:156–161. Russian (Аполихина И.А., Саидова А.С., Тетерина Т.А. Эффективность применения локальной цитокинотерапии в комплексном лечении пациенток с хроническим циститом. Акушерство и гинекология. 2019;12:156–161).
  17. Saidova A.S., Apolikhina I.A., Gankovskaya L.V., etc. The effectiveness of cytokine therapy in the complex treatment of patients with chronic recurrent cystitis. Medical opponent. 2021;2(14):59-69. Russian (Саидова А.С., Аполихина И.А., Ганковская Л.В. и др. Эффективность применения цитокинотерапии в комплексном лечении пациенток с хроническим рецидивирующим циститом. Медицинский оппонент. 2021;2 (14):59–69).
  18. Rees J., Abrahams M., Doble A., Cooper A. and the Prostatitis Expert Reference Group (PERG). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int. 2015;116:509–525. 10.1111/bju.13101' target='_blank'>https://doi: 10.1111/bju.13101
  19. Kuzmenko A.V., Kuzmenko V.V., Gyaurgiev T.A. Combined drug therapy of patients with BPH. Urology. 2018;1:101–105.
  20. Kuzmenko A.V., Gyaurgiev T.A., Kuzmenko G.A. Our experience of using hexane extract of Serenoa Repens fruit (Permixone) in the treatment of LUTS in clinical practice. Urology. 2022;2:84–89.
  21. Kuzmenko A.V., Kuzmenko V.V., Gyaurgiev T.A., Barannikov I.I. Chronobiological status of patients with chronic prostatitis on the background of prostate adenoma. System analysis and management in biomedical systems. 2017;16(3):513–516.
  22. Thakkinstian A., Attia J., Anothaisintawee T., Nickel J.C. α-blockers, antibiotics and anti-inflammatories have a role in the management of chronic prostatitis/chronic pelvic pain syndrome. BJU Int. 2012;110(7):1014–1022.
  23. Bozhedomov V.A. Modern opportunities for the treatment of chronic prostatitis. Andrologiya i genital’naya khirurgiya = Andrology and Genital Surgery. 2016;17(3):10–22. Russian (Божедомов В.А. Современные возможности лечения хронического простатита. Андрология и генитальная хирургия. 2016;17(3):10–22).
  24. Polackwich A.S., Shoskes D.A. Chronic prostatitis/chronic pelvic pain syndrome: a review of evaluation and therapy. Prostate Cancer Prostatatic Dis. 2016;19(2):132–138. doi: 10.1038/pcan.2016.8.
  25. Lokshin K.L. Prostatitis: what’s new in basic science and clinical studies? Vestnik urologii = Herald Urology 2017;5(4):69–78. Russian (Локшин К.Л. Простатит: что нового и полезного в фундаментальных и клинических исследованиях? Вестник урологии 2017;5(4):69–78). doi: 10.21886/2308-6424-2017-5-4-69-78
  26. Chen L., Zhang M., Liang C. Сhronic prostatitis and pelvic pain syndrome: another autoimmune disease? Arch. Immunol. Ther. Exp. (Warsz). 2021;69(1):24.
  27. Miller L.J., Fisher K.A., Goralnick S.J. et al. Interleukin-10 levels in seminal plasma: implications for chronic prostatitis-chronic pelvis pain syndrome. J. Urol. 2002;167(2 Pt. 1):753–756.
  28. Chen L., Bian Z., Chen J., et al. Immunological alterations in patients with chronic prostatitis/chronic pelvic pain syndrome and experimental autoimmune prostatitis model: a systematic review and meta-analysis. Cytokine. 2021;141:155440.
  29. Ma J., Gharaee-Kermani M., Kunju L., Hollingsworth J.M. et al. Prostatic fibrosis is 22associated with lower urinary tract symptoms. J Urol. 2012;188(4):1375–1381.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig.1 Dynamics of the average score on the NIH-CPSI scale in a group during 3 visits, points

Download (41KB)
Indexing metadata
3. Fig.2 Dynamics of the average score on the IPSS scale in a group during 3 visits, points

Download (39KB)
Indexing metadata

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies