The prostate gland is anatomically and functionally closely connected with the urethra, sex glands and other organs of the small pelvis. Its inflammation is almost inevitably accompanied by inflammation of other genitourinary organs, as well as violations of sexual function, spermogram, psychoemotional sphere, and in older men - benign prostatic hyperplasia.
It seems appropriate to use a phosphodiesterase type 5 inhibitor Sildenafil in a complex of rehabilitation measures after the treatment of chronic prostatitis, since this drug is able to eliminate erectile dysfunction, testicular insufficiency and depression, which do not disappear against the background of standard therapy for chronic prostatitis.
Key words: chronic prostatitis, sildenafil, viagra, erectile dysfunction, treatment, rehabilitation.
Inflammation of the prostate gland almost never occurs in isolation. The conditions of sexual infection determine the presence of posterior urethritis, and the close anatomical and functional relationship of the prostate gland with the urinary tract, sex glands and other organs of the small pelvis is the pattern of inflammatory lesions of other organs of the genitourinary system . Since the prostate gland is innervated from n. hypogastricus (sympathetic fibers), n. erigentes, n. pudendus (parasympathetic fibers) and n. pelvicus supplying other pelvic organs, chronic prostatitis manifests itself in a variety of subjective sensations and functional disorders. Moreover, numerous and varied disorders caused by inflammation of the prostate gland are complemented by neuropsychiatric disorders [2, 3].
Despite the possibility of the occurrence of subjective sensations and functional disorders of different nature and intensity, subjective phenomena in patients chronic prostatitis are uncommon and depend both on the duration, intensity and prevalence of the pathological process, and on the state of the nervous system. Chronic prostatitis is often not accompanied by any disorders, is asymptomatic and is detected by chance during urological examination.
Subjective disorders in prostatitis are reduced to itching, burning in the urethra and paresthesias (sensations of pressure, heaviness, overflow) in the perineum and rectum, which increase with prolonged sitting in one place or driving in a car. The pain can intensify during bowel movements and radiate along the penis, into the scrotum, sacrum, lower back, thigh, or take on the character of periodically repeated painful neuralgic attacks.
Functional disorders in chronic prostatitis can be observed from the urinary apparatus (frequent and painful urge to urinate, constant or only at night; partial urinary retention, etc.), the nervous system and the psyche (mainly in the form of secondary neurasthenic syndrome), and also in the form of sexual dysfunction (weak erection, premature ejaculation, loss of orgasm).
In chronic prostatitis, due to a decrease in the receptor sensitivity of the genital organs, the copulatory phases undergo changes: in 36.2% there are violations of an adequate erection, in 30.1% - ejaculation, in 9.9% - changes in orgasm, in 13.7% - libido ... At the same time, spontaneous and adequate erection, as well as ejaculation, are more impaired in catarrhal prostatitis, and impaired libido and simultaneously several phases of copulation occur with different forms of prostatitis with approximately the same frequency . Such a variety of disorders of sexual function can occur both in patients with chronic prostatitis and in persons without urological diseases, causing congestion (stagnation) in the pelvic organs and contributing to its development.
Disorders of sexual function often occur with neurotic reactions due to various reasons: estrogenization of the hormonal background and the presence of testicular insufficiency, constant fixation of the attention of patients on their condition. In the formation of neurosis, prolonged irritation is important as a result of inflammation of a huge number of nerve endings embedded in the prostate gland.
The large role of sexual dysfunctions in the development of chronic inflammation of the prostate gland confirms the importance of measures aimed at restoring sexual function not only in patients with chronic prostatitis, but also in healthy men.
An effective means of eliminating erectile dysfunction is the drug sildenafil, which belongs to type 5 phosphodiesterase inhibitors (PDE-5). In addition, it serves as an important component of measures aimed at the ejaculatory component of the male copulatory cycle [5, 6, 7], and is used in the treatment of premature ejaculation, intravaginal delay in ejaculation and to stabilize ejaculatory control in men without clinically significant ejaculation disorders [8 ].
Since erectile dysfunction, ejaculation and urination disorders have a number of common risk factors due to the presence of nitric oxide synthase and PDE-5 expression in prostate tissues, these factors play an important role in the pathophysiology of benign prostatic hyperplasia glands (BPH), PDE-5 inhibitors, including sildenafil, are used in the treatment of BPH . According to Ya. Sageshe1 et al., The appointment of these drugs leads to relaxation of the smooth muscles of the urinary tract and is pathogenetically justified in erectile dysfunction and urinary dysfunction in elderly men with BPH .
The use of sildenafil in a complex of measures for the rehabilitation of a patient after the treatment of chronic prostatitis is associated with the effect of this drug on the relaxation of the excretory ducts of the prostate gland. In addition, leading to stabilization of the synthesis of nitric oxide in the organs of the genitourinary system, sildenafil is successfully used in the presence of lower urinary tract syndrome, having a positive effect on its symptoms, uroflowmetry indicators and residual urine volume . The researchers noted that the use of this drug leads to the elimination of a number of deviations in the most important parameters of the male reproductive system that remain after the treatment of chronic prostatitis. First of all, we are talking about such disorders as testicular insufficiency, estrogenization of the hormonal background, impaired testosterone biosynthesis in the testes and its metabolites in the liver and prostate gland, as well as high blood progesterone levels and the associated pituitary gonadal regulation , which cause impaired spermatogenesis and fertility disorders. In such patients, the normalization of copulatory function with the help of sildenafil, along with the restoration of libido, erection, ejaculation (together with the revival of the harmony of family relationships in married couples), leads to the elimination of testicular insufficiency, estrogenization of the hormonal background, a decrease in the concentration of progesterone in the blood, restoration of spermatogenesis and fertility.
As you know, chronic prostatitis is a common cause of spermogram abnormalities . In this regard, the inclusion of sil-denafil, which has a stimulating effect on sperm motility, in the complex of rehabilitation measures after chronic prostatitis therapy is advisable in case of II degree oligozoospermia, combined with a high level of blood prolactin (more than 300 IU / ml) .
Sildenafil can be used not only for the purpose of rehabilitation after treatment of chronic prostatitis in patients with grade II hyperprolactinemia and oligozoospermia, but also for BPH associated with chronic spastic colitis, gastric ulcer and duodenal ulcer , hemorrhoids, metabolic syndrome  and other diseases in which an infectious agent can penetrate the prostate gland by the lymphogenous or hematogenous route in conditions when the gland has not yet restored its lost functions (primarily, barrier).
"Sildenafil and chronic prostatitis"
Molochkov Vladimir Alekseevich - Doctor of Medical Sciences, Professor, Head of the Department of Dermatovenereology and Dermatooncology
Moscow, Russian Federation, 2020