Restorative treatment of patients with chronic prostatitis in resort conditions

Chronic prostatitis tends to be a continuously recurring type of course, which emphasizes the importance of the final, rehabilitation stage of complex therapy, which is optimally carried out in sanatorium and resort conditions. It is also advisable to regularly repeat courses of anti-relapse treatment there. The resort stage of restorative treatment and rehabilitation is most favorable in the general system of health improvement of the population, including reproductive health. The action of natural healing factors is aimed at increasing the body's resistance, has a general therapeutic effect.

Rehabilitation of patients with chronic prostatitis is carried out in the conditions of a resort with nitrogen-siliceous thermal waters. Numerous experimental studies indicate that the mechanism of their effect is realized at the cellular level. As a result, the activity of mitochondria increases, the number of cytoplasmic microvesicles increases. Mineral water stimulates connective tissue, epithelial and parenchymatous cells, affects the function of the hypothalamic-pituitary-adrenal and sympathetic-adrenal systems, stimulates hemodynamics and the exchange of biologically active substances, affects the immune system. Balneotherapy affects the course of the inflammatory process, in particular, delays the development of sclerosis.

The rehabilitation period is the most important stage in the treatment of patients with chronic prostatitis. Its necessity is determined by several factors. Firstly, the absence or disappearance of clinical signs of chronic prostatitis after treatment does not mean restoration of the secretory and barrier functions of the prostate. By the end of treatment, the content of leukocytes, lecithin grains, zinc, prostatic y-globulin, and acid phosphatase in the gland's secretion often does not have time to normalize.

Secondly, after treatment of urethrogenic chronic prostatitis, signs of local immune deficiency usually persist, manifested, in particular, by insufficient functional activity of urethral neutrophilic granulocytes, low levels of antibacterial antibodies that protect the epithelium from bacteria and have the ability to adhere to the epithelium of the urinary tract.

Thirdly, a course of antibiotic therapy disrupts the natural microflora of the urethra, which, along with other factors of local resistance, prevents the development of superficial or invasive infection of the urethra and prostate. It has been proven that "bacterial antagonism" plays a key role in the natural protection of the male urethra from pathogens of sexually transmitted diseases. Antibiotics (especially broad-spectrum) suppress not only pathogenic, but also protective microflora of the urethra. Under these conditions, pathogenic or opportunistic microorganisms that get on its surface during sexual contact cause inflammation not only of the urethra, but also of the prostate gland, which has not restored its barrier function. Moreover, if the infectious agent gets into the gland from the urethra through the lymphatic route, the primary symptoms of chronic prostatitis (pain, dysuria, etc.) can occur within a few hours after infection.

Long-term allergic and autoimmune consequences of chronic prostatitis are manifested, in particular, by antibacterial IgA (detected in the secretion of the prostate gland for 2 years after treatment) and IgG, the content of which in the secretion decreases only 6 months after the end of treatment. According to Shortliffe LMD et al. (1981), antibacterial secretory IgA in the secretion of the gland is determined even a year after the end of treatment. According to J.E. Fowler (1988), such "subclinical infections" of the male genital organs, in which antibacterial IgA are detected in the secretion of the gland and seminal plasma, can be one of the main causes of infertility. For example, IgA antibodies to E. coli have never been detected in the seminal fluid of men who suffered from infertility but did not have a urinary tract infection.

After antibacterial treatment, testicular insufficiency, hormonal background estrogenization, and impaired biosynthesis of testosterone in the testes and its metabolites in the liver and prostate persist. High blood progesterone levels associated with these disorders and changes in pituitary regulation of the gonads may also cause spermatogenesis disorders and fertility disorders that persist after treatment of chronic prostatitis.

During the rehabilitation period, the most promising treatment is sanatorium and resort treatment, which, along with traditional methods, uses mud therapy, ozokerite therapy, balneotherapy, various types of climatic treatment (aerotherapy, exposure to direct and diffuse solar radiation, swimming in open and closed bodies of water).

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