Novel Russian development redefines prostatitis management

Chronic prostatitis ranks third among urological disorders in men^[1]. Despite its high prevalence, the disease remains difficult to diagnose and treat — no universal therapy exists, and effective management requires a multidisciplinary approach, whose importance was emphasized by leading experts at the XXV Congress of the Russian Society of Urologists (RSU).

Chronic prostatitis is the most common urological disorder among men under 50^[1].

"Inflammation associated with prostatitis leads to fibrosis, which in turn causes smooth muscle dysfunction. Chronic inflammation remodels the extracellular matrix and triggers epithelial—mesenchymal transition in prostate tissue,"

said Professor Adel Salmanovich Al-Shukri, MD, PhD, of the Pavlov First Saint Petersburg State Medical University.

He noted that as a result, patients experience a wide range of symptoms — from urination disorders and sexual dysfunction to chronic pelvic pain.

Prostatitis is often diagnosed late and not always treated effectively. Antibiotic therapy may fail due to pathogen resistance and the limited ability of antibiotics to reach the infection site.

The formation of bacterial biofilms significantly reduces treatment efficacy. By creating an invisible protective barrier around bacteria, biofilms prevent antibiotics from reaching their targets. Moreover, biofilms promote calcification and the formation of prostatic stones, which further increase discomfort and negatively impact quality of life^[2].

"In the fight against antimicrobial resistance, greater emphasis should be placed on approaches that avoid antibiotics in mild infections, enhance nonspecific immunity, and employ antibodies or agents that destroy biofilms,"

explained Professor Roman Kozlov, Doctor of Medical Sciences, Corresponding Member of the Russian Academy of Sciences and Chief External Expert in Clinical Microbiology and Antimicrobial Resistance of the Ministry of Health of Russia.

Currently, there is no single therapy suitable for all patients with prostatitis. The most effective strategy is a multimodal approach, tailored to the patient’s symptoms and disease course. To support personalized therapy selection, the UPOINTS classification system has been developed.

Experts highlighted that the use of enzyme-based agents, such as bovhyaluronidase azoximer (Longidaza^®), as part of multimodal therapy can help prevent chronicity of the process and, in chronic cases, prolong remission periods.

"Treatment with the drug reduces the volume of bacterial biofilms twofold and decreases the concentration of antibiotics required for effective pathogen elimination by 16 times,"

said Professor Leonid Spivak, MD, PhD, of the Institute of Urology and Reproductive Health, Sechenov University.

He added that the drug’s strong evidence base, accumulated over many years of clinical use, includes nine major studies involving more than 1,000 patients with prostatitis.

The product was developed by Russian scientists at Petrovax Pharm, which served as a strategic partner of the anniversary Congress of Russian Society of Urologists.

"It is a great honor for us to partner with the professional community that defines the direction of urology in Russia. We see our mission as supporting medical specialists at every stage — from clinical research to the implementation of innovative solutions and educational initiatives. Our company is focused on developing original biotechnological medicines that make advanced therapy more accessible to patients,"

said Mikhail Tsyferov, President of Petrovax Pharm.

Reference Information

Longidaza^® (bovhyaluronidase azoximer) is an enzyme-based medicinal product with prolonged anti-inflammatory and antifibrotic effects, backed by more than 20 years of clinical experience. The drug is widely used by urologists across Russia for the treatment and prevention of diseases associated with inflammation and connective tissue hyperplasia (fibrosis, adhesions). Through its dual anti-inflammatory and antifibrotic action, bovhyaluronidase azoximer helps prevent the spread of connective tissue, reduce existing fibrosis, and disrupt bacterial biofilms, releasing bacterial cells from their structure^[3]. The drug is used in urology, gynecology, pulmonology, surgery, dermatology, cosmetology, and rheumatology. In 2011, a patent was obtained for a method of treating autoimmune male infertility. In 2015, the World Health Organization assigned the international nonproprietary name (INN) bovhyaluronidase azoximer. The product is exported to EAEU markets, protected by a European patent, and also holds patents in the United States, South Korea, and India.

¹ Pendegast HJ, Leslie SW, Rosario DJ. Chronic Prostatitis and Chronic Pelvic Pain Syndrome in Men. 2024 Jan 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 38261706.

² Cai T, Tessarolo F, Caola I, Piccoli F, Nollo G, Caciagli P, Mazzoli S, Palmieri A, Verze P, Malossini G, Mirone V, Bjerklund Johansen TE. Prostate calcifications: A case series supporting the microbial biofilm theory. Investig Clin Urol. 2018 May;59(3):187-193. doi: 10.4111/icu.2018.59.3.187. Epub 2018 Apr 4. PMID: 29744476; PMCID: PMC5934281.

³ E. V. Kulchavenya, S. Yu. Shevchenko, A. G. Cherednichenko, A. A. Breusov, A. A. Vinitsky. New possibilities for the use of hyaluronidase in chronic prostatitis. Urology, 2020, No. 3. https://dx.doi.org/10.18565/urology.2020.3.56-62 (in Russian)

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