Contrary to popular belief, the incidence of prostatitis identified and confirmed by laboratory testing is only about 9%.However, prostate inflammation often recurs or becomes chronic.
It is difficult to assess the prevalence of chronic forms of prostatitis, characterized by an inactive inflammatory process and minor clinical symptoms that reduce quality of life.
In addition to acute and chronic bacterial prostatitis, chronic inflammatory pelvic pain syndrome is separately distinguished, in which leukocytes are detected in the third portion of urine or seminal fluid, as well as chronic pelvic pain syndrome without inflammatory changes.
In the appearance and maintenance of the characteristic symptoms of chronic prostatitis, functional disorders of urination, expressed in high urinary pressure, intraprostatic reflux forming a turbulent urine flow, the pathogenic influence of microorganisms, immunological reactions and the altered state of the pelvic floor muscles, are of great importance.
The periodic appearance and intensification of lower urinary tract pain and symptoms (LUTS), sleep disturbances and often erectile function significantly affect the physical and psychological state of a man.
Most often, lower urinary tract symptoms in young and middle-aged men are caused by an inflammatory process in the prostate gland, however, given the patient's age, it is always necessary to carry out a differential diagnosis between adenoma and prostate cancer.
There are different opinions on the pathogenesis of chronic prostatitis, based on which various treatment methods are proposed.Treatment of acute prostatitis depends on the identified pathogen and includes mainly antibacterial drugs that have the greatest ability to penetrate the prostate tissue.
Acute bacterial prostatitis requires parenteral administration of bactericidal antibiotics such as aminoglycosides or third-generation cephalosporins.Treatment continues until fever disappears and blood counts return to normal.In less severe cases, fluoroquinolones may be prescribed.The duration of treatment with fluoroquinolones for acute prostatitis is 2 to 4 weeks.
For chronic bacterial prostatitis and chronic inflammatory pelvic pain syndrome, treatment is with fluoroquinolones or trimethoprim.The patient is then re-examined and antibiotics are continued only in cases where the microorganism that caused the disease is known or if the patient has noticed a positive effect from the therapy.
The recommended treatment period for chronic prostatitis is 4 to 6 weeks or longer.Urodynamic studies have shown increased urethral pressure.In this sense, it was observed that combined treatment with alpha-blockers and antibiotics is more effective than monotherapy with antibiotics in the inflammatory syndrome of chronic pelvic pain.When prescribing a course of therapy, the doctor should discuss with the patient its duration, the likelihood of side effects and the need to monitor the effectiveness and safety of treatment.
Herbal medicines in the treatment of chronic prostatitis.
The use of herbal preparations in the treatment of prostate diseases has a long history.Evidence for the efficacy and safety of herbal medicines has been empirically obtained.
Currently, the possibility of using herbal remedies should be determined by modern ideas about the pathogenesis and development of pathological processes, in particular in the prostate gland.
Processes such as functional obstruction, the appearance of turbulence in the prostatic urethra, the pathological influence of commensal microorganisms, immunological changes, alter normal metabolism.Some violations inevitably lead to others.For example, chronic inflammation causes cellular alteration and damage.
Normally, the body constantly produces products of incomplete oxidation, the so-called free radicals, the number of which increases in various pathological conditions, in particular during inflammation.A disruption in the supply of oxygen to tissues, in which the rate of accumulation of active radical compounds (oxygen, nitrogen and chlorine radicals) exceeds the rate of their neutralization, is called oxidative stress.As a result, oxidative stress leads over time to tissue damage, including the prostate gland.
Natural antioxidants - vitamins E, C and carotenoids - have long been known to biochemists, but they cannot seriously influence oxidative stress.In recent years, more and more attention has been paid to bioflavonoids, which have antioxidant activity tens of times stronger than vitamin E, vitamin C and beta-carotene.In total, more than 6,000 bioflavonoids are known, of which more than 3,000 are flavones and more than 700 areoflavones.Approximately 2% of the total organic carbon produced by photosynthesis is synthesized by plants into flavonoids or other polyphenols.
Flavonoids protect plants from radiation, ultraviolet radiation, oxidation, diseases, infections and bacteria.One of the representatives of medicinal plants containing bioflavonoids is Hedysarum negligum, a perennial herbaceous plant from the legume family.This small plant, 25 to 50 cm high, blooms from June to August with small purple-violet flowers.
The roots of the forgotten centella contain the flavonoid quercetin, saponins and other biologically active substances.It is quercetin derivatives that have antioxidant activity and are effective in patients with chronic prostatitis, which is confirmed by the results of clinical studies.
In addition to these properties, the catechins contained in the roots of the forgotten kopeck have high vitamin P activity, strengthen capillary walls and optimize microcirculation.The roots of the forgotten centella have adaptogenic properties, which also determines the value of including the plant in the complex therapy of patients with chronic prostatitis.
Knotweed (Polygonum aviculare), an annual herbaceous weed with small, elliptical leaves, also contains flavonoids.A single stem extending from the root base branches profusely and produces a mass of green shoots.This low-growing plant produces numerous inconspicuous greenish-white flowers in May.Knotweed also contains a large amount of ascorbic acid, vitamin K and provitamin A.
Products based on Knotweed herb have long been known in urological practice because they have a diuretic, antigout and adaptogenic effect.The combined use of common and knotweed grass allows us to expect a clinically significant effect.
The herbal medicines available in clinical practice, which are produced from the common grass (root and rhizome) as well as the knotweed, are a tincture of the root of the forgotten common grass.
The biologically active substances included in the tincture contain natural antioxidants and substances that improve microcirculation, which determines the ability of these herbal remedies to reduce the severity of the inflammatory process in the prostate and pain syndrome (feeling of pain and heaviness in the perineum, prostatorrhea).
Increasing blood circulation in the prostate reduces the severity of lower urinary tract symptoms (including frequent and difficult urination, discomfort when emptying the bladder, weakened urine flow and a feeling of incomplete emptying of the bladder) and also improves the functional state of the cavernous arteries.
Clinical efficacy of tincture of the roots of the forgotten kopeck.
The effectiveness of the tincture was studied in an open comparative randomized study.The aim of the study was to study the effect of herbal preparations on the dynamics of pain syndrome, objective data and laboratory parameters in patients with chronic prostatitis.
In addition to the study of complaints and clinical history, the diagnosis was confirmed by laboratory tests of pure prostate secretions or urine.In parallel groups with active control, the efficacy, safety and tolerability of the drug in patients with chronic prostatitis was evaluated.
To objectively describe the symptoms, the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), analysis of urinary diaries and comparison of laboratory data were used.In patients, urological diseases that could be accompanied by similar symptoms (benign hyperplasia, prostate cancer), pathological changes in the nervous system and gastrointestinal tract were excluded.
A long course of prostatitis with periodic exacerbations negatively affects the emotional and sexual sphere.Observation and changes in erectile function against the background of chronic prostatitis in patients receiving the drug were also carried out using standard questionnaires.In parallel, the safety of the drug was evaluated in comparison with other herbal medicines.
To clarify the effective dosage of tincture from the roots of the forgotten pennywort, the patients were divided into two groups.The first group, consisting of 30 people, received 1 teaspoon of tincture 3 times a day.Patients in the second group, which also consisted of 30 people, took the tincture 2 teaspoons 3 times a day.
The distribution of patients into groups was carried out using a simple randomization method, which allowed the effects of the drug to be studied in homogeneous groups.The Red Root Plus medication was prescribed on an empty stomach, at least 30 minutes before meals.Before use, the bottle with the medicine was shaken and a single dose was dissolved in 1/3 glass of water.The duration of treatment was 30 days.
A control group of 20 patients diagnosed with chronic prostatitis were treated with another herbal preparation during the same period.Criteria for effectiveness in the groups that used the tincture 1 teaspoon 3 times a day, 2 teaspoons 3 times a day, or took a comparator medication were changes in clinical symptoms based on a patient survey, questionnaire data, and voiding diaries.All included patients completed the study.
The average age of patients in the first group who received tincture of forgotten kopeck roots, 1 teaspoon 3 times a day, was 45.5 (37-56) years (the median, as well as the 25th and 75th percentiles are indicated below).The average age of patients in the second group, who took 2 teaspoons of tincture 3 times a day, was 45.5 (33-55) years.The average age of patients in the control group was 48 (36-59) years.
There were no statistically significant differences in age between the groups (p = 0.63) (analysis of variance was used hereinafter).It should be noted that chronic prostatitis has been identified in people of more active and working age, for whom the preservation of erectile and reproductive function is especially important.Of the total patients included in the study, 26 (32.5%) had a history of sexually transmitted diseases.The distribution of these patients in the groups was the same.
Before prescribing tincture plus, 57 (71.3%) patients received treatment for chronic prostatitis.In most cases it involved antibacterial therapy and/or alpha blockers.The distribution of patients who had previously received treatment, as well as the type of treatment, did not differ significantly between the groups, confirming modern ideas about the pathogenesis and, consequently, the methods of treatment of chronic prostatitis.
To objectively evaluate the symptoms and their severity, as well as the quality of life of the patients, the NIH-CPSI scale was used, recommended both for the basic evaluation and for monitoring the condition of the patients.Initially, the pain level according to the NIH-CPSI scale before treatment in the group receiving tincture of centella roots, 1 teaspoon 3 times a day, was 13 (10-15) points;in the group that received the tincture 2 teaspoons 3 times a day – 12 (10-15) points.In the control group, this indicator was 13 (10-15) points.The severity of pain between the groups had no statistically significant differences (p = 0.846).
The patient groups were homogeneous in both the location and intensity of pain, which is especially important given the variety of clinical manifestations of this disease.
Since among the supposed causes of the appearance and recurrence of chronic prostatitis, urinary disorders, such as bladder outlet obstruction, detrusor-sphincter dyssynergia, increased pressure in the lumen of the prostatic urethra and intraprostatic reflux, special attention was paid to the distribution of patients according to the presence and severity of LUTS in a context of pain and discomfort.Initially, in the first group this indicator was, according to the NIH-CPSI scale, 2 (1–3) points, in the second group – 2 (1–3) points and in the control – also 2 (1–3) points.
The severity of urinary disorders did not differ statistically significantly between the groups (p = 0.937).The study groups were homogeneous with respect to LUTS.There were no differences between the groups in the results of the voiding diary analysis.It can be said with reasonable confidence that LUTS were associated with prostate diseases and not with functional disorders of the bladder or water balance.
The maximum urinary flow, according to uroflowmetry, in the first group was 13.3 (11.8-14.2) ml/s, in the second group 13.2 (12.1-14.0) ml/s and in the control group 13.0 (11.8-14.6) ml/s.There were no statistically significant differences in this indicator between the groups (p = 0.996).The residual urine volume in the first, second, and control groups was 23.0 (20–26), 23 (18–25), and 20 (16.5–24) ml, respectively.The patient groups also did not differ in this indicator (p = 0.175).
It can be stated that no pronounced alterations of the reservoir and evacuation functions of the bladder were detected in patients with chronic prostatitis in the study groups, however, the existing LUTS allow us to suspect the source of the pathological symptoms precisely at the level of the prostatic urethra.
Patients' subjective perception of the symptoms of chronic prostatitis is also of great importance.A variety of uncomfortable sensations of varying severity, prone to repetition, often unpredictable, significantly disrupt the usual way of life of men.This affects not only your mood, but also your social activity.That is why the study of quality of life, which depends on the severity of the disease, its relapses and consequences, also serves as a criterion for the effectiveness of treatment.
Before prescribing the treatment, in the group that received the Red Root tincture plus 1 teaspoon 3 times a day, the quality of life, according to the questionnaire, was assessed at 6 (5–9) points, in the group that received the tincture 2 teaspoons 3 times a day – at 8 (6–9) points, and in the control group – at 6 (3–9) points.There were no statistically significant differences between the groups for this indicator (p = 0.22).
The total score on the NIH-CPSI scale in the first group was 22 (19–25), in the second group – 23 (19–25) and in the control – 22 (18–25) (p = 0.801).Therefore, the groups were homogeneous not only in terms of the sum of the scores on the chronic prostatitis symptom scale, but also in terms of their individual components.All patients answered questions from the Male Copulative Function Scale (MCF).In the first group the indicator was 31 (23–41) points, in the second – 34 (27–39) points, in the third – 34 (26–37) points.The effect of chronic prostatitis on erectile function also continues to be studied.
In the three groups the range of values is quite wide.This indicates the individual degree of a man's response to his symptoms and disorders.However, the distribution of chronic prostatitis patients with different states of erectile function in groups before treatment did not differ (p = 0.967).Thus, at the beginning of the study it was possible to form three groups of patients with chronic prostatitis, which were homogeneous in age, type and severity of clinical symptoms, which affected quality of life.At the same time, disorders of the reservoir and evacuation functions of the bladder were excluded.
After 30 days of treatment, symptoms were evaluated in the groups formed.In the group of patients who received tincture of forgotten pennyweed roots, 1 teaspoon 3 times a day, according to a control questionnaire, a decrease in the frequency and severity of pain and discomfort was observed by 51%.When taking tincture 2 teaspoons 3 times a day, a 55% decrease in the severity of symptoms was observed.
In the control group, pathological symptoms decreased by 37%.The differences between the three groups of patients were statistically significant (p = 0.029).However, no statistically significant differences were found between the first and second groups.Therefore, it is possible to achieve a clinically significant effect with minimal doses of the drug.In addition, statistically significant differences in the reduction of pathological symptoms were maintained when evaluating each of the groups that took tincture of forgotten kopeck roots, compared to the control.
According to the questionnaire, there was an improvement in urinary output in patients with chronic prostatitis during treatment, but the differences were not statistically significant either between the groups receiving tincture of centella roots at different doses, or in comparison with the control group.
When analyzing the voiding diary data obtained after the course of treatment, no statistically significant differences were also observed in the three groups.According to the results of control uroflowmetry, an increase in maximum urinary flow, which ranged between 5 and 12%, was observed in all groups.The residual urine volume in patients receiving the drug at various doses and in patients receiving treatment with an herbal reference drug decreased by 4% to 6%.The differences between the groups were not statistically significant.
This fact can be explained by the relatively short period of use, as well as by the absence in the Red Root Plus tincture of components that would have a similar effect to α-adrenergic blockers and 5α-reductase inhibitors.The main active ingredient of the drug is compounds from the bioflavonoid group, which have a variety of effects, mainly antioxidant and anti-inflammatory effects.
According to the control examination, based on repeated questions, an improvement in the quality of life indicator was observed after a 30-day treatment.In the first group, this figure changed by 55%, in the second - by 59%, and in the control group - by 39%.Differences in the dynamics of changes in quality of life during the use of forgotten kopeck root tincture and in the control group were statistically significant (p = 0.008).
It should be noted that the groups receiving the tincture in different doses did not differ significantly in the dynamics of quality of life.Analysis of changes in quality of life confirms the adaptogenic effect of components of the herbal preparation containing kopek and forgotten knots.The NIH-CPSI total score decreased in all three groups after 30 days of treatment.In the first group there was a decrease of 50%, in the second 52% and in the third 29%.At the same time, the same trend was observed as in the analysis of other indicators.
The difference was statistically significant between the patients who received the forgotten kopeck root tincture and the patients in the control group, and no differences were found between the groups receiving the drug in different doses.
The three groups of patients showed the same increase in the total score on the ICF questionnaire (p = 0.455).The change in the indicator in all groups did not exceed 10%.There were no statistically significant differences between the groups.
The improvement of copulatory function may be mainly associated with a decrease in pathological prostate symptoms, a decrease in LUTS, adaptogenic properties and better microcirculation.Of interest is the state of the prostate during the use of herbal preparations.This is demonstrated by the analysis of the results of a repeated study of prostate secretion.
If initially the patient groups did not differ in the presence and number of leukocytes in the prostate secretion (p = 0.528), after 30 days of treatment in all groups there was a decrease in the severity of the inflammatory process.In the groups that received the tincture of the roots of the forgotten pennyweed, a statistically significant decrease (p = 0.028) in the number of leukocytes was observed compared to the control group.The change in the dose of the drug had no effect on the dynamics of leukocyte decline.
According to a study of prostate secretions, a significant decrease in the severity of the inflammatory process and an improvement in the functional state of the prostate gland was found.
Different medicinal herbs contain an individual set of bioflavonoids that have different activities.Apparently, the combination of rhizomes and roots of the common and knotweed contains bioflavonoids that are active against the effects of oxidative stress on prostate tissue.This can be assumed based on the results of the efficacy of the drug and the absence of dose-dependent differences.However, this assumption needs to be confirmed by further research.
Conclusion
Among the methods of treating prostatitis, an important place is occupied by the use of herbal preparations.The effectiveness of this group of drugs has been confirmed by clinical experience.However, conducting randomized clinical trials aimed at evaluating the effectiveness of herbal preparations based on modern ideas about the active ingredient allows us to adopt a new approach to herbal medicine.
The effectiveness of plant bioflavonoids is justified by the theory of oxidative stress, according to which the products of uncontrolled oxidation of free radicals have a detrimental effect on the cell and cause numerous dysfunctions of organs and systems.
Taking into account the above, it seems possible to conclude that phytotherapy using tincture of roots of the forgotten kopeck, a drug with pronounced anti-inflammatory and antioxidant effects, is more effective both in the complex treatment of patients with chronic prostatitis and in monotherapy for the prevention of this disease.