Contrary to popular belief, the incidence of prostatitis identified and confirmed by laboratory tests is only about 9%.However, prostate inflammation often recurs or becomes chronic.
The prevalence of chronic forms of prostatitis, characterized by an inactive inflammatory process and mild clinical symptoms that reduce quality of life, is difficult to assess.
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 occurrence and maintenance of symptoms characteristic of chronic prostatitis, functional disorders of urination, expressed in high urinary pressure, intraprostatic reflux that forms turbulent urinary flow, pathogenic influence of microorganisms, immunological reactions and altered state of the pelvic floor muscles, are of great importance.
The periodic occurrence and intensification of pain and symptoms of the lower urinary tract (LUTS), sleep disorders and, often, erectile function significantly affect the physical and psychological state of men.
Most often, lower urinary tract symptoms in young and middle-aged men are caused by an inflammatory process in the prostate, 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 regarding the pathogenesis of chronic prostatitis, on the basis of which various treatment methods are proposed.Treatment of acute prostatitis depends on the identified pathogen and mainly includes antibacterial drugs that have a greater ability to penetrate prostate tissue.
Acute bacterial prostatitis requires parenteral administration of bactericidal antibiotics such as aminoglycosides or third-generation cephalosporins.Treatment continues until the fever disappears and the blood count returns to normal.In less severe cases, fluoroquinolones may be prescribed.The duration of fluoroquinolone treatment for acute prostatitis is 2 to 4 weeks.
In chronic bacterial prostatitis and chronic pelvic pain inflammatory syndrome, treatment is carried out with fluoroquinolones or trimethoprim.The patient is then examined again 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 showed increased urethral pressure.In this regard, it was observed that combined treatment with α-blockers and antibiotics is more effective than antibiotic monotherapy in chronic pelvic pain inflammatory syndrome.When prescribing a course of therapy, the doctor must discuss with the patient its duration, the likelihood of side effects, as well as the need to monitor the effectiveness and safety of the 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 of the efficacy and safety of herbal medicine has been obtained empirically.
Currently, the possibility of using herbal medicines should be determined by modern ideas about the pathogenesis and development of pathological processes, in particular in the prostate.
Processes such as functional obstruction, occurrence of turbulence in the prostatic urethra, pathological influence of commensal microorganisms, immunological changes, disrupt normal metabolism.Some violations inevitably lead to others.For example, chronic inflammation leads to cell rupture and damage.
Normally, the body constantly produces products of incomplete oxidation, so-called free radicals, the number of which increases under 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 to tissue damage over time, including in the prostate.
Biochemists have long known about natural antioxidants: vitamins E, C and carotenoids, but these cannot seriously influence oxidative stress.In recent years, more and more attention has been paid to bioflavonoids, which are tens of times stronger in antioxidant activity 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 are isoflavones.About 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, 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 tall, blooms from June to August with small purple-violet flowers.
The roots of forgotten pennyweed 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 forgotten kopeck have high vitamin P activity, strengthen capillary walls and optimize microcirculation.The roots of the forgotten toast have adaptogenic properties, which also determines the value of including the plant in the complex therapy of patients with chronic prostatitis.
Also containing flavonoids is knotweed (Polygonum aviculare), an annual herbaceous weed with small, elliptical leaves.A single stem extending from the base of the root 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 the herb Knotweed have long been known in urological practice for having a diuretic, anti-gout and adaptogenic effect.The combined use of common grass and knotweed allows you to expect a clinically significant effect.
The herbal medicines available in clinical practice, produced from the common herb (root and rhizome), as well as the common herb, are a tincture of the forgotten common herb root.
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 (a feeling of pain and heaviness in the perineum, prostatorrhea).
Increased 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 status of the cavernous arteries.
Clinical efficacy of tincture of forgotten kopeck roots
The effectiveness of the tincture was studied in an open-label randomized comparative 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 studying complaints and medical history, the diagnosis was confirmed by laboratory tests of prostate secretions in pure form or in urine.In parallel groups with active control, the efficacy, safety and tolerability of the drug in patients with chronic prostatitis were evaluated.
To objectively describe symptoms, the National Institutes 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 in the context of chronic prostatitis in patients receiving the drug were also carried out using standard questionnaires.In parallel, the safety of the medicine was evaluated in comparison with other herbal medicines.
To clarify the effective dose of the tincture of the roots of the forgotten toast, the patients were divided into two groups.The first group, made up of 30 people, received 1 teaspoon of the 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 made it possible to study the effects of the medication in homogeneous groups.The drug Red Root Plus 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 received treatment with another herbal preparation for the same period.The 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 urination diaries.All included patients completed the study.
The average age of patients in the first group, who received tincture of the roots of the forgotten kopeck, 1 teaspoon 3 times a day, was 45.5 (37–56) years (hereinafter indicated the median, as well as the 25th and 75th percentiles).The average age of patients in the second group, who took the tincture 2 teaspoons 3 times a day, was 45.5 (33–55) years.The mean 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) (hereinafter, analysis of variance was used).It should be noted that chronic prostatitis has been identified in people of more active and productive age, for whom the preservation of erectile and reproductive function is especially important.Of the total number of 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.Most of the time, it was antibacterial therapy and/or α-blockers.The distribution of patients who had already received treatment, as well as the type of treatment, did not differ significantly between the groups, which confirms modern ideas about the pathogenesis and, consequently, the methods of treating chronic prostatitis.
To objectively assess symptoms and their severity, as well as patients' quality of life, the NIH-CPSI scale was used, recommended for both basic assessment and monitoring of patients' status.Initially, the level of pain according to the NIH-CPSI scale before treatment in the group receiving tincture of pennywort 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 intensity of pain between the groups did not show statistically significant differences (p = 0.846).
The patient groups were homogeneous in both location and intensity of pain, which is especially important given the variety of clinical manifestations of this disease.
Given that urinary disorders, namely bladder outlet obstruction, detrusor-sphincter dyssynergia, increased pressure in the lumen of the prostatic urethra and intraprostatic reflux, play an important role among the putative causes of the onset and recurrence of chronic prostatitis, 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 group – 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 in relation 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 have been associated with prostate disease rather than functional bladder or fluid balance disorders.
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 volume of residual urine 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 disturbances in the reservoir and evacuation functions of the bladder were detected in patients with chronic prostatitis in the study groups, however, the existing LUTS make it possible to suspect the origin 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 mood, but also social activity.This 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 treatment, in the group that received the Red Root tincture plus 1 teaspoon 3 times a day, 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).Thus, the groups were homogeneous not only in terms of the sum of the chronic prostatitis symptom scale scores, 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 remains the subject of study.
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 erectile function status in the 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, 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 a tincture of the roots of forgotten toast, 1 teaspoon 3 times a day, according to a control questionnaire, a decrease in the frequency and intensity of pain and discomfort was observed by 51%.When taking the tincture 2 teaspoons 3 times a day, a decrease in the severity of symptoms by 55% 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.Thus, it is possible to obtain a clinically significant effect with minimal dosages of the drug.Furthermore, statistically significant differences remained in the reduction of pathological symptoms when evaluating each of the groups that took tincture of the roots of the forgotten kopeck, compared to the control.
According to the questionnaire, there was an improvement in urinary performance in patients with chronic prostatitis during treatment, but the differences were not statistically significant either between the groups that received tincture of pennywort roots in different dosages, or in comparison with the control group.
When analyzing the urinary diary data obtained after treatment, no statistically significant differences were observed in the three groups.According to the results of control uroflowmetry, an increase in maximum urinary flow was observed in all groups, which ranged from 5 to 12%.The volume of residual urine in patients who received the drug in various dosages and in patients who received treatment with a reference herbal medicine decreased by 4–6%.Differences between groups were not statistically significant.
This fact can be explained by the relatively short period of use, as well as the absence of components in the Red Root Plus tincture that would have a similar effect to α-adrenergic blockers and 5α-reductase inhibitors.The main active ingredient of the medicine are compounds from the bioflavonoid group, which have various effects, mainly antioxidant and anti-inflammatory.
According to the control examination, based on repeated questions, an improvement was noted in the quality of life indicator after the course of treatment for 30 days.In the first group, this figure changed by 55%, in the second - by 59%, and in the control group - by 39%.The differences in the dynamics of changes in the quality of life during the use of tincture from the roots of the forgotten kopeck and in the control group were statistically significant (p = 0.008).
It is noteworthy that the groups that received the tincture in different dosages did not differ significantly in the dynamics of quality of life.Analysis of changes in the quality of life confirms the adaptogenic effect of the components of the herbal preparation containing forgotten kopeck and knotweed.The total NIH-CPSI score decreased in all three groups after 30 days of treatment.In the first group there was a decrease of 50%, in the second – of 52%, and in the third – of 29%.At the same time, the same trend was observed when analyzing other indicators.
The difference was statistically significant between the patients who received the tincture of the roots of the forgotten kopeck and the patients in the control group, and no differences were found between the groups who received the medicine in different dosages.
All three groups of patients showed the same increase in the ICF questionnaire total score (p = 0.455).The variation in the indicator in all groups did not exceed 10%.There were no statistically significant differences between the groups.
The improvement in copulatory function may be mainly associated with the reduction of pathological symptoms of the prostate, the reduction of LUTS, adaptogenic properties and the improvement of microcirculation.The condition of the prostate during the use of herbal preparations is of interest.This is demonstrated by analyzing the results of a repeated study of prostate secretion.
If initially the groups of patients did not differ in the presence and number of leukocytes in 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 forgotten pennyweed roots, a statistically significant decrease (p = 0.028) in the number of leukocytes was noted compared to the control group.Changing the dosage of the drug had no effect on the dynamics of the decrease in leukocytes.
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 were established.
Different herbal medicines contain an individual set of bioflavonoids with different activities.Apparently, the combination of rhizomes and roots of common fennel and fennel contains bioflavonoids that are active against the effects of oxidative stress on prostate tissue.This can be assumed based on drug efficacy results and the absence of dose-dependent differences.However, this assumption must be confirmed by future research.
Conclusion
Among the methods of treating prostatitis, the use of herbal preparations occupies a significant place.The effectiveness of this group of drugs has been confirmed by clinical experience.However, carrying out randomized clinical trials with the aim of evaluating the effectiveness of herbal preparations based on modern ideas about the active ingredient allows us to take 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 cells and cause numerous dysfunctions in organs and systems.
Taking into account the above, it seems possible to conclude that herbal medicine using tincture of the roots of the forgotten kopeck, a medicine with pronounced anti-inflammatory and antioxidant effects, is more effective both in the complex treatment of patients with chronic prostatitis and as monotherapy for the prevention of this disease.