Contrary to popular belief, the incidence of prostatitis identified and confirmed by laboratory tests is only around 9%.However, inflammation of the prostate often returns or becomes chronic.
The prevalence of chronic forms of prostatitis, characterized by an inactive inflammatory process and minor clinical symptoms reducing 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 part 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 by high urinary pressure, intraprostatic reflux that forms a turbulent urine flow, the pathogenic influence of microorganisms, immunological reactions and an altered state of the pelvic floor muscles, are of great importance.
The periodic onset and intensification of lower urinary tract pain and symptoms (LUTS), sleep disturbances and, often, erectile function significantly affect a man's physical and psychological state.
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 still 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 the greatest 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 subsides and the blood count normalizes.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 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 causing the disease is known or the patient has seen a positive effect from the treatment.
The recommended treatment duration for chronic prostatitis is 4 to 6 weeks or longer.Urodynamic studies showed increased urethral pressure.In this regard, it was noted that combined treatment with α-blockers and antibiotics is more effective than antibiotic monotherapy in chronic pelvic pain inflammatory syndrome.When prescribing treatment, the doctor should discuss with the patient its duration, the likelihood of side effects, as well as 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 been around for a long time.Evidence for the effectiveness and safety of medicinal plants has been obtained empirically.
Currently, the possibility of using herbal remedies should be determined by modern ideas about the pathogenesis and development of pathological processes, especially in the prostate.
Processes such as functional obstruction, the appearance of turbulence in the prostatic urethra, pathological influence of commensal microorganisms, immune changes disrupt normal metabolism.Some violations inevitably lead to others.For example, chronic inflammation leads to cellular disruption and damage.
Normally, the body constantly produces products of incomplete oxidation, called free radicals, the number of which increases in various pathological conditions, especially 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 they cannot seriously influence oxidative stress.In recent years, increasing attention has been paid to bioflavonoids, whose antioxidant activity is tens of times higher than that of 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 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 rays, oxidation, disease, infection and bacteria.One of the representatives of medicinal plants containing bioflavonoids is Hedysarum neglecta, a perennial herb of the legume family.This small plant, 25 to 50 cm tall, flowers from June to August with small purple-purple flowers.
The roots of forgotten pennyweed contain quercetin, a flavonoid, 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 forgotten pennyweed 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 herb with small elliptical leaves, also contains flavonoids.A single stem that extends profusely from the base of the roots and produces a mass of green shoots.This low plant bears numerous inconspicuous greenish-white flowers in May.Knotweed also contains a high amount of ascorbic acid, vitamin K and provitamin A.
Knotweed products have long been known in urological practice because they have a diuretic, anti-gout and adaptogenic effect.The combined use of common and knotweed allows us to hope for a clinically significant effect.
Medicinal plants available in clinical practice, which are produced from the common plant (root and rhizome), as well as from the knotweed herb, are a tincture of the forgotten common plant root.
Biologically active substances included in the tincture contain natural antioxidants and substances that improve microcirculation, which determines the ability of these medicinal plants to reduce the severity of the inflammatory process of the prostate and pain syndrome (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 stream and the feeling of incomplete emptying of the bladder) and also improves the functional state of the cavernous arteries.
Clinical effectiveness of tincture from the roots of the forgotten kopeck
The effectiveness of the tincture was studied in an open-label randomized comparative study.The aim of the study was to investigate 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 medical history, the diagnosis was confirmed by laboratory analyzes of prostate secretions in pure form or in urine.In parallel groups with active control, the effectiveness, safety and tolerability of the drug in patients with chronic prostatitis were assessed.
To objectify the description of symptoms, the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), analysis of urine 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 who received the drug were also carried out using standard questionnaires.At the same time, the safety of the drug was evaluated compared to other medicinal plants.
To clarify the effective dose of forgotten pennyweed root tincture, patients were divided into two groups.The first group, consisting of 30 people, received 1 teaspoon of tincture 3 times a day.Patients from the second group, also consisting 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 drug 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 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 drug 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 of the first group, who received tincture of forgotten kopeck roots, 1 teaspoon 3 times a day, was 45.5 (37-56) years (hereinafter the median, as well as the 25th and 75th percentiles are shown).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 old.The mean age of patients in the control group was 48 (36 to 59) years.
There was no statistically significant age difference between groups (p = 0.63) (hereinafter, analysis of variance was used).It should be noted that chronic prostatitis was identified in the most active and active people, for whom the preservation of erectile and reproductive function is especially important.Among all 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.This most often involved antibacterial treatment and/or α-blockers.The distribution of patients who had previously received treatment, as well as the type of treatment, did not differ significantly between groups, which confirms modern ideas about the pathogenesis and, therefore, methods of treatment of chronic prostatitis.
In order to objectively assess symptoms and their severity, as well as the quality of life of patients, the NIH-CPSI scale was used, recommended both for basic assessment and for monitoring the condition of patients.Initially, the level of pain according to the NIH-CPSI scale before treatment in the group who received tincture of hydrocotyl 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.Pain severity between groups did not show statistically significant differences (p = 0.846).
The patient groups were homogeneous both in terms of location and intensity of pain, which is particularly important given the variety of clinical manifestations of this disease.
Since 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 andseverity of LUTS against a background of pain and discomfort.Initially, in the first group, this indicator was, according to the NIH-CPSI scale, 2 (1 to 3) points, in the second group – 2 (1 to 3) points, and in the control – also 2 (1 to 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 groups in the results of voiding diary analysis.It can be said with reasonable certainty that LUTS was associated with prostate disease and not with functional bladder or fluid balance disorders.
The maximum urine output, according to flowmetry, 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 for this indicator between 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 did not differ in this indicator either (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 TUBA allows us to suspect the source of 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 for men.This not only affects their mood, but also their social activity.This is why the study of quality of life, which depends on the severity of the disease, its relapses and its consequences, also serves as a criterion for the effectiveness of treatment.
Before prescribing treatment, in the group that received 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 tincture 2 teaspoons 3 times a day – at 8 (6-9) points and in the control group – at 6 (3-9) points.There was no statistically significant difference between 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 group – 22 (18-25) (p = 0.801).Thus, the groups were homogeneous not only in terms of the sum of scores on the chronic prostatitis symptom scale, but also in terms of individual components.All patients answered questions on the Male Copulative Function (MCF) scale.In the first group the indicator was 31 (23-41) points, in the second 34 (27-39) points and in the third 34 (26-37) points.The effect of chronic prostatitis on erectile function also remains a subject of study.
In all three groups, the range of values is quite wide.This indicates a man's individual degree of response to his symptoms and disorders.However, the distribution of chronic prostatitis patients with different erectile function states into 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 terms of age, type and severity of clinical symptoms, affecting 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 forgotten tincture of 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 noted by 51%.When taking the tincture 2 teaspoons 3 times a day, a decrease in the severity of symptoms by 55% was noted.
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 difference was found between the first and second groups.Thus, it is possible to achieve a clinically significant effect with minimal doses of the drug.In addition, statistically significant differences remained in the reduction of pathological symptoms when evaluating each of the groups that took tincture of forgotten kopeck roots, compared to the control group.
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 hydrocotyl roots in different doses, or in comparison with the control group.
When analyzing voiding diary data obtained after treatment, no statistically significant differences were observed in the three groups.According to the results of control flowmetry, an increase in maximum urine flow was noted in all groups, which ranged from 5 to 12%.The volume of residual urine in patients receiving the drug in various doses and in patients receiving treatment with a reference herbal drug 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 an effect similar to α-adrenergic blockers and 5α-reductase inhibitors.The main active ingredient of the drug is compounds from the bioflavonoid group, which have various effects, mainly antioxidant and anti-inflammatory effects.
According to the control examination, based on repeated interrogations, an improvement in the quality of life indicator was noted after 30 days of 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 the quality of life when using tincture from the roots of the forgotten kopeck and in the control group were statistically significant (p = 0.008).
It should be noted that the groups who received the tincture in different doses did not differ significantly in terms of quality of life dynamics.Analysis of changes in quality of life confirms the adaptogenic effect of components of the herbal preparation containing forgotten kopek and knotweed.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 by 52% and in the third by 29%.At the same time, the same trend was noted as in the analysis of other indicators.
The difference was statistically significant between patients who received the tincture of the roots of the forgotten kopeck and patients in the control group, and no differences were noted between the groups who received the drug in different doses.
The three groups of patients showed the same increase in the total score of the ICF questionnaire (p = 0.455).The change in the indicator in all groups was no more than 10%.There were no statistically significant differences between the groups.
Improvement in copulatory function may be associated primarily with a decrease in pathological symptoms of the prostate, a decrease in LUTS, adaptogenic properties and improvement in microcirculation.The condition of the prostate when using herbal preparations is of interest.This is demonstrated by the analysis of 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 prostatic secretion (p = 0.528), then 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 forgotten pennyweed root tincture, 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 leukocyte decrease.
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 were established.
Different herbal medicines contain an individual set of bioflavonoids that have different activities.Apparently, the combination of rhizomes and roots of common and knotweed contains bioflavonoids that are active against the effects of oxidative stress in prostate tissue.This can be assumed based on the results of the drug's effectiveness and the absence of dose-dependent differences.However, this hypothesis needs to be confirmed by further research.
Conclusion
Among the methods of treating prostatitis, the use of herbal preparations occupies an important place.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 makes it possible 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 malfunctions of organs and systems.
Taking into account the above, it seems possible to conclude that herbal medicine using tincture of forgotten kopeck roots, a drug with pronounced anti-inflammatory and antioxidant effects, is the most effective both in the complex treatment of patients with chronic prostatitis and as monotherapy for the prevention of this disease.