Contrary to popular belief, the incidence of prostatitis identified and confirmed by laboratory tests is only about 9%.However, inflammation of the prostate gland often recurs or becomes chronic.
The prevalence of chronic forms of prostatitis, characterized by an inactive inflammatory process and minor clinical symptoms that affect quality of life, is difficult to assess.
In addition to acute and chronic bacterial prostatitis, a separate distinction is made between chronic inflammatory pelvic pain syndrome, in which leukocytes are detected in the third part of the urine or semen, and chronic pelvic pain syndrome without inflammatory changes.
For the appearance and maintenance of the symptoms characteristic of chronic prostatitis, dysfunction of urination, which is manifested by high urinary pressure, intraprostatic reflux, which forms a turbulent flow of urine, the pathogenic influence of microorganisms, immunological reactions and a changed state of the pelvic floor muscles are of great importance.
The periodic occurrence and worsening of lower urinary tract pain and symptoms (LUTS), sleep disorders and often erectile dysfunction 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 gland.However, due to the patient's age, a differential diagnosis between adenoma and prostate cancer is always required.
There are different opinions about the pathogenesis of chronic prostatitis, on the basis of which various treatment methods are proposed.Treatment of acute prostatitis depends on the pathogen identified and primarily includes antibacterial drugs that are most capable of penetrating the 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 blood counts return to normal.In less severe cases, fluoroquinolones may be prescribed.The duration of treatment with fluoroquinolones for acute prostatitis is 2-4 weeks.
For chronic bacterial prostatitis and the inflammatory syndrome of chronic abdominal pain, treatment is with fluoroquinolones or trimethoprim.Then the patient is re-examined and antibiotic treatment is continued only if the microorganism that caused the disease is known or if the patient has noticed a positive effect of the therapy.
The recommended duration of treatment for chronic prostatitis is 4-6 weeks or more.Urodynamic studies have shown increased urethral pressure.In this regard, combined treatment with α-blockers and antibiotics was found to be more effective than antibiotic monotherapy in the inflammatory syndrome of chronic abdominal pain.When prescribing therapy, the doctor should discuss with the patient its duration, the likelihood of side effects, as well as the need for monitoring the effectiveness and safety of treatment.
Herbal medicines for the treatment of chronic prostatitis
The use of herbal preparations to treat prostate diseases has a long history.Evidence of the effectiveness and safety of herbal medicines has been provided 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 dysfunction, the appearance of turbulence in the prostatic urethra, the pathological influence of commensal microorganisms, immune changes disrupt normal metabolism.Some violations inevitably lead to others.For example, chronic inflammation leads to cell disruption 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, especially inflammation.A disruption in the oxygen supply to tissues, in which the 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 affect oxidative stress.In recent years, more and more attention has been paid to bioflavonoids, whose antioxidant activity is ten times stronger than vitamin E, vitamin C and beta-carotene.In total, more than 6,000 bioflavonoids are known, including over 3,000 flavones and over 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 radiation, oxidation, disease, infection and bacteria.One of the representatives of medicinal plants containing bioflavonoids is Hedysarum Neglectum, a perennial herbaceous plant from the legume family.This small, 25-50 cm tall plant blooms from June to August with small violet-purple flowers.
The roots of forgotten pennywort contain the flavonoid quercetin, saponins and other biologically active substances.They are quercetin derivatives that have an antioxidant effect 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 P-vitamin activity, strengthen the capillary walls and optimize microcirculation.The roots of the 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 herbaceous weed with small, elliptical leaves, also contains flavonoids.A single stem that branches widely from the base of the root and produces a mass of green shoots.This low-growing plant produces numerous inconspicuous greenish-white flowers in May.Knotweed also contains large amounts of ascorbic acid, vitamin K and provitamin A.
Products based on knotweed have long been known in urological practice because they have a diuretic, gout-inhibiting and adaptogenic effect.The combined use of field and knotweed can be expected to have a clinically significant effect.
The herbal medicines available in clinical practice, which are prepared from the field herb (root and rhizome), as well as the herb of knotweed, are a tincture of the root of the forgotten field herb.
The biologically active substances contained 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).
Increased blood circulation in the prostate reduces the severity of lower urinary tract symptoms (including frequent, difficult urination, discomfort when emptying the bladder, weakened urine stream and the feeling of incomplete bladder emptying) 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 examined in an open comparative randomized 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 examining the symptoms and medical history, the diagnosis was confirmed by laboratory tests of prostate secretion in pure form or in urine.In parallel active control groups, the efficacy, safety and tolerability of the drug were evaluated in patients with chronic prostatitis.
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.
Long prostatitis with periodic exacerbations negatively affects the emotional and sexual spheres.Observations 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 assessed in comparison to other herbal medicines.
To clarify the effective dose 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 three times a day.Patients in the second group, which also consisted of 30 people, took the tincture 2 teaspoons three times a day.
The patients were divided into groups using a simple randomization method, which made it possible to study the effect of the drug 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 drug was shaken and a single dose was dissolved in 1/3 glass of water.The treatment duration was 30 days.
A control group of 20 patients diagnosed with chronic prostatitis received treatment with a different herbal preparation during the same period.The criteria for effectiveness in the groups taking the tincture 1 teaspoon three times daily, 2 teaspoons three times daily or a comparator were changes in clinical symptoms based on a patient survey, questionnaire data and urine diaries.All enrolled patients completed the study.
The average age of the patients of the first group, who received 1 teaspoon of tincture from the roots of the forgotten kopeck three times a day, was 45.5 (37-56) years (hereinafter the median and the 25th and 75th percentiles are given).The average age of patients in the second group, who took 2 teaspoons of tincture three 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 age differences between groups (p = 0.63) (analysis of variance was used below).It should be noted that chronic prostatitis has been identified in people of the most active and working age, for whom the preservation of erectile and reproductive function is particularly important.Of 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 equal.
Before prescribing Tincture Plus, 57 (71.3%) patients were receiving treatment for chronic prostatitis.Most commonly this involved antibacterial therapy and/or α-blockers.The distribution of previously treated patients and the type of treatment did not differ significantly between the groups, which confirms modern ideas about the pathogenesis and thus treatment methods of chronic prostatitis.
To objectively assess the symptoms and their severity as well as the quality of life of the patients, the NIH-CPSI scale was used, which is recommended for both baseline assessment and monitoring of the patients' condition.Initially, the pain level according to the NIH CPSI scale before treatment in the group receiving 1 teaspoon of pennywort root tincture three times daily was 13 (10-15) points;in the group that received the tincture 2 teaspoons three times a day – 12 (10-15) points.In the control group, this indicator was 13 (10–15) points.Pain severity between groups showed no statistically significant differences (p = 0.846).
The patient groups were homogeneous in terms of both location and severity of pain, which is particularly important given the diversity of clinical manifestations of this disease.
Since urinary tract diseases, namely bladder outlet obstruction, detrusor-sphincter dyssynergy, increased pressure in the lumen of the prostatic urethra and intraprostatic reflux, play an important role among the suspected causes of the occurrence and recurrence of chronic prostatitis, special attention was paid to the distribution of patients according to the presence and severity of LUTS against the background of pain andComplaints filed.Originally, this indicator was 2 (1-3) points in the first group according to the NIH-CPSI scale, 2 (1-3) points in the second group and also 2 (1-3) points in the control.
The severity of urinary tract symptoms 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 urine diary analysis.It is safe to say that LUTS were associated with prostate disease and not with bladder dysfunction or water balance.
According to uroflowmetry, the maximum urine flow rate was 13.3 (11.8–14.2) ml/s in the first group, 13.2 (12.1–14.0) ml/s in the second group and 13.0 (11.8–14.6) ml/s in the control group.There were no statistically significant differences between groups in this indicator (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 did not differ in this indicator either (p = 0.175).
It can be noted that in patients with chronic prostatitis in the study groups, pronounced disorders of the reservoir and emptying functions of the bladder were not detected, however, the present LUTS allow us to suspect that the cause of pathological symptoms lies precisely at the level of the prostatic urethra.
The patient's subjective perception of the symptoms of chronic prostatitis is also of great importance.A variety of unpleasant sensations of varying severity, prone to repetition and often unpredictable, significantly disrupt the usual way of life of men.This not only affects their mood, but also their social activity.Therefore, the examination of the quality of life, which depends on the severity of the disease, its relapses and consequences, also serves as a criterion for the effectiveness of the treatment.
Before prescribing treatment, the quality of life was rated according to the questionnaire with 6 (5-9) points in the group that received redroot tincture plus 1 teaspoon three times a day, with 8 (6-9) points in the group that received the tincture 2 teaspoons three times a day, and with 6 (3-9) points in the control group.There were no statistically significant differences between the groups for this indicator (p = 0.22).
The total score on the NIH-CPSI scale was 22 (19-25) in the first group, 23 (19-25) in the second group and 22 (18-25) in the control group (p = 0.801).Thus, the groups were homogeneous not only with regard to the sum of the scores on the chronic prostatitis symptom scale, but also with regard to their individual components.All patients answered questions on 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 impact of chronic prostatitis on erectile function also remains a subject of investigation.
The range of values is quite large in all three groups.This indicates a man's individual level of reaction to his symptoms and disorders.However, the distribution of patients with chronic prostatitis with different erectile states between the groups before treatment did not differ (p = 0.967).At the beginning of the study, three groups of patients with chronic prostatitis were formed who were homogeneous in terms of age, type and severity of clinical symptoms that impaired quality of life.At the same time, disorders of the reservoir and emptying functions of the bladder were ruled out.
After 30 days of treatment, symptoms in the formed groups were assessed.In the group of patients who received 1 teaspoon of tincture from the roots of forgotten pennyweed three times a day, a 51% reduction in the frequency and severity of pain and discomfort was noted, according to a control questionnaire.When taking the tincture of 2 teaspoons three times a day, a 55% reduction in the severity of symptoms was noted.
In the control group, pathological symptoms decreased by 37%.The differences between the three patient groups were statistically significant (p = 0.029).However, no statistically significant differences were found between the first and second groups.Thus, it is possible to achieve a clinically significant effect with minimal dosages of the drug.In addition, statistically significant differences remained in the reduction of pathological symptoms when assessing each of the groups that took tincture from the roots of the forgotten kopeck 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 that received pennywort root tincture in different doses or compared to the control group.
When analyzing the urine diary data collected after treatment, no statistically significant differences were found in all three groups.According to the results of control uroflowmetry, an increase in the maximum urinary flow rate was found in all groups, which ranged from 5 to 12%.The volume of residual urine in patients receiving the drug at different doses and in patients receiving treatment with a reference herbal drug decreased by 4-6%.The differences between groups were not statistically significant.
This fact can be explained by the relatively short duration of use, as well as 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 are compounds from the group of bioflavonoids, which have a wide range of effects, primarily antioxidant and anti-inflammatory effects.
According to the control examination, an improvement in the quality of life indicator was determined after 30 days of treatment based on repeated surveys.In the first group this value 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 should be noted 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 quality of life confirms the adaptogenic effect of the components of the herbal preparation containing forgotten kopeck and knotweed.The NIH-CPSI total score decreased in all three groups after 30 days of treatment.There was a 50% decrease in the first group, 52% in the second and 29% in the third.At the same time, the same trend was noted as 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 that received the drug in different dosages.
All three patient groups showed the same increase in the total score in the ICF questionnaire (p = 0.455).The change in the indicator was no more than 10% in all groups.There were no statistically significant differences between groups.
Improvement in copulatory function may be primarily associated with a reduction in prostate pathological symptoms, a reduction in LUTS, adaptogenic properties and improved microcirculation.Of interest is the condition of the prostate while taking herbal preparations.This is shown by the analysis of the results of a repeated study of prostate secretion.
Although the patient groups initially did not differ in the presence and number of leukocytes in the prostate secretion (p = 0.528), after 30 days of treatment there was a decrease in the severity of the inflammatory process in all groups.In the groups that received the tincture from the roots of the forgotten pennywort, a statistically significant (p = 0.028) decrease in the number of leukocytes was found compared to the control group.Changing the dosage of the drug did not affect the dynamics of the decrease in leukocytes.
According to a study of prostate secretions, a significant reduction in the severity of the inflammatory process and an improvement in the functional state of the prostate were noted.
Different herbal medicines contain an individual set of bioflavonoids with different activities.Apparently, the combination of rhizomes and roots of field and knotweed contains bioflavonoids that counteract the effects of oxidative stress in prostate tissue.This can be assumed based on the results of drug effectiveness and the absence of dose-dependent differences.However, this assumption needs to be confirmed by further research.
Diploma
Among the methods of treating prostatitis, a significant 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 to evaluate 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 damaging effect on the cell and cause numerous dysfunctions of organs and systems.
Taking into account the foregoing, it can be concluded that herbal medicine with tincture of the roots of the forgotten kopeck, a medicine with a pronounced anti-inflammatory and antioxidant effect, is the most effective both in the complex treatment of patients with chronic prostatitis and in monotherapy for the prevention of this disease.