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 reduce the quality of life, is difficult to assess.
In addition to acute and chronic bacterial prostatitis, chronic inflammatory pelvic pain syndrome is distinguished separately, 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 urination 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 occurrence and intensification of pain and symptoms of the lower urinary tract (LUTS), sleep disturbances and, often, erectile function significantly affects the physical and psychological state of a man.
Most often, symptoms of the lower urinary tract 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 regarding the pathogenesis of chronic prostatitis, based on which various treatment methods are proposed.Treatment of acute prostatitis depends on the identified pathogen and primarily includes antibacterial drugs that have the greatest penetrating ability into 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 normalize.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 inflammatory syndrome of chronic pelvic pain, 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 noted a positive effect from therapy.
The recommended treatment period for chronic prostatitis is 4–6 weeks or more.Urodynamic studies have shown increased urethral pressure.In this regard, it was noted that combined treatment with α-blockers and antibiotics is more effective than antibiotic monotherapy in 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, 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 a long history.Evidence of the effectiveness and safety of herbal medicine 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, in particular in the prostate gland.
Processes such as functional obstruction, the occurrence 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 cellular disruption and damage.
Normally, the body constantly produces products of incomplete oxidation, the 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 gland.
Biochemists have long known about natural antioxidants: vitamins E, C and carotenoids, but they 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 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 irradiation, oxidation, diseases, infections, bacteria.One of the representatives of medicinal plants containing bioflavonoids is Hedysarum neglectum, a perennial herbaceous plant from the legume family.This small plant, 25–50 cm tall, blooms from June to August with small purple-violet flowers.
The roots of the 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, catechins contained in the roots of the forgotten kopeck have high P-vitamin activity, strengthen 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.
Also containing flavonoids is knotweed (Polygonum aviculare), an annual herbaceous weed with small, elliptical leaves.A single stem that extends from the base of the root branches profusely and produces a mass of green shoots.This low-growing plant bears 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 because they have a diuretic, anti-gout and adaptogenic effect.The combined use of commonweed and knotweed allows us to expect a clinically significant effect.
The herbal medicines available in clinical practice, which are produced from the commonweed (root and rhizome), as well as the herb of knotweed, is a tincture of the root of the forgotten commonweed.
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 gland and pain syndrome (feelings 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 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 comparative randomized study.The purpose 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 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 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 adversely 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.In parallel, the safety of the drug was assessed in comparison with other herbal medicines.
In order to clarify the effective dose of tincture of the roots of the forgotten pennyweed, the patients were divided into two groups.The first group, which consisted of 30 people, received 1 teaspoon of tincture 3 times a day.Patients of 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 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 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 comparison drug were changes in clinical symptoms based on a survey of patients, 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 the median, as well as the 25th and 75th percentile are indicated).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 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) (hereinafter analysis of variance was used).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 especially important.Of all patients included in the study, 26 (32.5%) had a history of sexually transmitted diseases.The distribution of such patients in the groups was the same.
Before prescribing tincture plus, 57 (71.3%) patients received treatment for chronic prostatitis.Most often this was antibacterial therapy 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 the groups, which confirms modern ideas about the pathogenesis and, accordingly, 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, which is 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 that received tincture of the roots of the pennywort, 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 did not have statistically significant differences (p = 0.846).
The groups of patients were homogeneous both in localization and severity of pain, which is especially 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 supposed 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 against the background of painand 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 analysis of the urination diary.It can be said with reasonable confidence that LUTS were associated with prostate disease, and not with functional disorders of the bladder or water balance.
The maximum urinary flow rate, 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 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 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, which are prone to repetition, often unpredictable, significantly disrupt the usual way of life of men.This affects not only their mood, but also their 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 treatment was prescribed, 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).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 its 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 effect of chronic prostatitis on erectile function also remains the subject of study.
In all 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 patients with chronic prostatitis with different states of erectile function 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, which were homogeneous in age, type and severity of clinical symptoms, which affected the 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 assessed in the formed groups.In the group of patients who received tincture of the roots of the forgotten pennyweed, 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 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 of the roots of the forgotten kopeck, compared with 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 the roots of the pennywort in different dosages, and in comparison with the control group.
When analyzing the urination diary data obtained after the course of treatment, there were also no statistically significant differences noted in all three groups.According to the results of control uroflowmetry, an increase in maximum urinary flow rate was noted in all groups, which ranged from 5 to 12%.The volume of residual urine in patients receiving the drug in various dosages, and in patients receiving treatment with a herbal reference drug, decreased by 4–6%.The differences between the groups were not statistically significant.
This fact can be explained by the relatively short period of use, as well as 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 group of bioflavonoids, which have a variety of effects, primarily antioxidant and anti-inflammatory effects.
According to the control examination, based on repeated questioning, an improvement in the quality of life indicator was noted 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 of 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 the quality of life confirms the adaptogenic effect of the 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 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 drug in different dosages.
All 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 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 gland, a decrease in LUTS, adaptogenic properties and improved microcirculation.The condition of the prostate gland during the use of 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 the prostate 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 tincture of the roots of the forgotten pennyweed, a statistically significant (p = 0.028) decrease 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 that have different activities.Apparently, the combination of rhizomes and roots of the commonweed 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 effectiveness of the drug and the absence of dose-dependent differences.However, this assumption must be confirmed by further 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, conducting randomized clinical trials aimed at assessing the effectiveness of herbal preparations based on modern ideas about the active principle 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 free radical oxidation have a damaging effect on the cell and cause numerous dysfunctions of 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 medicinal product with pronounced anti-inflammatory and antioxidant effects, is most effective both in the complex treatment of patients with chronic prostatitis and in monotherapy for the prevention of this disease.