Contrary to popular belief, the incidence of prostatitis identified and confirmed by laboratory testing 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 quality of life, is difficult to evaluate.
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 appearance and maintenance of the characteristic symptoms of chronic prostatitis, of great importance are functional disorders of urination, expressed in high urination pressure, intraprostatic reflux forming a turbulent flow of urine, the pathogenic influence of microorganisms, immunological reactions and an altered state of the pelvic floor muscles.
The periodic appearance 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, 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 age of the patient, it is always necessary to make a differential diagnosis between adenoma and prostate cancer.
There are different opinions regarding the pathogenesis of chronic prostatitis, according to 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 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 the blood count normalizes.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 chronic pelvic pain inflammatory syndrome, treatment is carried out with fluoroquinolones or trimethoprim.The patient is then examined again and antibiotic therapy is continued only in cases where the microorganism that caused the disease is known or if the patient has noticed a positive effect of the 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 has been noted 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 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 for 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, especially in the prostate gland.
Processes such as functional obstruction, 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 cellular breakdown 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 neutralization, is called oxidative stress.As a result, oxidative stress leads to tissue damage over time, including the prostate gland.
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, which are dozens of times more potent 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 rays, oxidation, diseases, infections, bacteria.One of the representatives of medicinal plants containing bioflavonoids is Hedysarum negligence, 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 forgotten centella contain the flavonoid quercetin, saponins and other biologically active substances.Quercetin derivatives have antioxidant activity and are effective in patients with chronic prostatitis, as 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 the walls of capillaries and optimize microcirculation.The roots of forgotten centella have adaptogenic properties, which also determines the importance of including the plant in the complex therapy of patients with chronic prostatitis.
Knotweed (Polygonum aviculare), an annual 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 the herb Knotweed have long been known in urological practice because they have a diuretic, antigout and adaptogenic effect.The combined use of common grass and knotweed allows us to expect a clinically significant effect.
Herbal medicines available in clinical practice, which are produced from the common herb (root and rhizome), as well as knotweed herb, is a tincture of the root of the forgotten common herb.
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 (sensation 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 sensation of incomplete emptying of the bladder) and also improves the functional status of the cavernous arteries.
Clinical effectiveness of tincture from the roots of forgotten kopeck
The efficacy of the tincture was studied in an open comparative randomized trial.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 anamnesis, the diagnosis was confirmed by laboratory tests on prostatic secretions in pure form or in urine.The efficacy, safety and tolerability of the drug in patients with chronic prostatitis were evaluated in parallel groups with active control.
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 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.In parallel, the safety of the drug was evaluated in comparison with other herbal medicines.
To clarify the effective dose of forgotten centella 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 in the second group, also made up 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 studying 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 efficacy in the groups that used the tincture 1 teaspoon 3 times a day, 2 teaspoons 3 times a day or took a comparator 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 the roots of the forgotten kopeck, 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 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) (analysis of variance was used below).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 particularly 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 Tintura Plus, 57 (71.3%) patients received treatment for chronic prostatitis.Most often this involved antibacterial therapy and/or α-blockers.The distribution of patients who had previously received treatment, as well as the type of treatment, did not significantly differ between groups, which confirms modern ideas about the pathogenesis and, accordingly, 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, which is recommended for both basic assessment and monitoring of patients' conditions.Initially, the pain level according to the NIH-CPSI scale before treatment in the group receiving centella root tincture, 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 differ statistically significantly (p = 0.846).
The patient groups were homogeneous in both localization and severity of pain, which is particularly important given the variety of clinical manifestations of this disease.
Since urinary disorders, namely obstruction of bladder outflow, detrusor-sphincter dyssynergia, increased pressure in the lumen of the prostatic urethra and intraprostatic reflux, play an important role among the alleged 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 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 complaints did not differ statistically significantly between groups (p = 0.937).The study groups were homogeneous with respect to LUTS.No differences were found between groups in the results of the urination diary analysis.It can be stated with reasonable certainty that LUTS are associated with prostate disease and not with functional disorders of the bladder or water balance.
The maximum rate of 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.No statistically significant differences were found in this indicator between 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.Patient groups also did not differ in this indicator (p = 0.175).
It can be stated that in patients with chronic prostatitis in the study groups no pronounced disturbances of the reservoir and evacuation functions of the bladder were detected, however the existing LUTS allow us to suspect the origin of the pathological symptoms precisely at the level of the prostatic urethra.
The subjective perception of patients of the symptoms of chronic prostatitis is also of great importance.A variety of unpleasant sensations of varying severity, subject 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 the prescription of treatment, in the group that received tincture of red root plus 1 teaspoon 3 times a day, the quality of life, according to the questionnaire, was rated in 6 (5–9) points, in the group that received tincture 2 teaspoons 3 times a day – in 8 (6–9) points, and in the control group – in 6 (3–9) points.No statistically significant differences were found 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 – 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 the 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 under 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 chronic prostatitis patients with different erectile function states in the groups before treatment did not differ (p = 0.967).Therefore, 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 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 trained groups.In the group of patients who received tincture of forgotten centella roots, 1 teaspoon 3 times a day, according to a control questionnaire, a decrease in the frequency and severity of pain and discomfort by 51% was observed.When taking the tincture 2 teaspoons 3 times a day, a decrease in the severity of symptoms is noted by 55%.
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.Therefore, it is possible to achieve a clinically significant effect with minimal dosages of the drug.Furthermore, statistically significant differences remained in the reduction of pathological symptoms in the evaluation of each of the groups that took the forgotten kopeck root tincture, compared to the control.
According to the questionnaire, an improvement in urinary output was observed during the treatment in patients with chronic prostatitis, but the differences were not statistically significant neither between the groups that received the tincture of centella roots in different dosages, nor compared to the control group.
When analyzing the urination diary data obtained after the treatment cycle, no statistically significant differences were observed in all three groups.According to the results of control uroflowmetry, an increase in maximum urinary flow was noted in all groups, which ranged from 5 to 12%.The volume of residual urine in patients taking the drug in various dosages and in patients receiving a herbal reference 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 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 noted after a 30-day course 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 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 that received the tincture in different dosages did not significantly differ in the dynamics of quality of life.The analysis of changes in the quality of life confirms the adaptogenic effect of the components of the herbal preparation containing forgotten kopek and knotweed.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 of 52% and in the third of 29%.At the same time, the same trend of the analysis of other indicators was noted.
The difference was statistically significant between patients who received the forgotten penny root tincture and patients in the control group, and no difference was found between the groups who received the drug in different dosages.
All three patient groups showed the same increase in ICF questionnaire total score (p = 0.455).The change in the indicator in all groups was not more than 10%.There were no statistically significant differences between the groups.
The improvement of copulatory function can be mainly associated with the decrease in pathological symptoms of the prostate, the decrease in LUTS, the adaptogenic properties and the improvement of microcirculation.Interesting is the state of the prostate gland 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 prostatic secretion (p = 0.528), after 30 days of treatment a decrease in the severity of the inflammatory process was observed in all groups.In the groups that received the forgotten centella root tincture, a statistically significant (p = 0.028) decrease in the number of leukocytes was observed 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 prostatic secretions, a significant decrease in the severity of the inflammatory process and an improvement in the functional state of the prostate gland has been established.
Different herbal medicines contain an individual set of bioflavonoids that have different activities.Apparently the combination of rhizomes and roots of common grass and knotweed contains bioflavonoids active against the effects of oxidative stress in prostate tissue.This can be hypothesized based on the results of the drug's efficacy and the absence of dose-dependent differences.However, this hypothesis will need to be confirmed by further research.
Conclusion
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 aimed at evaluating the effectiveness of herbal preparations based on modern ideas about the active ingredient allows us to take a new approach to phytotherapy.
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 harmful 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 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.