Prostotiale

A combined complex for the prostate gland, including natural ingredients: sabal palm extract, hemolen , pumpkin seed oil, lycopene and vitamin E. The active components of the drug have a normalizing effect on the prostate gland. This combination of components is indicated for patients with the initial stage of prostate adenoma (BPH), reducing the proliferation (enlargement) of adenomatous nodes due to inhibition of type 1 5-alpha reductase and providing an antioxidant effect. The drug is also suitable for complex treatment of acute prostatitis and exacerbation of chronic ones, since the components of the drug have a reparative and antioxidant effect on the prostate gland.

Sabal palm extract – the active components of the palm tree have a normalizing effect on the prostate gland, prevents prostate enlargement due to the inhibition of type 1 5-alpha reductase, which converts testosterone into dehydrotestosterone , which causes hyperplasia of prostate cells and leads to an increase in its size.

Pumpkin seed oil – reduces the proliferation of prostate cells, normalizes their function by reducing inflammation and improving microcirculation of the prostate parenchyma.

Hemolen is a divalent source of iron, so it is absorbed in the human body 10 times better compared to iron of a different valency. Preserves the entire complex of biologically active substances: peptides, lipids, nucleic acids, growth factors, hormones, minerals. Has an antioxidant effect to stabilize prostate function

Lycopene is a carotenoid with powerful antioxidant effects. Lycopene selectively accumulates in prostate tissues and protects cells from damage by free radicals and inhibits the development of prostate cancer.

Vitamin E is a powerful antioxidant that protects cell membranes from damage by free radicals or oxidative processes.

Advantage:

– convenient to take, only 1 capsule per day.

– high bioavailability of the product due to the encapsulation of vitamins, fats and extracts in a soft gelatin capsule. This is the only technology that allows you to contain fats, preserving all the beneficial properties of animal and vegetable oils in the required dosage.

– without the use of titanium dioxide, dyes and artificial flavors.

№	Name of components	Content, mg (1 capsule)	% of RSP/AUP* (1 capsule)
1	Unrefined pumpkin oil	391,55
2	Linoleic PUFA (Omega-6), no less	150	15*
3	Sabal palm extract	160
4	Lycopene	1,5	30**
5	Hemolen - dried reindeer blood	10
6	Vitamin E	5	50*

Course of administration: 1 capsule 1 time per day for 1 month (recommended 3 months or more). Profile of the drug – prostatic hyperplasia (BPH), initial stages.

Prostotiale Forte

A combined drug consisting of 7 components. Essential fatty acids, sabal palm and pumpkin seed extract, a complex of antioxidants are an ideal combination in the complex treatment of acute prostatitis and exacerbation of chronic ones. The drug is also suitable for normalizing a man’s hormonal levels, stabilizing the functioning of the prostate gland and maintaining men’s health.

The complex contains organic selenium in the form of selexen , which does not cause side effects and has extremely low toxicity. Selenium is an indispensable element of the antioxidant defense system of the human body, has an immunomodulatory effect, and is involved in the regulation of the action of thyroid hormones.

Sabal palm extract – the active components of the palm tree have a normalizing effect on the prostate gland, prevents the enlargement of the prostate gland, which carries out the transition of testosterone to dehydrotestosterone . The active components of sabal palm normalize the cycle of sex hormones and stimulate the production of testosterone.

Pumpkin seed oil reduces the proliferation of prostate and bladder cells, normalizes their function by reducing inflammation and improving microcirculation.

Selenium , together with zinc, improves reproductive function, is involved in the synthesis of testosterone and the functioning of the gonads, and has an immunomodulatory effect.

Lycopene selectively accumulates in prostate tissues and protects cells from damage by free radicals.

Zinc is involved in the synthesis of testosterone and the functioning of the gonads, which is why there is an inverse relationship between the level of zinc in the body and potency. Being an inhibitor of 5-alpha reductase, zinc regulates the level of testosterone metabolite – dihydrotestosterone , the excess of which causes prostate hyperplasia.

Vitamin E is a powerful antioxidant that protects cell membranes from damage by free radicals or oxidative processes.

Omega-3 with a high concentration of EPA and DHA ( Omega-3 in the form of ethyl ester) increases the production of sex hormones, testosterone, and improves trophism of the prostate gland.

Advantage:

– fish oil containing 180 mg EPA and 120 mg DHA in two capsules.

– for better purification of fish oil from heavy metal salts and allergens, the molecular distillation method is used, which guarantees the preservation of the structure of fatty acids.

– safe and bioavailable form of selenium.

– high bioavailability of the product, due to the encapsulation of vitamins, fats and extracts in a soft gelatin capsule. This is the only technology that allows you to contain fats, preserving all the beneficial properties of animal and vegetable oils in the required dosage.

– without the use of titanium dioxide, dyes and artificial flavors.

№	Name of components	Content, mg/1 capsule	Content, mg/2 capsules	% of RSP in 2 capsules
1	Fish oil MEG-3 3322 EE Oil	272,7	545,4
2	Omega-3 PUFAs	150	300	15*
3	EPK	90 (72 – 108)	180	30
4	DHA	60 (48 – 72)	120	17
5	Pumpkin oil	150	300
6	Sabal palm extract	100	200
7	Zinc	3	6	40
8	Vitamin E	5	10	100
9	Lycopene	0,625	1,25	25*
10	Selexen Selenium	0,035	0,07	100

The course of administration is 1 capsule 2 times a day for 1 month (recommended use is 3 months). The profile of the drug (in complex treatment) is acute inflammatory diseases of the prostate gland and exacerbations of chronic prostatitis. The complex is also suitable for men to maintain prostate function and stabilize hormonal levels.

Anatomy of the prostate gland

The prostate gland is an androgen-dependent unpaired organ of the male reproductive system. The function of the prostate is to maintain spermatogenesis in the seminiferous tubules of the testicles, ensure the transport of sperm through the vas deferens and ejaculation, as well as the formation of sexual desire.

Shape and size. The prostate has the shape of an irregular ball, reminiscent of a chestnut, the base of which faces upward. The size of the prostate gland varies significantly depending on the age of the man. The average vertical size of the prostate is 30 mm, frontal – 40 mm, sagittal – 20 mm. The mass of the gland in mature men under 30 years of age is about 16 grams. Normally, the prostate has an elastic consistency.

Location. The prostate gland is located below the bladder between the pubic symphysis and the rectum. The base of the prostate, which is inclined slightly forward and downward, is almost completely fused with the bottom of the bladder. The posterior part of the gland is covered by the vas deferens and seminal vesicles. On the border between the posterior surface of the organ and its base there is a frontal groove. Through it, two vas deferens enter the prostate, which open into the lumen of the prostatic urethra on the sides of the seminal tubercle. From below, the gland is fixed by fibers of the anterior section of the muscle tissue that elevates the rectum. Anteriorly, the prostate connects to the pubic symphysis via the puboprostatic ligament.

Structure. The prostate is divided into apex, base, anterior, posterior and inferolateral surfaces. The gland has right and left lobes, which are connected to each other by the middle lobe, or isthmus. It is limited to the places where the vas deferens enters the cavity of the gland. The isthmus of the prostate is closely adjacent to the bottom of the bladder and protrudes into its lumen, forming a “tongue”, which is practically not expressed in young men, and in old age can significantly increase and lead to urination problems. The lateral lobes of the prostate normally protrude slightly into the lumen of the anus, through which the gland can be felt during a rectal examination.

Blood supply. The prostate gland contains arteries that are branches of the middle rectal inferior vesical blood vessels. Around the prostate there is a plexus of broad veins, which is connected with similar plexuses of the urethra and the end of the intestine.

Lymphatic drainage . The lymphatic vessels of the prostate gland are located along the vas deferens. They pass along the lateral walls of the pelvis to the internal and external iliac lymph nodes, as well as along the anterior surface of the sacrum towards the sacral lymph nodes.

Innervation. The prostate gland contains nerves that consist of postganglionic sensory parasympathetic and sympathetic fibers. Nerves travel to the prostate from the inferior hypogastric plexus. On the surface of the gland, the fibers form the prostatic nerve plexus.

What diseases of the prostate gland are there?

Prostatitis

Prostatitis is an inflammatory process affecting the tissue of the prostate gland. This is one of the most common diseases in the practice of a urologist. The disease is diagnosed mainly in men from 25-50 years of age, but by older age the risk of developing pathology increases significantly, against the background of the appearance of areas of fibrosis in the parenchyma of the gland.

The form distinguishes between acute and chronic prostatitis. In the latter case, the inflammation is characterized by a long course with periodic relapses. This condition is much more common compared to acute. This is also associated with changes in the parenchyma of the gland, the appearance of areas of fibrosis, and stones. These areas are a gap in the immune system of the gland, which leads to frequent inflammatory processes of a cyclical nature.

Causes of prostatitis?

Many prostate diseases, such as benign hyperplasia or cancer, are problems of the older age group. However, prostatitis does not fall into this category. Its symptoms usually appear in men between 30 and 50 years of age. Most often, the cause is an infectious lesion due to the penetration of pathogenic flora from the urogenital canal or glands of the genitourinary system.

Among the most common causative agents of bacterial (infectious) prostatitis, gram-negative organisms should be noted: pseudomonas , Escherichia coli, Serration , Enterobacter and Proteus. Often the inflammatory process develops against the background of infection with STIs, or previous STIs : chlamydia, gonococci, trichomonas, herpes virus, etc. As a rule, such forms of the disease are diagnosed in men under the age of 30 years. Cases of treatment of pathology due to infection by Mycobacterium tuberculosis are extremely rare.

There are also non-bacterial types of prostatitis. Among their main reasons:

increased pressure in the prostate gland

autoimmune disorders (destruction of prostate cells by antibodies)

muscle pain syndrome in the pelvic area (chronic pelvic pain syndrome)

psychoemotional disorders

motor activity deficit

excessive physical stress

Primary signs of prostatitis

The disease is accompanied by a complex of disorders that affects the functioning of the entire urinary system. Among the main symptoms:

Urine leakage

discomfort, pain when emptying the bladder

urgency to urinate

potency disorder in men of reproductive age

pain in the perineum when sitting for a long time

frequent and strong urge to urinate

difficulty urinating

decreased libido and erectile problems

unstable erection

decreased fertility

feeling of incomplete emptying of the bladder after going to the toilet

inability to achieve a high-quality and lasting erection even with strong arousal

lubricated sexual intercourse

urinating in small portions without the feeling of emptying the bladder

Signs of acute prostatitis

Symptoms of the disease in acute form and the general clinical picture differ depending on the stage of the pathological process:

Catarrhal. The patient complains of frequent urges, pain when urinating, pain in the perineum and sacrum.

Follicular. The pain syndrome becomes intense, can radiate to the anus and intensify during defecation. Urine is released in a thin stream. In some cases there is a delay. There is an increase in body temperature up to 38 degrees over a long period (low-grade fever) or moderate hyperthermia.

Parenchymatous. The man begins to experience general intoxication of the body with chills and a temperature of up to 38-40°C. Pain in the perineum becomes sharp and throbbing. The act of defecation is difficult, and normal emptying of the bladder is impossible, resulting in acute urinary retention (dysuria).

Symptoms of chronic prostatitis

The chronic form of prostate inflammation may be a consequence of the absence or untimely treatment of the acute stage. However, in many men it develops immediately and is characterized by “blurred” symptoms. Among the main signs are:

low-grade fever (occasionally)

mild pain in the perineum

discomfort when urinating

scanty discharge from the urogenital canal during defecation

frequent urination in small portions

In general, the clinical picture changes over time, differs in intensity in different patients and can become hidden when attempting self-medication. Symptoms of a chronic disorder may include a burning sensation in the urethra, pressure in the perineum, dysuria, impaired sexual function and increased general fatigue. Against the background of problems with potency, mental depression, irritability and anxiety arise. Fear of impotence leads to the development of complexes, but most men tend to put off visiting a urologist because of a feeling of shame.

Primary chronic prostatitis develops over a long period. Venous congestion in the capillaries ( prostatosis ) provokes the initial stage of non-bacterial inflammation, which leads to the appearance of the disease.

With an infectious etiology, the cause of the disease is a chronic inflammatory process due to infection with trichomonas, ureaplasma , chlamydia or gonococcus. Primary infection masks the signs of prostatitis, and its treatment does not eliminate inflammation of the prostate. Often the addition of a concomitant problem remains unnoticed by a man.

Let us consider in detail the three main symptoms of chronic prostatitis:

Urinary disorder (dysuria). Inflammation increases the volume of the prostate gland, which leads to compression of the urethra and increased reactivity of the bladder fundus. As its lumen decreases, a frequent urge to urinate and a feeling of an incompletely empty bladder appear. Dysuric disorders in many men occur in the early stages of prostatitis. The compensatory mechanism during this period is manifested by increased intravesical pressure and the presence of residual urine, which in the future can lead to the development of a neurogenic bladder.

The pain syndrome can be felt as the presence of a foreign object in the groin area. Increased discomfort occurs with prolonged sitting, ejaculation, sexual abstinence or excessive sexual activity. The pain radiates to the perineum, sacrum, scrotum and sometimes to the lumbar area.

Violation of potency. Lack of treatment in the early stages of prostatitis can lead to dyspotence , when a man experiences frequent nocturnal erections, deterioration in the quality of orgasm and accelerated ejaculation. In different patients, these signs manifest themselves with different intensity. The presence of an unstable erection or a drop in erection during sexual intercourse, this pathology can accompany the patient even after the escalation of the acute phase of the disease. Premature ejaculation occurs due to a decrease in the threshold of excitability of the orgasmic center. In this case, the patient experiences pain, which leads to the development of pain anticipation syndrome and gradual refusal of sexual activity. In the absence of comprehensive treatment that addresses the mental factor of the disorder, sexual disorders become increasingly worse. Ignoring the need to seek medical help for prostatitis often ends in impotence.

The degree of sexual dysfunction varies depending on individual factors. Some men are so afraid of erectile dysfunction that their problems arise due to suggestion rather than objective physiological factors, and the psychosomatic phase of erectile dysfunction begins. In particular, psychogenic dyspotence is observed precisely with increased anxiety and obsessive complexes. The very thought of possible disorders of male health is difficult for such patients to bear. This greatly affects their character and communication with others. Irritability, hypochondria, grumpiness and depression appear.

Complications of prostatitis

Lack of adequate treatment for prostate inflammation leads to concomitant diseases. The fact is that the prostate gland is closely connected with other organs of the male genitourinary system. It is located around the neck of the bladder and urinary canal. Therefore, when the prostate enlarges, the urethra is compressed and the normal outflow of urine is disrupted. Taking into account the peculiarities of physiology, if acute or chronic prostatitis is not treated in a timely manner, a number of serious pathologies and complications arise.

Benign prostatic hyperplasia (Adenoma)

Benign prostatic hyperplasia is a benign adenomatous growth of the periurethral part of the prostate gland. Symptoms are consistent with bladder outlet obstruction – sluggish urine stream, fluctuations in pressure, pollakiuria, urgency, nocturnal pollakiuria, a feeling of incomplete emptying of the bladder, dribbling of urine at the end of urination, urgency or overflow incontinence, and acute urinary retention. Diagnosis is based mainly on data from digital rectal examination and subjective symptoms, as well as data from cystoscopy, transrectal ultrasound, and urodynamic studies; other imaging modalities may also be required. Treatment options include 5 alpha-reductase inhibitors, alpha-blockers, tadalafil , and surgery.

high American Urological Association Symptom Score (see table American Urological Association Symptom Score Score for Benign Prostatic Hyperplasia ]), – the incidence of BPH in men aged 55–74 years without prostate cancer was 19%. But if the criteria include a maximum urinary flow rate < 10 ml/second and a residual urine volume > 50 ml, the incidence becomes only 4%. Based on autopsy findings, the prevalence of BPH increases from 8% in men aged 31–40 years to 40–50% in men aged 51–60 years and to over 80% in men aged over 80 years.

In the periurethral region of the prostate, multiple fibroadenomatous nodules develop, apparently arising from the periurethral glands, and not from the true fibromuscular tissue of the prostate (surgical capsule), which moves to the periphery due to the progressive growth of the nodules.

As the lumen of the prostatic urethra narrows and lengthens, the outflow of urine becomes progressively more difficult. Increased pressure associated with urination and bladder distension can lead to detrusor hypertrophy (muscle tissue of the bladder), trabeculations, honeydew formation, and false diverticula. Incomplete emptying of the bladder causes urinary stagnation and predisposes to stone formation and infection. Prolonged obstruction of the urinary tract, even incomplete, can cause hydronephrosis and impaired renal function or can cause neurogenic impairment of bladder contractility, including atony.

Lower urinary tract symptoms

Symptoms of benign prostatic hyperplasia (BPH) include a constellation of often progressive symptoms known collectively as lower urinary tract symptoms (LUTS):

Frequent urination

An urgent need to urinate (urgency)

Nocturia (night urination)

Difficulty starting to urinate

Frequency, urgency, and nocturia are associated with incomplete emptying and rapid refilling of the bladder. A decrease in the diameter and strength of the urine stream leads to uncertainty and intermittency of urination.

Pain and dysuria are usually absent. This may result in a feeling of incomplete emptying, dribbling of urine at the end of urination, urinary incontinence when the bladder is full, or acute urinary retention. The strain required to void can cause congestion in the submucosal veins of the prostatic urethra and bladder triangle, which can rupture and lead to hematuria. Tension can also quickly cause sinocarotid syncope, and over a long period – dilation of hemorrhoidal veins or the appearance of inguinal hernias.

Urinary retention

In some patients, the disease manifests itself suddenly with acute urinary retention with severe abdominal discomfort and distension of the bladder. The delay may be preceded by:

Prolonged attempts to postpone urination

Immobilization

Exposure to cold

Taking pain relievers, anticholinergic drugs, sympathomimetics , opioids, or alcohol

Symptom assessment

such as the 7-question American Urological Association Symptom Score (see table American Urological Association Symptom Score Score for Benign Prostatic Hyperplasia ]). This assessment also allows doctors to track the progression of symptoms:

Mild symptoms: points from 1 to 7

Moderate-severe symptoms: scores from 8 to 19

Severe symptoms: scores from 20 to 35

Digital rectal examination

On digital rectal examination, the prostate gland usually appears enlarged and painless, has an elastic consistency, and in many cases lacks the median sulcus. However, prostate size determined by digital rectal examination can be misleading; Apparently a small gland can cause obstruction. If the bladder is distended, it can be palpated or percussed while examining the abdomen. Dense or hard areas in the prostate may indicate prostate cancer.

Diagnostics. BPH

Digital rectal examination

Ultrasound of the pelvis with residual urine

Uroflowmetry (measuring urine flow rate ml/s)

Lower urinary tract symptoms from benign prostatic hyperplasia (BPH) can also be caused by other conditions, such as infection or prostate cancer and an overactive bladder. Moreover, BPH and prostate cancer can be present at the same time. Despite the fact that tenderness of the gland on palpation is characteristic of inflammation, the findings of a digital rectal examination for BPH and cancer are often the same. Although cancer may have a rocky, hard, lumpy, asymmetrically enlarged prostate, most patients with cancer, BPH, or a combination of both have an enlarged prostate of normal consistency. Therefore, patients who have symptoms or palpable changes in the prostate should undergo testing.

The level of prostate-specific antigen (PSA) is measured. In men with moderate or severe obstructive symptoms, uroflowmetry (objective measurement of urine volume and urination rate) and determination of residual urine volume by ultrasound examination of the bladder can be performed . A voiding rate of <15 mL/second suggests obstruction, and a residual urine volume of >100 mL suggests acute urinary retention.

Prostate-specific antigen (PSA) level

Interpreting prostate-specific antigen (PSA) test results can be difficult. PSA levels are moderately elevated in 30–50% of patients with BPH, depending on the size of the gland and the degree of obstruction, and elevated in 25–92% of those with prostate cancer, depending on tumor volume. If the PSA level is > 4 ng /mL (4 μg/L), further discussion/shared decision-making regarding other tests or biopsy is recommended.

For men under 50 years of age who are at high risk of developing prostate cancer, a lower threshold may be used ( PSA > 2.5). Other indicators may be informative, including the rate of rise in PSA levels, the ratio of free/bound PSA, and other parameters.

Transrectal biopsy is usually performed under ultrasound guidance (to minimize the risk of cancer) and is indicated only if prostate cancer is suspected. Transrectal ultrasound (TRUS) is a reliable way to determine prostate volume.

The assessment of the need for further evaluation should depend on the clinical situation. Need for imaging studies (eg, MRI of the prostate with contrast)

Alternatively, men whose PSA levels indicate the need for further testing may undergo multiparametric MRI, which is more sensitive ( using a contrast agent), TRUS.

Treatment of prostatic hyperplasia

Avoiding anticholinergics, sympathomimetics , and opioids

In the initial stages of adenoma development (BPH stage 1-2 ), without data on the development of chronic urinary retention, it is recommended to take herbal preparations with sabal palm extract and pumpkin seed extract, such as Prostial . The effect of the drug is determined to prevent prostate enlargement due to inhibition of type 1 5-alpha reductase. Prostial is suitable for patients with initial manifestations of BPH and who are sexually active. This is due to the fact that alpha blockers often cause symptoms of a lack of sperm in the ejaculate and lower blood pressure, which has a negative effect on erections.

Use of alpha blockers (eg, terazosin , doxazosin , tamsulosin , alfuzosin , silodosin ), 5-alpha reductase inhibitors ( finasteride , dutasteride ) or phosphodiesterase type 5 inhibitor tadalafil , especially with concomitant erectile dysfunction

Transurethral resection of the prostate or alternative bladder drainage procedure

Surgery

Severe acute urinary retention requires immediate drainage of the bladder. Initially, a regular urinary catheter is tried if this fails. If transurethral manipulation is unsuccessful, percutaneous suprapubic bladder drainage can be used ( trocar cystostomy )

Surgery is used when patients do not respond to drug therapy or when they develop complications such as recurrent urinary tract infections, urinary stones, severe bladder dysfunction, or dilatation of the upper urinary tract. Transurethral resection of the prostate (TURP) is the standard procedure (1, 2). Erectile function and the ability to retain urine are usually preserved, although approximately 5 to 10% of patients experience some acute postoperative problems, most commonly retrograde ejaculation. The incidence of erectile dysfunction after TURP is 1–35%, and the incidence of urinary incontinence is 1–3%. However, technical advances, such as the use of the bipolar resectocystoscope , which allows saline irrigation, have significantly improved the safety of TURP by preventing hemolysis and hyponatremia.

About 10% of men who undergo TURP need a repeat procedure within 10 years as the prostate continues to grow. As an alternative to TURP, various laser ablation techniques are used. Large prostates (typically >75 grams) have traditionally required open surgery using a suprapubic or retropubic approach (most surgeons now prefer laparoscopy or robotic laparoscopic-assisted open surgery), although some new techniques such as holmium laser enucleation of the prostate (see HoLEP ) can be performed transurethrally . All surgical treatments require postoperative bladder drainage with a catheter for 1–7 days.