1.Data and methods
1.1 Clinical data
Patients with chronic prostatitis who visited our male outpatient clinic from October 2010 to April 2011 were included in the study. Inclusion criteria: ① age 20-50 years old; ② National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scores of 1 and 2 ≥ 1; ③ duration of disease ≥ 3 months and actively seeking treatment; ④ urinary routine, urine culture, prostate massage fluid routine, four-cup method and other tests to exclude chronic bacterial prostatitis. Exclusion criteria: ① those who had been treated with other drugs in the past 2 weeks, acute urinary tract infections, and severe cardiovascular disease; ② those who did not receive treatment or grouping protocols. According to the above criteria, a total of 113 patients were enrolled.
1.2 Treatment method
The Chinese medicine prescription was the author’s experienced formula “Eight Flavors of Huangbai Feijao Tang”; the ultrasonic electric conduction therapy instrument was produced by Nanjing Early Spring Medical Equipment Company (ultrasonic electric conduction prostate therapy instrument, ZC-8800A). The treatment method is 1 time every other day, 2 weeks for 1 course of treatment, a total of 1 course of treatment. The NIH-CPSI scores were evaluated before and after treatment. The Chinese herbal medicine prescription consisted of 15 g of Phellodendron, 12 g of rhubarb, 20 g of sophora, 15 g of alba, 15 g of wang buxian, 15 g of dandelion, 15 g of white foxglove, and 15 g of acacia. 100 mL of the Chinese herbal medicine was decocted by the preparation room of our hospital before treatment. . The patient was instructed to evacuate the stool, adopt the left
The patient was instructed to empty the stool, adopt the left knee-chest position, remove the pants to the knee and expose the anus. Clean the anal opening with a sterile cotton swab, connect the infusion skin strip to the infusion bottle and vent it, and connect one end to the ultrasound introduction treatment head. Lubricate the ultrasound introduction treatment head and the patient’s perianal area with lubricant, and slowly insert the treatment head; the in vitro treatment head was placed at the Guan Yuan point. The treatment time was 30 min, and the ultrasound frequency was 1.2 MHz for the in vivo treatment head and 600 kHz for the in vitro treatment head. 20~30 drops/min were adjusted after starting the treatment, and the drug was slowly dripped in, and the patient’s response was observed, and the drip was finished in about 30 min. When the drip is finished, the treatment head is gently removed and the patient is asked to relax and lie flat for a moment to complete the treatment. Observe and record any adverse reactions of the patients at the same time.
1.3 Comparison of observation indexes and symptoms
NIH-CPSI urinary symptom score and pain score were used as the main indicators, NIH-CPSI quality of life score was used as a secondary indicator, and other indicators included NIH-CPSI total score and adverse reactions, etc.
1.4 Observation of therapeutic effect
Cure: clinical symptoms completely disappeared; significant effect: NIH-CPSI score decreased by more than 10 points compared with that before treatment; effective: NIH-CPSI score decreased by more than 5 points compared with that before treatment; ineffective: NIH-CPSI score decreased by less than 5 points compared with that before treatment.
1.5 Statistical analysis
The database was established and statistical analysis was performed with SPSS 14.0 software package, and the whole process was completed by uniform professional staff to ensure the quality of data processing. Statistical differences were considered at P<0.05.
2. Results
2.1 General information
113 cases participated in this study, among which 7 cases withdrew for various reasons (including lost visits), and 106 patients completed the treatment and efficacy assessment. The mean age of the 106 patients who completed treatment was (34.96±9.49) years, and the mean duration of disease was (16.39±9.76) months.
2.2 NIH-CPSI score
NIH-CPSI scores before and after treatment in 106 patients who completed treatment. The total NIH-CPSI score before treatment was (25.44±5.56); the voiding symptom score was 5.59±2.76; the pain score was 12.70±3.65, and the quality of life score was 7.20±3.92. After treatment, the scores decreased to 14.33±3.97, 3.16±1.87, 6.82±2.31, and 4.31±2.13, respectively. Compared with the pre-treatment period, there was a significant difference with P<0.05.
2.3 Treatment effect
Among the 106 completed patients, 39 cases had complete disappearance of symptoms, 35 cases had significant effect, and 17 cases had effective effect, with an overall effective rate of 85.85%.
2.4 Adverse reactions and others
There were no serious adverse reactions in 113 patients during the treatment. One patient felt a little discomfort around the anus after the initial treatment, and the discomfort disappeared after 1 h of rest, so he did not withdraw from the treatment.
3. Discussion
The anatomical location of the prostate gland is adjacent to the anterior rectal wall, in order to improve the efficacy of drugs, combined with the idea of Chinese medicine external treatment, transrectal drug delivery has been a common method for the treatment of chronic prostatitis. shafik found that there are 2-6 small hemorrhoidal genital veins between the rectal vein and the prostatic venous plexus of the bladder, these traffic branches deliver blood from the rectal vein to the genitourinary venous plexus in a unidirectional manner, providing a high depth of local aggregation of drugs absorbed through the rectum. anatomical conditions for the local formation of high depth aggregates of drugs absorbed transrectally. This further provides a theoretical basis for transrectal drug delivery for the treatment of prostate disease.
However, it is well known that chronic prostatitis is still a very difficult clinical disease that lacks a specific treatment. Although transrectal drug delivery is superior to oral drug delivery in terms of avoiding first-pass effects in the liver, its efficacy has not yet reached a level of satisfaction for both patients and physicians. How to enhance its efficacy has been a hot issue of research. Chinese medicine enema is a common method of transrectal drug delivery; it is also a good choice to use other therapeutic means (such as oral Chinese medicine, oral Western medicine, acupuncture, physiotherapy, etc.) to synergize the efficacy. In our clinical work, we have also observed the therapeutic effect of Chinese herbal enemas on chronic prostatitis, and combined with transrectal microwave therapy, and achieved good results.
Ultrasound as a diagnostic tool has been used very widely in medicine. In recent years, ultrasound’s role in promoting drug penetration and therapeutic effects has also been gaining attention. Existing studies have confirmed that low-frequency ultrasound introduction can be used not only for transdermal injection of low-molecular-weight drugs like lidocaine and epinephrine, but also for transdermal injection of high-molecular-weight proteins like insulin, γ-interferon and erythropoietin. Through the combined application of electroporation, ultrasonic cavitation and modern ion introduction technology, it firstly generates artificial channels for drug penetration, and then penetrates into the body driven by physical energy, which can make the drug effectively concentrated and infiltrated in tissues and improve the effect of drug on target tissues. In addition, the mechanical and physicochemical effects of ultrasound can also play a role in softening tissue, enhancing penetration, improving metabolism, promoting blood circulation, stimulating the nervous system and cell function, so ultrasound itself has a unique therapeutic significance.
This study combines the advantages of transrectal drug delivery for the treatment of prostatitis with the further use of ultrasound to increase the absorption of drugs and the therapeutic effect of ultrasound itself can be applied to some extent. The total NIH-CPSI score before treatment was (25.44±5.56); the voiding symptom score was 5.59±2.76; the pain score was 12.70±3.65; and the quality of life score was 7.20±3.92. After treatment, the scores decreased to 14.33±3.97, 3.16±1.87, 6.82±2.31, and 4.31, respectively. ±Compared with the pre-treatment period, all the scores were significantly different with P<0.05. Their overall effective rate was 85.85%, which was a better efficacy.
The overall treatment effect of this group of cases was obvious, and the Chinese herbal formula used was the author’s experienced formula “Eight Flavors of Huangbai and Feijao Tang”, which consisted of eight herbal medicines, including Huangbai, Dahuang, Feijao, Baihua Snake-Tongue Herb, Wang Buliu Xing, Dandelion, Baimao Root, and Sophora. Among them, Phellodendron Bark, Rhubarb, Dandelion, and White Flower and Serpent’s Tongue have the functions of clearing heat and detoxifying, reducing swelling and pain; Wang Bu Liuxiang and Fructus septicum have the functions of activating blood stasis, softening hardness and dispersing knots; White Fructus roots and Sophora flowers have the functions of cooling blood and detoxifying. The combination of all the drugs, together with the function of clearing heat and detoxification, dampness and dispel blood stasis, cool the blood and reduce swelling. The author believes that chronic prostatitis belongs to the category of “essence turbidity” in Chinese medicine, and its evidence can be divided into kidney deficiency, spleen deficiency, dampness (heat), stagnation and so on. In terms of localized lesions, they are mostly the “symptoms” of the disease, i.e., damp-heat and stasis; therefore, the formula is based on clearing heat and relieving dampness, invigorating blood and dispersing stasis, which will definitely have good effects.