Apitherapy is used to treat multiple sclerosis, rheumatoid arthritis, various infections, inflammation, burns, to heal wounds, reduce pain, and a number of other problems. In the last decade, there has been an increase in the number of patients with chronic prostatitis (CP), usually in men of working and reproductive age. Due to untimely treatment of patients for help, doctors often detect chronic prostatitis in the late stages, in the presence of not only local, but also pronounced extra-organic manifestations of the disease. The purpose of the study is to investigate the effectiveness and tolerability of a combination of drugs: suppositories with drone homogenate and wheat germ oil, drone homogenate lyophilized in a capsule and bee bread in granules in patients with chronic bacterial prostatitis. The study revealed high efficiency and tolerability of the proposed method, a significant improvement in clinical and laboratory indicators was achieved.

Key words: apitherapy, chronic bacterial prostatitis

Introduction. Apitherapy is an alternative method of medicine that uses bee products for the prevention and treatment of diseases: honey, beehive, propolis, royal jelly, drone homogenate, wax, and bee venom. These products can be applied topically, consumed orally, or injected directly into the bloodstream.

The website of the American Association of Apitherapists states that this method is used to treat multiple sclerosis, rheumatoid arthritis, various infections, inflammation, burns, wound healing, pain relief, and a number of other problems.

More and more people are turning to alternative methods for treatment. The popularity of apitherapy in Ukraine as one of the areas of alternative medicine is impressive: courses and conferences, congresses, and numerous publications in the scientific literature have become regular events. The main focus of research is on the descriptions by individual enthusiasts of cases of positive effects of bee products for scientific research on the mechanisms of bee products' impact on the human body, with detailed physicochemical and microbiological analysis, and even on the combination of various treatments with apitherapy. The experience of previous years shows that apitherapy is a universal area of medicine that allows us to fight a large number of diseases. Today, the effectiveness and safety of this method are beyond doubt.

The main dilemma that each of us faces when choosing a treatment method is the choice between the effectiveness and safety of the proposed remedies. This paper shows that apitherapy is a field of medicine that can solve this problem.

In the last decade, there has been an increase in the number of patients with chronic prostatitis (CP) in all countries of the world. It is believed that this trend is associated with the spread of a sedentary lifestyle, exposure to harmful environmental factors, non-compliance with the rules of safe sexual activity, widespread and uncontrolled use of drugs, allergies, etc.

Inflammation of the prostate gland develops, as a rule, in men of working and reproductive age - 20-45 years. Due to untimely treatment of patients, doctors often detect chronic prostatitis in the later stages, in the presence of not only local but also severe extra-organic manifestations of the disease.

Frequent recurrences of chronic prostatitis, accompanied by constant pain, dysuria, sexual dysfunction, manifested by erectile dysfunction and fertility, not only reduce the patient's ability to work, but also often cause family disorders, which defines the medical and social significance of the problem.

Approaches to the treatment of patients with chronic prostatitis are still the subject of debate. When solving the problems that arise in the treatment of patients in this category, many researchers pay attention to substances of natural origin. Information on the successful use of such drugs in medical practice is abundant, but the use of bee products for the treatment of chronic prostatitis deserves special attention.

The aim of the study was to investigate the efficacy and tolerability of a combination of drugs: suppositories with drone homogenate and wheat germ oil, lyophilized drone homogenate in capsule and parchment in granules in patients with chronic bacterial prostatitis.

Materials and methods of the study

In the complex treatment of 60 patients with chronic bacterial prostatitis, we used a combination, suppositories with drone homogenate and wheat germ oil, 1 suppository rectally at night for a month, lyophilized drone homogenate, 1 capsule 3 times a day for a month, and 5-7 granules of bee breead in granules 30 minutes before meals once a day for 30 days.

The diagnostic algorithm for the examination of patients included: study of anamnesis; manifestation of symptoms; obtaining information about previous examination and treatment; finger rectal examination; ultrasound examination of the prostate gland and bladder with the determination of residual urine was performed on the Toshiba Aplio 500 apparatus; laboratory tests (complete blood count; urinalysis; biochemical blood test; analysis of sex hormones, microscopy of prostate secretion; bacterioscopic examination of prostate juice was performed in an Olimpus BH2 emission microscope. Micrographs were stained using the Gram-Siev, Romanowsky-Gimse, and methylene blue methods. Bacteriological examination of the prostate secretion was performed by morphological, tintorial, and culture methods (J. Hault et al., 1997). The number of live microorganisms (CFU) was determined by the method of serial dilutions followed by sowing on nutrient media. The sensitivity of cultures to antimicrobial drugs was determined by the Bauer-Kirbi disc diffusion method using commercial disks.

Hormonal studies (testosterone, LH, prolactin, estradiol) were performed in blood serum by ELISA using CISBiointernation test kits (France).

Patients were also interviewed using an international specific questionnaire for assessing lower urinary tract symptoms (International Prostate Symptoms Score with Quality of Life (IPSS-QoL) scale) and determining quality of life using the QoL scale.

All examinations were performed twice: before treatment and control examinations after treatment.

Standard basic therapy included immunomodulators, antibiotic therapy, systemic enzyme therapy, nonspecific anti-inflammatory drugs, and physiotherapy.

The efficacy of the study drugs was evaluated according to the scale given in Table 1.

Table 1

Evaluation of the efficacy of investigational drugs

Side effects were assessed using a five-point system: 5 points - no side effects; 4 points - no side effects side effects are minor, without harm to the patient and do not require drug withdrawal; 3 points - side effects affect the patient's condition but do not require drug withdrawal; 2 points - undesirable side effects have a significant impact on the patient's condition and require drug withdrawal; 1 point - side effects that require drug withdrawal and additional medical interventions.

During the examination of the anamnesis, great attention was paid to patients' complaints of pain and discomfort in the perineum, testicles and suprapubic area, fever, and urinary disorders. The intensity of pain, its nature, frequency and relationship with physical activity, ejaculation, and urination were determined. The questionnaire was administered before and during treatment according to the modified international system for the assessment of symptoms in prostate disease.

Results and discussion. In the proceedings of the 2nd (1993) and 3rd (1995) International Meetings on Benign Prostatic Hyperplasia, a questionnaire was published and recommended as an official tool for assessing patients with symptoms of this disease.

J.K. Nickel and R. Sorensen (1996) proposed a modification of the international IPSS system for subjective assessment of symptoms in chronic prostatitis. The system is based on a questionnaire designed for self- administration by patients. The questionnaire contains 10 standard questions that reflect the severity of individual symptoms and one question that assesses the quality of life (Table 2).

Table 2

IPSS-QoL questionnaire

Quality of life as assessed by the patient

Quality of life index

Assessment of the general condition by the sum of points (S+L): mild degree no more than 7 points,

moderate - from 8 to 19 points, severe

- from 20 to 35 points, very severe - more than 35 points.

As a result of the treatment, the sum of IPSS scores decreased by 93.9%, according to patients, the quality of life improved by 29.3%, and the general condition assessment was rated from severe to mild (S + L) (Table 3).

Table 3

Results of symptom assessment during treatment

During the finger rectal examination of the prostate gland before treatment, its painfulness was determined in all patients, and pastiness - in 36 (60%) patients, 2 months after treatment, pain was determined only in 6 (10%) patients. At the same time, the clarity of the prostate gland contours was determined before treatment only in 42 (73.3%), and after treatment in all patients (Table 4).

During the laboratory examination of patients, no significant differences were found in the general and biochemical blood tests, as well as the general urinalysis (Table 5).

Table 4

Results of clinical examination of patients with chronic prostatitis

Table 5

Results of laboratory tests

At the same time, significant (p<0.001) differences were found in the analysis of prostate secretion before and after treatment. Thus, the number of leukocytes in the field of view before treatment was 21.8±23.2, and after treatment - 7.3±3.2, that is, decreased by 66.5%; the number of red blood cells before treatment - 0.4±0.6, and after treatment

• 0.1±0.2, i.e., decreased by 75%; the number of lecithin grains before treatment - 112.6±71.6, and after treatment
• 164.3±79.6, i.e., an increase of 68.5%.

Significant (p<0.001) changes were also detected in hormonal blood tests in patients. Thus, the testosterone level increased from 6.4±2.4 to 8.2±3.1 ng/ml, i.e. by 22%, while the estradiol level decreased by 6.7% from 28.3±9.3 to 26.4±7.6 pg/ml.

Ultrasound examination of the prostate gland before treatment revealed heterogeneity of its structure in 52 (86.7%) patients, after treatment heterogeneity was detected only in 14 (23.3%)

of patients. There was also a significant (p<0.05) decrease in the size of the prostate gland in the dynamics of treatment. Thus, the longitudinal size of the prostate gland before treatment was 37.8±3.2, and after treatment -

32.6±2.9 mm, its transverse size before treatment was 30.6±3.4, and after treatment - 28.4±3.2 mm. In 6 patients, residual urine with a maximum volume of up to 30 cm was determined before treatment3 . After treatment, no patient had residual urine (Table 6).

Table 6

Ultrasonography of the prostate gland

Localized changes in the structure of the prostate gland by ultrasound were detected before treatment in 8 (13.3%) patients, after treatment - in 6 (10.0%). At the same time, diffuse changes before treatment were detected in 52 (86.7%) and after treatment - only in 14 (23.3%) patients (Table 7).

Table 7

Dynamics of objective changes in the prostate gland

As a result of the complex treatment of patients with chronic bacterial prostatitis who received a combination of drugs for 60 days, high and moderate efficacy was achieved in 93.3% of patients, and low efficacy was achieved in only 6.7% (Table 8).

Table 8

Evaluation of the effectiveness of the use of a combination of drugs: suppositories with drone homogenate and wheat germ oil, lyophilized drone homogenate in a capsules

Only 2 (4.7%) patients had slight itching of the skin while taking, while other patients had no side effects (Table 9).

Table 9

Evaluation of side effects when using the complex of drugs

Conclusions.

Beekeeping products have a number of advantages when choosing a treatment and prevention method, combining safety, efficacy, the ability to be used without additional processing, shelf life, relative cheapness and availability.

Apitherapy can be used as a leading therapeutic factor in the treatment of a number of diseases, as an adjunct to the main treatment and can be used as a means of prevention.

The established efficacy is mediated by the components of bee products, general strengthening, anti- inflammatory, immunocorrective properties.

Thus, the study on the efficacy and tolerability of the combination of drugs: suppositories with drone homogenate and wheat germ oil, lyophilized drone homogenate in capsule in patients with chronic bacterial prostatitis showed high efficacy and tolerability.

In addition, a significant improvement in clinical and laboratory parameters was achieved:

• The IPSS score decreased by 93.9%, according to patients, while the quality of life improved by 29.3%, and the general condition score (S+L) went from severe to mild;
• in the analysis of prostate secretion, the number of leukocytes in the field of view after treatment decreased by 66.5%, the number of red blood cells - by 75%, and the number of lecithin grains increased by 68.5%;
• testosterone levels increased by 22% over 2 months of treatment, and estradiol levels decreased by 6,7%;

• the size of the prostate gland decreased and the heterogeneity of its structure disappeared in 76.7% of patients;
• The size of the prostate gland decreased in 76.7% of patients, and pain disappeared in 86.7% of patients.