Treatment of chronic prostatitis: low-intensity laser therapy

Laser therapy can combine the properties of various pathogenetic procedures. Low-intensity laser radiation (LILR) has been used in medicine since 1962, and since then this highly effective multifaceted method of influence has found unusually wide application.

For therapeutic purposes, laser radiation in the blue, green, red and near IR spectrum ranges is used, with a wavelength of 0.42 to 1.1 μm. The most widely used lasers are those with a wavelength of 0.6-0.63 μm (usually helium-neon) and 0.8-1.1 μm (usually semiconductor gallium arsenide), which have a greater penetration depth.

We share the point of view of the authors who believe that laser therapy is based on a trigger mechanism that initiates sanogenesis processes, and therefore recommend adhering to minimal doses of laser exposure - up to 10 mW/ ^cm2.

Numerous domestic and foreign studies have shown the pronounced analgesic effect of LILI, its anti-inflammatory and antioxidant effects. Laser therapy has a bioenergetic stimulating, immunocorrecting, desensitizing effect, stimulates reparative processes, improves microcirculation, and leads to a decrease in tissue edema. The hypotensive and diuretic effects of LILI, neuroleptic and detoxifying effects have been described. LILI reduces protein loss with urine, prevents excessive scarring. The phenomenon of LILI aftereffect is very important, which ensures prolongation of the effect for 1.5-2 months after the end of the laser therapy course.

At the same time, it has been proven that continuous LILI exposure in adequate doses does not have a damaging effect on organ tissues, although the data on pulsed lasers are contradictory. In order to clarify some mechanisms for implementing the biological and therapeutic effects of low-intensity laser radiation (with a wavelength of 0.63 and 0.8 μm), many studies have been carried out both in our country and abroad. M.A. Berglezov et al. (1993) conducted a series of experimental studies. The authors believed that the mechanism for implementing LILI and the specificity of its action should be considered at various levels of the entire organism: subcellular, cellular, tissue, systemic, and organismic.

The specific action of laser radiation is determined by the impact on the operational link of pathogenesis, after which genetically determined healing processes (sanogenesis) are launched. Under certain parameters, LILI acts as an irritant causing a non-specific adaptation reaction. In this case, its implementation is carried out indirectly through central regulatory mechanisms. V.I. Eliseenko et al. (1993) believed that in the pathogenetic mechanism of LILI action on biological tissues, the initial link is the photoacceptance of light by intraepidermal macrophages (Langerhans cells), including the reaction of the microcirculatory bed in the area of light exposure, and after some time acquiring a universal character. Capillary blood flow is activated (by 30-50%) due to the opening of previously inoperative capillaries.

Under the influence of LILI, there is also a change in the conformational properties of hemoglobin with its transition from deoxy to oxy form, in which its bond with oxygen becomes unstable, which facilitates the transition of the latter into tissues. A kind of respiratory, or, in the terminology of other authors, oxygen "explosion" develops, leading to the intensification of all enzyme systems of biotissues. Activation of microcirculation, and consequently, exudative processes after the first laser therapy (LT) sessions causes an exacerbation of clinical manifestations of various pathological processes. However, after the third laser therapy session, there is a reduction in the exudative phase of inflammation and activation of cellular elements of the mononuclear phagocyte system, causing the onset of the proliferative phase of inflammation with active formation of granulation tissue in the area of the pathological focus.

A.A. Minenkov (1989) investigated the use of LILI in combined methods of physiotherapy. In doing so, the author established that the effect of red-range LILI on tissues directly subject to irradiation is achieved through its resonant adsorption by a specific membrane-bound photoacceptor from among heme-containing enzymes - catalase.

As a result of tissue microheating, the lipid structure of cell membranes changes, creating a physicochemical basis for the formation of non-specific reactions of the irradiated tissue and the body as a whole. The therapeutic effect of LILI is realized due to local processes occurring in the tissues that have absorbed the radiation energy, primarily the activation of regional hemodynamics. Under the influence of LILI (including in reflexogenic zones), the content of biologically active substances in tissues and blood changes, which entails a change in the mediator and endocrine links of humoral regulation. Due to the restoration of the sympathetic-adrenal system and the glucocorticoid function of the adrenal glands, suppressed by the pathological process, it is possible to weaken the activity of the inflammatory process, stimulate tissue trophism, and coordinate the regulation of vascular tone. G.R. Mostovnikova et al. (1991) believed that a certain role in the mechanism of the therapeutic action of laser radiation is played by light-induced rearrangements of molecular and submolecular bioliquid crystalline structures (light-induced Fredericks effect) in the field of the laser light wave.

The protective effect of molecular oxygen is due to its participation in the formation of weak bonds responsible for maintaining the spatial structure of biomolecules. The formation of equilibrium complexes of molecular oxygen with biomolecules is evidenced by a change in the spectral-luminescent characteristics.

According to R.Sh. Mavlyan-Khodjaev et al. (1993), the structural basis of the stimulating effect of LILI is primarily changes in microvessels (their expansion and accelerated neoplasm).

Ultrastructural reorganization of cells is observed, indicating an increase in their specific functions. The volume of the endoplasmic reticulum and the Golgi complex of fibroblasts increases, collagen formation is enhanced. The activity of phagocytes capturing microorganisms and products of catabolism increases, the number of phagosomes and lysosome-like formations in the cytoplasm increases. In mast cells, eosinophils and plasma cells, an increase in secretion and an increase in intracellular structures associated with heterosynthesis are observed.

Yu.I. Grinstein (1993) noted the following factors in the mechanism of biological and therapeutic action of endovascular low-intensity laser therapy: inhibition of hyperlipid peroxidation, activation of enzymes of the antioxidant system, which leads to the restoration of the morphofunctional state of biological membranes. This is evidenced by the normalization of the spectrum of membrane lipids, improvement of the transport of substances through the membrane and an increase in membrane receptor activity. A reliable improvement in microcirculation is observed primarily due to an improvement in the deforming capacity of erythrocytes, moderate hypocoagulation, and a modulating effect on the tone of arterioles and venules.

G.E. Brill et al. (1992) claimed that under the influence of helium-neon (He-Ne) laser radiation, activation of some regions of the cell's genetic apparatus, in particular the nucleolar organizer zone, can occur. Since the nucleolus is the site of RNA synthesis, an increase in the functional activity of the nucleolar organizer creates the prerequisites for an increase in protein biosynthesis in the cell.

It is known that mast cells are important regulators of tissue metabolism and the state of microcirculatory homeostasis due to their ability to synthesize, store and release biologically active substances into the environment. T.P. Romanova and G.E. Brill (1992) found that the effect of He-Ne laser radiation during the formation of a stress response has a stabilizing effect on mast cells, preventing their degranulation and release of biologically active substances. V.F. Novikov (1993) assumed a dispersed sensitivity of the animal cell to the effects of light energy. The author believed that attempts to search for a specific morphological acceptor of light are futile. The commonality of the characteristics of the functional responses of plant and animal cells to light radiation of a certain wavelength suggests the presence of a certain "animochrome" in the animal cell.

In conclusion, it should be noted that the views of researchers on the mechanism of action of LILI are contradictory, which indicates the lack of reliable knowledge of its mechanism at the current stage of scientific development. However, the empirical use of laser therapy has proven this method in many areas of medicine. Laser therapy is also widely used in urology. Intravascular, transcutaneous and extracorporeal irradiation of urological patients with He-Ne laser is described. In this case, patients experienced a decrease in temperature, neuroleptic and analgesic effects, a decrease in the level of leukocyte intoxication index, a decrease in the level of medium molecules in the blood and an increase in their concentration in the urine, which indicates increased excretion by the kidneys and a decrease in intoxication of the body.

A distinct hypoproteinuric effect, immunomodulatory and biostimulating action of laser therapy have been recorded (Avdoshin V.P., Andryukhin M.I., 1991). I.M. Korochkin et al. (1991) performed laser therapy on patients with chronic glomerulonephritis. In patients with mixed and nephrotic forms of nephritis, hypotensive and diuretic clinical effects, as well as increased fibrinolytic activity, were noted during He-Ne laser treatment. He-Ne laser radiation made it possible to overcome refractoriness to previously conducted pathogenetic therapy (glucocorticoids, cytostatic, hypotensive and diuretic drugs).

O.B. Loran et al. (1996) were convinced that magnetolaser therapy in the complex treatment of inflammatory diseases of the genitourinary system shortens the phases of the inflammatory process, normalizes and improves blood supply in the affected organ, expands its compensatory and adaptive capabilities in conditions of inflammation. V.E. Rodoman et al. (1996) noted an improvement in microcirculation in the area of the inflammation focus, anti-edematous, desensitizing and immunomodulatory effects of local IR irradiation in nonspecific pyelonephritis. Laser therapy helps to prolong the action of medications and potentiate them. The inclusion of laser therapy in the treatment complex in 91.9% of cases made it possible to transfer chronic pyelonephritis into clinical and laboratory remission. B.I. Miroshnikov and L.L. Reznikov (1991), studying the possibilities of conservative treatment of diseases of the genitourinary system using LILI, proved that laser therapy reduces the number of necessary surgical interventions for acute inflammatory diseases of the scrotum from 90 to 7%; in general, the number of operations on the organs of the genitourinary system is reduced by 35-40%.

Good results were obtained by M.G. Arbuliev and G.M. Osmanov (1992), using laser therapy in patients with purulent pyelonephritis by irradiating the kidney during surgery, irradiating the renal pelvis through a nephrostomy, and using laser puncture. A.G. Murzin et al. (1991) reported on the use of amplitude-modulated laser irradiation in patients with ureterolithiasis and functional disorders of urodynamics. Laser radiation with a wavelength of 850 nm and a power of 40 mW in continuous mode stimulated the tone and peristalsis of the renal pelvis. The authors observed 58 patients with ureterolithiasis and 49 patients with pyelectasis. The effect of amplitude-modulated laser radiation on reflexogenic zones was accompanied by a decrease in the intensity of pain in the lumbar region, an increase in the tone of the renal pelvis and ureter, restoration of the outflow from the obstructed kidney and gradual migration of the calculus. In 60.3% of patients, the calculus passed after a course of laser therapy.

O.D. Nikitin and Yu.I. Sinishin (1991) used intravascular laser irradiation of blood in the treatment of calculous pyelonephritis. Both He-Ne and IR lasers are widely used in the treatment of inflammatory diseases of the male genital organs (orchiepididymitis and prostatitis), and both external and rectal and urethral irradiation are used. A rapid and persistent analgesic effect, normalization of rheographic parameters of the prostate, cessation of dysuria, and improvement of the copulative function are noted.

Regression of the inflammatory process and acceleration of reparation made it possible to reduce the length of stay of patients in hospital by more than 2 times.

The immunostimulating effect of LILI applied locally determined the good clinical effect of laser therapy in genital herpes and in the postoperative period in patients with acute purulent pyelonephritis. R.Sh. Altynbaev and N.R. Kerimova (1992) used laser therapy in the complex treatment of chronic prostatitis with impaired spermatogenesis.

The authors used a laser with a wavelength of 0.89 μm, with a pulse repetition rate of 500 Hz, and an exposure of 6-8 min (unfortunately, the radiation power was not specified). Rectal irradiation was alternated with exposure to the symphysis, anus, and root of the penis daily for 10-12 days. The authors note that the immediate results are worse than the remote ones (after 2 months), and explain this by the aftereffect.

L.L. Reznikov et al. (1991) used the LG-75 laser in the treatment of acute epididymo-orchitis, determining the energy at 4 J per session. The authors noted a pronounced analgesic effect from the first sessions of laser therapy, rapid relief of intoxication and an increase in treatment efficiency by 38.5%. The authors explained the mechanism of action as follows. After the first sessions of laser therapy, the parietal layer of the vaginal process of the peritoneum intensively deposits exudate in the layers located immediately under the mesothelium, and the infiltrated areas of the membrane are delimited by a powerful leukocyte shaft. Thus, laser therapy for acute nonspecific epididymitis allows for a sharp reduction in the acute inflammation phase, relief of the consequences of exudation, and effective decompression of the testicular tissue, i.e. to minimize the development of secondary testicular alteration, which is detected in almost 90% of cases of epididymitis. Laser therapy in the complex treatment of patients with prostate adenoma complicated by inflammatory diseases of the lower urinary tract, used both before surgery (rectally) and after adenomectomy (irradiation of the adenoma bed and retropubic space) made it possible to reduce the incidence of complications by 2 times. He-Ne laser has proven itself in the treatment of diseases of both the upper and lower urinary tract. Ante- and retrograde irradiation of the renal pelvis and ureteral mucosa helps to improve urodynamics, resolve ureteral stricture. Transurethral laser therapy of chronic cystitis and urethritis in women showed excellent results in 57.7% and good results in 39.2% of patients. During and after laser therapy, the effect of antibacterial and anti-inflammatory drugs is sharply enhanced. A significant reduction in the frequency of relapses was noted.

S.Kh. Al-Shukri et al. (1996) used an IR laser with a power of 8-15 mW in the treatment of patients with chronic non-specific cystitis. In the acute phase, a frequency of 900 Hz was used, and when the pain syndrome subsided, it was reduced to 80 Hz. The duration of irradiation was 3-5 min, 5-10 sessions per course. The authors noted a decrease in dysuria, urine sanation, and a positive cystoscopic picture. L.Ya. Reznikov et al. (1991) reported on the experience of laser therapy in the treatment of cicatricial stenosis of the urethra and fibroplastic induration of the penis. The effect of LILI on cicatricial tissue promotes gradual resorption of scars, reducing their rigidity due to the activation of enzymatic reactions. The authors irradiated urethral strictures with subsequent bougienage and achieved restoration of patency after 7-9 sessions.

The effect of He-Ne laser on fibroplastic induration of the penis had a local and general effect in the form of an increase in the concentration of cortisol and testosterone in the blood. Moreover, the best effect was observed with the sequential use of laser radiation with a wavelength of 441 and 633 nm. The greatest number of studies are devoted to laser reflexology (LRT) in urology and, especially, in andrology. By means of laser puncture, researchers achieved stimulation of spermatogenesis, improvement of copulative function, relief of dysuria in cystalgia, analgesia in the early postoperative period.

There are reports on the use of laser therapy in the treatment of genitourinary tuberculosis. R.K. Yagafarova and R.V. Gamazkov (1994) locally affected the genital area of male patients with genital tuberculosis with a He-Ne laser. Against the background of chemo-laser therapy, the authors noted normalization of urine tests in 60% of patients, detoxification in 66%, and the process was resolved conservatively in 55.3%. In general, 75% of patients achieved a positive effect. V.T. Khomyakov (1995) included laser therapy in the treatment complex for men with genital tuberculosis and reduced the number of operations on the scrotum by 2 times, and increased the effectiveness of treatment for patients with prostate tuberculosis by 40%.

Various laser therapy methods have been developed: external (or transcutaneous) irradiation, impact on acupuncture points, intracavitary, intravascular laser irradiation of blood (ILIB). Recently, transcutaneous (supravenous) laser irradiation of blood has also gained more and more supporters.

External or transdermal exposure

If the pathological process is localized in the superficial layers of the skin or mucous membrane, then the effect of LILI is directed directly at it. In this case, matrix pulse lasers can be used, allowing to cover a larger area of action with a uniformly distributed radiation power density. Such a technique allows to significantly increase the efficiency of laser therapy and to obtain a more stable effect. Due to the dispersion of radiation sources on the body surface, the light flux affects a larger volume of biological tissues compared to a point emitter. Due to this, the most probable "hit" of energy on the pathological focus is ensured, the localization of which is not always precisely known and can change relative to the body surface when the patient's position in space changes. A distinction is made between the contact method of action, when the emitting head is in contact with the irradiated surface, and remote (non-contact), when there is space between the emitting head and the irradiated surface. In addition, it has been established that compression of soft tissues allows to increase the therapeutic effect of LILI, since this increases the penetration of laser radiation into biological tissues.

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Impact on acupuncture points

Acupuncture points are a projection of a specific area of greatest activity of the system of interaction of the body covering - internal organs. The pinpoint nature and low intensity of the impact on the receptor apparatus at acupuncture points, due to the spatial and temporal summation of irritation, causes multi-level reflex and neurohumoral reactions of the body. The general reaction of the body to laser reflex action is carried out in two main ways: neurogenic and humoral.

LILI of therapeutic parameters does not cause subjective sensations in the patient when applied to the skin. Most authors recommend following the principle of "low power - low frequencies - short exposure time". According to T. Ohshiro and RG Calderhead (1988), exposure to continuous laser IR radiation (wavelength 0.83 μm, power 15 mW) for 20 s causes immediate reactive vasodilation in the tissues surrounding the exposure zone, resulting in an increase in temperature by 1-2 °C at the acupuncture points. The synthesis of prostaglandins E and F, enkephalins and endorphins increases. The effects are cumulative and reach a maximum by the seventh procedure. The features of LRT methods include a small impact zone, non-specific nature of photoactivation of receptor structures, tissue and enzymatic elements, the ability to cause targeted reflex reactions, non-invasiveness of the impact, asepticity, comfort, the possibility of using the method both independently and in combination with various medicinal, dietary and phytotherapeutic methods of treatment.

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Intracavitary impact

It is effectively used in therapy, gynecology, urology, surgery, etc. Unlike transcutaneous exposure to the projection of the affected organ, when most of the radiation energy is dissipated in biological tissues on the way to the organ, with the intracavitary method of laser therapy, LILI is delivered with minimal energy loss, with the necessary form of power distribution directly to the pathological focus. Special optical attachments are intended for this purpose, which are inserted into the natural cavities of the body.

Intravascular laser irradiation of blood

The method was developed in the 1980s and proved effective in treating a number of diseases. A needle with a thin sterile light guide is inserted into the ulnar or subclavian vein by venipuncture, through which the blood is irradiated. For BLOCK, LILI is usually used in the red region of the spectrum (0.63 μm) with a power of 1-3 mW at the end of the light guide (the procedure lasts 30 minutes). Treatment is carried out daily or every other day, with a course of 3 to 8 sessions. The effect of LILI on erythrocytes in circulating blood helps stabilize their cell membranes and maintain functional integrity, which improves circulation in the vessels of the microcirculatory bed in pathological conditions. BLOCK is accompanied by an increase in oxygen content and a decrease in the partial pressure of carbon dioxide. The arteriovenous difference in oxygen increases, indicating the elimination of tissue hypoxia and improved oxygenation. The therapeutic effect of BLOCK is based on, on the one hand, the effect on hemoglobin and its transfer to a more favorable state for oxygen transport, and on the other hand, an increase in the amount of adenosine triphosphoric acid and an increase in energy production in cells. BLOCK reduces the aggregation capacity of platelets, activates fibrinolysis, and normalizes the content of antithrombin III. This leads to an increase in the rate of peripheral blood flow and improved tissue oxygenation. Improvement of microcirculation and oxygen utilization in tissues when using BLOCK is closely related to the positive effect of quantum hemotherapy on metabolism: oxidation of energy materials - glucose, pyruvic and lactic acids - increases. Improvement of microcirculation is due to vasodilation and changes in the rheological properties of blood. The latter occurs due to a decrease in blood viscosity, a decrease in the aggregation activity of erythrocytes due to a change in their physicochemical properties, in particular an increase in the negative electric charge. As a result, microcirculation is activated, capillaries and collaterals open, trophism improves, and nervous excitability is normalized.