Chronic prostatitis treatment: low-intensity laser therapy

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

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

We share the point of view of the authors who believe that the basis of laser therapy is the trigger mechanism that triggers the sanogenesis processes, and therefore recommend that the minimum dosage of laser exposure be adhered to - up to 10 mW / cm ².

Numerous domestic and foreign works show a pronounced analgesic effect of LIL, anti-inflammatory and antioxidant effects. Laser therapy has bioenergetic stimulating, immunocorrecting, desensitizing action, stimulates reparative processes, improves microcirculation, leads to a reduction in edema of tissues. The hypotensive and diuretic effects of LILS, neuroleptic and detoxification effects are described. NILI reduces the loss of protein in the urine, prevents excessive scarring. Very important is the phenomenon of aftereffect of NLI, which ensures prolongation of the effect by 1.5-2 months after the end of the course of laser therapy.

At the same time, it has been proved that the effect of NLI in continuous mode in adequate doses does not have a damaging effect on the tissues of organs, although the information on the pulsed lasers is contradictory. In order to elucidate some of the mechanisms for realizing the biological and therapeutic effects of low-intensity laser radiation (with a wavelength of 0.63 and 0.8 μm), many works 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 of NLLI implementation and the specificity of its action should be considered at different levels of the whole organism: subcellular, cellular, tissue, systemic, organismic.

The specific effect of laser radiation is determined by the impact on the operative link of pathogenesis, after which the genetically conditioned processes of sanitation (sanogenesis) are triggered. With certain parameters, NLI acts as an irritant, which induces a nonspecific adaptation reaction. In this case, its realization is carried out indirectly through the central mechanisms of regulation. IN AND. Yeliseyenko et al. (1993) believed that in the pathogenetic mechanism of the action of LIL on biological tissues, the initial link is the photoacceptance of light by intra-epidermal macrophages (Langerhans cells), which include the reaction of the microcirculatory bed in the area of light exposure, and after a while acquiring a general character. There is an activation of capillary blood flow (by 30-50%) due to the disclosure of previously not functioning capillaries.

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

A.A. Minenkov (1989) investigated the use of NLI in combined methods of physiotherapy. At the same time, the author has established that the effect of LLR in the red range on tissues directly subject to irradiation is due to its resonance adsorption by a specific membrane-bound photoacceptor from among the hemocontaining enzymes, catalase.

As a result of microheating of tissues, the lipid structure of cell membranes changes, creating a physico-chemical basis for the formation of nonspecific reactions of irradiated tissue and the organism as a whole. The therapeutic effect of LILI is realized due to local processes occurring in tissues that absorbed radiation energy, primarily - activation of regional hemodynamics. Under the influence of LIL (including in the reflexogenic zones), the content of biologically active substances in tissues and blood changes, which leads to a change in the mediator and endocrine links of humoral regulation. Due to the restoration of the sympatho-adrenal system and the glucocorticoid function of the adrenal glands, which are inhibited by the pathological process, it is possible to weaken the activity of the inflammatory process, stimulate trophic tissue, and coordinate the regulation of vascular tone. G.R. Mostovnikovaissoavt. (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 bio-liquid crystal structures (the light-induced Fredericks effect) in the field of a 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 indicated by a change in the spectral-luminescent characteristics.

In the opinion of R.Sh.Mavlyan-Khojayev and co-authors. (1993), the structural basis of the stimulating effect of LILI is primarily changes in microvessels (their expansion and accelerated neoplasm).

There is an ultrastructural rearrangement of cells, which speaks of the intensification of their specific functions. The volume of the endoplasmic reticulum and Golgi complex of fibroblasts increases, collagen formation is increased. The activity of phagocyte capture by microorganisms and catabolism products increases, the number of phagosomes and lysosome-like formations increases in the cytoplasm. In mast cells, eosinophils and plasma cells, there is an increase in secretion and an increase in intracellular structures associated with heterosynthesis.

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

G.E. Brill et al. (1992) argued that under the influence of radiation from a helium-neon (He-Ne) laser, activation of certain areas of the genetic apparatus of the cell, in particular the nucleolus organizer zone, may occur. Since the nucleolus is the site of RNA synthesis, increasing the functional activity of the nucleolar organizer creates the prerequisites for increasing protein biosynthesis in the cell.

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

Summarizing, it is necessary to note the contradictory views of researchers on the mechanism of NILI, which indicates the lack of reliable knowledge of its mechanism at the present stage of the development of science. Nevertheless, the empirical use of laser therapy has proved this method well in many areas of medicine. Laser therapy is also widely used in urology. Intravascular, transcutaneous and extracorporeal irradiation of He-Ne laser by urological patients 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 average molecules in the blood and an increase in their concentration in the urine, which indicates an increased allocation of their kidneys and a decrease in body intoxication.

A distinct hypoproteinuric effect, immunomodulating and biostimulating effect of laser therapy (Avdoshin VP, Andryukhin MI, 1991) is fixed. THEM. Korochkin et al. (1991) conducted laser therapy for patients with chronic glomerulonephritis. In patients with mixed and nephrotic forms of nephritis in He-Ne laser treatment, hypotensive and diuretic clinical effects were noted, as well as an increase in fibrinolytic activity. He-Ne laser radiation made it possible to overcome refractoriness to earlier pathogenetic therapy (glucocorticoids, cytostatic, hypotensive and diuretic drugs).

OBLoran et al. (1996) found that magnetolaser therapy in the complex of treatment of inflammatory diseases of the genitourinary system reduces the phases of the inflammatory process, normalizes and improves blood supply in the affected organ, and expands its compensatory-adaptive capabilities in conditions of inflammation. V.E. Rodoman et al. (1996) noted an improvement in microcirculation in the area of the inflammatory focus, decongestant, desensitizing and immunomodulating effects of local IR irradiation with nonspecific pyelonephritis. Laser therapy promotes the prolongation of the action of medicines and their potentiation. Inclusion in the treatment complex of laser therapy in 91.9% of cases allowed to transfer chronic pyelonephritis to clinical and laboratory remission. B.I. Miroshnikov and LL Reznikov (1991), investigating the possibility of conservative treatment of diseases of the genitourinary sphere with the use of NLI, proved that laser therapy reduces the number of necessary surgical procedures for acute inflammatory diseases of the scrotum from 90 to 7%, in general the number of operations on the organs of the genitourinary system decreases 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 pelvis through the nephrostomy and using laser puncture. A.G. Murzin et al. (1991) reported 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 pelvis. Under the supervision of the authors there were 58 patients with ureterolithiasis and 49 patients with pyeloectasia. The effect of amplitude-modulated laser radiation on the reflexogenic zones was accompanied by a decrease in the intensity of pain in the lumbar region, an increase in the tone of the pelvis and ureter, restoration of outflow from the obturated kidney, and gradual migration of the calculus. In 60.3% of patients after the course of laser therapy, the calculus receded.

OD Nikitin and Yu.I. Sinishin (1991) used intravascular laser irradiation of blood in the therapy of calculous pyelonephritis. Widely used as He-Ne, and IR-lasers in the treatment of inflammatory diseases of male genital organs (orcoepididymitis and prostatitis), and use both external and rectal and urethral irradiation. There is a rapid and persistent analgesic effect, normalization of rheographic parameters of the prostate, cessation of dysuria, improvement of the copulatory function.

The regression of the inflammatory process and the acceleration of repair have made it possible to reduce the length of stay of patients in the hospital by more than 2 times.

Immunostimulating effect of LILI, applied locally, led to a 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 microns, with a repetition rate of 500 Hz, an exposure of 6-8 minutes (unfortunately, no radiation power is indicated). Rectal irradiation alternated with exposure to the symphysis, anus and root of the penis on a daily basis for 10-12 days. The authors note that the immediate results are worse than the remote ones (after 2 months), and they explain this by the effect of aftereffect.

L.L. Reznikov et al. (1991), laser LH-75 was used in the treatment of acute epididymorchitis, determining energy in 4 J per session. The authors noted a pronounced analgesic effect from the first sessions of laser therapy, the rapid arrest of intoxication and the increase in the effectiveness of treatment by 38.5%. The authors explained the mechanism of action in the following way. After the first sessions of laser therapy, the parietal leaf of the vaginal process of the peritoneum intensively deposits exudate in the layers immediately below the mesothelium, and the infiltrated sections of the membrane are delimited by a powerful leukocyte shaft. Thus, laser therapy with acute nonspecific epididymitis allows to sharply reduce the phase of acute inflammation, to curtail the effects of exudation, to create an effective decompression of testicular tissue, i.e. As much as possible to reduce the development of secondary alteration of the testis, which is detected in almost 90% of cases of epididymitis. Laser therapy in 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 and perpendicular bed) reduced the incidence of complications by a factor of 2. He-Ne laser has proven itself in the treatment of diseases of both upper and lower urinary tract. Ante- and retrograde irradiation of the pelvis and mucous membrane of the ureter contribute to the improvement of urodynamics, the resolution of ureteric stricture. Transurethral laser therapy for chronic cystitis and urethritis in women had excellent results in 57.7% and good in 39.2% of patients. Against and after laser therapy, the effect of antibacterial and anti-inflammatory drugs is dramatically increased. There was a significant decrease in the frequency of relapses.

S.H. Al-Shoukri et al. (1996) used an IR laser with a power of 8-15 mW in the treatment of patients with chronic nonspecific cystitis. In the acute phase, the frequency of 900 Hz was used, when the pain syndrome subsided, it was reduced to 80 Hz. The duration of irradiation is 3-5 minutes, 5-10 sessions per course. The authors noted a decrease in dysuria, sanitation of urine and a positive cystoscopic picture. L.Ya. Reznikov et al. (1991) reported on the experience of laser therapy in the treatment of cicatricial narrowing of the urethra and fibroplastic induction of the penis. The effect of LIL on scar tissue contributes to gradual resorption of scars, reduction of their rigidity due to the activation of enzymatic reactions. The authors irradiated the strictures of the urethra with subsequent bougie, and received a recovery of patency in 7-9 sessions.

The effect of He-Ne laser on the fibroplastic induction 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. And the best effect was observed with consecutive use of laser radiation with a wavelength of 441 and 633 nm. The greatest number of works is devoted to laser reflexotherapy (LRT) in urology and, especially, in andrology. Through laser puncture, researchers sought to stimulate spermatogenesis, improve copulatory function, stop dysuria in cystalgia, analgesia in the early postoperative period.

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

Various methods of laser therapy have been developed: external (or percutaneous) irradiation, impact on acupuncture points, intracavitary, intravascular laser irradiation of blood (HLOC). Recently, more and more supporters have also acquired percutaneous (supraventricular) laser irradiation of blood.

External or percutaneous exposure

If the pathological process is localized in the surface layers of the skin or mucous membrane, then the effect of NLLI is directed directly at it. In this case, matrix pulsed lasers can be used to capture a large area of influence 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 dispersal of radiation sources on the surface of the body, the light flux affects a larger volume of biological tissues as compared to a point source. This ensures the most likely "hit" of energy on the pathological focus, the localization of which is not always accurately known and can change relative to the body surface when the patient's position changes in space. Distinguish the contact method of exposure, when the emitting head is in contact with the irradiated surface, and remote (non-contact), when there is space between the radiating head and the irradiated surface. In addition, it was found that soft tissue compression allows to increase the therapeutic effect of LILS as the penetration of laser radiation into biological tissues increases.

[1], [2], [3], [4]

Effects on acupuncture points

The points of acupuncture are the projection of a specific area of the greatest activity of the body's interaction system-the internal organs. The point and low intensity of the effect on the receptor apparatus at the points of acupuncture due to the spatial and temporal summation of stimulation causes multilevel reflex and neurohumoral reactions of the organism. The general reaction of the body to laser reflex action is carried out in two main ways: neurogenic and humoral.

LINI therapeutic parameters do not cause the patient subjective sensations when they get on the skin. Most authors recommend to follow 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 produces immediate reactive vasodilation in tissues surrounding the area of exposure, resulting in points of acupuncture increases the temperature by 1-2 ° C. The synthesis of prostaglandins E and F, enkephalins and endorphins increases. Effects are cumulative and peak to the seventh procedure. Peculiarities of LRT methods consist of a small area of influence, the non-specific nature of photoactivation of receptor structures, tissue and enzyme elements, the ability to cause directed reflex reactions, the non-invasive effects, asepticity, comfort, the possibility of applying the method either alone or in combination with a variety of drug, diet - and phytotherapeutic methods of treatment.

[5], [6], [7], [8], [9]

Intracavitary effect

It is effectively used in therapy, gynecology, urology, surgery, etc. Unlike percutaneous effects on the projection of the affected organ, when most of the radiation energy is scattered in biological tissues on the way to the organ, with intracavitary laser therapy, LILI is delivered with minimal energy loss, with the necessary form of power distribution directly to the pathological focus. For this purpose special optical nozzles are designed, which are introduced into the natural cavities of the body.

Intravascular laser irradiation of blood

The method was developed in the 1980s. And proved effective in a number of diseases. By venipuncture an elbow with a thin sterile light guide is introduced into the ulnar or subclavian vein, through which blood is irradiated. For BLOCK, LILS in the red spectral region (0.63 μm) with a power of 1-3 mW is usually used at the end of the fiber (duration of the procedure is 30 min). Treatment is carried out daily or after 1 day, on a course from 3 to 8 sessions. The effect of LIL on red blood cells of circulating blood contributes to the stabilization of their cell membranes and the maintenance of functional fullness, which favors the improvement of circulation in the vessels of the microcirculatory bed in pathological conditions. The BLOCK is accompanied by an increase in the oxygen content and a decrease in the partial voltage of carbon dioxide. The arteriovenous difference in oxygen increases, which indicates the elimination of tissue hypoxia and improvement of oxygenation. At the heart of the therapeutic effect of the BLOCK lies, on the one hand, the effect on hemoglobin and its transfer to a more favorable oxygen transport state, on the other - an increase in the amount of adenosine triphosphate and an increase in energy production in cells. The block reduces the aggregation capacity of platelets, activates fibrinolysis, normalizes the content of antithrombin III. This leads to an increase in peripheral blood flow velocity and an improvement in tissue oxygenation. Improvement of microcirculation and utilization of oxygen in tissues when using BLOCK is closely related to the positive effect of quantum hemotherapy on metabolism: the oxidation of energy materials - glucose, pyruvic and lactic acids - increases. Improvements in microcirculation are due to vasodilation and changes in the rheological properties of the blood. The latter occurs due to a decrease in blood viscosity, a decrease in the aggregate activity of erythrocytes due to a change in their physico-chemical properties, in particular, an increase in the negative electric charge. As a result, microcirculation is activated, capillaries and collaterals are opened, trophic is improved, nervous excitability is normalized.