Laser therapy in the treatment of chronic prostatitis

The first successes of laser therapy for chronic prostatitis were associated with LRT, which is able to penetrate sufficiently into the prostate tissue. However, some authors noted earlier that the use of low-intensity laser therapy in the complex treatment of chronic prostatitis makes it possible to achieve rather high treatment efficacy and shorten the treatment period.

L.Ya. Reznikov et al. (1990) also included LILS in the treatment of residual urethritis of various etiologies, including those complicated by chronic prostatitis. The helium-neon lasers LT-75 (wavelength 0.632 μm, radiation power 28 mW), equipped with quartz monofilament in a plastic shell with a core diameter of 0.6 and 0.4 cm (output power corresponding to 12 and 9 mW). Endouretral laser therapy, carried out daily for 10-14 days, had a curative effect not only on the mucous membrane of the anterior and posterior parts of the urethra (reduction of edema and hyperemia of the mucous membrane), but also on the tissue of the seminal tubercle and prostate (decreased sensations of gravity in the perineum, disappearance to 3-4-day pain with irradiation into the rectum, inguinal areas, scrotum). Against the backdrop of treatment, the patients noted an increase in morning erections and restoration of potency.

A.L. Shabad et al. (1994) for laser therapy of patients with chronic prostatitis, a laser therapeutic device "Uzor" with a wavelength of 0.89 μm was used to generate a pulsed LRI of the near-infrared spectral region using semiconductor gamma-radiation emitters at a pulse frequency of 80, 150, 300, 600, 1500 , 3000 Hz. The main advantages of this device are deeper penetration of infrared radiation into biological tissues (by 6 cm) and the absence of side effects. The laser effect in the treatment of chronic prostatitis in these cases was applied purposefully to the lesion site detected by ultrasound. For this purpose, an improved laser rectal nozzle was used, which allows radiation to be directed to one of the lobules of the gland.

Electro-laser therapy with the AELTU-01 "Yarilo" device was carried out by the combined action of urethral irradiation with laser electro-stimulation. This combination with the radiation of an IR laser through the skin made it possible not only to provide a more uniform irradiation of the prostate, but also by selectively irradiating the pathological zones of the organ by changing the position of the urethral light guide and the emitter of the IR laser. This combined effect in the experiment improved the blood flow of the organ and allowed to strengthen the action of medications due to their more effective penetration into the pathological focus. Electro-laser therapy had anti-inflammatory, analgesic, anti-edematous effect on the prostate, promoted immunity, improved microcirculation of blood and lymph. Electro-laser treatment is carried out 2-3 times a week or daily, the course of treatment consists of 8-12 procedures. The duration of the first procedure is 9 minutes, the second and the third - for 12 minutes, the rest - depending on the clinical picture and the dynamics of the process.

S.N. Kalinina et al. (2002), V.P. Karavaev et al. (2002) used laser therapy to treat copulative dysfunction in patients with chronic prostatitis. After treatment, 60% of the patients showed a significant improvement in erection and recovery of libido. PM Safarov and E.K. Yanenko (2002) found that the most favorable effect of laser therapy is with congestive and infiltrative forms. Fibrous form is much less liable to laser therapy. The laser therapy allowed to improve the functional state of the prostate gland in 72.4% of patients.

We evaluated the effect of low-intensity IR laser irradiation on clinical and laboratory symptoms of 20 patients on chronic prostatitis, as well as on

Hemodynamics of the prostate. For laser therapy, a multifunctional laser device "Adept" with a wavelength of 1.3 μm was used, generating continuous IR low-intensity radiation with a frequency from 1 to 1950 Hz, the output power of monofilament is 17 mW. Apparatus "Adept" refers to the class of low-intensity universal semiconductor lasers capable of operating in continuous and modulated radiation modes.

Before treatment, 85% of patients were psycho-emotional lability; 66% of patients complained of pain, 10% - noted general poor health, 95% - violations of urination, 25% - sexual disorders. 95% of patients had pathological changes in the analysis of the secretion of the prostate gland.

IR laser irradiation was performed transrectally, in the patient's position on the side. The number of sessions is 8-10, in a day. Exposition - 3-7 minutes. As an antioxidant for elimination of decay products due to activation of metabolism under the influence of laser radiation, patients were assigned vitamin E + retinol (Aevit).

Clinical and laboratory indicators indicated the effectiveness of low-intensity IR laser radiation on the prostate in patients with chronic prostatitis. Due to the analgesic effect of laser radiation, 61% of patients managed to stop pain in the genital organs. Almost all patients disappeared dysuria, which is associated with the anti-inflammatory effect of laser radiation. In 100% of cases, there was an improvement in potency. In 95% of patients, the secretion of the prostate gland was normalized. In 5% of patients with initial minor changes in the secretion of the prostate (5-10 leukocytes in the field of vision) after the start of laser therapy (3-4 sessions), the number of leukocytes increased. We consider this sign as favorable, since there is a stimulation of the secretory and excretory functions of the prostate with restoration of the drainage function of its excretory ducts in connection with their release from mucus and detritus. This increases the number of lecithin (lipoid) grains, which indicates the restoration of the functional capacity of the prostate.

The hemodynamic parameters at the CDC also responded to laser therapy. The values of peak, diastolic and average linear velocities increased after treatment in both the central and peripheral zones. The pulsation index decreased after treatment in the central zone. The resistance index did not change. The diameter of the vessels did not change in the central zone and increased in the peripheral zone. The density of the vascular plexus increased after treatment in the central zone - 1.3 times, in the peripheral zone - 2.12 times. The average value of the volumetric flow velocity increased after treatment: in the central zone - in 1.86 times, in the peripheral zone - in 1.93 times.

According to the results of the study, it can be concluded that the use of NLI is particularly useful in the lesion of the peripheral zone of the prostate, since the greatest increase in the density of the vascular plexus (more than 2-fold) occurred precisely here. Linear velocities increased in both zones, especially strongly in the peripheral. A similar situation was noted with the diameter of the vessels. Changes in the diameter of the vessels in the central zone after treatment did not occur - the indices remained the same. Minor changes or their absence in the characteristics of hemodynamic parameters and vascularization of the central zone indicate an insufficient depth of penetration of low-intensity IR laser radiation. On the contrary, with the defeat of the peripheral zone of the prostate this technique is optimal.

Thus, the leading mechanism of action of physical methods of treatment in chronic prostatitis is the improvement of blood supply to the prostate, which allows to level the most essential link in the pathogenesis of this disease. Under the influence of complex therapy supplemented with microwave, the greatest effect was noted in the neutral zone of the prostate, where the density of the vascular plexus increased, the average diameter of the vessels, the linear and volume velocities of the blood flow. In the peripheral zone, the changes were minimal. IR laser radiation caused an improvement in hemodynamics in the peripheral zone and did not affect the central zone of the prostate gland. At the same time, magneto-electrophoresis uniformly increased the density of the vascular plexus and the average diameter of the vessels in all areas of the prostate and improved blood circulation in the organ as a whole.

[1], [2], [3], [4], [5], [6], [7]