Laser therapy in the treatment of chronic prostatitis

The first successes of laser therapy for chronic prostatitis were associated with LRT, which was capable of sufficiently penetrating prostate tissue. However, some authors noted earlier that the use of low-intensity laser therapy in the complex treatment of chronic prostatitis allows for fairly high treatment efficiency and shorter treatment periods.

L. Ya. Reznikov et al. (1990) also included LILI in the complex therapy of residual urethritis of various etiologies, including those complicated by chronic prostatitis. The radiation source used was LT-75 helium-neon lasers (wavelength 0.632 μm, radiation power 28 mW), equipped with a quartz monofilament in a plastic shell with a core diameter of 0.6 and 0.4 cm (radiation power at the output, respectively, 12 and 9 mW). Endourethral laser therapy, performed daily for 10-14 days, had a therapeutic effect not only on the mucous membrane of the anterior and posterior sections of the urethra (reduction of swelling and hyperemia of the mucous membrane), but also on the tissues of the seminal tubercle and prostate (reduction of the feeling of heaviness in the perineum, disappearance by the 3rd-4th day of aching pain radiating to the rectum, groin area, scrotum). Against the background of treatment, patients noted an increase in morning erections and restoration of potency.

A.L. Shabad et al. (1994) used the laser therapeutic device "Uzor" with a wavelength of 0.89 μm, generating pulsed LILI of the near IR spectrum region using semiconductor emitters on GaAs with a pulse frequency of 80, 150, 300, 600, 1500, 3000 Hz for laser therapy of patients with chronic prostatitis. The main advantages of this device are deeper penetration of IR radiation into biological tissues (by 6 cm) and the absence of side effects. Laser exposure in the treatment of chronic prostatitis in these cases was used purposefully on the lesion identified by ultrasound. For this purpose, an improved laser rectal attachment was used, allowing the radiation to be directed to one of the lobes of the gland.

Electrolaser therapy using the AELTU-01 "Yarilo" device was carried out by a combined effect of urethral irradiation with laser and electrical stimulation. This combination with the effect of IR laser radiation passing through the skin allowed not only to provide more uniform irradiation of the prostate, but also to selectively irradiate pathological areas of the organ by changing the position of the urethral light guide and the IR laser emitter. Such a combined effect in the experiment improved the blood flow of the organ and allowed to enhance the effect of drugs due to their more effective penetration into the pathological focus. Electrolaser therapy had an anti-inflammatory, analgesic, anti-edematous effect on the prostate, contributed to an increase in immunity, improved blood and lymph microcirculation. Electrolaser 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 third - 12 minutes each, 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 patients showed significant improvement in erection and restoration of libido. R. M. Safarov and E. K. Yanenko (2002) found that laser therapy has the most favorable effect in congestive and infiltrative forms. The fibrous form is much less responsive to laser therapy. Laser therapy improved the functional state of the prostate gland in 72.4% of patients.

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

Prostate hemodynamics. 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 of 1 to 1950 Hz, the output power of the monofiber is 17 mW. The "Adept" device belongs to the class of low-intensity universal semiconductor lasers capable of operating in continuous and modulated radiation modes.

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

IR laser irradiation was performed transrectally, with the patient lying on his side. The number of sessions was 8-10, every other day. Exposure was 3-7 minutes. As an antioxidant for the elimination of decay products due to the activation of metabolism under the influence of laser radiation, patients were prescribed vitamin E + retinol (aevit).

Clinical and laboratory indices showed the effectiveness of low-intensity IR laser radiation on the prostate in patients with chronic prostatitis. Due to the analgesic effect of laser radiation, pain in the genitals was relieved in 61% of patients. Dysuria disappeared in almost all patients, which is associated with the anti-inflammatory effect of laser radiation. Improvement in potency was noted in 100% of cases. Prostatic secretion returned to normal in 95% of patients. In 5% of patients with initial minor changes in prostatic secretion (5-10 leukocytes in the field of vision), the number of leukocytes increased after the start of laser therapy (3-4 sessions). We consider this sign to be favorable, since it stimulates the secretory and excretory functions of the prostate with restoration of the drainage function of its excretory ducts due to their release from mucus and detritus. At the same time, the number of lecithin (lipoid) grains increases, which indicates restoration of the functional capacity of the prostate.

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

The results of the study show that the use of LILI is especially appropriate for lesions of the peripheral zone of the prostate, since the greatest increase in the density of the vascular plexus (more than 2 times) occurred here. Linear velocities increased in both zones, especially strongly in the peripheral zone. A similar situation was noted with the diameter of the vessels. There was no change in the diameter of the vessels in the central zone after treatment - the indicators remained the same. Minor changes or their absence in the characteristics of hemodynamics and vascularization of the central zone indicate insufficient penetration depth of low-intensity IR laser radiation. On the contrary, in case of lesions of the peripheral zone of the prostate, this technique is optimal.

Thus, the leading mechanism of action of physical methods of treatment for chronic prostatitis is the improvement of blood supply to the prostate, which allows to neutralize the most significant link in the pathogenesis of this disease. Under the influence of complex therapy supplemented with microwaves, the greatest effect was noted in the neutral zone of the prostate, where the density of the vascular plexus, the average diameter of the vessels, the linear and volumetric blood flow rates increased. 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, magnetoelectrophoresis uniformly increased the density of the vascular plexus and the average diameter of the vessels in all zones of the prostate and improved blood circulation in the organ as a whole.

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