Technika, Ltd.
LASER THERAPY IN MEDICAL PRACTICE
V.A.Buylin
LOW-INTENSITY LASER THERAPY OF prostatitis
Information and Methodology
INTRODUCTION
Treatment of male genital organs is a intricate area of urology, requiring further studies. This acquires a special significance due to the fact that in recent years there has been a marked rise in the number of patients with inborn genital diseases, chronic inflammatory processes, disorders of the copulative and generative functions. The literature data available on this subjects are scarce. According to I.F. Yunda (1974), inflammatory processes are one of the most widespread male urogenital disorders (40%) and account for 21% of all urologic diseases.
In the past 20-30 years, prostatitis has become a very common disease. According to statistical data, about 30% of men aged over 35 years, most them being not married, are affected by this disease. Among etiologic factors, in addition to gram-positive, gram-negative and specific microflora, such infectious agents as L-forms of bacteria, Mycoplasma, Chlamydia, viruses, Trichomonas, as well as noninfectious (autoimmune, dyshormonal, vegetovascular) factors can play a role. Interesting results were provided by a clinical bacteriological investigation performed in 646 patients with inflammatory diseases of male genital organs (orchitis, epididymitis, orchoepididymitis, funiculitis, vesiculitis, prostatitis, colliculitis, posterior urethritis, balanitis, balanoposthitis) using a specially designed technique [Yunda I.F., Sinev N.F., 1973], with one-time separate sampling of excreta of genital organs: secretion of the prostate, secretion of the right and the left seminal vesicles, ejaculate, and urine. Pathogenic microbial flora in the prostate secretion, ejaculate and the secretion of seminal vesicles was found in 76.8%, 75% and 54.6% of patients, respectively. One-time bacteriological examination of prostate secretion, secretion of seminal vesicles and ejaculate revealed the presence of a nonidentical microbial flora in 34.5% of patients. This shows that inflammatory diseases of genital organs in one patient can be caused by both common and different agents.
In acute inflammatory process in the urinary tract, pathogenic flora replaces saprophytic flora of the urethra and causes urethritis [Ludvik, 1964]. Many authors [Krylova M.D., 1964; Pytel A. Ya, 1967; Umarova D.M., 1967; Petrovskaya V.G., 1974] showed that under extreme conditions (supercooling, trauma, radiation, intoxication) nonpathogenic and conditionally pathogenic flora turns into pathogenic one and causes the development of inflammatory process. Due to wide use of potent antibacterial drugs, the conditionally pathogenic flora gets deep inside urogenital organs and causes inflammatory process [Dobrovolskaya L.I., 1979]. Not infrequently this is accompanied by fungous diseases. Hofstettev and Schmiedt (1972) performed detailed examination of 500 patients with abacterial prostatourethritis and detected fungi in 75% of them. V.M.Pashchenko and V.M. Rukavishnikova (1969), Stewart et al. (1954), Elste (1966) established in their studies that prostatitis had fungous etiology. According to I.F. Yunda (1981), the incidence of tuberculosis of the male genital organs was 0.8% of all urologic diseases. The greatest susceptibility to tuberculosis mycobacteria was shown by the epididymis (7.3%), prostate (3.9%), and seminal vesicles (1.1%).
Nonspecific inflammatory processes include trichomoniasis, mycotic lesions and gonorrhea. According to N.S. Lyakhovitskiy (1969) and I.N. Ilyina (1967), 35-40% of patients with mycotic urethritis develop prostatitis. I.F. Yunda (1981) established that the incidence of trichomoniasis-induced prostatovesiculitis was 11.5%. I.B. Veynerov and L.M. Rozhinskiy (1961), Yu.N. Kovalev (1971) observed chronic prostatitis of gonorrheal etiology in 15-19.8% of patients. Naturally, this concerns nonmanifest forms of chronic gonorrhea. In nonmanifest abacterial forms of prostatitis, the pathogenic agents in many cases are mycoplasma and viruses. The rate of detection of mycoplasma in patients with prostatitis reaches 20-25% in monoculture and 48.9% in combination with other flora [Sukhodolskaya A.E., Yunda I.F., 1977].
Aseptic prostatitis is caused by autoimmune, hormonal and vegetative shifts.
According to the presently available data, the clinical course of prostatitis is characterized mainly by functional changes, such as sexual disorders, reproductive changes, persistent pain, dysuric and psychoneurologic syndromes. They have a negative impact on marital relations. Therefore, prostatitis is not only a medical, but also a social problem.
The existing conservative methods of prostatitis therapy fail to provide the desired efficacy. Their effect rises significantly if the multimodality therapy includes exposure to low-intensity laser radiation, especially in the near infrared (IR) range [Reznikov L. Ya. et al., 1988; Yasinskiy B.V. et al., 1988].
Red (helium-neon) and infrared semiconductor lasers Uzor, Gelios-01M, Milta, Alfa, and Mustang are successfully used in laser therapy. The latest achievement in the field of low-intensity laser therapy is Mustang-Bio, a therapeutic laser device for biosynchronized therapy. It automatically adjusts radiation power in synchronism with the rhythms of respiration and cardiovascular activity of the patient’s body. The efficacy of such therapy is much greater than under the use of other therapeutic laser devices.
ETIOPATHOGENESIS OF PROSTATITIS
Prostatitis was distinguished as an individual nosologic entity more than 100 years ago. An untreated chronic inflammatory process in male genital organs, as a rule, has a generalized character, but the leading, or the main, pathologic site is located in only one organ.
Nonspecific prostatitis is one of the most prevalent genital disorders among men of reproductive age. Over the past 15-20 years the incidence of prostatitis has grown considerably. The predominance of nonmanifest and latent forms of this disease can be explained by general pathomorphism of human inflammatory diseases as a result of the advent of potent antibacterial drugs. In the pre-antibiotic period, acute forms of prostatitis were more common [Kholtsov B.N., 1927; Fronstein R.M., 1933], whereas at present latent chronic forms account for 98% of cases.
The incidence of chronic prostatitis varies considerably from 5 to 70% [Shapoval V.I., 1968], with the incidence of latent and primary chronic prostatitis ranging from 30% [Proskura O.V., 1970] to 50% [Efendzhiyev M., 1955]. An important contributing factor is a fall in the general immune potential of population due to an unfavorable environmental situation, tobacco smoking and alcohol abuse by men. Chronic tonsillitis and acute respiratory diseases were found to play a role in the development of prostatitis [Nizamov F.Z. et al., 1984].
The age pattern of patients with prostatitis has changed considerably. The incidence of prostatitis in persons under 30 years has reached 40.4%. The growth in its incidence among younger men can be explained by a rise in the number of patients with venereal and nonvenereal urethrites due to sexual promiscuity [Ilyin I.I., 1971]. Such a hypothesis is confirmed by data on etiology and pathogenesis of chronic prostatitis.
Inflammatory process in the prostate develops as a result of penetration of infectious agents. The disease can also develop without infection of the gland, which is called noninfectious, aseptic prostatitis. Its development is underlain by various immunologic, hormonal and vegetative disorders [Yunda I.F et al., 1972, 1975, 1978]. Considering mechanisms and ways whereby male genital organs become infected, many authors put a special emphasis on urethritis and urethrogenic infection [Stamey, Pfan, 1970; Blackloct, 1974; Harzman, Chiari, 1975]. In the opinion of I.F. Yunda (1981), urethritis and the urethral route of infection are possible as a result of the effect of previous factors, which lead to dysbacteriosis, weakening of interorganic defense mechanisms and subsequent infection.
Depending on the spread of the process and the duration of the disease, the type of isolated microflora changes. Whereas in isolated prostatitis it is isolated mostly as monoculture (75.9%), in extended complicated prostatitis microbial associations tend to rise (up to 30.2-37.2%0.
The prostate is a gland of epocrinic type. The secretion of glands of such kind does not absorb into blood at all [Aleshin B.V., 1978]. In a healthy man, the prostatic secretion is released constantly (called prostatic secretion at rest) [Hyggins S., 1942]. In urination and defecation the prostate becomes almost entirely devoid of its secretion.
It was established that the main factors predisposing to the development of prostatitis and other diseases of male genital organs, in 81.1% of observations, were venous congestion and atony of the muscle tissue of the small pelvis organs [Yunda I.F., Dobrovolskaya L.I., 1977]. These diseases are caused by the interruption or prolongation of sexual acts, sexual immoderation, masturbation (38.8%); persistent constipation due to proctitis, anusitis, sigmoiditis (17.8%); prolonged sitting (16.9%); and supercooling (8.3%). The provoking factors were an injury caused by instrumental examinations (18.3% of observations); manipulations (1.9%); general septic state associated with inflammatory changes in the liver and biliary ducts, angina, otitis, caries, proctitis, chronic endocarditis, chronic pneumonia, intoxication (16.3%).
Thus, the main pathogenetic factors in the infection of genital tract in men are congestion in the small pelvis organs and atony of muscle tissues. Congestive factors contribute not only to infection, but also to the development of such disorders as autoaggression and dyshormonal dystrophy. According to N.A. Lopatkin (1972), urethral and canalicular routes of infection account for 75% of cases. In the opinion of Harzman and Chiari (1975), this percentage is still higher - 100%. I.F. Yunda (1981) noted that infection was urethrogenic in 44.2% of cases, extended per continuitatem in 10.3%, lymphogenic in 6.3% and hematogenic in 4.6% of cases. In the remaining cases (34.6%) the route of infection could not be established. Urethrogenic spread of infection depended on a number of conditions, such as pathogenicity and biological peculiarities of the flora, as well as resistance of the urogenital organs to this flora. The prostatic secretion possesses bactericidal properties [Tsirkin A.Ya, 1973; Lopatkin N.A. et al., 1977]. The weakening or loss of these properties can be caused by androgenic insufficiency of testicles as a result of acquired diseases or congestive states.
At the same time, the functional state of accessory sexual glands needs to be taken into consideration. In particular, the acid-alkaline potential has a great significance in this respect. For instance, the optimum medium for staphylococcus and streptococcus is at pH 7.4-7.6 and for Trichomonas at pH 6.2-6.5. Therefore, the prostate is biologically more resistant to pyogenic coccal flora and more susceptible to Trichomonas.
The spread of a pathologic process depends on the duration of the disease and the route of infection. In hematogenic and lymphogenic infection, the inflammatory process is usually acute and localized. Urethrogenic and canalicular infection, as a rule, leads to the involvement of several organs, and the inflammation course is less acute. All variant forms of inflammation course are united by the commonness of preceding factors. The success of treatment largely depends on the timely elimination of the effect of these factors.
The preceding factors, by their significance, can be divided into the following main groups: 1) those responsible for the development of congestion in the small pelvis organs; 2) potential sites of infection; 3) those decreasing testosterone metabolism and leading to androgenic insufficiency; 4) those producing vegetoneurotic disorders in the pelvic organs; 5) those reducing general and local immune reactions.
The mode of action of preceding factors can be dual. In some cases glandular defense reactions become abated (congestion in pelvic organs, androgenic insufficiency, vegetoneurotic disorders, decrease in general and local reactivity), whereas in others the leading role is played by potentially hazardous factors (genital and pelvic), extragenital infection sites, and metabolic correlative factors. Potentially hazardous factors include obligate (infectious agents) and facultative (immune shifts, androgenic disorders, vegetovascular changes) ones.
Potent parasympathetic ganglia and abundant network of sympathetic receptors are located in the prostate. Therefore, disorders in the state of the vegetative nervous system can themselves cause organic changes in the prostate, rather than be their consequence. This was confirmed by A.I. Akulovich (1979, 1982) who showed that patients with disturbed pelvic blood circulation develop aseptic prostatitis. Thus, changes in the vegetative nervous system in prostatitis can be primary (etiologic) and secondary (pathogenetic). In the former case, treatment should be started with the correction of disorders of the vegetative nervous system; in the latter, a timely treatment of prostatitis is needed. After the inflammatory process in the prostate is eliminated, disorders of the vegetative nervous system disappear. Experimentally, by mechanical (surgical) exclusion of various parts of the sympathetic and parasympathetic innervation, V.G. Kondratenko (1958) induced purposeful destructive changes in the sexual glands. Similar effect was obtained by T.I. Khodorovskiy (1964) after the administration of vegetotropic drugs. Under clinical settings, I. Ginye (1944) established a pathologic lability of the vegetative nervous system in men with sexual disorders. I.F. Yunda and I.I. Gorpinchenko (1975) found that the parasympathetic tonicity prevailed in patients with prostatitis showing interoceptive copulative dysfunction, whereas patients with predominantly psychogenic component (80%) showed an excessive tonicity of the sympathetic part of the vegetative nervous system.
The prostate has three defense barriers: 1) healthy morphologic and functional structure. The disturbance of this barrier is favored by negative psychoemotional state, such as marked asthenia or depression, as well as organic changes in genitalia, caused by intoxication, circulation disorders, etc.; 2) sufficient physiologic tonicity and vascularization of internal sexual organs. This barrier is impaired in adynamic state, sexual dysrhythmicity, supercooling, androgenic insufficiency; 3) anti-infectious barrier. It becomes penetrable if local immunobiological reactions are decreased, which is caused by vegetovascular discorrelation, androgenic insufficiency, drug intoxication, etc.
Androgenic function plays an important role among protective physiological mechanisms. A normal level of androgens maintains the tonicity of genitalia and active secretion in the prostate, producing sufficient amount of bactericidal secretion components. In prostatitis, the androgenic-estrogenic balance is disturbed, as a rule, due to the changes in metabolism of steroid hormones, the impaired tonicity of the prostate, congestion in small pelvis organs, and chronic inflammatory processes in the biliary tract.
Pathogenic flora from distant organs in tonsillitis, flu, acute respiratory virus infections, cholecystocholangitis, etc. in 3-12% of cases is extended by hematogenic route [Efendzhiyev M., 1955]. Lymphogenic extension of infection into the prostate is observed if an inflammation site is located in the adjacent and presenting organs (rectum, urinary bladder, bulbourethral glands, testicle, seminal vesicles) in 8-17% of cases. Intoxication (tobacco smoking, alcoholism, etc.), trauma, neurovegetative, vascular and immune disorders, as a result of their long-term indirect effect on the prostate, disturb trophicity, vegetative innervation, and immune reactivity of the gland. This causes destructive degenerative-dystrophic changes.
In latent prostatitis, inflammation sites are usually located near the urethra. Macroscopically, the gland is not altered, although its secretion can contain inflammatory elements. In calculous prostatitis, salt incrustation with isolated or multiple infiltrates, scars and closed purulent cavities are observed. Chronic nonspecific prostatitis is characterized, in addition to the release of inflammatory exudate, by active “peeling” of glandular and transitional cell elements.
The cell composition in sections and smears of the prostatic secretion is uniform. Using sophisticated microscopy techniques (luminescence microscopy) additional valuable information about the severity of gland damage and the pace of reparative processes during prostatitis therapy can be obtained. In 89% of patients, prostatitis is accompanied by significant changes in the seminal hillock and posterior urethra. A regular examination of the above parts has a great significance for diagnosis and treatment.
Timely healing of urethritis and colliculitis is the main precondition for successful treatment and prevention of prostatitis. A noninfectious process without signs of infectious inflammation in the patient history is called primary prostatosis. If there are implications of infection in the patient history, but at present no infectious agents are found, the diagnosis is secondary prostatosis. Complications are specified in the diagnosis separately. For instance, if copulative function is disturbed, the diagnosis says: “Interoceptive copulative dysfunction”. If there is pain syndrome, its character is mentioned in the diagnosis (genital algesic syndrome, extragenital algesic syndrome, pelvic sympathalgia, etc.).
The planning of treatment and prevention should include primarily measures to eliminate predisposing factors.
CLINICAL COURSE OF PROSTATITIS
General symptoms of prostatitis: chill, a rise in body temperature, general weakness, undue fatiguability, sleep disturbance, undue nervousness, obsessions.
Local symptoms: prostatalgia, changes in the prostate shape, size and consistency; elevated leukocytic reaction of the prostatic secretion; extragenital pain; pelvic sympathalgia; sensation of heaviness in the lower abdomen; itch in the urethra, perineum, anus; paresthesias in the genitals (sensation of tickling in the urethra, creeping sensation, chill of the genitals, etc.); pathologic discharge from the urethra; frequent urination; stuttering urination; changes in seminal hillock, posterior urethra, and seminal vesicles; rectal disorders.
Functional symptoms: enhanced spontaneous erections, with normal ones being adequate; strengthening or weakening of adequate erections; accelerated ejaculation; incomplete orgasm; painful orgasm; low libido; infertility; changes in the amount of ejaculate; pathospermia; primary sterility; secondary sterility.
PATHOGENETIC GROUNDS FOR THE USE OF LASER THERAPY IN PROSTATITIS
The therapeutic effect of laser irradiation of tissues is due to biochemical and biophysical changes in the irradiation area at the cellular level and cannot be explained only by thermal reactions [Kana, 1981; Karu, 1989; Braverman, 1989]. Experimental and clinical investigations showed that this produces stimulation or normalization of local microcirculation, whose local effects can be supplemented and enhanced by the normalization of systemic microcirculation taking place in additional laser irradiation of acupuncture zones [Kozlov V.I., Buylin V.A., Terman O.A., 1989]. These changes and effects are rather stable and reproducible under laser irradiation with power of up to 2 mWt; they are generally accompanied by a rise in the temperature of tissues by 0.1-0.5oC [Krötlinger M., 1979; Bahr F., 1986]. If these parameters are exceeded, this can cause side effects at the cellular level and the blood system [Basford, 1989].
Clinical practice has shown a high therapeutic efficacy of direct exposure of affected tissues to helium-neon laser radiation at a wavelength of 0.63 um (red light) [Kovacs, 1982; Ding, 1984; Burgudzhiyeva T. et al., 1985] and of intravenous blood irradiation [Artemyev V.E. et al., 1991; Etsko L.A. et al., 1991; Ivanyuta L.I. et al., 1991]. Transcutaneous exposure of internal organs to IR laser radiation (portable therapeutic semiconductor lasers Uzor, Kolokolchik, Erga, Lazur, Alfa, Mustang and other devices) was shown to be even more effective.
Changes in tissues are dose-dependent, with therapeutic effects being produced by low radiation doses. The use of greater doses or lasers with radiation power of over 30 mWt leads to the breakage of hydrogen and other bonds in biomolecules, i.e., to the restructuring at the molecular level [Greguss, 1989], a rise in tissue temperature by 5-7oC [Ohshiro, 1986]. This is accompanied by instant thermal stimulation of microcirculation in the exposed area. However, even under local irradiation, a generalization effect is observed [Cherednichenko, 1990], which is significantly enhanced by the exposure of acupuncture zones.
The advantage of infrared radiation (wavelength of 0.8-1.3 um) over radiation at other wavelengths (ultraviolet and visible range) is that IR radiation penetrates much deeper (from 7 mm in blood to 6-8 cm in contact technique with moderate compression of soft tissues) and its therapeutic effects are due predominantly to biophysical changes in tissues (as compared to the effects of, for instance, red helium-neon laser radiation). The bulk of energy, however, is absorbed by superficial 10 mm-thick tissue layer [Evstigneyev A.R. et al., 1987; Duplik, 1990; Tsyb, 1991; Svaasand F., 1985].
The analysis of clinical and experimental findings obtained by Russian and foreign researchers allows to distinguish the following factors of biological effect of low-intensity IR laser and visible (red) radiation on the body: 1) improvement of lympho- and hemomicrocirculation; 2) activation of metabolic processes in the irradiated area and in the whole body; 3) decrease in intensity of free-radical processes; 4) stimulation of ATP formation and the synthesis of nucleinic acids; 5) acceleration of regenerative processes; 6) immunostimulating effect; 7) antiinflammatory and desensitizing effects; 8) sedative and hypotensive effects.
In recent years, the advantages of magnetolaser effects on the body, especially in chronic diseases, has been demonstrated experimentally and clinically [Polonskiy A.K. et al., 1982, 1984; Matyashova M.A. et al., 1987; Illarionov V.E., 1989]. These effects have a synergetic character, i.e., they are not due to mere summation of biological effects of magnetic field and laser radiation, but are, in fact, a third effect.
LASER AND MAGNETOLASER THERAPY OF PROSTATITIS
In chronic nonspecific prostatitis in incomplete remission stage, complicated by the weakening of sexual function, I.N. Danilova et al. (1987) used irradiation of a helium-neon laser through the wall of the rectum using a rectal laser probe (labile contact technique; power density, 1-5 mWt/cm2; exposure time, 5-8 min; 7-14 daily procedures per course). B.V. Yasinskiy and B.N. Zhiborev (1990) reported about a high efficacy of laser reflexotherapy (radiation wavelength, 0.63 um; power density, 20 mWt/cm2) in chronic prostatitis complicated by male infertility (irradiation of a corporal acupuncture zone; exposure time, 6 min) and chronic prostatitis accompanied by disturbance of generative function (oligoazoospermia of the 2nd degree with signs of pyospermia; exposure time, 40 sec). In the first group, 52% of patients were cured and 26% showed a significant improvement.
R.Sh. Altynbayev and N.R. Kerimova (1993) used laser in multimodality therapy of chronic prostatitis associated with disturbed spermatogenesis. Laser Agnisa-01 (fully analogous to Gelios-01M) was used. Rectal method (pulse recurrence frequency, up to 500 Hz; exposure time, 6-8 min) was alternated with external irradiation (over symphysis, the areas of the anus and the root of the penis) using the same parameters (the authors do not indicate pulse power, but the maximum power of these lasers is 10 Wt). Prior to the treatment, all patients complained of pain in the groin and the area of the rectum, increased sweating, nervousness, sexual disorders. Spermatogram test in all patients revealed oligoasthenospermia of the 1st-2nd grade, i.e., a fall in qualitative and quantitative parameters of the sperm. After 3-4 laser therapy procedures, pain syndrome disappeared; after 7-8 procedures vegetative disturbances were eliminated and sexual activity improved. The first course of therapy failed to produce significant results: there were no considerable qualitative changes in the spermatogram, except a rise in total number of spermatozoa (by 15-20 million per ml). After two courses of therapy, two months later, an “aftereffect” was observed: spermatogram showed a significant improvement of quantitative and qualitative parameters.
Yu.I. Kushniruk et al. (1988) used laser radiation in patients with chronic prostatitis and posterior urethritis, being the core syndromes of ejaculatory component damage. Irradiation was directed to the perineal projection of the prostate and posterior urethra as well as to reflexotherapy zones. The patients were simultaneously given antibacterial and immunostimulating therapy.
All patients showed a good antiinflammatory effect, accompanied by a significant improvement of sexual function. Restoration of adequate erections was observed in 59.4% of patients; prolongation of sexual act, in 71.8%; pain during ejaculation was eliminated in all cases when it was present before treatment. In the control group, the first two parameters were improved in 47.5% and 52.3% of patients, respectively.
G.Kh. Makhmudova (1992) reviewed results of laser therapy in chronic prostatitis and its complications, reported by various authors. Chronic prostatitis, complicated by copulative dysfunction, was successfully treated by radiation of a helium-neon laser, acting on reflexogenic zones: VC2, VC1, V25, RP6, R5. Laser radiation power was 5-10 mWt, with exposure time of 6 min per zone; 3-4 acupuncture zones were irradiated during one procedure. Total exposure time was 18-24 min per procedure.
Our investigations [Kozlov V.I., Buylin V.A. et al., 1993] showed that large doses of laser irradiation cause negative reactions in various systems of the body. The procedure should not last longer than 10-12 min; the optimum power of laser IR radiation pulse is 5-7 Wt; the total dose should not exceed 0.3 J/cm2 per procedure (for red laser radiation at the wavelength of 0.63 um, not more than 4 J/cm2).
Before the start of laser therapy the patient needs to be carefully examined by urologist, using clinical and laboratory investigations, in order to make a correct diagnosis and to reveal complications.
A high curative effect, reduction in the duration of treatment and the elimination of the need for the patient to be overloaded by drugs can be attained if simple organizational and therapeutic rules are observed. They include: rational diet, individual rhythmicity of work and leisure, therapeutic physical training, observance of healthy sex practices, normalization of function of organs involved in hormonopoiesis, sedative drugs if required by psychoneurologic symptoms, and elimination of potential infection foci.
The interrelation between target organs and organs responsible for testosterone metabolism is complex and needs to be further studied. It has been only shown that the liver is a source of hyperestrogenia, which leads to significant disturbances of generative and copulative functions. Chronic latent liver diseases need to be treated timely. The weakening of disintoxication function of the liver causes disturbance of testosterone metabolism. Therefore, the effect on the liver is of primary importance in treatment of prostatitis.
Irradiation of the liver area by laser device Uzor resulted in a marked stimulation of hepatic blood flow, accompanied by a rise in liver temperature by 0.3oC (noninvasive radiothermographic method of determination of temperature of internal organs) [Kozlov V.I., Buylin V.A., Terman O.A., 1989].
Indications to laser and magnetolaser therapy of prostatitis: 1. Chronic nonspecific prostatitis or residual signs of acute prostatitis without functional and organic complications and without changes in other organs and systems. 2. Chronic nonspecific prostatitis tending to get exacerbated, with or without sexual disorders, but accompanied by gastric or hepatobiliary diseases associated with hyper- and normoacid states. 3. Chronic nonspecific prostatitis tending to get exacerbated, accompanied by diseases of other organs (chronic gastroduodenitis and colitis, cholecystoangiocholitis), caused by gastric hyposecretion. 4. Chronic nonspecific prostatitis with torpid course and functional sexual disorders, accompanied by ischemic heart disease. 5. Chronic nonspecific prostatitis with a prolonged course, accompanied by algesic syndrome. 6. Chronic nonspecific prostatitis with functional sexual disorders, accompanied by neurotic symptoms and hyperthyroid states.
Contraindications: 1. General contraindications: marked cardiovascular, renal, hepatic insufficiency; mental diseases; malignant tumors; systemic blood diseases. 2. Acute and subacute nonspecific diseases of the prostate and other sexual glands as well as presenting organs. 3. Specific infectious prostatitis in acute and subacute stage. 4. Polypous, ulcerative, hemorrhagic proctitis, bleeding hemorrhoids, adenoma of the prostate with marked urination disturbance.
Patients with latent trichomoniasis, tuberculosis and other specific infections of the prostate should be given only multimodality therapy, including specific drug therapy and immunologic monitoring.
In our method of noninvasive transcutaneous low-intensity laser therapy of prostatitis using pulsed IR lasers the irradiation is directed to area of perineum (projection of the prostate), lumbosacral area (painful sites, determined by the physician by palpation), liver projection area, neurovascular bundles (to the left of the navel - projection of abdominal aorta bifurcation, sinocarotid area), basic and additional acupuncture zones (see scheme). The efficacy of this method is 75-90% (depending on the character and severity of the process, equipment used, patient compliance).
Pulsed IR laser radiation at a wavelength of 0.89 um (pulse power, 4-7 Wt; pulse duration, 100-200 nsec) is used. Lasers of the Mustang series, especially Mustang-Bio, show the highest efficacy and are convenient in use. General tactical principles of laser therapy of prostatitis are: a) at the first three procedures, 2-3 zones are irradiated; then the number of zones can be raised to 6; at the 10th-12th procedure the number of irradiation zones is reduced to 3-4; b) exposure time should not be more than 2 min (120-128 sec) per zone, with maximum total irradiation time being 10 min per procedure; c) pulse recurrence frequency should be 80 Hz during the first three procedures; 150 Hz during 4th-7th procedures; 1500 Hz during 8th-9th procedures; and 150 Hz during 10th-12th procedures; d) the perineum, the area over the symphysis and the basic acupuncture zones are irradiated daily; the remaining zones are chosen from those proposed (see the scheme), in total not more than six zones per procedure, alternating them every other procedure; e) irradiation of acupuncture zones is performed at the frequency of 150 Hz, with pulse power of 7-8 Wt, during 32 sec per zone, or using continuous radiation at the wavelength of 1.3 um, with the power of 0.4 mWt, during 20 sec per zone (laser head MLO3).
Optimally, magnetolaser radiation should be performed using matrix radiator MLO1K (10 laser diodes with radiation power control, light beam area of 12 cm2) with magnet 75-150 mT to perineal area during 2 min; irradiation is alternated (every other day) with direct rectal irradiation of the prostate using a special proctologic universal attachment P-2. The attachment is fixed on the radiating head LO1-LO3 and introduced into the rectum (with patient lying on his side; a condom is put over the attachment) so as to bring radiation to the gland. Radiation power is 7-8 Wt, exposure time is 128 sec. Matrix radiator can be used for the irradiation of the liver area, the zone to the left of the navel, and the area over the symphysis.
For transcutaneous irradiation of the above zones, it is expedient to use simultaneously two radiating heads, MLO1K and LO1 (LO2) in the biosynchronization mode (Mustang-Bio laser). To do this, timer on the control panel is put into position “H” (indefinite operation time) and pulse and respiration sensors are fixed on the patient. Irradiation, 2 min per zone (according to the scheme), is performed using a stopwatch; radiators are moved over zones without turning laser radiation off, avoiding the exposure of eyes of both patient and physician. Such treatment regimen can be recommended from the 4th till the 10th procedure daily, irradiating 4-5 pairs of zones (2 min per pair, with total exposure time of 10 min). This treatment regimen allows to synchronize laser irradiation, as much as possible, with various rhythms of the body and to receive a greater therapeutic effect at a lower (as compared with other devices) laser radiation dose.
The scheme of irradiation zones for laser therapy of prostatitis
a: 1 - sinocarotid zones; 2 - liver projection zone; 3 - VC12; 4 - zone to the left of the navel; 5 - MC6; 6 - zone over the symphysis; 7 - E36; 8 - RP6
b: 1 - painful sites in the area of inner angle of the scapulae; 2 - GI14; 3 - painful sites in lumbosacral area; 4 - V40
Unsatisfactory or negative result of laser therapy was observed mostly in patients with prostatitis accompanied by latent Trichomonas infection, Mycoplasma, Chlamydia, tuberculosis mycobacteria. Other causes of treatment inefficiency are: incorrect choice of doses of laser and magnetolaser irradiation; failure to take into consideration psychosomatic state of patient and the importance of a good contact between the patient and the physician.
If signs of posterior urethritis and calliculitis prevail, as well as if there is a marked disturbance of ejaculation component, the upper surface of the penis in its posterior third and its root are exposed to transcutaneous contact-mirror irradiation during 64 sec at the frequency of 80 Hz. The effect of laser therapy of prostatitis with impaired erection is significantly enhanced in transcutaneous irradiation, using the contact-mirror method with the above parameters, of the penial blood circulating in large volume during the procedure with the use of local negative pressure (LNP). To do this, the working vessel of the LNP therapy device is specially equipped to be used in combination with laser irradiation. These procedures are performed twice a week, with the duration of the procedure 10 minutes. No other interventions are performed on these days.
The effect of laser and magnetolaser therapy of the above forms of prostatitis and their complications is observed as early as by the end of the first course of treatment, which is confirmed by subjective sensations of the patient and clinico-laboratory investigations.
Laser therapy shows a still greater efficacy (up to 90%) if the multimodality treatment (including laser reflexotherapy and physical therapy, drug therapy and phytotherapy) is supplemented by color therapy, a unique method of treatment. This possibility is provided by the availability of CO-type LED heads for lasers of the Mustang series, generating light beams, colored red, blue, green and yellow. This method has been known since ancient times. It has been used in India, China and other Oriental countries for thousands of years.
Color therapy is used 2 weeks after the end of the course of laser therapy. The exposed parts should be bare, with the adjacent areas covered by clothes. After the corresponding LED head is attached to the Mustang laser device, continuous power control knob is turned fully clockwise. The radiator is positioned at the distance of 1 cm from the skin surface. Large areas are irradiated by the scanning (labile) method, whereas for smaller sites the stable method is used. The scheme of color therapy course is given below:
Procedure 1: the perineal area is exposed to blue light for 15 min (area at the anus); the navel is exposed to green light for 1 min.
Procedure 2: blue light to the perineum (20 min); green light to the navel (2 min).
Procedures 3-4: yellow light to the heels (5 min per each), the site over the symphysis (along median line) (5 min), the sacral area and perineum at the anus (10 min each).
Procedures 5-8: green light to the heels (5 min each), over pubis (5 min), perineum and sacral area (10 min each), navel (1 min).
Procedures 9-12: red light to the area from LV to SI (15 min); yellow light to the area ThX-LI (10 min); blue light to the head vertex (10 min).
Color therapy using this scheme enhances the efficacy of treatment of prostatitis, stimulates endocrine glands, potency and the renal function, and relieves depression.
Two weeks after this course the second course of laser therapy is performed, using the same scheme as in the first course. If necessary, laser and color therapy is repeated after 6 months. Such a treatment results in normalization of the general state of a patient and restores his marital and social functions.
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